The People's Pharmacy

For the last several decades, nutrition scientists have been debating the pros and cons of various dietary approaches. The Mediterranean diet has a lot of proponents, and we have interviewed some of them on The People’s Pharmacy. Dr. Barry Popkin and Dr. Walter Willett endorse olive oil, whole grains, fruits and vegetables with only small amounts of animal-sourced food. Listen to Show 1359: Is the Food on Your Plate Real or Fake? for more information. Dr. Will Bulsiewicz is a fiber evangelist. You can hear him on Show 1312: fiber, Phytonutrients and Healthy Soil. Plant-based diets can fall along a spectrum from mostly plants with some meat, fish and eggs to completely vegan. In contrast, there are experts who recommend a low-carb, high-fat ketogenic diet. Carnivore diets consisting of only animal products (meat, poultry, fish) are a subcategory of keto diets. That is the focus of this episode. Carnivore Controversy: We know that people have strong feelings about food. The DIETFITS study, one of the best randomized controlled trials comparing healthy low-carb to healthy low-fat diets found that both led to weight loss. Learn more by listening to our interview with lead investigator Dr. Christopher Gardner on Show 1126: Can You Find Your Best Diet? We have heard from fans of ultra-low-fat diets like those promoted by Pritikin or Dean Ornish, MD. We acknowledge that hearing about a carnivore diet may put their teeth on edge, at the very least. But information from knowledgeable sources about controversial topics is what we aim for, and this is indisputably controversial. At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care, treatment, or diet. How You Can Listen: You could listen through your local public radio station or get the live stream on Saturday, Sept. 13, 2025, at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Sept. 15, 2025. Ketogenic and Carnivore Diets: Doctors have long prescribed ketogenic diets to treat children with hard-to-treat epilepsy (Epilepsy & Behavior, Sep. 8, 2025).  Studies suggest that people with migraines or depression might benefit from a ketogenic diet (Brain and Behavior, Sep. 2025; Translational Psychiatry, Sep. 10, 2025). Most people now following carnivore diets, which are more extreme than ketogenic diets, began following this eating plan to lose weight and have more energy. Our co-host for this show, AAAS Mass Media Fellow Bianca Garcia, has done some investigation of this approach to nutrition, including a personal trial. She joined us in interviewing Dr. Eric Westman, an advocate for ketogenic and carnivore diets to help people with obesity and diabetes. What is a ketogenic diet? It minimizes the carbohydrate available as fuel by including only low-starch vegetables such as greens. High-fat food sources make up the bulk of the energy in the diet. This forces the body to burn ketones derived from body fat instead of glucose derived from sugar or starch. In a carnivore diet, the vegetables disappear completely and the high-fat food sources are all derived from animals. How Do Dietary Guidelines Mesh with Carnivore Diets? We asked Dr. Westman about changing dietary guidelines, and he pointed out that most of the national dietary guidelines have limited scientific support. Of course, randomized controlled trials of people following carnivore diets are also few and far between. A survey of more than 2,000 self-selected volunteers following the diet was published in 2021 (Current Developments in Nutrition, Nov. 2, 2021). The DIETFITS trial, which compared a healthy low-fat, high-carb regimen to one high in fat and low in carbs found no significant difference in weight loss over the course of a year (JAMA, Feb. 20, 2018). What Are the Effects of a High-Fat Diet? In the clinical trials he conducted, Dr. Westman found that blood insulin levels were lower as people followed a ketogenic diet (Expert Review of Endocrinology & Metabolism, Sep. 2018). The body does not require insulin to utilize ketones for fuel. As a result, people with type 2 diabetes have better control of their blood glucose when following a low-carbohydrate ketogenic diet (Nutrition & Metabolism, Dec. 19, 2008). He and his colleagues have published a case series suggesting that a ketogenic diet could help people with food addiction (Journal of Eating Disorders, Jan. 29, 2020). There are also hints that people with other psychiatric conditions might benefit from a ketogenic diet as well (Psychiatry Research, May 2024). What Is Driving the Interest in Carnivore Diets? Bianca Garcia and Dr. Eric Westman agree that the internet has a huge influence on people’s interest in carnivore diets. Podcasters like Joe Rogan and multiple influencers have promoted this approach, especially to younger people. This can contribute to social pressure to try it. Dr. Westman warns listeners that adopting a ketogenic or carnivore diet should be undertaken under knowledgeable guidance. A drastic dietary change can alter how medications work, so people with chronic illness really need to work closely with health care professionals. That may require searching for someone who is open to this approach with the expertise to recommend when supplements or salt might be needed and provide information on doses. This Week’s Guest: Eric Westman MD, MHS, is an Associate Professor of Medicine at Duke University. He is Board Certified in Obesity Medicine and Internal Medicine and founded the Duke Keto Medicine Clinic in 2006 after conducting clinical research regarding low-carbohydrate ketogenic diets. Dr. Westman is a past President and Master Fellow of the Obesity Medicine Association and Fellow of the Obesity Society. He is a board member of the Society of Metabolic Health Practitioners and the American Diabetes Society. In addition, he has written and edited numerous bestselling books and is a co-founder of Adapt Your Life Academy (www.adaptyourlifeacademy.com), which provides science-backed education on a range of subjects rooted in the therapeutic effects of dietary carbohydrate restriction… including his newest course, Carnivore Made Simple, which is open now for enrollment for a limited time. Eric Westman, MD, Duke University Our Co-Host: Bianca Garcia is a Filipina-American anthropologist, foodie, and radio person. She holds a master’s degree in Media, Medicine, and Health from Harvard Medical School, where she created an audio documentary on the carnivore diet. She was a AAAS Mass Media Fellow covering health and science at WUNC, North Carolina Public Radio when we conducted the interview; her favorite stories to cover always involve what people eat, and why. Bianca Garcia, photo copyright Christina Thompson Lively Listen to the Podcast: The podcast of this program will be available Monday, Sept. 15, 2025, after broadcast on Sept. 13. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. In the podcast for this episode, you’ll hear the real patient story of a doctor who weighed 350 pounds and suffered from POTS (postural orthostatic tachycardia syndrome). Do we have any idea of how a carnivore diet affects the gut microbiome? Dr. Westman describes his study on how a low-carb diet helps GERD (gastroesophageal reflux disease). Years ago, Joe looked for evidence on the traditional heartburn diet limiting fat, alcohol, coffee and tomatoes and couldn’t find any. What we have found is that science changes as researchers pursue further studies and that is not a reason to mistrust science even though the changing recommendations may be frustrating. Dr. Westman offers a message to everyone trying to make the right dietary choices but feeling overwhelmed by many different messages about food. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify. Transcript for Show 1444: A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. This transcript is copyrighted material. All rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:01 I’m Joe Graedon.   Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy.   Joe 00:06-00:26 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Americans have been fighting about food for decades. What’s healthier: low‑fat or low‑carb eating patterns? This is The People’s Pharmacy with Terry and Joe Graedon.   Terry 00:33-00:44 We’ve talked with many experts about the value of a Mediterranean diet, rich in produce and low in red meat. Today we’re going to find out about the carnivore diet.   Joe 00:44-00:49 What’s the difference between a carnivore diet and a ketogenic diet?   Terry 00:49-00:59 Our guest is Dr. Eric Westman of Duke University. He started as a skeptic of the Atkins diet. Then he conducted research that turned him into an advocate.   Joe 00:59-01:15 Coming up on The People’s Pharmacy, the food fight over fat. Learning about keto and carnivore diets.   Terry 01:13-01:56 In The People’s Pharmacy Health headlines, COVID cases are increasing, especially on the West Coast. Oregon has seen a late summer surge in cases. California has also seen an alarming increase. Hospitalizations for COVID patients have almost doubled in recent weeks. An objective measure of viral spread comes from wastewater samples. The CDC’s wastewater surveillance system reports very high genomic sequencing levels for the SARS-CoV-2 virus. There is hope, however, that the summer surge will ease soon, though public health officials worry another COVID wave could start as early as November, just in time for holiday travel.   Joe 01:56-03:07 People who are trying to avoid COVID-19 might want to consider an inexpensive, low-risk strategy to stay safer. A study published last week in JAMA Internal Medicine tested the nasal spray Azelastine for prevention of SARS-CoV-2 infections. This over-the-counter antihistamine is sold under the brand names Astelin and Astepro. Beyond its anti-allergenic and anti-inflammatory properties, this medication has antiviral activity against several respiratory viruses from SARS-CoV-2 to RSV and flu. A double‑blind, placebo‑controlled trial in Germany included 450 patients who spritzed either azelastine or placebo into their noses three times daily for roughly two months. During that time, five people spritzing the antihistamine came down with COVID. In the group using the placebo spray, there were 15 positive cases. The authors concluded that their results support the potential of azelostine as a safe prophylactic approach, warranting confirmation in larger multicenter trials.   Terry 03:07-03:57 A different study tested the effects of inhaled nitric oxide against COVID-19. The investigators note that this gas is produced naturally in the body and is well known as a vasodilator. It also has antiviral and anti inflammatory properties. In a recent study, fifty-five patients hospitalized with COVID associated pneumonia got inhaled nitric oxide or usual care. Those who had up to six hours exposure to high dose nitric oxide were released from the hospital more quickly and needed less supplemental oxygen. According to the investigators, the inhaled nitric oxide treatment was safe and well‑tolerated. They suggest this approach might be helpful against other pulmonary infections.   Joe 03:58-05:11 Generalized anxiety disorder, GAD, is one of the most common psychiatric conditions in the U. S. Doctors may prescribe anti-anxiety drugs such as alprazolam or diazepam. But these benzodiazepines may not be suitable for long-term use. SSRI antidepressants are also prescribed, but they too don’t work for everyone with anxiety problems. Now, scientists report a single dose of the hallucinogen LSD can have lasting effects. Nearly 200 patients were recruited for the study. The researchers randomly assigned them to take placebo or one of four different doses of the active compound. The two lowest doses of LSD did not have an effect that was significantly greater than placebo. People receiving the two highest doses—100 or 200 micrograms—were significantly less anxious one month later. Adverse effects included hallucinations, nausea, and headache during the treatment. This helps establish the groundwork for further research on the potential benefits of one dose of LSD to treat disabling anxiety under careful medical supervision.   Terry 05:11-06:17 Are you a coffee lover? How do you drink your brew? Previous studies have shown that regular coffee drinkers get substantial health benefits. They tend to have a lower risk of liver cancer, diabetes, dementia, and cardiovascular disease. Few studies get into the details of coffee consumption, though. Now a cohort study of more than 42,000 American adults participating in the National Health and Nutrition Examination Survey. demonstrated that higher coffee consumption was associated with a lower likelihood of dying between 1999 and 2018. People drinking one to three cups daily got the most benefit, but they needed to drink their coffee black. Adding sugar or cream or non-dairy creamer blunted the effects. And that’s the health news from The People’s Pharmacy this week. Welcome to The People’s Pharmacy. I’m Terry Graedon.   Joe 06:17-06:30 And I’m Joe Graedon. You’ve heard a lot about the health benefits of the Mediterranean diet here on The People’s Pharmacy. We’ve also talked to guests like Dr. Will Bulsiewicz about the value of fiber in our diet.   Terry 06:30-07:02 Today we’ll be considering a different dietary approach. Is there any science to support the keto or carnivore diet? Joining us for this interview is Bianca Garcia. She holds a master’s degree in Media, Medicine, and Health from Harvard Medical School, where she created an audio documentary on the carnivore diet. She served as the AAAS Mass Media Fellow at WUNC. We invited Bianca to co-host this interview.   Joe 07:00-07:30 To help us better understand the carnivore diet, we turn to Dr. Eric Westman, Associate Professor of Medicine at Duke University. He founded the Duke Keto Medicine Clinic in 2006 after conducting clinical research regarding low-carbohydrate ketogenic diets. He’s written a number of popular books, such as End Your Carb Confusion and Keto Clarity, his newest course, Carnivore Made Simple, is open for enrollment.   Terry 07:31-07:35 Welcome to The People’s Pharmacy, Dr. Eric Westman.   Dr. Eric Westman 07:35-07:36 Thank you. It’s great to be here.   Terry 07:37-07:42 And we are… (DR. WESTMAN 07:38-07:38) Again. Yes, again for the I don’t know how many-eth time.   Dr. Eric Westman 07:42-07:43 I lost count.   Terry 07:43-08:00 Okay, me too. And we are really pleased to have with us in the studio helping us with the interview. Bianca Garcia, who is a journalist and I might say a medical anthropologist. We’re glad to have you here, Bianca.   Bianca Garcia 08:01-08:02 It’s my pleasure.   Joe 08:03-08:27 Dr. Westman, I have to tell you, when it comes to food, I get so confused It seems like the dietary guidelines have changed so much in my lifetime. How do you keep up and tell us what you think about this whole process? Because you’ve been studying food for decades.   Dr. Eric Westman 08:27-08:51 Well, so you have to think about uh the human body first. not the well this is my perspective. I’m an internal medicine specialist. So I got trained in an era where we were dealing with Oh, diabetes a little bit, high blood pressure a little bit. No obesity. I mean in the 80s in training, there’s really nothing there.   Terry 08:51-08:52 Obesity existed.   Dr. Eric Westman 08:53-13:16 Yeah, but not like today, right? So uh you know, my colleagues started giving pills and shots for everything. And I started to work here in Durham at the Durham Veterans Affairs Hospital. and started to learn about research and worked with the inventor of the nicotine patch for ten years, Jed Rose in Durham. So I got to learn about science and how to apply the scientific method to humans, I mean to clinical research. And so randomized trials were paramount. And really you might even say ignore everything until there’s a randomized trial. Well, that worked for a while. I after ten years I realized I was not fixing anything. I mean and after ten years of my patients at the VA I l I loved them dearly, and they were all kind of getting worse. So two patients show up in my office right about the same time having fixed their diabetes and obesity and I asked them what they did. They said, all I did is eat steak and eggs. I’m like, what the heck? This is nineteen ninety-eight, okay? And so I’m thinking to myself, uh, well, lightning strikes And yet then another patient comes in. All I did is do the Atkins diet. I said, What’s that? And he said, Well, you know This book, it probably came out before you were born. And that wait wait a minute. Now you’re getting personal. So I I go to the bookstore and sure, there’s the Atkins diet, there’s the Ornish diet. There back then there was the Uh even “The Zone” hadn’t come out yet. So there weren’t a whole lot of books on the shelf. But there was a doctor who had a clinic that you could visit, and that was Dr. Atkins. So I wrote him a letter, he calls back and invites me to his office with a couple of young researchers who were doing a different job at the time. And so I saw a clinic in action and after he seeing two people do the total opposite of everything that I was taught. And even then one of the patients who I was treating at the VA said, What are you worried about? And I said, Well your cholesterol. Your cholesterol will go up. Remember this is 1998 for me. And he looked at me and said, Well, why don’t you check it? And he the lab was down the hall at the VA and didn’t cost anything for me or him to do it. So in two cases, people lost weight. These were men- lost over fifty pounds and their cholesterol levels got better regardless of how you look at it total in LDL triglyceride and HDL Like, what the heck’s going on? So I had to learn basically for myself as an internist, as a clinical researcher, about nutrition. And when I went to the diet dietary meetings, the nutrition meeting, there was like, everything’s low fat, everything’s now plant-based. And I’m like, well, but but what about the patient sitting in front of me who’s fixed conditions that doctors can’t fix by doing the exact opposite of what they were taught. And I met uh Michelle Hurn who wrote the book, “The Dietitian’s Dilemma.” What if you have to do the exact opposite of what you were taught to fix yourself? And that’s Michelle, she is a dietitian and you know I’m on a board of a new society with her, so I’ve got to know her, uh gotten to know her pretty well. So I guess, you know, looking back, What do you eat matters? You know, if if I could be dean of the all the schools of medicine and even DO schools, I’d say, you know: nutrition should be key to your education of what a human body needs attention to And in my last 25 years, we’ve documented over and over again, and other people have documented, there’s no nutrition training for doctors. They’re or they get taught the wrong thing. So so here I am today asked to talk about low carb and keto and LCHF and, and I gave a talk in London recently, and it was The Fad That Never Fades. The Fad That Never Fades was the title of my talk. And so the concepts of what we’re talking about has been here you know, for hundreds of thousands of years, the name has changed.   Terry 13:16-13:25 Okay. Bianca, how did you get interested in the carnivore diet? Because you’ve been following up on this for at least a year now.   Bianca Garcia 13:25-14:39 That’s right. I was pursuing my master’s of science and I was thinking about media and health together. And I was as a social media user starting to see a lot of social media content on the carnivore diet. Someone who’s looked at nutrition, who’s been interested in nutrition, I thought it was really, really strange that people were eating, as Dr. Westman said, just steak and eggs. So I wanted to look into kind of the anthropology of this. What is, what is making people eat the way that they are eating? And how do we think about this personal sort of decision as it weighs up against the weight of the medical institution, and that kind of knowledge. And so I have a yet unpublished audio documentary on the carnivore diet called Against the Grain. And in doing that research, I’ve seen Dr. Westman’s content. I’ve seen the content of many other creators. I’ve spoken to carnivores and learned about their personal experiences, and I’ve spoken to doctors who are also equally skeptical of the diet. So there is a wide range of opinions out there that I have been interested in following up on as a journalist.   Terry 14:40-14:52 Dr. Westman, I can imagine that you get some reactions, probably not so much from your patients, because your patients are coming to you saying, This is what I want to do, right?   Dr. Eric Westman 14:53-15:34 Well, not necessarily. Although although that that’s uh a good expectation that no uh, I’ve in fact this week, that’s why I’m in clinic at Duke four days a week in a private practice insurance pay system. Um no, actually some people have no idea who I am. I and there was just recently someone who uh goes to the Lincoln Community Health Center was referred to me and I had to kind of figure out how do I help this uh person from Mexico navigate the foods and when I say you can have all the chicharron you want, the eyes light up. You can have all the pork rinds you want. That’s also a telltale sign for uh someone from North Carolina typically. Uh but uh so   Terry 15:34-15:38 But thank you for translating Chicharron.   Dr. Eric Westman 15:38-15:51 Chicharron is or uh I’ve had the best chicharron, in uh in Colombia. The kind it was really pork belly. But anyway, it has no carbs and it’s kind of a secret trick if you’re trying to (TERRY) it’s very high fat. It’s very high fat.   Terry 15:51-15:54 Which is great on a carnivore or keto diet.   Dr. Eric Westman 15:54-16:37 It it may not be great on a low fat diet. I, I understand. And I think there are a lot of ways to be healthy, just to kind of declare I’m not just a carnivore keto proponent. I in fact it was recently when Lucia Aronica at Stanford asked Christopher Gardner to do a sub study of his paper. It’s called the DIETFITS study. The substudy was let’s look at people who did ultra low fat and let’s look at people who do did ultra low carb. And and so it selected out people who were actually following those, and looked at health parameters and actually the ultra-low carb diet looked very similar to the ultra-low fat diet.   Terry 16:37-16:38 In terms of outcomes?   Dr. Eric Westman 16:38-16:41 In terms of improving insulin resistance.   Terry 16:41-16:41 Uh-huh.   Dr. Eric Westman 16:41-16:45 Improving what we understand now is probably the root cause.   Joe 16:47-17:04 Well we just have a minute before the break, but I would love to have you explain insulin resistance because we are hearing about it so frequently now and it’s so critical. But I fear that a lot of people don’t yet understand it. So you have one minute to give us the insulin resistance overview.   Dr. Eric Westman 17:04-17:52 Yeah, so insulin resistance uh actually is a term, I don’t like it. It, you really should say high insulin levels. Because insulin resistance gives the connotation that there’s something wrong in the person, something wrong in the cell, and you just need a drug. But what insulin resistance functionally is, is that insulin is not working to lower the blood glucose like it used to. So what you see is an elevated blood glucose compared to before or A1C, the hemoglobin A1C, the three month average of the glucose. And but you see the insulin resistance also means your insulin level is high. So I would rather have you talk about high insulin levels and how to get those down than insulin resistance, which is this, you know, term out there you need a drug for.   Terry 17:52-18:08 You’re listening to Dr. Eric Westman, Associate Professor of Medicine at Duke University. He’s a board member of the Society of Metabolic Health Practitioners and the American Diabetes Society Dr. Westman is a specialist in internal and obesity medicine.   Joe 18:09-18:13 After the break, we’ll consider why dietary guidelines haven’t made a difference.   Terry 18:13-18:19 There’s not impeccable evidence to support the current guidelines, but that’s also true for the carnivore diet.   Joe 18:19-18:21 What does science tell us about how it works?   Terry 18:21-18:25 How do carnivore and keto diets differ?   Joe 18:24-18:29 What are the pros and cons for patients following a carnivore diet?   Terry 18:39-18:48 You’re listening to The People’s Pharmacy with Joe and Terry Graedon. This podcast is brought to you in part by Sonu.   Joe 18:48-19:12 Ready to breathe like never before? Meet Sonu, S O N U, the world’s first FDA‑approved wearable headband that gives you drug-free relief from nasal congestion in minutes. It’s safe for adults and kids 12 and up, making it perfect for families dealing with allergies, sinus issues, or chronic stuffiness.   Terry 19:12-19:31 Sonu uses personalized sound-based therapy to naturally open nasal passages. No meds, no steroids, no sprays. Even better, up to four users can share one account so the whole household can benefit. It’s compatible with both Apple and Android smartphones.   Joe 19:32-19:52 Learn more at getsonu.com and sonu.com. Welcome back to The People’s Pharmacy. I’m Joe Graedon.   Terry 19:52-20:15 And I’m Terry Graedon. On The People’s Pharmacy, you hear a lot about the value of vegetables. We’ve interviewed nutrition experts like Dr. Walter Willett and Dr. Christopher Gardner who are enthusiastic about a plant-based dietary pattern. Today we’re considering a different approach to eating. What are the benefits of a carnivore diet?   Joe 20:15-20:24 What’s the difference between a ketogenic diet and a carnivore diet? What are the benefits and risks of such eating patterns?   Terry 20:24-20:52 Our guest is Dr. Eric Westman, Associate Professor of Medicine at Duke University. He founded the Duke Keto Medicine Clinic in 2006 after conducting clinical research regarding low carbohydrate ketogenic diets. He’s a board member of the Society of Metabolic Health Practitioners and the American Diabetes Society. His areas of expertise include obesity and metabolic disorders.   Joe 20:52-21:12 We’re also joined by Bianca Garcia. We invited her to co-host this interview while she served as WUNC’s AAAS Mass Media Fellow. She holds a master’s degree in media medicine and health from Harvard Medical School where she created an audio documentary on the carnivore diet.   Terry 21:12-21:28 Dr. Westman, we’ve uh kind of reviewed the, a little bit of history of dietary guidelines and advice. Do we have any idea why so many of these dietary guidelines don’t seem to have done the job?   Dr. Eric Westman 21:29-22:07 Well, you know, uh the way I look at it is the there was never any science behind these dietary guidelines. That’s pretty clear. And people have written papers on uh there have been a paper uh was a thought piece of was there any evidence when the dietary guidelines were made that that there were we should have those guidelines and basically know there wasn’t any evidence. So I think it was the government being lobbied to make the foods America makes be consumed more by Americans. Thus we don’t have coconut oil in the guideline because we really are not big producers of coconut oil.   Joe 22:08-22:15 True enough. But before we go any further, when we say the guidelines, uh what are we even talking about?   Dr. Eric Westman 22:15-23:25 Well I know and you know I, fortunately, the guidelines are pretty much uninterpretable right now to the average consumer, except institutions are still somewhat beholden to them. I was just on a panel recently at a meeting where we all kind of agreed no guideline is better than a bad guideline. And I was past president I am past president of the Obesity Medicine Association. We lobbied the government at the time and I sat in the office of the woman who created the food pyramid, Susan Susan Davis. And we said, you know, people aren’t healthy. She said, well this is a guideline for healthy Americans. And we said, no, people aren’t healthy. I’m, you know, advocating for obesity treatment. So I think the first uh question is, are we giving guidelines to healthy people? Or like the studies say and you just look around at the mall, are should we give guidelines and guidance to people who need a corrective therapeutic diet generally. So I’m not a big guideline guy and and uh I work with the patient in front of me and get results. And I yeah I think the guidelines have been a bad idea. Even even the latest ones.   Bianca Garcia 23:26-23:49 And Dr. Westman, as you’re pointing out, there’s not a lot of evidence for the current guidelines, but from what I’ve seen, there is not a lot of published evidence about the carnivore diet either. But we can intuit from the keto diet and other similar low carbohydrate diets why it might work. So can you walk us through a little bit about the science of why the carnivore diet works?   Dr. Eric Westman 23:49-24:58 Absolutely. And I, I share your kind of assessment that there’s not a whole lot of published literature. If you search carnivore, you know, you’ll get a survey. There was a survey from the Harvard group, Belinda Lennerz and David Ludwig, where they surveyed self-described carnivores and what happened to their health and all that. We actually surveyed a a group who was of type one diabetics, as people affected by type one diabetes as well. It was a Facebook survey and it was the most cited publication in the journal Pediatrics at the time. So I, I don’t discount this information, but you have to keep it in, you know, it’s preliminary um information. The the grassroots change that we’ve seen over the last ten to fifteen years is that people are changing their own diet with influencers or or just word of mouth. And getting amazing changes, including keto, including carnivore, and I think the mechanism is that they both really fix insulin resistance, meaning they lower the insulin levels. And really any effective diet can do that.   Terry 24:58-25:10 Dr. Westman, we’ve been talking about the carnivore diet as if we all know what it is, but I don’t. So maybe you can tell us what are people eating? What is the carnivore diet?   Joe 25:10-25:15 And before that even, what is the keto diet? So how do they differ and what are they?   Dr. Eric Westman 25:16-25:30 Yeah, so uh I think there are many different versions of these things. Carnivore, I think, can be best described as just animal-based foods. So kinda like you’re used to saying plant-based, plant-based, plant-based, plant, uh oh. That’s kind of…   Terry 25:30-25:31 Or plant forward.   Dr. Eric Westman 25:33-26:09 Oh, it changed. Oh that’s one way to do things, but you know, uh people who come to me, yes, some do self-select, they want to follow what I, not everyone comes not knowing what I do. A lot of I would say two-thirds of the people come seek me out because of the teaching that I give. I I have to admit that. But so two years ago there was a textbook called “Ketogenic: The Science of Therapeutic Carbohydrate Restriction” and I use this as show and tell to people from a first visit to my office to just show that there is a body of knowledge now out there on the keto diet.   Joe 26:09-26:23 And keto really makes it Let me read the the subtitle of the book you’re holding up. It’s “ketogenic, the science of therapeutic carbohydrate restriction in human health.” That’s it. Tell us about it.   Dr. Eric Westman 26:23-29:28 Well, Dr. Will Yancey and I at Duke have been doing research since 2002 and we contributed chapters on obesity and type 2 diabetes reversal in this textbook. But it’s much more detailed. In fact, I I haven’t read every word in it yet because, you know, uh there’s a lot of information on the keto diet. Well, keto really means that you’re using ketones in your body to an extent that you didn’t before. Is there a certain level? No, no, not really. And i is there a maximal or greatest greater keto diet? I, I don’t think we know that yet. So to me, a keto diet is a very low carbohydrate diet that allows your body to access the fat stores in a flexible manner, so that you can be burning your body fat and and as a result your ketone level goes up compared to those who eat carbs. Uh and uh the idea of fat loss, weight loss has been implanted, and that’s how I learned it. The keto diet was a weight loss diet. But it does much more than that. And now I have people coming to me whom I’ve taught a keto diet for years and and there’s a few conditions that still remain I haven’t been able to fix; I can fix almost every internal medicine problem that my colleagues use drugs for. I can fix,  uh reverse type 2 diabetes, obesity, PCOS, heartburn, migraines, all these things. But there’s a a nagging uh uh uh uh component of problems that have to do with inflammation and autoimmunity that keto doesn’t quite fix. And and I have to say that the keto, the way I teach it, it’s unlimited meat, poultry, fish, and shellfish and eggs, till you’re comfortably full. And one cup of non-starchy vegetables, and two cups of leafy greens. Now I don’t enforce those vegetables and and so what I teach is not strictly a carnivore diet. It allows for these vegetables and leafy greens. But people are coming to me now over the last few years fixing these autoimmunity conditions by dropping those vegetables. And so I’m I’m just wondering it, you know, so what I teach is carnivore-ish. And I passively allow people eat a carnivore diet under my care. You know, I, I monitor things. And it the science I want to go in the direction They’re case series, case studies of people who fix their inflammatory bowel disease, ulcerative colitis, the rheumatoid arthritis, and and we have a case study brewing trying to get it published of of palindromic arthritis that was basically fixed by just changing the food. So, so keto means ketosis, keto means fat metabolism. Carnivore to me is a subset of a low carb keto diet so that it doesn’t seem as far afield to me as it might to someone else.   Bianca Garcia 29:29-29:50 Still, this is a pretty socially and scientifically divisive idea. So I wonder how your peers and your colleagues look at um this kind of keto carnivore-ish diet, especially without uh the immense evidence base that like a plant forward diet might have. Well what kinds of reactions do you get from your colleagues?   Dr. Eric Westman 29:51-32:32 So actually there will never be uh uh unanimity in diet. Let that be just my first statement. There were and and that’s one reason why I’ve kept keto out of the press. In fact, whenever I’d get onto the the press or something, they would try to find someone against it. Well you can always find someone against it. You can always find a plant-based is best. No, there’s no evidence that a plant-based diet is better than a carnivore, animal‑based diet. It’s all implanted in people’s minds. So, no, because that Stanford study where they finally looked at insulin resistance between these two different very extreme diets, they both worked. And you know, I remember, gosh, how long has it been, Joe and Terry? We were talking the Duke Rice diet started all this at the Duke campus in the nineteen thirties or you know the history of (TERRY) Yeah, before our time even. Yeah, well And then, you know, the rice diet no longer exists, although there’s still people who remember that. That was would be like an Ornish/Pritikin ultra‑low‑fat kind of diet. And and I I think it works, you know, but it doesn’t mean there’s no other way to do it. So I guess um coming around, uh Bianca, that there never will be agreement among the the experts. And so what I’ve learned is I, I, I put my head down, created a clinic. And over the last 15 years, I learned as much as I could about using a keto and carnivore diet in a clinical setting. And if other people say, well, it doesn’t work, that’s not true. The long-term effects remain unknown, but that’s true, true for any diet. So that, you know, w we get into this, you know, oh there’s no evidence. Well, there’s really precious little evidence even for the Mediterranean diet, which everyone believes is the best. So in evidence meaning randomized trials long‑term. So we’re we’re left with what is biologically sensible and and also therapeutic. I just want to loop back to this textbook. I think there’s general consensus that a keto diet can be a therapeutic tool. I mean, so even my naysaying colleagues who don’t like the idea of carnivore and keto will say, okay, well, you can reverse things and fix things, but then what? You know, you gotta get off that eventually. And I’m like, well, but if it reversed all their problems, why would you want that get them off it? You know? And because they just know that it’s bad. I mean, if it if it’s not known, it must be bad, which I learned, you know, you and I sat in a room like this. when that first Atkins paper came out and oh the controversy and now nobody really knows that name other than the the food on the shelf.   Terry 32:33-32:54 So, Dr. Westman, would you please tell us briefly what you have seen as the clinical benefits for people who are following this carnivore or even carnivore-ish diet? And then we’d also like to talk about some potential downsides.   Dr. Eric Westman 32:54-34:52 Absolutely. So from my bench or or clinic, um what I see for those who follow uh carnivore or keto kind of diet with instruction from someone who knows what they’re doing. Now you know, internet and carnivore internet and keto internet there are so many different places to learn, it’s very confusing. But so you want to learn from someone who knows what they’re doing and if you’re on multiple medications, you wanna be sure to be working with someone who knows how to get you off those medicines safely. And so what I see is uh the average patient coming to me is 60, 65 years old on seven to ten medications. Medications for diabetes, high blood pressure, heartburn, arthritis. Many of these people have already had hip and joint replacements, and and now they’re have they have obesity too. And so I simply tell people that we store fat on our bodies for energy and we want to get access to that fat store. And I could use a keto, a low glycemic, a a carnivore type of diet based on this someone’s preference. And over time I can fix, reverse all of those medical conditions by changing the food. It’s so unbelievable you won’t believe me. So for the last 10 years I’ve at medical conferences I’ve said, come to my office. And partly I set up this clinic so that it could be a teaching clinic, not only for for the patients, but for doctors. So residents and students at Duke come through my office. Other doctors have come even from around the world to see it in action. And so basically it’s the all the internal just about all of the internal medicine problems that are treated with medications today can be reversed or greatly reversed just by changing the food.   Joe 34:53-35:43 I want to ask you a little bit about a couple of conditions that are widespread in our society, and we don’t have good treatments for. Inflammation, which I’d love to have you define what that means from a biological perspective, and also the impact on the brain, on mental clarity, because there are a lot of people in the age bracket that you’re talking about who are complaining about mental fogginess, in you know just functionality. I, I can’t remember those names anymore the way I used to. And they were also complaining about their knees and their elbows and their fingers. What impact does this approach have on those two areas?   Dr. Eric Westman 35:44-36:12 Yeah, so inflammation is basically your body’s ability to clot, to fight infection, to to function. And you need some inflammation. So you don’t someone came to a meeting, an expert, and said, Well I don’t eat that ’cause it causes inflammation. I don’t eat that ’cause it causes inflammation. The first question at the microphone was, Well, what do you eat? Basically you said, I fast because eating causes inflammation. And I mean that’s to the absurd degree.   Terry 36:14-36:15 Not a long‑term strategy.   Dr. Eric Westman 36:15-37:26 Yeah. So so you w n you want some inflammation, but you don’t want too much. I guess it’s like Goldilocks, you know. You want a little bit uh of inflammation but not too much. And I I think the the elephant in the room is that food causes inflammation. Of course, stress causes inflammation and and so food, the carbs are uh and refined sugar and flour are really kind of the the ones that are causing most of the inflammation today. Uh you know, the brain function is fascinating and I think the common consensus is that insulin resistance, oh, remember that term? High insulin levels. over a period of time actually cause Alzheimer’s. Just cause. But the problem is once you get a a memory issue from Alzheimer’s, it’s too late. So it’s like the you know, the plane’s going down. So everything I’ve learned about Alzheimer’s is that you want to take action now. Like if you have a family history of it, uh a loved one where you want to address that insulin resistance and there are numerous uh dietary ways to do that.   Terry 37:27-37:59 You’re listening to Doctor Eric Westman, Associate Professor of Medicine at Duke University. He founded the Duke Keto Medicine Clinic in two thousand six after conducting clinical research regarding low carbohydrate ketogenic diets. His newest course, Carnivore Made Simple, is open now for enrollment by People’s Pharmacy listeners for a limited time. Bianca Garcia, a AAAS Mass Media Fellow at WUNC, joined us in co-hosting this interview.   Joe 38:00-38:05 After the break, we’ll find out what people are saying on the internet about the carnivore diet.   Terry 38:04-38:08 How long does it take for people to see weight loss from a carnivore diet?   Joe 38:08-38:13 What downsides might we expect from such a diet or the keto diet?   Terry 38:13-38:18 Bianca will share her experience trying a carnivore diet. How did that go?   Joe 38:18-38:23 Should we change our thinking on nutritional science?   Terry 38:35-38:39 You’re listening to The People’s Pharmacy with Joe and Terry Graedon.   Joe 38:47-38:51 Welcome back to The People’s Pharmacy. I’m Joe Graedon.   Terry 38:51-38:52 And I’m Terry Graedon.   Joe 38:52-39:06 What’s a healthy way to eat? Humans around the world have come up with different answers to this question. Most nutrition scientists agree that the standard American diet falls far short.   Terry 39:06-39:38 Our guest today is Dr. Eric Westman. He is Associate Professor of Medicine at Duke University, where he founded the Duke Keto Medicine Clinic almost 20 years ago. Dr. Westman is a co-founder of Adapt Your Life Academy, where his newest course is Carnivore Made Simple. It’s open for enrollment by people’s pharmacy listeners for a short time. Bianca Garcia, a AAAS mass media fellow at WUNC, joined us in co-hosting this interview.   Bianca Garcia 39:40-40:12 Dr. Westman, you were talking about the internet culture of this diet. And you were saying how, you know, it’s important to get instruction from people who know what they’re doing and how to get you off your meds in order for you to, you know, safely carry out this diet. But I think I want to talk a little bit about the internet culture and you know, how this diet is spreading popularly. What are you seeing out there? What do we have to be aware of as people might be encountering this diet in the wild?   Dr. Eric Westman 40:13-42:05 Uh yeah, great and you know I’m uh just kind of in awe of the internet compared to twenty years ago. And it’s a wonderful thing and a terrible thing all at the same time. So the big line of, of demarcation should be if you see a doctor for a a problem that you’re taking a medicine for. Be sure to do this with a doctor who knows what they’re doing, because medicines can become too strong on the first day. I’ve had people have low blood sugars from insulin and other diabetes medicines on the first day. So if you’re consuming this information online and it’s to the general healthy person, I’m not so worried about it. But once you get into that clinical population, now, you know, I don’t know uh uh any of my patients who are on TikTok. So that that might all automatically select the ’cause the people who come to me are generally older. But that’s that’s not always the case. So I I’m getting patients who come to me because I kind of passively endorse a carnivore diet as a subset of a keto diet. That uh I think uh you want to do things um that um and not only feel feel right isn’t the right word. It’s the thing uh changes that make you feel good. I mean that that may correct a problem that you have. And if it even if it’s excessive hunger and all you can do is think about food. Then this is something the food is really the answer and and um I’m afraid doctors don’t have that information and you know it it really is hard to police this, isn’t it? But uh to me I I try to make sure that if you’re you know older, you’re on medicines, that you have someone who knows what they’re doing help you.   Bianca Garcia 42:06-42:50 I also want to add though from my field work and from the interviews that I do that young people are exploring this diet. I think there’s a lot to say about the simplicity of it. People are attracted to it because unlike the Mediterranean diet, which has like very strict um ideas of what you can and can’t eat. This is just like take out everything and stick with just meat. And that’s pretty intuitive and simple. But at the same time, that can have some, let’s say bodily impact. I tried the carnivore diet for a little bit. I couldn’t stick with it. So what can we expect about people who just get on the diet? And I guess the the essence of this question is like: how long does it take for this thing to work?   Dr. Eric Westman 42:51-43:07 Well, I um it depends what you’re doing it for. So uh y I I have no problem compared to all the other things you can do in terms of nutrition. I think can we agree that the standard American diet just isn’t highest on the list?   Terry 43:08-43:09 I think we can all agree with that.   Dr. Eric Westman 43:10-43:21 So what’s then next? Can everyone do a super strict eat local, go to the farmer’s market, um, never go to McDonald’s and all or Burger King or Wendy’s?   Terry 43:21-43:22 Not everyone.   Dr. Eric Westman 43:22-45:38 Not everyone. So we have to have some sort of compromise, I believe. And and that’s also my doctor perspective. I don’t just preach as an influencer, do this and you have to be perfect. There are those who do that. They preach that and and I see people coming in worried about the the carblets, the the little microcarbs and the maltodextrin in the cheese and the I mean, come on. That’s not metabolically substantially anything you should worry about. So how you get it taught matters a lot. And the carnivore diet as it’s taught today, just eat meat. Well, I think it’s relatively healthy and and you know, if there’s if I could go back, Joe and Terry, twenty-five years ago, I would have said, show me a study that Atkins diet is bad. There never was one. And it took me just two years ago in with Jeff Volick, a researcher who’s been with me in this space for twenty-five years. For him to be on a podium and say, you know, there’s never been a study that showed that nutritional ketosis, the Atkins diet induction even, which now, you know, is carnivore, there’s never been a study to show that it’s bad. When I thought about that and look back, we had the wrong emotional reactive position of we had to try to prove that it was good, when nobody had shown that it was bad. It was prejudging. And I have that same feeling here. Yes, it’s a feeling, and I want science. I want more science. That that’s what’s going on today. Hey, it’s just eating meat, which is a lot better than eating all that other garbage and and you know in a scientific venue, I I do say things like, you know, prove that a keto diet is bad, you know, using the method that I use. Because we don’t see that it’s bad and if you just say a keto-ish diet from nutritional epidemiology shows that it’s bad, that doesn’t count. But so anyway, I I’m I you know me, I I was taught to to protect my data, and and protect what I saw in front of me, but then I cheated. I went to doctor’s offices who they’d done it for thirty years before me.   Terry 45:39-46:01 Well, Doctor Westman, here at The People’s Pharmacy, we rarely hear about a medical intervention that is just all good and has no downside ever for anyone. So can you tell us about some downsides that people might want to be aware of that could happen while you’re following a carnivore diet?   Joe 46:01-46:22 Or a keto diet. Because what we have learned over the years. And it took us about 40 or 50 years to recognize that some people will say, oh, this drug is marvelous. I love gabapentin, It takes away my nerve pain. And other people say gabapentin ruined my life.   Terry 46:23-46:23 Made me crazy.   Joe 46:24-46:58 I had hallucinations, it was, my brain stopped working. So nothing is ever really black or white. And some people, I am sure, as we’ve interviewed in the past, I love fiber, fiber, fiber fuel diet. It’s the best diet. And then other people say, oh my gosh, I just had so much gas I couldn’t tolerate it. So give us the pros and the cons. You’ve already given mostly the pluses, but are there some people who have problems with a keto or carnivore-ish diet?   Dr. Eric Westman 46:58-49:20 Well, that’s a great point. And that raises the issue and and the reason why formal research is necessary. Is that I learned a long time ago that if someone is just selecting out to come see me that because they have good results. Then I have a selection bias, what happened to people who couldn’t follow it? What happened to someone who had a problem and they didn’t come? So it’s important to have a study not only to I don’t think we need studies to show efficacy. I mean, I I could show efficacy with fifty people compared to a standard American diet for diabetes. We, our study of low glycemic versus low carb diets published in 2008 only had 50 people in it. So we can show efficacy. And it’s the safety side that you need more people involved and, you know, you get a hundred people, you get thousands of people. Then well, with a drug, then you get millions of people, then you start to really get an idea of the side effects. But so I I think the um side effects that most people have with keto or carnivore are manageable. We teach how to have keto adaptation at first where you add salt back in if you don’t have a salt sensitive condition. If someone has headache or cravings that goes away typically in a few days or a week. There might be change in bowel function where you you treat that with a little magnesium early on or some other electrolyte supplement. What s being able to stay on the diet to me i is is not only the biologic change that occurs, it’s also how that person perceives other people think of them and if they don’t want to go to the store and just have meat in their grocery cart. I mean that that’s a different so metabolically I have yet to see someone who cannot do a keto or carnivore diet metabolically because all of those problems are kind of screened out in pediatrics. So if if you have a serious fatty acid disorder, you can’t burn fat, you don’t really get out of childhood. So as an internist, as an adult I’m comfortable having people do a keto or carnivore diet. And most of the side effects, if if this were a drug, we’d say, well, these are mild and manageable.   Bianca Garcia 49:21-51:07 I’ll tell you a little bit about my perspective because like I mentioned I tried and I failed the carnivore diet. And before, before I get into that experience, I think I’ll frame it by saying like I’m a generally pretty healthy person. I was trying this as like a social experiment. There was nothing really keeping me going when I hit these roadblocks. And so for a lot of people who approach the carnivore diet, they’re doing it because they need something out of their health experience that they’re looking for at in the carnivore diet. That wasn’t my that wasn’t my case. So when I got the keto flu, as it’s popularly known, I was nauseous. I had headaches. I couldn’t get up in the morning. I was like, oh my gosh, this isn’t for me. But also, I felt the immense social pressure of the diet. I couldn’t go out and eat with my friends the way the the way I wanted to. I am a foodie and I felt a little depressed about not getting to eat the colors on my plate. Uh and also meat is kind of expensive. So, you know, I was feeling that in my wallet. These are all social things about the carnivore diet that are pitfalls of it, and I think that we need to talk about these because nutrition is inherently social. So while there could be and while there is evidence for these like immense changes to embodied health, there’s also the social health that’s important to think about. But I do want to follow up with a question for Dr. Westman, uh, which is about the common skepticism for this diet, which is like, what do we do with this information that we’ve all heard that red meat is carcinogenic and that if we don’t eat vegetables, we’re gonna get like a vitamin C deficiency? How do I think about that?   Dr. Eric Westman 51:08-51:16 Well, that’s a lot to unpack. Thanks for sharing your story. I wonder if you added salt during the keto adaptation.   Bianca Garcia 51:16-51:26 I learned afterwards that I should have been doing that. And I was going off the internet, you know? I think that’s the other thing. Which is…   Dr. Eric Westman 51:26-53:09 Ignore every internet thing except mine. Isn’t that funny? So but uh the the social things are are are real and but you know I I think back in the nineteen seventies, people started jogging and it wasn’t socially acceptable. In fact, people started starting to get treadmills and jogging I mean I’ve traveled to Europe and I was jogging and the Europeans looked at me like I was a nutcase ’cause you just didn’t jog in Europe. I didn’t see a whole lot of Europeans jogging even today. But so social acceptance can change over time. And i if you’re I think that trade-off for you w r wasn’t right. You know, you weren’t getting some benefit that you were, you know, fixing your ins incessant hunger. Or or um so I’m watching some influencers and I do React videos. One of the things that’s really important to remember if you’re exercising a lot, And if that’s part of your life. You’re at the gym and all that. That’s not where the the clinical application of keto and carnivore came from. It started with people who were unable to exercise, fixing metabolic issues. And so th there that’s a different context that you need to learn from people who’ve figured that out online. There are I think there are some good influencers online who’ve helped a lot of people. But again the the selection bias is a problem. So that perhaps your story or your your result is some biologic factor, not just social, and and maybe that’s underrepresented in the internet, you know, the highlight reel of, oh look me, look at I all I did all this And those who are not getting results don’t say it publicly.   Terry 53:10-53:21 Dr. Westman, how does what we have learned now about the carnivore diet change how we think about nutritional science?   Dr. Eric Westman 53:21-54:24 Well, that’s a great question, and I’ve always been a critic of nutritional epidemiology. Where you ask people what they eat periodically, sometimes once a year, and then you follow their health outcomes without any sort of experimental manipulation. And so I’ve I’ve always been critical of that and I’m a clinical trialist and so I value the Stanford paper with a couple hundred people on the diet and they were they know they were following it and and I trust the prospective data more than the cohort studies. So that so my perspective is we have to get to biology. So I’ve started to teach, let’s look at what the body’s made of. Let’s understand that we’re mostly water, protein, and fat. In fact, there’s no carbs stored on our body. I go over this with the body composition personally with my patients now. And I explain that we store fat on our body, not carbs.   Joe 54:25-55:23 Dr. Westman, people learn best from stories. And I know it’s not science. But on the other hand, we we can begin to have some sense of your many decades of experience with um first the Atkins diet, then the keto diet, now the carnivore-ish diet, you’ve had, you know, probably hundreds of patients, perhaps now thousands of patients. Tell us about some that stand out in your mind where they they came in perhaps overweight, perhaps with a diabetes problem, perhaps taking, as you said many medications and not feeling well. Tell us about, without actually naming someone who could identify him or herself, how your approach has changed their lives.   Dr. Eric Westman 55:24-55:39 Well, that’s a great question. And I I don’t know where to begin. I mentioned the kind of garden variety reversal of diabetes, hypertension, obesity, PCOS, and GERD. And I would say those are uh papers that we have published.   Terry 55:40-55:51 Now, Dr. Westman, I’m gonna call you on the alphabets. You need to tell us what PCOS means. And a lot of people know what GERD means, but not everybody, so you’ll have to explain that one too, please.   Dr. Eric Westman 55:52-58:03 Sure. PCOS means polycystic ovarian syndrome. And then GERD is gastroesophageal reflux disorder or heartburn. Heartburn. So these are things that either my colleagues who are internists can’t fix or they give drugs for. So uh I I think the extreme cases that I’m seeing now that I’m really kind of proud of, ’cause I stick to my guns. I I don’t I I just I’m a I’m a source where people can come and say, Hey I relapsed to sugar. And there are several patients who just when they relapse to sugar, they can gain 20 pounds in two months. And they come back and they have the safe zone almost like um I I don’t know, like be getting in a church and having sanctuary, because we know now that sugar is as addictive as any other drug. It was regarded as a drug and then in Gary Taubes’s “the case against sugar,” book he gives the history of that. So I think this um uh woman who’s stressed just stressful life and and and the sugar is just uncontrollable for that person. Um and and that’s kind of the new frontier of understanding that sugar is an addiction, uh and it’s okay not to have it. Um but the other the medical side if I put on my internist hat, it’s the inflammatory bowel disease that goes away. It’s the again, uh my my colleagues have super strong anti-inflammatory drugs now. They can give shots that cut out any symptom from inflammatory bowel disease, Crohn’s, or ulcerative colitis. The problem is those shots are so good, you’re at risk for having cancer, because you need that anti-inflammatory response to fight cancers. And so these drugs are so strong they’re being used and then most people don’t think they need to change their diet. So I like people to understand that there’s just another way to go about things. It’s not wrong to take the drugs and eat carbs and and all, but their lifestyle is so important and so powerful when it’s done right.   Joe 58:04-58:24 So I’m gonna ask you in your mind to imagine John Doe or Jane Doe, a patient, a real patient, who came in struggling, came in frustrated. Their diets haven’t worked in the past, their medications are only working so well. And tell us their stories.   Dr. Eric Westman 58:24-58:53 Yeah, well, uh a doctor comes to mind. who uh who’s weighing three hundred and fifty pounds ish, so it doesn’t matter how tall you are, you’re gonna find you’re gonna hit the high BMI obesity category. But he he also had a really serious metabolic problem called POTS, postural orthostatic tachycardia syndrome. I’m seeing a lot more of that. And it actually he was so skeptical. I mean, come on.   Joe 58:53-58:55 And what’s it like to have POTS?   Dr. Eric Westman 58:55-59:09 Well POTS makes you uncomfortable when you stand. You might get tachycardia at a fast heartbeat, you get flushing, and then you can even pass out. So he was finding himself on the floor at home. His family would come find him.   Terry 59:10-59:13 And so he’s at three hundred and fifty pounds they couldn’t lift him up.   Dr. Eric Westman 59:13-01:00:30 Yeah. Well that that that all goes without saying. The the problems of the obesity too. I mean, so it’s like, the obesity’s kind of become, oh yeah, I can fix that, no problem. I just explain w we have fat on our body, we need your body to burn fat. It’s these other conditions. So that when he came back thinking uh or uh seeing the weight loss, that was one thing. But then when he starts saying, you know, I’m not having those spells anymore. You know, you are starting to understand the metabolic changes that are happening go beyond just the weight loss. And this could apply to any number of things. It’s common today for people to be very skeptical and then they come back sort of the tail between their legs, you know, I didn’t think this was gonna work. Uh one gentleman in his seventies, uh and he and his wife came back and and they were like, Wow, this really does work, down, you know, twenty pounds in the first visit dur uh duration since the first visit. And so uh that kind of change can happen fast, and the idea that you could change these medical issues just by changing the food, that’s just not common knowledge. It’s not commonly known. And food really is is king   Terry 01:00:28-01:00:35 Do we have any idea how a carnivore diet affects the gut microbiome?   Dr. Eric Westman 01:00:36-01:00:37 Oh, it changes it for sure.   Terry 01:00:37-01:00:44 I would imagine it would because uh what what you eat does change the microbes inside you. Well what’s the impact?   Dr. Eric Westman 01:00:45-01:02:03 I I wrote a book with uh super smart uh writer that’s my my method is I team up with other people for books and we would go, not the microbiome again, you know, it’s another study, another distraction. So of course the microbiome changes, and it changes in a favorable way. Best way I can it can can explain it is like a a scientist who showed me at a at a world class meeting. He showed, click, here’s a slide of this jungle, like the Amazon, and here’s your microbiome. It’s beautiful, it’s of colors, and I’m like, well, there are things that can kill you there. It’s uh, you know, it’s the Amazon, little frogs and th and then he goes, Click, and here’s the microbiome on a low carb diet and it was like a desert. And I’m thinking, man, Zen meditation and and uh resort area. This is really calm. That’s what happens. Your microbiome calms down when you do a current, of course it changes. And it’s fascinating today. Well we, we study carb eaters and look at their microbiome and say, well, if we can just have that bacteria and put that in another person who doesn’t eat carbs, we’re gonna get all no, no. So the best thing for your microbiome is to cut the carbs out.   Joe 01:02:03-01:03:02 I’ve got a question, Dr. Westman, about GERD. I remember a paper that you wrote that was I would say semi-heretical, because at that time uh the H2 antagonist drugs were in the ascendancy, and then along came the proton pump inhibitors, which were going to be even so much better. And no more heartburn, no more GERD, we’ve got drugs. And you did a study, not a huge one, but it said a low carb diet could change everything for people suffering from GERD, from bad heartburn, esophagitis. And then we started writing about it and people started reporting, hey, you know what? It works. Even though conventional west wisdom from the medicine community was, oh, just give them a PPI.   Terry 01:03:02-01:03:06 Oh, and you should not be eating fat, obviously, if you have GERD, right?   Joe 01:03:06-01:03:06 Exactly.   Dr. Eric Westman 01:03:07-01:03:08 Or caffeine or chocolate.   Joe 01:03:08-01:03:09 Or any of that stuff.   Dr. Eric Westman 01:03:09-01:04:59 So that’s all the old, old stuff that doesn’t really work. (JOE) So give us an update. Dr. Eric Westman Well uh looking back, the studies we did really are proof of concept studies, right? So they aren’t big randomized trials looking at different types of diets. So differ many different diets could work. But this was a interesting study by a GI fellow at UNC. So we actually had a Duke UNC collaboration at the time and he put a pH probe down the nose into the stomach of these people with refractory heartburn. and and looked just over a few days of changing the diet, the acidity changed. So you actually were changing the diet was like taking an antacid. So whoa, yeah, so that was after the clinical signal is so strong. If I put someone on twenty grams, total grams, not net of carbs a day. The heartburn goes away almost uniformly, a hundred percent. But now time passes, so so uh another study comes out where they gave a hundred grams of carbs, you know, the typical American may have two to three hundred grams. And they changed, cleaned up the food so it wasn’t junky. A hundred grams of carbs a day reduced the heartburn as well. So if we do a study that says 20 grams or less can fix, you know, 10 people, it doesn’t mean 50 grams can’t or a hundred grams can’t. And so there’s all this level of carbs that needs to be studied in my mind, or you just try it yourself, uh if you uh but the problem with that a hundred gram fixing or reversing heartburn is it didn’t work a hundred percent like the twenty gram one did. So uh yeah, that was uh a signal that, you know, I I cheated and I read that in Dr. Atkins book. Dr. Atkins health revolution, because he had seen this in his clinical practice. You know, you know.   Joe 01:05:00-01:05:22 You mentioned the science. Oh, we’re always looking for the science because we hear, oh Evidence-based medicine, randomized controlled trials. I searched high and low for data to support the traditional heartburn diet. Which as you say, it was uh no chocolate, no coffee, no fat.   Terry 01:05:23-01:05:23 No alcohol.   Joe 01:05:23-01:05:33 No alcohol. I mean, I I I looked for the data. Because this diet was given out by gastroenterologists all across the country for anybody who came in with heartburn. I couldn’t find it.   Dr. Eric Westman 01:05:34-01:06:04 Yeah, and I I think we can understand why. The mechanisms have been key for so long. So there’s the oh well caffeine loosens the lower esophageal sphincter. So it is c chocolate and and protein makes the glomerular filtration rate go up, therefore it must be bad. So if you only talk about mechanism, you can get into these strange rabbit holes. I really value whole human research where you’re not just focusing on those little things.   Bianca Garcia 01:06:04-01:06:52 Yeah, I think this is a really great transition into what I wanted to ask because science changes. And the carnivore diet kind of rose in popularity around COVID-19. And this was a time when scientific mistrust started to grow in the public. And we saw that as COVID guidelines changed, people were like, wait, why is science so flip-floppy? And there’s kind of a parallel here with the carnivore diet too. We’ve all been told plant-based, plant forward. Now it’s like, okay, meat forward. What do we do about this? And I think, you know, you’re you’re telling us a little bit about how science changes, but what would you say to somebody who was trying to make the right choice, but maybe feeling a little bit overwhelmed with the scientific method.   Dr. Eric Westman 01:06:53-01:09:27 Yeah, well, uh we do the best we can, and the basic biology to me rules. And nutrition epidemiology, even that’s the red meat causes cancer thing, it’s weak, observational, and to me that’s not something I use in my clinic. I don’t value that. That red meat does not cause cancer to the level of certainty that I need to say don’t eat red meat. And I I know I’ve been on panels with folks and there are international organizations that are based on plant-based anti-red meat principles. I understand that. But the group at McMaster, whom I visited in the late 1980s is evidence-based medicine for the world, basically. Uh and they call out that this evidence about red meat and cancer is weak. And it’s not clinically relevant. So so I don’t worry about that. But getting back to the basic principle, don’t eat a lot of junk food. Uh ultra-processed food today unfortunately suffers from this definitional thing. And, and processed food, people come to me saying, You mean I can’t have bologna and it can’t have that I said, No, you can have bologna, but that’s processed. No, that that’s minimally processed. There’s more nitrates in beets and and broccoli than in these other you know, so I, yeah, it gets confusing, doesn’t it? So you want to eat protein, we’re made of protein. It doesn’t matter to me if it comes from an animal or a plant. We’re made of protein. Water is a given. You’re gonna have thirst. Then you can run your body on carbs or fat. It’s your choice. You can, you know, to sustain whatever kind of activity you’re trying to do. So that opens the idea that you might do a keto or carnivore diet because you’re running on fat. And that’s why we see people having such success with it. The body works just fine. If you don’t like that way of eating and the social things today, I mean but let’s get real. Were we really designed to eat at a Thai food place and then a Mexican place and then a and then a uh you know, all these great flavors, not you know, I don’t think that’s particularly a good thing, healthy thing to do. Uh it’s very new and and uh you want to be um honest about your ability to control things. If you’re out of control with sugar, you avoid sugar. If you’re out of control with bread, you avoid bread. You know, if you’re uh so I think protein comes first. Instead of plant forward, I wish we would say protein forward.   Joe 01:09:28-01:09:37 Final words? (Dr. ERIC WESTMAN) To summarize about a carnivore diet?   Dr. Eric Westman 01:09:35-01:10:14 I think it’s a reasonable tool, and it may even be a healthy way to eat in the long run. There’s a study that just came out, meaning in the last few years. where they looked at women who had been keto‑adapted for an average of three years and all of the biochemical parameters they were able to check looked great. They fed them a UK based diet with carbs and everything went to hell in a handbasket, I know, a great scientific term. And then they went back on a keto diet, and everything looked great. The average age was 32 years old. So what’s unknown is is this a long-term thing, but it might be.   Terry 01:10:15-01:10:21 Dr. Eric Westman, thank you so much for talking with us in The People’s Pharmacy today.   Dr. Eric Westman 01:10:21-01:10:22 My pleasure.   Terry 01:10:23-01:10:26 And thanks to you, Bianca Garcia, for helping us with the interview.   Bianca Garcia 01:10:27-01:10:28 Thank you.   Terry 01:10:28-01:10:43 You’ve been listening to Dr. Eric Westman, Associate Professor of Medicine at Duke University. He’s a board member of the Society of Metabolic Health Practitioners and the American Diabetes Society.   Joe 01:10:43-01:11:00 We had help today from Bianca Garcia, a medical anthropologist, foodie, and radio person. She served as a AAAS mass media fellow covering health and science at WUNC North Carolina Public Radio.   Terry 01:11:01-01:11:13 Lynn Siegel produced today’s show. Daenerys Thomas and Al Wodarski engineered. Dave Graedon edits our interviews. B. J. Leiderman composed our theme music.   Joe 01:11:13-01:11:21 This show is a co-production of North Carolina Public Radio WUNC with The People’s Pharmacy.   Terry 01:11:21-01:11:40 Today’s show is number 1444. You can find it online at peoplespharmacy.com. That’s where you can share your comments about today’s interview. You can also reach us through email, radio@peoplespharmacy.com.   Joe 01:11:40-01:11:51 Our interviews are available through your favorite podcast provider. This week we’re celebrating 10 million downloads.   Terry 01:11:51-01:11:52 That’s cool.   Joe 01:11:52-01:12:18 Yes. You’ll find the podcast on our website on Monday morning.   Terry 01:12:18-01:12:42 At peoplespharmacy.com, you could sign up for our free online newsletter. That way you get the latest news about important tell stories. When you subscribe, you also get regular access to information about our weekly podcast. We’d be grateful if you’d consider writing a review of The People’s Pharmacy and posting it to the podcast platform you prefer.   Joe 01:12:42-01:12:45 In Durham, North Carolina, I’m Joe Graedon.   Terry 01:12:45-01:13:28 And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to The People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.   Joe 01:13:28-01:13:38 If you like what we do and you’d like to help us continue to produce high quality, independent healthcare journalism please consider chipping in.   Terry 01:13:38-01:13:43 All you have to do is go to peoplespharmacy.com slash donate.   Joe 01:13:43-01:13:59 Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. 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Americans take a lot of medications. Luckily, the Food and Drug Administration only approves those that are safe and effective. However, the agency’s definition of “safe” includes medicines that can harm or kill some people, and the definition of “effective” covers some drugs that only work a little better than placebo. Has the FDA changed its standards? Maybe we should be rethinking medications. At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. How You Can Listen: You could listen through your local public radio station or get the live stream on Saturday, Sept. 6, 2025, at 7 am EDT on your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Sept. 8, 2025. Rethinking Medications: If you watch television or streaming video, you probably see a lot of commercials for prescription pharmaceuticals. Decades ago, prescription drugs weren’t advertised on television, and the prices for prescriptions were much lower. How has the pharmaceutical industry changed? On this episode, we talk with an expert observer of the industry and its regulation. Dr. Jerry Avorn is one of the country’s most respected pharmacoepidemiologists. He describes how the business of making and selling medicines has evolved. What Is the Role of Orphan Drugs? The Orphan Drug Act was passed in 1983. Its goal was to offer incentives to drug companies to develop medicines for rare diseases.  The FDA encouraged Congress in this, viewing these as “significant drugs of limited commercial value.” The idea was to make sure that even though only a few hundred Americans might have leprosy, for example, that drugs would still be developed to treat their condition. Tax breaks, patent extensions and market exclusivity made the proposition more appealing. In fact, one of the reasons Americans spend twice as much on drugs per capita as citizens of Canada, Australia or other countries is the cost of orphan drugs. Although these compounds were seen as having “limited commercial value,” the industry has figured out how to charge exceedingly high prices for anything considered an orphan drug. How Effective Is Your Medicine? When it comes to evaluating effectiveness, pharmaceutical firms have a powerful tool. Dr. Avorn considers it one of the best inventions of all time, although it is a concept rather than a thing. RCT stands for Randomized Controlled Trial, which in turn is shorthand for randomized placebo-controlled double-blind (or in the UK, double-dummy) clinical study. The idea is to take a group of people who are alike in some important ways, so that they are equally likely to develop some type of health problem. Divide them up using a random number generator or some other similar impersonal technique. Those on one side of the divide get the medicine, while those on the other side get an indistinguishable placebo. Neither the participants nor the investigators know who is in which group. At some pre-specified time, the researchers will check to make sure there have not been too many adverse reactions. They may also check that the intervention appears to be doing something. When the trial is over, the methods and results should be described in a publication so that doctors will know if they should incorporate the treatment into their practice. We love RCTs when the outcome is avoiding some serious problem such as a stroke or a cancer diagnosis. For us, biomarkers are less compelling, even though they have become far more common. What is a biomarker? It is easy to measure, like blood sugar or blood pressure. The biomarker is a stand-in or surrogate for a condition like diabetes or heart disease because they are often correlated. It is important to remember, though, that the biomarker is not the disease. Comparing Absolute and Relative Risk While Rethinking Medications: Once the company has completed its RCT, more than likely it will want to publicize the results to promote the drug. How it describes effectiveness can change the way people think about the medicine. One of our favorite examples comes from a print advertisement for Lipitor. It boasted that Lipitor (atorvastatin) lowered the risk of a heart attack (myocardial infarction) by 36 percent. That sounds great, doesn’t it? There was an asterisk next to that number, and in small print lower on the page was an explanation. During a five-year trial, out of 100 people on Lipitor, two had heart attacks. Out of 100 people on placebo for that trial, three had heart attacks. So you can see the absolute difference between Lipitor and placebo was just one heart attack per hundred (the absolute risk reduction). That probably would not have sold many pills. But stated as a relative risk reduction of 1 fewer heart attack compared to the baseline of 3 (1/3), using larger numbers because there were thousands of people in the study, you get 36 percent. What Do We Know About Safety? When patients see multiple health care providers who don’t talk with each other often, it may be difficult to detect serious safety problems. That was the case with the anti-inflammatory drug Vioxx. Early warning signs of cardiovascular problems resulting from this pain-reliever were overlooked for years. Researchers detected trouble as early as 2001, but the drug company resisted removing the drug until 2004. As a result, millions of people were needlessly exposed to danger and too many died. The silver lining to this cloud is stepped-up surveillance for side effects. Rethinking Medications with Respect to Side Effects: Some years ago, Dr. Avorn and his colleagues conducted a brilliant study (Drug Safety, 2009). They compared the side effect profiles from RCTs of different antidepressants. Mind you, they were not looking at the side effects of the drugs. They examined the side effects of the placebos in studies of tricyclic antidepressants and compared them to side effects of placebos in studies of SSRI antidepressants. All the participants had depression, so there should have been no differences due to the underlying condition. Yet the placebos had vastly different side effect profiles, mirroring the divergent side effects of the active agents. This striking difference might be due to changes in the way researchers elicited symptoms. Or it might be due to the nocebo effect, in which a person who expects to feel nauseated becomes queasy. Nocebo is like an inverse of the placebo effect. Either way, it suggests that when side effects of the placebo are similar to those of the investigational drug, we shouldn’t assume that the drug has no side effects. How Can You Protect Yourself? In rethinking medications, it is important to make sure that you really need all the drugs you are taking. Dr. Avorn strongly recommends a brown bag review periodically, in which the patient brings in everything he or she is taking, including OTC meds and dietary supplements. The health care provider reviews them, looking for duplication or incompatibilities. If they find problems, it’s time for a conversation about alternatives or deprescribing. Some medicines cannot be stopped suddenly, so the prescriber should provide detailed instructions about tapering and should monitor progress as the patient reduces the dose. This Week’s Guest: Jerry Avorn, MD, is a professor of medicine at Harvard Medical School and a senior internist in the Mass General Brigham health-care system. He built a leading research center at Harvard to study medication use, outcomes, costs, and policies and developed the educational outreach approach known as “academic detailing,” providing evidence-based information about medications to prescribers. One of the nation’s most highly cited researchers, Dr. Avorn is the author of Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs, and he has written or cowritten over six hundred papers in the medical literature as well as opinion pieces in TheNew York Times, The Washington Post, JAMA, and The New England Journal of Medicine. Dr. Avorn’s new book is Rethinking Medications: Truth, Power, and the Drugs You Take. His website is www.RethinkMeds.info Jerry Avorn, MD, author of Rethinking Medications Listen to the Podcast: The podcast of this program will be available Monday, Sept. 8, 2025, after broadcast on Sept. 6. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. In the podcast for this episode, we discuss sourcing medications from abroad. How does that affect drug shortages? How will tariffs affect costs? In addition, you’ll get more details on a brown bag review. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify. Transcript of Show 1443: Rethinking Medications: Uncovering the Truth About Common Drugs A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. This transcript is copyrighted material. All rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:01 I’m Joe Graedon. Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of the People’s Pharmacy. Joe 00:06-00:27 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Americans spend more on drugs and have less to show for than people in other countries. Today, rethinking medications. This is the People’s Pharmacy with Terry and Joe Graedon. Terry 00:34-00:41 The FDA used to be the envy of the world. Has it been captured by the pharmaceutical industry it’s supposed to regulate? Joe 00:41-00:52 You’ve heard of Ozempic and Wegovy. They both contain semaglutide as the active ingredient. How could they have dramatically different rates of side effects? Terry 00:52-00:59 Are you fed up with all the prescription drug commercials on TV? What about the high price of many prescriptions? Joe 00:59-01:15 Coming up on the People’s Pharmacy, uncovering the truth about common drugs. Terry 01:14-02:31 In the People’s Pharmacy Health Headlines, lowering sodium intake is good for cardiovascular health, but increasing potassium intake may be just as important, if not more so. A Danish study of twelve hundred patients with implanted cardioverter defibrillators, or ICDs, compared usual care to a strategy designed to get potassium levels into the upper end of the normal range. All of these study participants were at high risk of atrial fibrillation and all started with potassium levels at the low end of the normal range. The outcomes of the study were ventricular tachycardia, which is a dangerous heart rhythm, or having the ICD kick in appropriately. In addition, the investigators looked at hospitalization for arrhythmias. The patients assigned to the high-potassium group were prescribed potassium-sparing blood pressure medicines, such as ACE inhibitors. They were encouraged to follow a diet rich in potassium, including foods such as cabbage, beets, white beans, bananas, spinach, nuts, and fish. If those steps were unsuccessful at nudging potassium into the high normal range, the researchers prescribed potassium supplements. Joe 02:29-03:12 In this vulnerable population, targeting high normal potassium was helpful. They had significantly fewer episodes of ventricular tachycardia or hospitalization for arrhythmia, and their ICDs activated less frequently. A hundred and thirty-six of them experienced such an event, a rate of 7.3 per 100 person-years. In the usual care group, 175 volunteers had one of these dangerous episodes, a rate of 9.6 per 100 person-years. The patients in the high normal potassium group were also less likely to die during the three years of the study. Terry 03:11-04:10 The VITAL trial is a randomized controlled study of vitamin D and omega-3 fatty acid supplementation. The initial findings were that neither supplement reduced heart attacks or cancer in otherwise healthy middle-aged people. After four years, however, people taking 2,000 international units daily of vitamin D3 had longer telomeres than those taking placebo. Telomere length is a powerful measurement of aging. Telomeres are located at the tips of chromosomes and appear to protect them. As a result, shorter telomeres are associated with chronic diseases such as cancer and cardiovascular disease. Longer telomeres are a biomarker for slower aging. The authors conclude that vitamin D3 supplementation reduced telomere attrition and preserved telomere length, supporting an anti-cellular aging effect of vitamin D. Joe 04:11-05:17 Scientists have known for years that people with high blood pressure can benefit from drinking beet juice. British scientists have now done a more thorough study of this effect. They compared the reaction of 39 people under 30 to that of 36 volunteers in their 60s or older. Each group took nitrate-rich beet juice every day for two weeks or a placebo juice that had the nitrate removed. After a two-week washout period, they took the other treatment for two weeks. During this time, the researchers monitored participants’ blood pressure and their oral microbiome. In older volunteers, both oral microbiome and blood pressure improved with beet juice. A healthier mix of microbes in the mouth helps metabolize the nitrates in beet juice into nitric oxide that relaxes blood vessels. The investigators point out that beet juice is not a substitute for prescription blood pressure medication, but it can help. People who don’t like beets might consider other nitrate-rich vegetables such as spinach, celery, and kale. Terry 05:17-06:16 For decades, cardiologists prescribed beta-blocker heart drugs to almost everyone who had a heart attack. A new study published in the New England Journal of Medicine calls that practice into question. The randomized controlled reboot trial assigned over 8,000 patients to receive either a placebo or the beta-blocker bisoprolol. After nearly four years of follow-up, there was no difference in outcomes. The new consensus is that many heart attack patients with good heart function don’t need beta blockers. Those with poor ejection fractions may still benefit. And that’s the health news from the People’s Pharmacy this week. Welcome to the People’s Pharmacy. I’m Terry Graedon. Joe 06:17-06:29 And I’m Joe Graedon. Americans love pills. We take more medicines, spend far more on them, and see way more prescription drug ads than anyone else in the world. Terry 06:29-06:43 The Food and Drug Administration was once regarded as the best regulatory agency. Over the past decade, though, standards for drug approval have changed. Are Americans more vulnerable now than they were before? Joe 06:43-07:19 To help us tackle questions about drug safety and effectiveness, we turn to Dr. Jerry Avorn. He is a professor of medicine at Harvard Medical School and a senior internist in Mass General Brigham Healthcare System. He built a leading research center at Harvard to study medication use, outcomes, costs, and policies. Dr. Avorn is the author of “Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs.” His new book is “Rethinking Medications: Truth, Power, and the Drugs You Take.” Terry 07:19-07:23 Welcome back to the People’s Pharmacy, Dr. Jerry Avorn. Dr. Jerry Avorn 07:24-07:25 It’s good to be back. Joe 07:26-08:00 Dr. Avorn, during your really long and illustrious career at Harvard Medical School, you have focused so much of your research on the benefits and risks of pharmaceuticals. I would have to say you are probably the country’s most respected pharmacoepidemiologist, and we have been tracking your work for decades. We’re honored, honored to have you as a guest today on the People’s Pharmacy. So thank you so much for writing Rethinking Medications and joining us today. It’s a pleasure to be with you. Terry 08:01-08:11 Dr. Avorn, I’m wondering, how has the pharmaceutical industry changed since you started studying medications that Americans are taking? Dr. Jerry Avorn 08:11-08:35 Well, it has become even bigger business than it was, which is something we need to all be kind of cognizant of. But also the science has gotten more and more impressive, both within the industry and also within medical schools and academic medical centers where we’re just really discovering things and putting them into practice in ways that would have been unthinkable even 30 years ago. Joe 08:36-08:46 What about the FDA, Dr. Avorn? I mean, it seems as if the FDA has also changed over the last couple of decades. Dr. Jerry Avorn 08:46-10:10 Yeah, and that’s I think a less happy story, in the sense that uh a lot of the mischief began with the best of intentions back in the nineties at the height of the AIDS epidemic and there was concern that FDA was being so careful about reviewing drugs that maybe it was taking longer than it should. And the idea came up of let’s have a system of accelerated approval in which even if a drug hasn’t really been shown in a clinical study to benefit patients, if it looks promising, let’s approve it and then have the company do follow up studies so we know what we’re dealing with. That was a sensible idea back in the early nineties, because we did have no good treatments for AIDS at that point, and we did want to get anything that looked promising out there. But unfortunately, that accelerated approval program has become a loophole that has been widened and widened well beyond what anybody ever intended. And we now have drugs, you know, like for ALS or muscular dystrophy or other conditions, which are approved on the scantiest of evidence. And then the companies don’t quite get around to always doing the follow-up studies that they promised to do. And we have a lot of medications that actually should not have been approved hanging around on the market and costing money and presenting risks and not doing any good for patients. Joe 10:10-11:31 Well Dr. Avorn, you brought up a really, uh hot topic for us. Because it used to be that the FDA was very clear and it said, we will not approve any medication unless it’s proven safe and effective. And I think the FDA’s definition of safe and effective is obviously quite different from what the average citizen would define as safe and effective. And all you have to do is turn on the television and watch one of the uh commercials for for pharmaceuticals where they say this drug can cause heart attacks and strokes and severe infections and cancer, and even death, and uh uh it’s like, well, how could that medicine be considered safe if those are potential side effects. And then when it comes to the effectiveness side, we have drugs that are barely better than placebo, as you’ve sort of alluded to. And in particular, I’m thinking of the FDA’s approval of the most recent Alzheimer’s drugs that uh don’t actually do very much. So tell me about safe and effective and what that means to you versus what it means to the FDA versus what it means to the average citizen. Dr. Jerry Avorn 11:31-13:51 Boy, is that a good question? Yes. Let me say something encouraging for starters, and that is all of those adverse effects that we see rattled off on the TV commercials that you can’t possibly avoid if you want to watch the evening news, um, are there because they are required to be there by the FDA. But you know, if you were to look at the adverse effects of, you know, aspirin or Tylenol, uh it would be a pretty scary list as well. What we have relied on the FDA for is to say, in effect, over the years: Every drug can cause side effects, some of which are very scary, but we want some assurance that it’s been looked at carefully. And that the good that the drug does is overwhelmingly better and more common and more useful than the rare side effects that it can cause. Because there is no drug, as you both know so well. that doesn’t have side effects. We just want that balancing to be done by the FDA and then by the prescribing doctor or other healthcare professional. That’s the ideal. Where things have really gone off the rails is with FDA paying less attention to the real does it help patients question And then frankly, as you mentioned for the Alzheimer’s drug, the worst of which was this drug called Aduhelm that did not benefit patients at all. Was approved kind of over the objection of the outside advisors and the FDA’s own staff, and turns out to actually have some substantial side effects And it was initially priced, uh, as you know, at $56,000 a year for getting an infusion intravenously every other week. to achieve no important clinical benefit. You know, that was really kind of the low point of of FDA’s recent history and it got pulled off the market a couple of years ago because it was such a stupid drug. But so I think where FDA has gone astray is that it has really lost its uh value system or a sense of balance. and has really lowered the standards of, okay, if you can make a lab test look a little better, then we’ll let you have approval. And even if you’ve not been able to show benefit to patients. And that that’s really not what the FDA was designed to do in the modern era Terry 13:49-13:59 Oh well Dr. Avorn, how did the FDA get to the point where it was willing to lower its standards so much? You do write about that in “Rethinking Medications.” Dr. Jerry Avorn 13:59-15:02 Well, you know, as as you both know so well, this is a half a trillion dollar a year industry in the US alone, probably more than that by now. And that brings with it an enormous amount of political pressure. And it used to be that the FDA would kind of rise above political pressure and just do what the science said. But over a number of years, the pharmaceutical industry became the most powerful and richest lobbying entity in Washington, and they’ve got more lobbyists than there are people in Congress. And there’s a lot of pressure both on Congress people from both sides of the aisle and on the administration under Democrat and Republican presidents. To, you know, have the FDA kind of go easy on industry and just approve stuff that hasn’t really been shown to pass muster. And the more dollars go into medications and the bigger business it is, the more firepower there is behind that political pressure. And the political pressure has been sort of winning out over the science more and more in recent years. Joe 15:02-15:39 Dr. Avorn, when you started your career and when we got started, there were no prescription drug ads on TV. You know, there were you know Anacin ads and Alka-Seltzer ads, but there there weren’t ads for Jardiance. And for um oh you go down the list, there’s so many that it’s almost takes your breath away these days and they come on every other every other commercial. Can we get your perspective on the direct-to-consumer prescription drug advertising that’s everywhere? Dr. Jerry Avorn 15:40-18:03 Yes. As your listeners will know, and as you both know very well, we are the only country on earth that allows drug companies to advertise prescription drugs direct to consumers. And every other country, with the one exception of New Zealand, which is kind of an asterisk, but every other kind of wealthy industrialized country that we often compare ourselves to has said, no, these are too complicated issues. They are not something you can boil down into a 60-second commercial with people dancing around and singing songs and having the adverse effects flash by quickly on the screen. Everybody knew that this is not something you can condense into a quickie commercial and then get the patient to go to their doctor and say, gimme this. And actually the industry was pretty the drug industry was pretty okay with that for many, many years because ads to consumers, especially the kind that are on prime time, are very, very expensive to buy airtime. and they’re expensive to produce. And as long as uh the industry felt it was okay not competing with shampoos or cars or toothpaste or any of the other things you see ads for, they were willing to go along with that ban. And then in the 90s, with the rise of managed care and health maintenance organizations that said, no, this drug is not on our formulary. It’s way overpriced. It’s not particularly good. We’re not going to cover it. The industry said, hey, wait a minute, we gotta try to get around that prohibition. And they said to themselves, we can make every patient into a potential sales rep. And by, you know, having releasing our our our self-imposed w unwillingness to have drug ads. Let’s have the FDA say it’s okay because we need to get to the patients to make them into agents of sales to go to the doctor and say, I want Ozempic because I saw a commercial for it. And so in 1997, for the first time ever, the FDA said, okay, it’s all right for there to be direct-to-consumer drug ads, again, alone in the entire world. I don’t think we can say that this has somehow benefited the public health or made prescribing of medications better or safer or more effective, but it is something which billions of dollars get spent on. by the companies. And of course those billions of dollars just get added on to the drug price. Terry 18:04-18:21 You’re listening to Dr. Jerry Avorn. He’s a professor of medicine at Harvard Medical School and a senior internist in the Mass General Brigham Healthcare System. Doctor Avorn is the author of Rethinking Medications Truth, Power, and the Drugs You Take. Joe 18:21-18:28 After the break, has the FDA been captured by the industry it’s supposed to regulate? Joe 21:03-21:07 Welcome back to the People’s Pharmacy. I’m Joe Graedon. Terry 21:06-21:08 And I’m Terry Graedon. Joe 21:08-21:20 Today we are putting the FDA and the pharmaceutical industry under a microscope. Should we be rethinking how our medications are regulated, priced, and advertised? Terry 21:20-21:52 Our guest is Dr. Jerry Avorn. A professor of medicine at Harvard Medical School and a senior internist in the Mass General Brigham Healthcare System, he built a leading research center at Harvard to study medication use, outcomes, costs, and policies. Dr. Avorn is the author of Powerful Medicines, The Benefits, Risks, and Costs of Prescription Drugs. His most recent book is Rethinking Medications: Truth, Power, and the Drugs You Take. Joe 21:52-23:00 Dr. Avorn, the cost of prescription drugs has skyrocketed, and in particular for something called orphan drugs. Now, I have to be honest with you, I visited Dr. Marion Finkel at the FDA shortly after the Orphan Drug Act was passed, because she had led the Committee on Drugs of what were called limited commercial value. I wonder what happened to those ideas about kind of facilitating the development of medications for rare conditions, because the FDA thought, you know, no drug company is going to make money from medications for these so-called orphan drugs. That is not the way it turned out, and I Fear that Marion is turning over in her grave. Your thoughts on drug prices for orphan drugs and drugs in general. Dr. Jerry Avorn 22:59-25:52 Well, as you both know, Americans spend twice per capita what citizens of other wealthy countries spend on medications. Whether it’s uh Canada or England or um Japan, Australia, all of Europe, um, they pay literally half of what we do for the same drugs made by the same companies in the same factories. And orphan drugs are one important example, but it really is across the board. Even Ozempic, which we’ve talked about in the last segment, is a drug which in the uh in most of Europe costs half of what it costs Americans. Why is that? It’s because America is the only country on earth that says to the drug companies, set your price at any amount you want, and that’ll be the price. Not only is that weird, it’s also not the way we pay for anything else in our economy. It’s certainly not the way the federal government pays for anything. They don’t um you know, go to a um airplane manufacturer and say, charge whatever you want uh for this new fighter plane and we’ll pay whatever you ask. It’s up to you. That’s a crazy way to do business. For people who are fans of a functioning marketplace, you know, it’s not a marketplace. It’s just this weird arrangement that is only there because we have legislated it into being. And in fact, when the Medicare program started paying for drugs in the early 2000s, the guy that shepherded the program through Congress. Passed a law that said that no company can be negotiated with over the price of its drugs in the Medicare program. And then he promptly left Congress and took a job at a million bucks a year to head the pharmaceutical lobbying group. So he was well rewarded for that legislation. And we then are left with this crazy system where, you know, there was there was a one drug company CEO when he raised the price of a drug by thousands of percent when he bought the rights to it, and they said. How can you possibly do that? And his answer was, because I can. And sadly, although that was more crude and he ended up doing some jail time for some fraudulent activity in other ways. He was he was ruggedly honest. Yeah, because they can. So when you have companies that understandably want to please their shareholders and they’re allowed to charge anything they want, why wouldn’t they? And and we’ve in our group at Harvard have talked to folks from other countries where they have a much more thoughtful process for looking at what a medication is worth. Drug companies ought to earn handsome profits on the work that they do. And if they discover a new drug, they ought to be richly rewarded for it. But if they’re just taking a same old, same old little modification and they say it’s a new molecule and we want our own patent and then charge whatever they damn please, that that really shouldn’t be allowed, as it isn’t most everywhere on earth. Joe 25:53-26:54 Dr. Avorn, I had mentioned orphan drugs and you know there are now designated orphan drugs for cancer, for example. That cost literally hundreds of thousands of dollars a year per patient. And there are some other rare diseases, muscular dystrophy, et cetera, where the cost can be, you know. uh close to a million dollars a year. Uh and these were supposed to be drugs of limited commercial value. Um It’s not unusual for some of these so-called orphan drugs to bring in billions of dollars a year for the manufacturer. I, I’m I’m just wondering what will happen if there is truly an effective drug for Alzheimer disease. The company could easily charge couple hundred thousand dollars a year and say, hey, it’s a bargain keeping people out of nursing homes, and yet that would break the bank on Medicare and break the bank of insurance companies almost overnight. Dr. Jerry Avorn 26:54-28:52 Absolutely. And of course, Alzheimer’s would not be an orphan condition because it is so appallingly common, but other conditions, and you you mentioned cancer drugs. If a company says this drug is going to attack a particular kind of mutation or a particular kind of receptor or a particular kind of pathway in a particular kind of cancer, they can manage to narrow it down to the point where that condition affects less than 200,000 Americans a year. And that is the legal definition of an orphan drug. But, you know, we think of cancer as a relatively common condition. But if they’re able to structure the application to the FDA for a particular kind of a particular kind of lung cancer. They can say, oh, this is now an orphan drug, so we get to have all the goodies that come with it, which is much uh more generous research and development money and much more freedom to get it approved uh with perhaps lower standards. And so that that’s a particular um anomaly for drugs that are for conditions that are uncommon. You mentioned muscular dystrophy. That has got to be one of the more egregious examples of companies. There’s one company here in the Boston area called Sarepta that got through on not the orphan drug pathway primarily, but on the accelerated approval pathway. And they said, look, we’re changing the level of a certain protein in muscle. And that’s you know by just a tiny bit, but I bet that’ll help patients It didn’t help patients, but the FDA said, well, you did change that level a little bit. Maybe that might work, even if you didn’t show any benefit. And that company then went on to not just market that drug, but several other drugs of exactly that approach with tiny modifications, none of which have been shown to be very helpful. And the FDA’s excuse was they wanted to bring cash into the company because that will help them to do more research to find a cure. Terry 28:52-28:53 So wait a second. Dr. Jerry Avorn 28:53-29:14 That’s not FDA’s job to bring cash into companies. And B you, it actually had the opposite effect. It said to the companies. Hey, you can get by with a drug that has a trivial change in a lab value and you’ll get yourself a drug. So that’s why we now have multiple ones of these drugs, each of which cost hundreds of thousands of dollars per person per year, and none of which work hardly at all. Terry 29:15-29:55 All right, so Dr. Avorn, this really brings up the issue of the FDA is supposed to be reviewing drugs and the research that has been done on these drugs to make sure that they’re safe and effective. And we we haven’t really talked about how do you tell if a drug is safe enough. We have talked about the fact that every drug that we know of has some side effects for some people some of the time. But has the FDA actually changed its objectives? Has it, in fact, been captured by the industry it’s supposed to be regulating? Dr. Jerry Avorn 29:53-32:54 I think that’s a great question, and the quick answer is yes, they have. To look separately at effectiveness and safety. The effectiveness, as we’ve discussed, if you are going to be willing as FDA to now accept a tiny change in a lab test as your replacement for this helps patients, then you know the horse is really out of the barn. And we’ve seen that with the accelerated approval of these muscular dystrophy drugs, the Alzheimer’s drugs and so forth. So they’ve lowered the bar so low that you almost, you know, it’s kind of rubbing on the ground. So that’s on that’s on the effectiveness side. And that’s not what the nation had in mind in the 1960s when they said for the first time anywhere, The government can require a company to show that a drug works before you can sell it. That was a revolutionary advance in 1962, and we’ve really bit by bit backed away from that. Safety-wise, I think there’s a somewhat happier story, but it followed a kind of tragedy, and that is the drug that you both know well. which is Vioxx, which was made by Merck as a treatment for arthritis and pain. And it appeared that it was likely to cause heart disease. And we actually did a fair amount of research uh on that question in in our group at Harvard. And it turns out that we found, as did other groups, around the country that yeah, it if you take this drug, it’s going to increase your risk of heart disease. And is that worth it, you know, to get a little bit better pain relief or a little bit gentler on your stomach? And the company said no, no, no. They said we should not publish our research because we would become laughing stocks. And they denied it up until the moment, after five years on the market. That a randomized trial that they themselves at Merck had funded showed that the drug doubled or tripled the risk of heart attack and stroke. And then once that data was available from a randomized trial, they kind of had to take the drug off the market and they ended up spending the next several years paying out five billion dollars or so to patients who had had heart attacks and strokes after taking Vioxx. So the good news, if you can to come back to your question and How is this leading to good news? Is that there were congressional hearings right after that drug was withdrawn? Because after all, 20 million Americans had had taken the drug. Medicaid spent a billion dollars on just that one drug. And Congress said, essentially, to Merck and to the FDA, how the hell did you let this happen? And that unleashed a program that many of us had been advocating for years. which is FDAs performing more proactive surveillance of side effects for drugs that are in widespread use so that they get claims data. anonymized from people all over the country so they know who took which drug and who had what side effect. And so the the happy outcome of that tragedy is that uh we are now much better able to spot a side effect of a drug while it’s on the market before it’s affected millions of people. Joe 32:55-34:48 We’ll talk a little bit about the MedWatch program in a moment and how firings at the FDA may have affected that, but I want to go back to the issue of effectiveness first. Because I don’t think the average patient, and maybe even the average physician or prescriber Understands the difference between relative risk reduction and absolute risk reduction. And our favorite example is atorvastatin. And the commercial for the brand name Lipitor. There were ads in magazines that showed Lipitor lowered the risk of MI, myocardial infarction, heart attacks, by 36%. And I think a lot of people thought, oh, that sounds terrific. You know, 100 people take Lipitor. 36 of them out of 100 will avoid a heart attack. Wow, that’s impressive. But there was a little asterisk next to that, and it said three percent of the people on placebo experienced a heart attack after five years. Whereas two percent of the people on Lipitor experienced a heart attack after five years, so the absolute risk reduction was actually one percent, not thirty-six percent. And I I think this idea of absolute versus relative risk gets hidden because drug companies love to talk about relative risk reduction. How does the average physician understand the difference between absolute and relative risk reduction when it comes to, for example, statins? Dr. Jerry Avorn 34:49-37:23 To answer your question, we often don’t understand it as well as we should. Uh my view of how we train doctors is that while we do fill the heads of our very smart students with a lot of important facts, and we gotta do that, What we do a less good job at is helping them think about data in the way that you just described. And the fact that we are always, whenever we prescribe a medication, not only balancing risks and benefits, but also needing to think about the magnitude of those risks and those benefits. And that’s something which, you know, I’ve often felt that The facts that we cram into students’ heads, um, half of them may turn out to be wrong in ten years, but giving them the ability to think in the way that you were just describing about, you know, it still may well be that a statin is if it’s if it’s as safe as they are, is still, you know, for a high risk patient a good thing. But you want to come to that conclusion or not, based on thinking carefully about that issue of absolute risk reduction and relative risk reduction, and also about the the magnitude of the risks that are involved with taking any drug. And that’s where FDA could do a much better job. And that’s where we doctors, frankly, and we medical educators need to also do a better job. FDA’s standard has been If you have a drug that works better than placebo, unless it’s unethical to do a placebo-controlled study, like for AIDS or cancers. But if you have a drug that works better, which was the standard for that awful Alzheimer’s drug, Aduhelm, it it changed the level of amyloid in the brain a little bit tiny bit more than a placebo did. That’s not a comparison that I as a prescriber want to hear about. I want to hear how well does it work compared to other alternatives that we might want to offer? And then of course the the big granddaddy question is is whatever change it causes worth the exorbitant amount that we might be asked to pay for it. And that’s a level of analysis that is tricky to do. And you can’t just tell patients, Or doctors for that matter, go do your own research, you know, look up the papers and decide for yourself. We need to say this is a public good kind of question. And just as we don’t ask everybody to build their own section of roadway or make sure that you know, the water in their tap is you know clean and forget about where it’s coming from. These are things societies need to provide to their citizens. And it’s something we need to do a much better job of as a society. Terry 37:24-37:53 And we certainly have not done that very well for uh prescription medications. Consumer Reports uh offers you evaluations if you’re going to buy a car or a computer. You can take a look at the various categories in which you might rank such a consumer product, there is nothing like that for prescription drugs and they’re more important to our lives than uh a car or a computer, one could argue. Dr. Jerry Avorn 37:54-38:40 Mm-hmm. Absolutely. And I’ve tried to provide people with lists of reliable websites that you can go to without feeling like you’re being barraged by advertising or or just scammery. And you know those sites do exist and I tried to make that list available to people because While I’m not encouraging people to always just figure out for themselves what they need to take for their diabetes, it does help for to kind of even the playing field so that when a patient does go to the doctor, they at least can come equipped with questions like You know, is this drug just better than a placebo or is it really effective? What about the newer drugs? Is this affordable? Are there generics? And the kinds of things that everybody needs to be able to think about when they’re talking with their doctor about a prescription. Terry 38:39-39:07 You’re listening to Dr. Jerry Avorn. He’s a professor of medicine at Harvard Medical School and a senior internist in the Mass General Brigham Healthcare System. He developed the educational outreach approach known as academic detailing, providing evidence-based information about medications to prescribers. Dr. Avorn’s new book is “Rethinking Medications: Truth, Power, and the Drugs You Take.” Joe 39:07-39:11 After the break, we’ll talk about side effects. Terry 39:11-39:16 All medicines have some side effects. How do we learn which ones to watch out for? Joe 39:16-39:27 Dr. Avorn did a groundbreaking study comparing the side effects of placebos in antidepressant studies. What lessons can we take away? Terry 39:27-39:33 We’ll also get tips on the questions we should ask before we start taking a medication. Joe 39:34-39:39 And what should you know about stopping your prescription? Joe 40:59-41:01 Welcome back to the People’s Pharmacy. I’m Joe Graedon. Terry 41:02-41:04 And I’m Terry Graedon. Joe 41:04-41:18 One of the fastest-selling drugs in the pharmacy is semaglutide. You’ve probably seen commercials for its brand names, Wegovy or Ozempic. Why are the side effect rates for the same medicine so different? Terry 41:18-41:35 Our guest today is Dr. Jerry Avorn. He’s a professor of medicine at Harvard Medical School and a senior internist in the Mass General Brigham Healthcare System. His most recent book is Rethinking Medications: Truth, Power, and the Drugs You Take. Joe 41:36-42:10 Dr. Avorn, we’d like to segue a little bit into the side effect profile of medications. and how drug companies do their data collection. And we were so impressed with a study that you did many, many years ago. comparing placebo rates of an old-fashioned antidepressant category called tricyclics, drugs like amitriptyline. versus the side effects in the placebo group of the so-called SSRI. Terry 42:10-42:24 So comparing placebo to placebo So first explain please to the listeners why you compared placebo to placebo. Dr. Jerry Avorn 42:22-44:55 Well, one of the best inventions of all time is not a thing, but is a concept, the randomized control trial. Because it in the old days, um, people you know used to say, like if you were a doctor, in my experience this drug works well, or in my experience this one causes side effects. And it turns out As most of your listeners will know, you can’t figure that out from the perspective of any one doctor or any one patient. You’ve got to look at this systematically. And the beauty of a randomized control trial, which simply means that patients are given a new drug or a dummy pill, a placebo, And they look exactly alike, and they are randomly allocated to who gets the new drug and who gets the placebo. And neither the patient nor the doctor knows who got what. That is a very, very effective way of getting a handle on moving beyond this, in my experience, this drug works, you know, because if it doesn’t come across in a randomized controlled trial, then you got to wonder what in the world is is going on. But then we introduce the other really interesting issue of what some people call the nocebo effect And most listeners will know about the placebo effect, which is you give somebody a dummy pill and they say, thanks, Doc, that made me feel much better. There is the opposite um effect called the nocebo, which is from the Latin word for noxious, which is you give somebody a dummy pill and I mean I I don’t encourage ever doing this in practice, but in research, and they say, boy, that that pill really made me have side effects. And you know it’s not the pill because the pill just had, you know, some lactose powder in it. And so this has been a real boon to thinking about research studies because it gives you a handle on what is from the pill and what is just the patients. expectation that either they’re going to feel better or that they’re going to sometimes feel worse. And so what what we’re talking about in comparing Well the placebo rate of side effects is there shouldn’t be any difference if you have ideally people getting a dummy pill. in one study or another, if the patients are similar enough, you shouldn’t have it vary based on what the studied drug is that you’re testing. But we do see this, and it uh reminds us that an awful lot of the effects that people report from meds, both for good or for ill, may be not from the med, but may actually just be from the patient’s expectations or or perceptions. Joe 44:56-46:14 And one of the things that we think we’ve discovered is that drug companies have become ex- Extraordinarily skilled at influencing the reports of side effects. So let’s just compare two identical drugs Semaglutide is the ingredient in ozempic, which is a drug that was approved for diabetes, followed by Wegovy, the same exact drug that was approved for weight loss. In the clinical trials that the drug companies performed, 20% of the people who got Ozempic reported nausea. Forty to forty-four percent of the people who got Wegovy reported nausea, so almost twice as many on the same exact drug, but more interestingly, the people who were given placebo, that is to say, a dummy injection, 6. 1% reported that they experienced nausea on the dummy shot, whereas 16 to 18 percent of those getting the placebo shot complained of nausea. How did the drug company create those kinds of numbers? Twice as many. Dr. Jerry Avorn 46:12-47:45 Well, I think that they were probably as surprised as you were when they looked at those numbers because in principle, giving somebody a dummy shot should not create nausea or diarrhea or any other side effect. And so the reason it’s so important that we as prescribers and and the FDA have access to well-done randomized placebo-controlled studies is that we can look for things like that, and then we can say, well, gee, maybe there was there is a dose difference in the active drugs in those two examples. But the placebo doesn’t have a dose because it’s basically salt water. Why is this going on? And that makes me think as someone who evaluates drug evidence. Maybe there was a difference in the underlying patient populations, maybe because one was mostly for obesity and one was mostly for diabetes, or maybe there was some difference in the way they elicited the um symptoms. That is, you know, if they said, did you have any queasiness in the last week, as opposed to were you severely nauseated and vomiting? You know, you’re going to get very different answers depending upon how you ask the question. Now, ideally, the randomization should take care of that. And when you see a difference, you know that the difference is from the ingredient and not from any kind of expectation by the patient or the doctor. But it’s it’s a little hard to explain why it would be. And it must come down to either the underlying patient population and or the way they asked about the nausea, the vomiting, the diarrhea that created that. Joe 47:45-48:30 I am a bit cynical and I do think it has something to do with the way they asked the question because when they asked about diarrhea, the people on placebo had ten times the diarrhea rate if they were in a uh trial for Wegovy compared to a trial with Ozempic. But I I know we’re now in the weeds. And I guess what I’d like to do is segue quickly to the questions that patients should ask their doctor. whether it has to do with benefits or whether it has to risks, so that a patient will really have some substantive data to be able to evaluate whether they should be taking this medicine or not. Dr. Jerry Avorn 48:31-50:38 Absolutely. And as both of you have advocated for many, many years, patients need to be informed consumers and informed um patients when they go to the doctor. And that’s getting harder and harder every year because doctors are more and more rushed than ever. You know, it’s not their fault, but they’re asked to see more and more and more people. And it makes it hard for them to find time to actually sit down with a patient and talk about meds. But, you know, a as you both know, this is some of the most important conversations that we doctors can possibly have with our patients. And what I used to say was if your doctor doesn’t have time to that to do that, find another doctor. That was before it became impossible to find another doctor because we’ve so depopulated the field of primary care in our healthcare system. But still, I think the patient needs to advocate for him or herself, and come in with a list of questions. Because I know when I go to my doctor, I forget half the things I wanted to ask him before the visit, unless I write it down. And then I forget half the things he tells me and that’s, you know, and I’m a professor. So um people should go in knowing that you’ve got to advocate for yourself. Uh and in the book I try to give some questions that people should go in and ask their doctor, like, what is this medication for? Do I take it forever or until my symptoms are better? You know, in some drugs we say Take as little of this as you can and stop as soon as you can, like an opioid. Other drugs like drugs for high blood pressure or diabetes, we say you’ll take this probably for the rest of your life. And patients aren’t born knowing the difference between those categories. So how long will I need to take it? Is there a more affordable alternative that will work just as well? What side effects should I be on the lookout for? And what is the goal here? Is it to get my blood pressure down to a certain number? Is it to make me feel better? Is it to get rid of a target symptom? And you know, unless you know what the doctor is is going for, uh you’ll not be able to tell if you’ve gotten there or not. So it’s hard to extract that amount of time from a doctor, but I think patients really do need to use those, that list of questions of that they can ask their doctor. Terry 50:38-51:11 I think that idea of goal is really important and it’s not one that’s always incorporated into the conversations that we have with our doctors. Um and especially important, how will I know when I have reached the goal? Uh because If if you aren’t clear on the metric, you’re not going to know that, oh, okay, that’s that’s all I needed to do. And now I can look at something else that might be uh getting my attention. Joe 51:12-51:24 Well you know, Dr. Avorn, there’s another question that is rarely asked, and uh we think it’s really important, and that is how Should I stop this medication? Terry 51:24-51:25 And when? Joe 51:25-51:58 Because you know, there are a lot of Americans, literally tens of millions of them, taking antidepressant medications. uh, like Prozac, Paxil, and sertraline and we go down the long list. And you just can’t stop cold turkey Because this quote-unquote sudden discontinuation syndrome can be quite devastating. So finding out how to discontinue a medicine may be almost as important as how to start it Dr. Jerry Avorn 51:56-53:49 Exactly correct. And there has been an interest in the last number of years in this relatively new term of deprescribing. And seeing all these people that and I’ve I when I was in active practice people would come in with these long lists and I would ask them to please bring me a list or even better, a bag of all the drugs you’re taking. And, you know, things I would say, gee, you know. I thought I stopped that two years ago. Or who gave you that? Or, you know, all sorts of things that your doctor may not No, despite their being diligent because maybe it’s somebody else prescribed it or they thought it had long since gone away. So this issue of deprescribing is useful. However, there was a period where it was almost I would consider kind of a fad that, you know, let’s get everybody off of everything as much as we can. And it turns out there have again been, you know, the the answer for me to everything is rigorous clinical research. Studies where people were randomly assigned to stop a drug, and particularly antidepressants, was one of the drugs studied. Or keep going, but it was done as a placebo-controlled trial where neither the doctor nor the patient knew who was still getting a placebo and who had been switched over uh who’s still getting an antidepressant and who is switched over to placebo. And the answers are not always what one would expect from one’s armchair. That is, there are some people that um really when you stop their antidepressant, even if you do it carefully, really get worse and really get depressed. And then there’s others who don’t have any problems at all, might even feel a little bit better, but you can’t know that without really having good research data. And that’s not a topic that, you know, the drug industry is keen on funding clinical trials of stopping medications. But we do need more than more information on that because it comes up, you know, like millions of times a day in medical practice. Terry 53:50-54:20 Dr. Avorn, I’d like to turn a little bit to the topic of uh current events, as it were. I’d I’d like to ask you for your thoughts on what is going on with the FDA currently. Is the agency going to have the personnel it needs to carry out the functions we expect of it? What reforms if the FDA were to be reformed, what reforms would you see as beneficial? Dr. Jerry Avorn 54:20-57:46 Okay, I’m glad you asked that because I am scared out of my mind at these dramatic cuts that are being made wholesale. Not just at FDA, but at CDC, the Centers for Disease Control, and at the National Institutes of Health, that seem to be getting made without a whole lot of attention to are these cuts a good idea? We know that FDA has been understaffed for many, many years. And a solution that was proposed decades ago was that the drug industry said, gee, Congress doesn’t want to give you enough money to hire the people you need to review our drugs, FDA. Why don’t we just pay you to review our drugs? And the so-called User Fee Act, which was put in place in 1992 and has been renewed every five years ever since, has gotten us to to a situation in which the drug industry is now paying for about half of the salaries that FDA spends on the scientists who review the drug company’s products. Which does not seem like an ideal plan, but FDA was not able to get the money it needed from Congress going back many decades, many administrations, many different parties in power. They just never got the staff they need and they were all too willing to let the FD the uh drug companies pay for fifty percent of their salaries. So we were already starting from a bad place. And then these draconian cuts that do not seem to be getting made in a thoughtful way. And we know that because they were done so abruptly, have put the whole drug evaluation activity at risk. They’ve also put at risk apparently the people who are trying to figure out how to negotiate lower drug prices, which was a reform put in by the prior administration. Many of them have let have been let go, so the government is kind of down on its staff who are supposed to be negotiating with the drug companies But what scares me the most is these draconian cuts in the National Institutes of Health funding who are funding the research that, as we all know, leads to the drugs of tomorrow. The drug companies do research themselves, to be sure, but our our group at Harvard has shown that an awful lot of the best drugs we’ve got came from NIH funded research in universities or or academic medical centers. And then when the product is kind of ready for prime time it comes to be owned by a drug company that then charges whatever it wants for the drug. But what nobody is really talking enough about is if we stop that pipeline of discovery of basic biological insights as we are doing now at NIH. And my own institution, Harvard, is being hit with all kinds of billions of dollars of cuts by the administration. It’s not like we are all driving around in limousines and, you know, taking six-month vacations in the Caribbean. You know, most of us earn way less than we would earn in the private sector, and are doing this work because we really believe in it and then to find out that active grants are being just absolutely canceled with stop work orders going out. Is really going to come to a head, not in the next month or two, but in the next couple of years, where all the basic research that led to the development of new drugs will have been shut down or at least crippled. And then so sometime around 2027, people might say, hey, where’s all these new pharmaceutical wonders that we were expecting? You know, they’re not going to be there and that’s going to be a tragedy. Joe 57:47-58:22 Dr. Avorn, a lot of our medications now come from abroad. It’s been reported that over 90% of our generic medications come from places like China and India. And I do worry about the FDA’s ability to monitor the manufacturing process. D do you have any thoughts about A: the drug manufacturing abroad, and uh and B: the drug shortages that have resulted over the last couple of years. Dr. Jerry Avorn 58:22-01:00:40 And if I may add a C, which is what is going to happen to drug prices when tariffs kick in, given that so many of our drugs, as you just said, come from India and China. And if there are huge tariffs slapped on any imports from those countries, that is going to make not only make drugs harder to afford. But it also, I think, is gonna make our shortage problem worse, because a lot of generic manufacturers, and we’ll we’ll get back to the inspection thing in a second, a lot of generic manufacturers based in India and China operate on very, very thin margins, because generics are very, very cheap. That’s one of the great things about generics for the consumer. But if they find that their thin margins are now being essentially erased by these crippling tariffs, They’re just gonna say, hey, I’m gonna lose money with every pill I make. I’m just gonna stop making these pills. And that is gonna, and we’ve seen that before with cancer drugs and and other medicines. That is going to get exponentially worse because of the tariffs if they are handled in as careless a way as many of us worry that they might. But to come back to your earlier question, which is so important about inspection. Yeah, this is another thing that I referred to before as a public good. You know, it’s it’s the right of every citizen to know that their tax dollars are going to be used by government agencies working on behalf of everyone to make sure that somebody’s inspecting the meat, and that the water in your tap is is pure, and that the drugs that you are getting that come from another country–that those factories are being inspected adequately and are passing muster. And FDA has had a very hard time keeping up with that. And they’ve not had enough budget to do it. And as a result, uh particularly if the cuts at FDA extend to this part of their mission, we’re not going to be able to be as sure as we want to be that our blood pressure pill, diabetes pill, cholesterol pill, whatever, that may have been made in India or China, leave aside the unaffordability and leave aside the shortage, is that factory being inspected as well as it should be, especially if FDA has gotten staff cuts that it’s getting, and they don’t have the people to do that work. So it’s it’s pretty scary. Terry 01:00:41-01:01:34 Dr. Avorn, I’d like to ask about primary care. You mentioned during our interview that uh at at one point at least you were doing brown bag reviews with your patients in which They would put everything they’re taking into a brown bag and bring it in so that you could review everything they’re taking, including over-the-counter stuff and dietary supplements. And I think more and more patients are anticipating that they will be seeing specialists. So they’ll see the cardiologist, they’ll see See the podiatrist, they see the ophthalmologist, they don’t see one person who is looking at the whole patient. Can you give us some idea of the difference between the practice and the effect on the patient of primary care versus these very siloed specialist cares? Dr. Jerry Avorn 01:01:35-01:04:14 That that’s a really important point. I did my residency in in Boston when in in the 70s when we thought this is now the era of primary care. And you know, we’re going to train people particularly to be general internists who will deal with most everything that walks in the door and once in a while you’ll need a specialist to help with particularly complicated problems. But we’ve really, as a healthcare system, been beating up on primary care doctors mercilessly for the last several decades. They get paid much less than the specialists. The hours are not compatible with having a life. The emotional and intellectual responsibility of taking on whatever walks in the door, which is I think what most of us would like to have as patients as our first stop in the healthcare system really takes stall. I think primary care doctors ought to be, you know, rewarded the most and made their lives as easy as possible, but that’s quite the opposite has happened. So as a result, as you’re pointing out, somebody might be getting medications from their diabetes doctor and their heart doctor and their arthritis doctor. And it is not always possible for every doctor to be aware of what all the other doctors are prescribing. And uh I’ve written about how somebody may be taking, you know, Advil for headaches, and ibuprofen for their sore knee, and Motrin because they have low back pain, and aspirin because they think it’ll prevent a heart attack, and not ever knowing that those are all basically the same class of drugs, and they’re just multiplying the potential risk for for side effects. That’s where a primary care doctor can really shine. And, you know, we are an endangered species. It’s imperative. I’ve found some of the most useful time I would spend with patients. would not be listening to their heart or listening to their lungs, but actually saying, next visit, bring in a brown bag and fill it with not just what I’ve prescribed, but what you’re getting from all your other doctors and as you said in the question, whatever dietary supplements you’re taking and whatever herbal remedies you’re taking, whatever over-the-counter meds you’re taking, and dump it out on my desk and we’ll talk about every one. The reason that’s so useful is that you find stuff that actually is uh you know can kind of chill your blood about, oh my God, who put you on that? And you’re still taking that? I’s a very useful activity, and I urge all patients, if their doctor doesn’t ask to do it because every doctor is just so horribly overloaded with not enough time and too much to do is to offer to bring it in and you know include those supplements and over-the-counters and things from the other doctor and see what happens when you dump them on the doctor’s desk and see what his or her reaction is. Terry 01:04:14-01:04:59 And they may actually say, oh my God, we got to fix this. Well, one of the examples that you gave in rethinking medications, that is something we have heard from probably hundreds of people. is the idea that um you may have a chronic cough, that it doesn’t go away no matter what cough medicine you take and you’ve been worked up for allergies and you’ve been worked up for this and that, sometimes people get worked up for um acid reflux to see if that’s the cause of the cough. And if you just looked at the blood pressure medicine that the patient is taking. Exactly. If they’re on an ACE inhibitor, the chronic cough might be a reaction to their blood pressure medicine. Dr. Jerry Avorn 01:05:00-01:05:43 You said it. Right. I think the the figure I know is about 15% of people. And by the way, ACE inhibitors are wonderful drugs. They do a great job of lowering blood pressure. But as as you’re as you’re saying, about 15% of people on ACE inhibitors will develop a cough from them. And there’s ways of fixing that. You know, there’s angiotensin receptor blockers you can switch people to, you can use another category of drugs. But if it doesn’t come up in the conversation with a doctor, you know, they could, as you point out, they could get worked up for lung disease or put on meds for, you know, asthma or things that they don’t really need because it’s their blood pressure med. It may be a great med for most people, but if like one in seven people gets a chronic cough, that’s something that ought to be part of the doctor’s questioning of the patient. Joe 01:05:43-01:07:16 Uh Dr. Avorn, you’ve mentioned how important it is for patients to bring in all the medications and the dietary supplements and the vitamins and the goodness knows what they’re taking. for the physician, but I’d also suggest that it’s important for pharmacists to also be part of the process And also do these brown bag uh examinations, but there’s a a problem that we hear from pharmacists all the time. A patient comes into the pharmacy and they get a flag on their computer that says, uh, this antibiotic should not be taken at the same time you’re taking one of these blood pressure medications. It, it could cause potassium levels to go through the to the roof and it it could cause cardiac arrest. So this is a dangerous combination and the patient is waiting to g to get their antibiotic And now the pharmacist has to contact the physician. But when the pharmacist calls the doctor’s office, the receptionist says, I’m sorry, doctor is seeing patients now. And as you said, so many doctors are overworked and overwhelmed, it may be hours before that physician can call back to the pharmacist. And we hear from pharmacists who say, I never got a call back. What do I do when I’ve got an interaction and a patient sitting right there in front of me waiting for their prescription to be filled? What what would you recommend in a situation like that? Dr. Jerry Avorn 01:07:17-01:08:59 Absolutely. And as you both know from what I’ve written over over many years, I think pharmacists are one of the most potentially valuable and underused and abused healthcare professionals that we have. You know, they know so much about medications and yet most pharmacists find themselves working in increasingly in chain drugstores where the entire premium is on throughput and fill them and send them home and get, you know, make sure they pay. And the idea that a smart enlightened pharmacists can be part of the healthcare team just has not caught on as much as I had hoped because it could deal with a lot of these issues that that come up. It’s and then of course it puts the pharmacist in a rough spot. And sometimes, as you both know, some of these alerts are really not very sensible. But it you know the computer flashes a red light and then the pharmacist says, oh my God, I can’t do this. And then you can’t reach the doctor. I mean my vision, which is very naive and and probably unrealistic, is that practices would increasingly have pharmacists embedded in the practice who are part of the whole healthcare team. And that when the question comes up, first of all, they might even be involved in the dispensing of the drug. But if not, uh the outside pharmacy could call and they talk to the inside pharmacist, then he or she would be able to look at the patient’s records. They may even be able to snag the doctor as he or she walks by. Or they would have their own expertise and say, yeah, it’s okay. That’s one of those automatic computer flashes. Or they might say, holy cow, don’t fill the prescription But leaving everyone holding the bag because everyone is too busy to be able to just get their work done is not a good solution for anyone. Terry 01:08:59-01:09:05 Dr. Jerry Avorn, thank you so much for talking with us on the People’s Pharmacy today. Dr. Jerry Avorn 01:09:06-01:09:09 I’ve really enjoyed talking with you both again. Thanks for having me. Terry 01:09:10-01:09:44 You’ve been listening to Dr. Jerry Avorn, a professor of medicine at Harvard Medical School and a senior internist in the Mass General Brigham Healthcare System. He built a leading research center at Harvard to study medication use, outcomes, costs, and policies, and he developed the educational outreach approach known as academic detailing Providing evidence-based information about medications to prescribers. Dr. Avorn is the author of Rethinking Medications: Truth, Power, and the Drugs You Take. Joe 01:09:44-01:09:46 Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music. Terry 01:09:52-01:10:00 This show is a co-production of North Carolina Public Radio WUNC with the People’s Pharmacy. Joe 01:10:00-01:10:14 Today’s show is number 1443. You can find it online at peoplespharmacy.com. That’s where you can share your comments about today’s interview. You can also reach us through email, radio at peoplespharmacy.com. Terry 01:10:15-01:10:38 Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning. In the podcast this week, we discuss sourcing medications from abroad. How does that affect drug shortages? How will tariffs affect costs? In addition, you’ll get the details on a brown bag review. Joe 01:10:38-01:11:13 At peoplespharmacy.com, you can sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast. We are pleased to announce we are now launching transcripts for selected interviews, including our conversation with Dr. Jerry Avorn. We would be grateful if you would consider writing a review of the People’s Pharmacy and posting it to the podcast platform you prefer. In Durham, North Carolina, I’m Joe Graedon. Terry 01:11:13-01:11:48 And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money. Joe 01:11:48-01:11:58 If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism please consider chipping in. Terry 01:11:58-01:12:03 All you have to do is go to peoplespharmacy.com/donate. Joe 01:12:03-01:12:19 Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

In this episode, our guest is a dermatologist who wants us to consider sunlight’s health benefits. That is a minority opinion among dermatologists. Dr. Richard Weller tells us why vitamin D is overrated and not the most important aspect of sun exposure. At The People’s Pharmacy, we bring you the latest research-backed insights on health, even when they challenge established views. In this episode, Dr. Richard Weller highlights how moderate sunlight may offer unexpected health benefits while placing melanoma risk in context. This content is provided for informational and educational purposes only. Always consult a qualified healthcare provider before making changes to your sun exposure habits or medical care. You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Sept. 1, 2025. The Secrets of Sunlight’s Health Benefits: Dermatologists generally advise us to stay out of the sun as much as possible. After all, excessive sun exposure causes skin aging and skin cancer, conditions for which people frequently consult them. However, even if we could all live inside, wear protective clothing and high SPF sunscreen whenever we ventured out, would that be wise? According to our guest, Dr. Richard Weller, and his colleagues, “insufficient sun exposure has become a real public health problem” (International Journal of Environmental Research and Public Health, July 13, 2020). While this problem is more acute in Europe than the US, they still estimate that more than 300,000 Americans die each year due to inadequate sun on their skin. What is going on? How Does Sunlight Affect Skin? For decades, we have heard that the principal effect of sunlight on skin is the production of vitamin D. Therefore, the dermatologists have concluded, rather than take the risk of exposing skin to sunshine, why not just swallow vitamin D supplements? The problem with that proposal is that it hasn’t worked very well. Many studies show that people with low levels of circulating vitamin D are more vulnerable to high blood pressure, atrial fibrillation, heart disease, diabetes and infections, among other problems. However, people who take vitamin D supplements don’t always get the expected benefits.  Perhaps vitamin D is a marker for sun exposure rather than the most important outcome. Human Evolution and Skin Color: Humans evolved in Africa, where dark skin is an advantage, offering protection from the most harmful effects of ultraviolet radiation. By about 60,000 years ago, people were migrating to other parts of the world. Yet analyses suggest that although they arrived in Europe by about 40,000 years ago, genes for pale skin didn’t become common until less than 10,000 years ago. Anthropologists have hypothesized that pale skin is an adaptation to inadequate sunlight in northern regions. Because vitamin D is a well-recognized consequence of sunlight on skin, they have assumed that was the driver. Dr. Weller suggests that nitric oxide was (and still is) more important. He notes that the evolution of pale skin happens around the same time that people begin to cluster together in farming communities, where they are more likely to be exposed to infectious diseases. Is Nitric Oxide the Source of Sunlight’s Health Benefits? In 1996, Dr. Weller was the first scientist to find that human skin creates a compound called nitric oxide (NO) under sunlight. This compound is then absorbed into the skin, where it helps relax blood vessels and lower blood pressure. Here is a link to his TED talk on the topic. This is where Dr. Weller’s approach differs from that of more conventional dermatologists. With proper caveats that the US is at much lower latitudes, in general, than most of Europe, he proposes that more sunlight, not less, could lower mortality rates. (Lower latitudes get more sunshine.) His analysis was just published in the prestigious Journal of Investigative Dermatology (August 2024). The data underpinning this claim are from an analysis of the UK Biobank, a remarkable treasure trove of information. Dr. Weller and his colleagues have found that in the UK, people who get more sunlight are less likely to die within a specified time frame. We call that lower all-cause mortality. You can read the research report here (Health & Place, Sept. 2024).  It was discussed in this article in The Economist (Aug. 12, 2024). This Week’s Guest: Richard Weller, MD, FRCP(Ed), is Professor of Medical Dermatology at the University of Edinburgh. He holds the Personal Chair of Medical Dermatology in the Deanery of Clinical Sciences.  He is also Honorary Consultant Dermatologist at NHS Lothian and Principal Investigator at the Centre for Inflammation Research. Dr. Weller serves as Programme Director for the M Med Sci at the University of Edinburgh and is President of the Scottish Dermatology Society. He is the Clinical Lead for the Dermatology Speciality Group at NHS Research Scotland, the Global Health Academy and Edinburgh Imaging. Listen to the Podcast: The podcast of this program will be available Monday, Sept. 1, 2025, after broadcast on Aug. 30. You can stream the show from this site and download the podcast for free. Learn More: Dr. Weller kindly shared links to some research by his colleagues that he mentioned during the show. Here is an article by Joel Gelfland showing the benefits of home phototherapy for psoriasis. This article by Adewole Adamson presents evidence that dark skin is not susceptible to UV-induced melanoma. Download the mp3 of the show, or listen to the podcast on Apple Podcasts or Spotify. Transcript of Show 1397: The Surprising Secrets of Sunlight’s Health Benefits A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. This transcript is copyrighted material. All rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission. Joe 00:00-00:01 I’m Joe Graedon. Terry 00:01-00:05 And I’m Terry Graedon. Welcome to this podcast of the People’s Pharmacy. Joe 00:06-00:27 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Do you avoid the sun? We’ve all heard that we should wear sunscreen all the time and stay inside from 10 till 2. This is the People’s Pharmacy with Terry and Joe Graedon. Terry 00:33-00:45 Are there hidden health benefits from sunlight? Is it all about vitamin D? Why don’t supplements protect people against heart disease, cancer, diabetes, or depression? Joe 00:45-00:52 New research suggests that some sun exposure may be helpful. Our dermatologist guest has done fascinating research. Dr. Richard Weller 00:53-01:04 We have showed in Britain that after accounting for confounding factors, other factors, the more sunlight people have, the longer they live. Joe 01:04-01:10 Coming up on the People’s Pharmacy, the surprising secrets of sunlight’s health benefits. Terry 01:14-02:31 In the People’s Pharmacy Health Headlines, following a Mediterranean-type diet may help lower the risk of dementia in vulnerable people. People who carry a gene called APOE4 are particularly susceptible to developing Alzheimer disease. But an analysis of the Nurses’ Health Study and the Health Professionals Follow-up study published in Nature Medicine shows that those who come closest to a Mediterranean eating plan are less likely to come down with Alzheimer’s disease. There were more than 4,000 women and nearly 1,500 men included in the analysis, which covered three decades of data. People with two ApoE4 genes lowered their risk by 35% if they followed a Mediterranean diet high in vegetables, fruits, whole grains, fish, and olive oil. The lead author, Dr. Yuxi Liu, told CNN, “Not only did following a baseline Mediterranean diet reduce the probability of developing dementia by 35% in people with two APOE-e4 genes, but higher adherence to the diet further reduced their risk.” Joe 02:30-03:36 The anti-vax movement has been gaining momentum, but there’s growing evidence that the shingles vaccine offers benefit far beyond protection against shingles. Several studies have demonstrated that the shingles vaccine can reduce the risk for dementia. A new study published in the journal Clinical Infectious Diseases reports that the recombinant herpes zoster vaccine Shingrix can reduce the risk of heart attack, stroke, and herpes zoster ophthalmicus, a potentially vision-robbing eye infection. The researchers compared over 100,000 vaccinated patients to over 400,000 unvaccinated patients. The median age was 68 years old. The average follow-up was two and a half years. The investigators concluded that two doses of Shingrix vaccine “were effective in preventing herpes zoster ophthalmicus in adults over 50, and were associated with significantly reduced risk of hospitalized acute myocardial infarction and stroke compared to unvaccinated individuals.” Terry 03:36-04:27 The FDA has just approved a new and far more general indication for evolocumab, known by its brand name Repatha. Back in 2015, the agency approved this powerful injectable medication for lowering LDL cholesterol. At first it was used primarily for patients at high risk who couldn’t tolerate statins, or who didn’t respond adequately to statins for lowering cholesterol. Then the use was expanded to cover people with cardiovascular disease. Now, doctors can prescribe this medicine for any adult at risk for heart attacks, strokes, unstable angina, or other cardiovascular complications. Occasionally, people react to evolocumab with angioedema, which can be life-threatening. Such individuals will not be able to use it. Joe 04:28-06:18 At one time, x-rays were the only tool doctors had to see inside the body. Since then, MRIs and CT or CAT scans have become widely available. Computed tomography imaging is performed on over sixty million patients annually. That number has increased by over thirty percent since 2007. Such images can be extremely helpful in making a diagnosis, but there are risks that many patients may not realize. The name CAT scan sounds innocuous, but in fact it represents ionizing radiation similar to X-rays. An investigation published in JAMA Internal Medicine projected the number of future cancers due to this radiation exposure. The researchers used data from the University of California, San Francisco International CT Dose Registry and modeled the effects of the radiation. They estimated that approximately 103,000 cancers are likely to result from the 93 million scans conducted in 2023 on 60 million people. The risks are highest in children and adolescents, but many more adults undergo CT scans. The scientists conclude that if current practices persist, CT associated cancer could eventually account for 5% of all new cancer diagnoses annually. And that’s the health news from the People’s Pharmacy this week. Joe 06:15-06:17 Welcome to the People’s Pharmacy. I’m Joe Graedon. Terry 06:18-06:35 And I’m Terry Graedon. For decades we’ve been told to stay out of the sun, especially in the summertime. If we venture out, we need to be wearing protective clothing, including a hat and high-SPF sunscreen. If we’re good, we’ll never get a tan in the summer. Joe 06:36-06:51 Dermatologists worry about sun exposure because ultraviolet radiation is damaging to the skin. It causes premature aging and is linked to various forms of skin cancer, including the most dangerous, melanoma. Terry 06:52-06:57 But could sunlight be more complicated? Does it have hidden health benefits? Joe 06:58-07:24 To learn more about this very controversial topic, we turn to Dr. Richard Weller. He is a professor at the University of Edinburgh College of Medicine and Veterinary Medicine. He holds the personal chair of medical dermatology at the Deanery of Clinical Sciences. His research interests include eczema, psoriasis, and the effects of sunlight on human skin. Terry 07:24-07:28 Welcome to the People’s Pharmacy, Dr. Richard Weller. Dr. Richard Weller 07:29-07:32 Hello, it’s very nice to be talking to you today. Joe 07:32-07:40 Dr. Weller, there’s a rumor that you are a dermatologist. Do I have that right? Dr. Richard Weller 07:41-07:52 I am. I’m perhaps not a conventional dermatologist in some of my views, but those have really developed over the years as a consequence of my research. Joe 07:53-08:43 Well, speaking of your research, it kind of contradicts what American dermatologists have come to believe, which is: If you could just live in a cave, that would be ideal because that way you would never be exposed to ultraviolet radiation. In other words, sunlight. And the only time you’re allowed to go out in the sun is if you have slathered on a high SPF sunscreen, 50 or above. And definitely avoid being outside between 10 and 2 because sun is your enemy. It’ll cause cancer, it’ll cause wrinkling, it’ll mess up your life. Terry 08:42-08:43 You are exaggerating. Joe 08:44-08:44 Of course. Terry 08:44-08:46 But not by very much. Joe 08:46-08:58 So you’ve kind of come up with a different perspective, Dr. Weller. Can you tell us a little bit about your time in Australia and why that started you down this path in part? Dr. Richard Weller 08:59-10:30 Sure. I mean, I think you’re you’re pretty accurate about the American dermatology view to sunlight. And I think what I really want to say is we need a more nuanced view on sunlight. And of course, the second thing to say to you is that I’m speaking to you from Scotland, and people forget how much further north Europe is than Scotland [Scotland is than the US]. So you know, the further away you are from the equator, the less sunlight there is. And as an example, if you live in the cold woolly fringes of Maine or New England, you’re actually at the same latitude as the Côte d’Azur, as Cannes, right down on the Mediterranean coast of France. And if you live in Florida, you’re on the same latitude as the Sahara. So the amount of sunlight Americans are getting is way more than we North Europeans are getting. So I’m speaking to you with someone from Scotland and probably what I see is different from what my American colleagues see. Nonetheless, sunlight has significant health benefits, as my research and that of other colleagues around the world is now showing.  There has to be more to the message we give than just ‘sunlight is bad’ because that’s becoming outdated. And that’s really the message I’d like to get across. Terry 10:31-10:38 I wonder if you could summarize for us, Dr. Weller, what some of those benefits of sun exposure might be. Joe 10:38-10:45 And in particular, can you tell us a bit about Australia and cardiovascular disease? Dr. Richard Weller 10:46-11:46 Sure. So yeah, I mean so look, I I suppose a bit about my career. I’m an academic dermatologist. I’ve been a dermatologist for about 30 years. Before I became a dermatologist, I did an internal medicine training and as part of that I worked in Australia, in Northern Australia and Queensland for a year. And Australia is much sunnier than the UK. So in Cairns, where I was living- the UV index is seven or above every single day of the year. So in mid-winter, the UV index, which is a measure for the burning ability of the sunshine, hits about seven, you know, for an hour or so around midday, and it rises to fourteen in midsummer. So in Scotland last year, the UV index hit seven for ten minutes. It was just after lunchtime on the 24th of June, if you want to know exactly when. Terry 11:47-11:47 Okay. Dr. Richard Weller 11:48-13:58 And yet we are given sunlight protection advice copied directly from the historical Australian advice. Designed for white Australians, you know, Australians of North European heritage who’ve moved to somewhere hugely sunnier and that is inappropriate [in Scotland]. You know, skin color is an evolutionary adaptation to sunlight. So, you know, Homo sapiens, that’s us, we’re about 160, 200,000 years old as a species. Non-African humans are the descendants of people who left Africa about 60,000 years ago And what is interesting is those humans who’ve moved to high latitude, so Europe and China, modern China have independently evolved pale skin repeatedly on moving to low light environments. So the pale skin gene variants that we see in Europe, um SLC 45A2 in particular, arose about 8,000 years ago. Independently pale skin gene variants arose in humans who had moved to high latitude modern China. So skin color determines your response to sunlight. That’s that’s what it’s about. And what’s happened is repeatedly humans who’ve lived in low-light areas have there’s been an evolutionary fitness advantage to getting to to developing pale skin which allows you to get more of sunlight’s benefits. But at the same time, if you fly down to or go by convict ship from Britain to Australia you’re very suddenly moving to somewhere with way more sunlight than your skin um is adapted to manage. And that’s when you see the problems of skin cancer and and sunburn and so on. Texas is the same as Australia in that sense. Terry 13:59-14:38 Now, Dr. Weller, as an anthropologist, I’m familiar with what I guess is uh the hypothesis that as you say, uh, pale skin is an evolutionary adaptation to not getting enough sunlight, and therefore when we expose our pale skin to the uh sunlight that we can get in uh you know, North Carolina or New Jersey or France or where have you, we’re able to make the vitamin D we need. Are there other considerations beyond vitamin D? Dr. Richard Weller 14:39-17:39 Yes, very much so. And of course the key question is, you know, that there must be a benefit because it keeps occurring. What are those benefits? And I and I have to say straight off, I think the benefits of vitamin D are hugely overstated. Vitamin D is less important than we have thought for much of the last hundred years. So we look, it may have played a part in the development of pale skin. We know that people with darker skin need more sunlight to get the rise, same rise in vitamin D. But you know, we don’t in Britain nowadays see rickets or problems that associate with vitamin D deficiency in African, you know, British African communities, for instance. And actually, skin color doesn’t enormously affect vitamin D synthesis. A lot of my research about sunlight has been looking at cardiovascular disease. We find that sunlight lowers blood pressure independently of vitamin D. There’s a substance called nitric oxide, which my research has shown is stored in the skin, and when sunlight hits the skin, it releases that nitric oxide, the circulation where it dilates blood vessels and lowers your blood pressure. And that has really quite a big effect at population level. So again hit here in Britain The average blood pressure is six millimeters of mercury systolic lower in summer than winter. And that appears, that’s probably a nitric oxide effect. It’s definitely not a vitamin D effect. In terms of the evolutionary history of skin, that gets more interesting. My feeling is that heart disease, blood pressure, high blood pressure related disease like heart attacks and strokes is unlikely to have been a problem in evolutionary times. You know, chasing after woolly mammoths, running away from saber toothed tigers. Pre-the invention of cigarettes, I think it is unlikely that heart disease was a big problem. What I’m looking at now with my research is we wonder if infection may have played a role. Because what’s fascinating is humans have been in Europe for about 40,000 years, been in Asia for about 60,000 years. And yet the development of those pale skin gene variants in Europe only starts about eight thousand years ago, and initially the that the that the white skin gene variants arise in in the fertile crescent, you know. Anatolia. And those white skin gene variants arise in East Asia around eleven thousand years ago. And it it arises at the time when we make the shift from being hunter-gatherers to farmers. Terry 17:40-17:57 You’re listening to Dr. Richard Weller, Professor at the University of Edinburgh College of Medicine and Veterinary Medicine. He holds the personal chair of medical dermatology in the Deanery of Clinical Sciences and participates in the Center for Inflammation Research. Joe 17:58-18:07 After the break, we’ll find out more about how farming might have contributed to evolutionary changes in skin color. Terry 18:07-18:11 Dr. Weller offers us a summary of the health benefits sunlight can provide. Joe 18:12-18:16 Lack of sun exposure is actually associated with some health problems. Terry 18:17-18:22 Studies on sunshine are mostly being done in the UK and Europe, not in the US. Joe 18:22-18:31 Dermatologists sometimes suggest we could just take vitamin D supplements to make up for lack of sunlight. Why isn’t that adequate? Terry 19:45-19:48 Welcome back to the People’s Pharmacy. I’m Terry Graedon. Joe 19:49-20:12 And I’m Joe Graedon. Terry 20:13-20:28 Why do people who live in northern latitudes tend to have pale skin? Presumably, there’s some evolutionary advantage. Anthropologists have suggested that pale skin is better at making vitamin D when sunlight is scarce. Joe 20:29-20:49 Many dermatologists encourage people to avoid the sun as much as possible. To make up for the possible lack of vitamin D, they suggest taking vitamin D supplements. But research on vitamin D pills or injections has been strangely disappointing. Why would that be? Terry 20:49-21:18 Does sun exposure have any other physiological effects beyond triggering vitamin D synthesis? Dermatologist Steve Feldman of Wake Forest University has found that Ultraviolet exposure can boost psychological mood, making people feel more relaxed. He also found it can help people with chronic pain such as fibromyalgia feel more comfortable. Our guest today has also been studying the impact of sunlight on skin for years. Joe 21:18-21:40 We’re talking with Dr. Richard Weller. He’s professor at the University of Edinburgh College of Medicine and Veterinary Medicine. He holds the personal chair of medical dermatology at the Deanery of Clinical Sciences. His research interests include eczema, psoriasis, and the effects of sunlight on human skin. Terry 21:41-21:55 Dr. Weller, how would the rise of uh domestication and farming tie in to a change in skin color? How does that make sense? Dr. Richard Weller 21:56-24:58 Yeah well this is the really interesting thing because being at high latitude, low light, by itself has not driven a move to pale skin. Because humans have been 40,000, you know, I mean if you go to the Dordogne in France, the amazing cave art, you know, the wonderful pictures of woolly mammoths and so on and ancient animals on the roofs of the caves, dates back twenty thousand years ago, when actually the people who painted that were dark-skinned. So this this move to, so it’s not just being at high latitude, because most of the time that Europe’s been inhabited, it’s been inhabited by dark-skinned people. And it’s not just being a farmer, because farming has arisen independently. I mean farming arose independently in what’s now Mexico, maize; it’s arisen independently in India; it’s arisen independently in Papua New Guinea. So either by themselves does not precipitate that move to pale skin. It’s when the two come together. It’s when you’re a farmer in a low light environment that pale skin arises. So that sort of information sets the question. It doesn’t give the answer. It is possible that part of it’s dietary, you know, we know that that Neolithic transition from being a hunter-gatherer to a farmer actually led to a poorer diet. shorter people, probably higher infant mortality. You know, it wasn’t all milk and honey when we moved to being farmers. So it could be a dietary factor, it could be related to vitamin D. Sorry, vitamin D for an American audience. My but I have to say my feeling is it may be or it is likely to be infection. Because the thing that really happens when you make that Neolithic transition shift is that’s the advent of infectious disease. Because most infectious disease comes from animals, what we call zoonotic. You know, COVID comes from bats, TB comes from cows, influenza comes, you know, most infectious disease comes from animals. And when you’re a farmer, you’re living with animals. And the other thing, of course, is when you’re a farmer, you’re living in communities, you’re living in villages close to other people, rather than being hunter-gatherer bands dispersed across the landscape. And so most infectious disease arises from that time, we think. And I suspect that there are UV-driven processes which reduce infection. And that’s what we’re really looking at at the moment. And the point about skin color is it mediates your response to sunlight. It’s not pale skin itself that prevents you get infections. It’s the fact that pale skin allows you to maximize the biological effects of sunlight. Joe 24:58-26:23 Dr. Weller, I’d like to go back and sort of summarize, if you don’t mind, all of the benefits of exposure to sunlight, because as I introduced a little bit tongue in cheek, American dermatologists believe that that sunlight is problematic, that it will cause all kinds of problems, and that we need to use these high SPF sunscreens or better yet stay out of the sun completely. So you’ve already suggested that blood pressure is affected by exposure to sunlight. You’re now alluding to the possibility that our immune system may be enhanced by sunlight, but there are a whole lot of other conditions as well. I think about inflammatory conditions like arthritis. I think about autoimmune conditions like eczema. I think about kidney disease and osteoporosis and diabetes. So can you just sort of summarize all of the potential health problems associated with lack of exposure to sunlight? How people in Australia may be quite different from people in Greenland,  in terms of their risk of heart disease? So give us that big perspective. Dr. Richard Weller 26:23-32:25 Yeah, look, I’m delighted to and of course I’ve start I’ve jumped straight into where my my current research is because that’s really exciting. So so sunlight’s got ups and downs, got a good side and a bad side. So look with my dermatologist hat on broad brimmed shady hat. Sunlight is a risk factor for skin cancer and it is a risk and it leads to skin aging. So that’s the kind of downside. But it’s also got an upside. There is a wonderful means about looking at how do these risks and benefits weigh out. And that’s what we call all-cause mortality: death from any cause. And that gives you very robustly a summation of those two factors, the pluses and the minus. So we have a paper coming out actually next week. We’re just uh arranging uh stuff with the journal at the moment. which touches on this subject, but the first person to look at it uh was a colleague and friend of mine, Pelle Lindqvist, who is an obstetrician in Sweden. And he did a wonderful study called the Melanoma or the Melanoma in Southern Sweden study. So this was set up in 1990. It was designed, as the name suggests, to find what causes melanoma, and how does it kill people. And 30,000 Swedish women, 30,000 middle-aged Swedish women in southern Sweden. So that that at the time was a quarter of the population of southern Swedish and middle-aged women were recruited in 1990 and they were asked a series of questions about how much sunlight they got. But they were also asked an extensive range of other questions asking about lifestyle factors, education, income, health, you know, other smoking habits, medical conditions. So the baseline information was taken, they were then followed for 25 years, and then the investigators went back to find out what had happened to them. And the first thing to say is that those had most sunlight were more likely to have had a case of melanoma. But Pelle’s interest and my interest is what about the deaths? I’m not interested in cases of the diseases. I’m interested in death from any cause. And there, much to the surprise of the dermatologists who set the study up, the direction was in the opposite direction to melanoma cases. They found that the women who had the most sunlight after correcting for all of these other factors, you know, income, education, smoking, etc. , etc. , those that had the most sunlight were half as likely to be dead. 25 years after the study started, as those who had the least sunlight. So that’s the first study. We have just done a much larger study looking at the UK Biobank. So the UK Biobank, uh half a million middle aged people in Britain were recruited (I was one of them) and examined in great depth over about it took about four years to recruit the whole cohort, um, all around Britain. And every subject went up to an investigation center where there was about three hours of questionnaires, investigations, measurements, you know, mass of information taken. And that was back in 2000 and uh, anyway, about about 20 years ago. And those people have followed up long term. And we have gone into that database and we’ve taken 400,000 people from that, and we have looked at measures of sunlight exposure. So the measures of sunlight exposure we have used have been how far south people live in Britain, because the further south you live, the more sunlight you get. And our other measure actually was people who use sun beds, not so much because of the sun beds themselves as because behaviorally we know that people that use sun beds sunbathe more, actively seek the sun more. Now, we then had to correct for all the confounders. You know, sun bed users are younger, more female, less educated, more likely to come from Manchester, etc etc and we had to correct for the same factors the further south people lived. And what we find is that the more sunlight people get the longer they live. They have a reduced all-cause mortality. They have a reduced cancer mortality. Melanoma is an interesting one. There was an increase in diagnoses of melanoma in those that got more sun, but no increase in mortality from melanoma and pretty much all the other cancers had a reduced mortality. And cardiovascular mortality was also greatly reduced. So just as Pelle showed in Sweden, we have showed in Britain that after accounting for confounding factors, other factors, the more sunlight people have the longer they live. Now one big caveat I’m gonna throw in for your audience is these are North European studies. And our sunlight levels here are much lower than your levels in America. You know, white skin has developed in Europe because we don’t have much sunlight. And this data applies here. I’m not sure how much it’s going to apply in America. And of course the studies haven’t been done because all people have thought about sunlight is oh gosh, it’s dangerous, it’s bad. But really interesting. Certainly for us in northern Europe, I think a really important, really important finding. Terry 32:26-32:46 So you’re not aware of any American colleagues who are doing anything similar? Of course, we don’t have a resource like the UK Biobank, which is an extraordinary resource of a huge amount of information, I don’t believe anything of that sort has been collected in the US. Dr. Richard Weller 32:47-35:46 No, I mean these studies can’t really be done in America. I mean most of these studies come out of Scandinavia and Britain because we have universal health systems. So if you get sick or have disease or die, you know, all our data are collected centrally.  America has such a bizarre health system and it’s so fractured and broken up into small things, it’s not really possible to do there. What America has been very good at at doing though is things like clinical trials and I need to mention vitamin D, vitamin D. Because the other thing to say here is vitamin D’s benefits have been vastly overplayed. Now we know that so sunlight is responsible for making vitamin D. Vitamin D has some important benefits, rickets, you know, it prevents rickets. And we know that when you measure vitamin D People with higher measured vitamin D levels are healthier in almost every way you can mention. Less heart disease, less strokes, less multiple sclerosis, less diabetes, etc. , etc., etc. The problem is when you give vitamin D, there are you know, it prevents rickets, which we’ve known for a hundred years. And there is an enormous rearguard action going on by the vitamin D industry saying, oh, well, what about this? What about this? What about this? Um and the vitamin D industry, I mean it’s a it’s worth, I think, it’s about two billion dollars a year. It is a huge industry. The biggest study of all on vitamin D supplementation was run in America. You’re fantastic at this, you know, NIH comes in with its funding. And there was a study called the Vital Study, run by Joanne Manson 25,000 Americans, 25,000 adult Americans were recruited. Half of them were given vitamin D supplements for five years and half of them were given a placebo, a sham control. And at the end of five years and really the study has now ended, but the patients are being followed up. And what it confirms, and it confirms the findings from lots of other smaller studies, is vitamin D has absolutely no effect on heart disease, on strokes. Probably doesn’t do much for cancers. Um, you know, the results came back negative, negative, negative. And there was an editorial in the New England Journal of Medicine 18 months ago. summarizing all this saying stop taking vitamin D supplements. You know, unless you are one of those very few people with incredibly low levels of vitamin D, it’s not doing anything. And people come up saying I’ve got vitamin D deficiency. And you say, what do you mean? Oh, I had a blood test. Doctors do not treat blood tests. We treat disease. A blood test is not a disease. You know, you wouldn’t know if you hadn’t had it done. But there is a huge industry out there pushing this. Terry 35:46-36:11 So, Dr. Weller, we actually have spoken with uh Dr. Manson and with one of her colleagues, and there was one area in which the VITAL study showed some benefit for vitamin D supplements and that was it reduced the likelihood that someone would be diagnosed with a new autoimmune condition. So you know… Dr. Richard Weller 36:12-37:16 Yes, I look I’m I am not saying vitamin D is absolutely irrelevant. I think we know about rickets, the autoimmune condition is is interesting. But the vast array of benefits that have been claimed for vitamin D are not held up by that amazing study. So what is interesting is that sunlight acts in multiple ways. Now a bit of it is vitamin D. but there’s so many other areas by vitamin D independent mechanisms. And that’s really exciting. And the problem is our focus has been so much exclusively on vitamin D. We have just ignored this. We’ve said, oh yeah, I know the fact that people are healthier. It’s vitamin D. Live in a cave, take vitamin D supplements. And those vitamin D supplements only account for some of sunlight’s benefits. And we need to move on and look for what the other mechanisms are. Terry 37:17-37:36 You’re listening to Dr. Richard Weller, Professor at the University of Edinburgh College of Medicine and Veterinary Medicine. He holds the personal chair of medical dermatology in the Deanery of Clinical Sciences and participates in the Center for Inflammation Research. Joe 37:36-37:42 After the break: Why can’t we compensate for sun exposure by taking vitamin D supplements? Terry 37:43-37:48 Well, could it be that maybe, as doctor Weller says, vitamin D is just a marker for sun exposure? Joe 37:49-37:51 What exactly does that mean, a marker? Terry 37:52-37:58 Well, it means we can measure vitamin D, and there are things we can’t measure. We don’t measure nitric oxide that well. Joe 37:59-38:02 Well, what’s a reasonable amount of sun exposure? Terry 38:02-38:10 We’ll also find out more about Dr. Weller’s research on how sunlight triggers nitric oxide formation and how that affects us. Joe 38:10-38:15 What does nitric oxide do for the immune system? Terry 38:32-38:37 You’re listening to the People’s Pharmacy with Joe and Terry Graedon. Joe 38:45-38:48 Welcome back to the People’s Pharmacy. I’m Joe Graedon. Terry 38:48-39:13 And I’m Terry Graedon, Joe 39:13-39:34 Today on the People’s Pharmacy, we are exploring the controversial concept that some sun exposure might have hidden health benefits. Of course, we want to emphasize that no one should get burned by the sun. In addition to being painful, sunburn creates the risk for melanomas. Terry 39:34-40:04 To find out more about phototherapy and how ultraviolet light acts to produce nitric oxide in the skin, we turn back to our conversation with Dr. Richard Weller. He’s a professor at the University of Edinburgh College of Medicine and Veterinary Medicine, and holds the personal chair of medical dermatology in the Deanery of Clinical Sciences. He also participates in the Center for Inflammation Research. Joe 40:05-40:59 So Dr. Weller, you have just put into perspective the fact that vitamin D is not the answer to lack of sun exposure. And I want to just quickly go back and summarize all of the benefits of sunlight And what happens when you don’t get exposed to sunlight? And you’ve alluded to things like hypertension, cardiovascular disease, cancer. You’ve mentioned kidneys, you’ve mentioned diabetes. What about autoimmune conditions such as multiple sclerosis? What about eczema, which I believe is something that you have a lot of experience with? Tell us why sunlight is so important for our body’s health. Dr. Richard Weller 40:59-45:54 Yeah, great question, thank you. And I’m delighted you bring multiple sclerosis up. So multiple sclerosis It is the classic sunlight deprivation disease. So, you know, even when I was at medical school, and that was a frighteningly long time ago, We knew that MS was a disease that was most common in people who grew up in areas without much sunlight. So I’m in Scotland and we have the highest rates of MS in the world here. And in fact, the highest of the highest is the Orkney Islands, which are just off the north of Scotland. Beautiful place. But something like I think about one in eight hundred people there has MS. Incredibly common. So a colleague and friend of mine, Prue Hart in Australia. And so and again, the classic story. people with low measured vitamin D levels are more likely to get MS. You give vitamin D you know, kinda iffy you know, the the observational effect is huge. This huge great relationship measured vitamin D. You give vitamin D supplements, not very much happens. So it’s got to be more than just the vitamin D. And I might say there’s a super company in America, Cytokines,  led by a wonderful guy John McMahon, which is setting up a phototherapy study of MS in the United States. So there’s really good preliminary work done in Australia where people who when they had their very first diagnosis of MS, their very first demyelinating episode, were randomized either to get phototherapy, the kind of stuff that dermatologists use on their offices, well established, incredibly safe treatments, They were randomized either to get phototherapy or to get a control. And there was a really strong move towards a reduction in progress of MS, and a really marked improvement in the the biomarkers that are a good indicator of whether people are going to progress or not. Really exciting. The big problem, of course, was it was done in Australia. So your control group not getting phototherapy, well, they’re still in Australia under quite a bit of sunlight. And of course the other reason there isn’t much MS in Australia. It’s a very sunny country. There’s masses in Britain. So John McMahon and his company are leading this to me really exciting trial of phototherapy for MS in America. And I am watching with huge, I mean just really exciting, because here is a disease which should absolutely go along with phototherapy. And also the narrowband UVB phototherapy that we dermatologists use to treat eczema and psoriasis. has been around for twenty or thirty years incredibly safe. I think utterly over-medicalized. I mean It’s been around for 20 or 30 years. There’s no signal for skin cancer being found in Britain for people having UVB phototherapy. So it’s sunlight. We don’t see a skin cancer signal. And yet you have to see a doctor. You have to see a dermatologist to get it. Um, I think it should be used far more widely. Great American dermatologist called Joel Gelfland, again, fantastic guy. Has just done a wonderful trial of home phototherapy, people with phototherapy lamps at home. And he’s compared how well they do to people who go to their dermatologist office to get phototherapy. And he finds people with their lamps at home do amazingly well. They do as well in terms of reduction in their psoriasis as patients receiving these biologic treatments, these incredibly expensive but highly effective monoclonal antibody treatments. Well actually phototherapy, Joel showed, is as good. And I might say a fraction of the cost and, you know, I mean basically it’s it’s sunlight in a box. And I think we greatly underuse it. And we underuse it because we’ve demonized sunlight. So here is a sunlight-based treatment. And of course, that really threw dermatologists in the quandary. Hang on. We run around saying Don’t go in the sun. And then suddenly we’ve got a treatment which is based on ultraviolet. What do we do? What are oh no, we’re gonna surround it with caveats and cautions and warning signs. I think we’ve gone completely overboard with that and it means we are not using this safe and effective and clean treatment nearly as much as we should be. So I’m delighted that people like Joel Gelflands as a dermatologist and John McMahon with his MS studies is really restoring, you know, kind of rejuvenating this wonderful and underused treatment modality. Joe 45:54-47:02 Dr. Weller, I want to come back to your research with nitric oxide, because I’ve been fascinated by nitric oxide for decades. But first, you know, w we’ve been talking about sunlight exposure, and for the most part Americans have a kind of love-hate relationship with the sun. They want to go out to the beaches, they wanna play outside, they wanna be golfing and playing tennis and going for hikes. But they wouldn’t dare go out without their SPF 50 or 100. I’m just wondering, can you give us some practical guidelines about how we can expose our skin to sunlight for a quote unquote reasonable or safe amount of time that won’t do damage, that won’t burn our skin and lead to wrinkling and squamous or basal cell carcinomas. How do we use the sun without getting into the sunbox that you were talking about a moment ago in in a safe way? Dr. Richard Weller 47:02-48:45 Yeah, I mean a really good question. I mean the really key thing is to avoid sunburn and particularly for children to avoid sunburn because it’s sunburn particularly in children which is the major risk factor for melanoma, the serious skin cancer. Sunlight is photoaging. Sunlight is a risk factor for skin cancer. And you know, non-melanoma with skin cancers in particular, the more sunlight you get, the greater your risk. Look, I uh you know I have a kind of conflict of interest in here because I have, I’ve developed a a a compound you can add to sunscreen that will release nitric oxide in the sunscreen. You know, it’s it’s sort of in development. We’d love to get it out there. I I think sunscreens could be better than they are. I mean at the moment sunscreens are all about blocking sunlight, and blocking the sunlight will reduce the aging, it will reduce the burning, it will reduce the cancer. My concern is it’s also going to block the good things. I think sunscreens could be better than they are. It certainly my, in Britain I am pretty quite relaxed about sunscreen use because we live in a much less sunny place than it than America. Um in America you do have an awful lot of sunlight. Now I suppose what I’m going to say is more research is needed. I think sunscreens could be better. I think we haven’t looked hard enough at the benefits of sunlight and how much sunlight is required to get them to be able to give a really robust answer. And the reason we haven’t done that is because we’ve purely been focused on sunlight is bad, vitamin D will make up for the absence of it. And clearly the story is much more nuanced and complex than that. Joe 48:46-49:07 Well, even if you are unwilling to make a recommendation because there’s a lack of science. What would be a reasonable amount of sun exposure, and at what time should we contemplate that sun exposure if we want to avoid sunburn and some of those damages you mentioned? Dr. Richard Weller 49:07-51:42 Well if you live in Florida or Texas you’re gonna need some protection. You’re living in an African latitude, and if you’ve got white skin, you’ve got you I think you’ve just got to be protecting your skin a great deal out around the middle of the day. If you’re farther north, you know, it gets less of an issue, but you’re still in a very sunny climate I think Americans do need more sun protection than Europeans because you live so far south. And of course the other thing is skin color. Because um so really I work in Ethiopia a lot, although sadly with the political situation there, uh not for the last three or four years. So UV-induced melanoma really does not occur in dark-skinned people. Jay Adamson, a wonderful dermatologist, American dermatologist in Texas, has really shown that UV-induced melanoma does not occur in African Americans. When I work in Ethiopia, we do not see UV-induced melanoma. On at two and a half thousand meters altitude, eight thousand feet, in the tropics in Ethiopia. Incredibly sunny is the point. Dark-skinned Ethiopians do not get UV-induced melanoma. They get these rare subtypes of melanoma, not related to sunlight, but but skin color really determines your risks of of skin cancer. And I am concerned by the way that the American Academy of Dermatology regards all skin types as the same when it comes to sun protection Because certainly the work that we have done uh in America. So we looked at how sunlight lowers blood pressure in America, a big study on three hundred and thirty thousand Americans. And we showed that African Americans need more sunlight to lower their blood pressure than white Americans. So just as skin color determines your risks of getting skin cancer, It also determines how much UV you need to get the benefits of sunlight. You know, skin color is all about response to UV. And I am concerned that by putting out the same message to everyone of every skin color, that’s not wise because that risk-benefit ratio for sunlight is absolutely determined by your by your skin color. And it needs to be a different message dependent on your skin color. Joe 51:42-51:56 Dr. Weller, we just have a couple of minutes left. I wonder if you could briefly summarize your research with nitric oxide and why it’s so incredibly important for so many physiologic functions. Dr. Richard Weller 51:56-53:20 Yeah. Well the biggest killer in the world today is heart disease. So half, basically half of deaths in the world are caused by high blood pressure-related diseases, heart attacks and strokes. Sunlight lowers blood pressure and with it the risk of having a stroke or a heart attack. And the mechanism by which it does it is release of nitric oxide from the skin into the circulation. Hugely important. If you’re a male in Scotland, you are 30% more likely to drop dead of any cause in a week in December than a week in July. I’m pretty mellow at the moment, It’s July, It’s a good time of year. I’ll get through to the end of the week. I start getting a little nervous as the year gets later. And a lot of that is driven by nitric oxide from the skin and its effects on the cardiovascular system. So it’s not sunlight has benefits as well as risks. Those benefits are not just vitamin D. There’s other mechanisms. The mechanisms include importantly for cardiovascular disease, nitric oxide, but also I suspect other mechanisms that really just started to look at, like immune function in particular. So I really think we need to be reconsidering our approach to sunlight in a more balanced way, considering benefits and not just risks. Joe 53:21-53:47 And Dr. Weller, in the one minute we have left, the role of sunlight and perhaps nitric oxide on the immune system, because goodness knows, we have certainly learned a lot from COVID-19 and the pandemic. A lot of people would prefer to reduce their risk from infection. How does sunlight help there? Dr. Richard Weller 53:47-55:33 So well so interesting. So, so we looked at so we um at at the same time as, uh as a rival group in Harvard were looking at the effects of sunlight on COVID mortality. And we found in the very first three months of the pandemic that the sunnier it was after accounting for other factors, the less deaths there were from uh COVID. And that the Harvard group showed that the more sunlight there was, the less growth in cases. Now that’s observational studies, but we uh colleagues in America ran a pilot study in Louisiana giving phototherapy or, or a control to patients admitted to hospital with COVID. And it was a small study, only fifteen in each group, but they found a trend to reduce deaths in the sunlight group. And the third bit of evidence is people with high measured levels of vitamin D were less likely to get COVID or die of it, but multiple trials giving people vitamin D supplements, it had no effect. The usual story, measured vitamin D is a marker for sunlight exposure, not necessarily causative. So look, so I think there’s some really interesting data there suggesting that sunlight is driving processes which we’re now looking at that reduce your risk um of death from COVID. And that may apply to other infectious diseases, but the work needs to be done. And I suspect in evolutionary terms, that’s what has driven this move to pale skin in humans who move to low light areas. Joe 55:33-56:04 So, Dr. Weller, you’ve described the benefits of sunlight as being more than just vitamin D. Dr. Richard Weller 55:42-55:43 Yep. Joe 55:43-56:04 That nitric oxide is also a critical factor, and it’s manufactured in the skin and then circulates in the bloodstream and lowers blood pressure and probably has a lot of other benefits as well. What else is going on? Do we know what sunlight exposure does beyond vitamin D and nitric oxide? Dr. Richard Weller 56:04-59:08 Yeah, uh well I, I strongly suspect it’s having effects on the immune system and and in fact we’ve got f Pretty good evidence showing that. And that’s what I’m actually looking at at the moment with my current PhD student. So we’re so a really good early study in this area which we’re building on now by a chap called Dopico in Cambridge. Came to I think into Edinburgh actually. And he did one of these studies where you use other people’s data um very well. And they looked at um gene expression patterns in blood. Now what they did was they used about eight studies where people had had blood, and the studies have been done for various reasons. Everybody had their blood taken throughout the year during these studies, and the gene expression pattern, what genes were turned on and off in the whole blood, um, was looked at. And what Dopico and colleagues did was they looked, they analyzed the gene expression in these data sets by the month of the year in which the blood was taken. The studies were done for different reasons, but they happened to run over 12 months. And so he went in and thought, gosh, I’ll just analyze it by month of the year. And what he showed was that 30% of all the genes in your blood, you know, which are uh immune genes are very important there, show seasonal variation. So there is a huge uh seasonal variation, possibly I would imagine sparked off by UV, uh which occurs in immune cells. And broadly what he found was that inflammatory genes were turned on in winter and anti-inflammatory genes in summer. And the the, they suggest that maybe, you know, infectious disease flies around in winter. Maybe your body turns up the immune system to be able to jump on infectious disease. That was the hypothesis. So there’s now a technique called single cell RNA sequencing where you can look at every single individual cell, and so you can take, draw blood, you can look at ten thousand different cells, and you can look at every single gene turned on in every single cell. So the experiments I’m doing at the moment we do in winter. We take healthy volunteers. We load them up with vitamin D at the beginning, so they’re full of vitamin D at the start. Take their blood, look at all of their gene expression pattern, we then give them two weeks of daily solar-simulated UV, as if they were on in the Mediterranean, and we then repeat it. And we’re early days, don’t want to talk about the results yet, but we’re getting very interesting effects on gene expression patterns in in immune genes, T cell genes in particular. So it looks as if sunlight has significant effects on the immune system. And we’re really we’ll see where it takes us, but but really exciting stuff. Joe 59:08-59:53 Dr. Weller, if we were to dial back, what, 100, maybe 150 years to a day when tuberculosis was rampant and a terrible killer around the world. There were sanatoriums where people would go and they were often exposed to sunlight. Even in the winter, they would take people outside, bundle them up and exposed them to the sun, they somehow thought that exposure to sunlight could help people dealing with tuberculosis recover or at the very least survive better. Did they know something we didn’t know? Dr. Richard Weller 59:53-01:02:34 Yeah, I mean it’s really interesting and and I think sadly they never did, they had not yet invented robust, placebo-controlled clinical trials as we would understand them. But they weren’t fools. And of course, places like Davos, now an expensive ski resort and uh financial center. Davos was set up initially as a heliotherapy center, a center where people would go to get the sunlight for their tuberculosis. I I gave the opening address at the meeting of the Swiss the annual meeting of the Swiss Dermatology Association last year. And I pointed out and I was talking about the work we’ve been discussing today, and I pointed out to them that had I been there a hundred years ago, I would have been going as a disciple of the great Rollier, you know, the Swiss doctors who developed heliotherapy to treat tuberculosis. And instead, here I was a hundred years later, coming along to remind them of what they’d done previously. So absolutely, you know, we had it, you had it in America, we had it here in Britain. That was before antibiotics, the treatment for tuberculosis. And of course, and then for tuberculosis of the skin, a chap called Finsen in Denmark, developed ultraviolet lamp treatment for treatment of lupus vulgaris, tuberculosis of the skin. And he actually got the Nobel Prize for Medicine for this in I think it was 1904, really one of the very early Nobel Prizes for Medicine. So there is actually a history of UV having been used to treat infectious disease. And certainly since then we’ve had antibiotics and vaccines and we’ve had sewers and we’ve had clean airs, you know, we’ve had all of these measures that have reduced infectious disease death now. You know, the miracle of vaccination has basically eradicated infectious disease from our day-to-day life. So COVID was, I mean it was very tragic. It was also scientifically very interesting because suddenly you had a new infectious disease against which we had none of our usual defenses. You know, before the vaccines came, it was us and the virus. And you began to be able to see what happens to populations with a new virus. And it certainly looks as if those that had more sunlight had less deaths from COVID. And that for me was really very interesting. What the mechanisms are, we don’t yet know, and that’s what we’re looking for now. Terry 01:02:34-01:02:41 Dr. Richard Weller, thank you so much for talking with us on the People’s Pharmacy today. Dr. Richard Weller 01:02:41-01:02:44 Well thank you. I’ve enjoyed the conversation. Joe 01:02:44-01:03:15 You’ve been listening to Dr. Richard Weller, professor at the University of Edinburgh, College of Medicine, and Veterinary Medicine. He holds the personal chair of medical dermatology in the Deanery of Clinical Sciences and participates in the Center for Inflammation Research. The show notes for today’s show have a link to the recent article in The Economist about his research and a link to his paper in the Journal of Investigative Dermatology. Terry 01:03:15-01:03:26 Lynn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B. J. Leiderman composed our theme music. Joe 01:03:26-01:03:32 This show is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy. Joe 01:03:57-01:04:12 Today’s show is number 1397. You can find it online at peoplespharmacy.com. That’s where you can share your comments about today’s show. You can also reach us through email radio at peoplespharmacy.com. Terry 01:04:12-01:04:32 Our interviews are available through your favorite podcast provider, and now you can find them on YouTube as well. You’ll find the podcast on our website on Monday morning, and this week it’ll have some extra information about Dr. Weller’s research on sunlight, vitamin D and nitric oxide. Joe 01:04:32-01:04:50 At peoplespharmacy.com you can sign up for our free online newsletter to get the latest news about important health stories. When you subscribe you can also have regular access to information about our weekly podcasts so you can find out ahead of time what topics we’ll be covering. In Durham, North Carolina, I’m Joe Graedon. Terry 01:04:50-01:05:24 And I’m Terry Graedon. Thanks for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money. Joe 01:05:25-01:05:34 If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism please consider chipping in. Terry 01:05:35-01:05:39 All you have to do is go to peoplespharmacy.com/donate. Joe 01:05:40-01:05:53 Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you. Citations

A randomized controlled trial published in the New England Journal of Medicine confirmed what some cancer specialists have long hoped: physical activity can prolong cancer patients’ lives. Last week, we heard from the senior author of that study, medical oncologist Christopher Booth. In this episode, we hear from an exercise physiologist who has been helping cancer patients with exercise prescriptions. The goal was for them to feel better. Many also lived longer. How You Can Listen: You could listen through your local public radio station or get the live stream on Saturday, Aug. 23, 2025, at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Aug. 25, 2025 Who Needs Exercise Prescriptions? We start our conversation with exercise physiologist Claudio Battaglini, PhD, by asking about his career trajectory. How did he go from playing soccer in Brazil to studying how to coach Olympic-level athletes to providing exercise prescriptions tailored to cancer patients’ unique needs? You will want to hear his story. What Is the Cancer Gym? Dr. Battaglini describes how he initially resisted working with young cancer patients. How did that experience affect him? He eventually ended up setting up the cancer gym at the Rocky Mountain Cancer Rehabilitation Institute at the University of Northern Colorado (UNC for those in Greeley). After earning his doctoral degree there, he began teaching and research at a different UNC (the University of North Carolina at Chapel Hill). He established the Get REAL & HEEL Breast Cancer Rehabilitation Program and credits the breast cancer patients for pointing out the benefits of group exercise training. In addition to positive physiological effects, participants experience emotional support. This also helps motivate patients to continue their physical activity consistently. How to Motivate People to Exercise: Let’s face it: most of us could benefit from exercise prescriptions. But would we follow through? It turns out that personal relationships are hugely important in helping to motivate people to show up. That could be with their personal trainer who is expecting them for their appointment. It could also be one or more friends counting on them to participate in the activity. If others are holding you accountable, you are far more likely to get with the program. Another important factor is matching the right kind of exercise to each patient. Most people are motivated to do what they enjoy. Do you love pickleball or swimming? Dancing or hikes in the woods? If the recommendation is right, staying motivated is far less of a problem. Physical Activity for Young People: Decades ago, physical education classes were mandatory in public schools. In recent years, some school boards have been tempted to drop them as too expensive. (North Carolina and some other states have statewide policies requiring all students in grades K-8 to have the opportunity of 30 minutes of exercise daily.) How important is it to encourage youngsters to be physically active? Do they need exercise prescriptions? Practical Advice for an Exercise Program: For those of us writing our own exercise prescriptions, we discussed the pros and cons of counting steps. Where can you find exercise programs suited to you? The YMCA might be one place to start. Dr. Battaglini also mentioned online resources and qualities to look for in a personal trainer. Above all, whatever you choose to do should feel like fun. This Week’s Guest: Claudio L. Battaglini, PhD, FACSM, is a Professor of Exercise Physiology and the Director of the Graduate Exercise Physiology Program at the University of North Carolina at Chapel Hill. He is Co-Director of the Exercise Oncology Laboratory in the Department of Exercise and Sport Science at UNC Chapel Hill. Dr. Battaglini is also a member of the UNC Lineberger Comprehensive Cancer Center. Listen to the Podcast: The podcast of this program will be available Monday, August 25, 2025, after broadcast on August 23. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. In the podcast for this episode, you’ll find information about walking speed and how much it matters. We also discuss swimming or cycling as ways to protect your joints if walking is difficult. Does cross-training become more important as you grow older? What kinds of activities can slow osteoporosis? Be sure to tune in if you are interested in the importance of family and friends supporting our exercise goals. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Physical activity, aka “exercise,” is a cornerstone of good health, just like adequate sleep and a balanced diet. No one questions the benefits for people who are already healthy. But doctors may assume that cancer patients are too debilitated and demoralized to exercise. They may think physical activity wouldn’t be much help to patients who have just suffered through radiation or chemotherapy. Such assumptions are wrong and could be harmful, as a recent study shows. In actuality, structured exercise can help cancer patients survive and even thrive. How You Can Listen: You could listen through your local public radio station or get the live stream on Saturday, Aug. 16, 2025, at 7 am EDT on your computer or smart phone (wunc.org). Here is a link  so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Aug. 18, 2025. Does Exercise Belong in Cancer Treatment? An exciting study published in The New England Journal of Medicine demonstrates that a personalized exercise program can be an important component of the treatment for colorectal cancer (New England Journal of Medicine, July 3, 2025).  We spoke with the senior author, Dr. Christopher Booth, who explained that originally he and his colleagues wondered if exercise can help cancer patients feel less fatigued while undergoing chemo. Then they decided to design a trial that would go much further. They intended to answer two questions: can cancer patients exercise during treatment? And does that improve their likelihood of survival? Increasing Physical Activity Can Help Cancer Patients Survive Longer: The study, known as the CHALLENGE trial, hit a home run. The investigators recruited 889 people who had just had surgery and chemotherapy for their colorectal cancer. They randomly assigned half of them to get a health education booklet urging them to eat right and stay active. The other half got the booklet (usual care) PLUS a personalized exercise prescription designed to increase the amount of moderate to vigorous physical activity people did over the week. How Did This Challenge Work? The exercise prescriptions were devised by personal trainers who met with the “intervention” patients every two weeks for a year. Half of the meeting was devoted to motivational coaching and the other half to moving. Patients loved it. Increasing their fitness also improved their quality of life. In addition, patients in the exercise intervention group had better immune function and lower inflammation and less insulin-like growth factor, which can contribute to tumor expansion. Both men and women participated in this trial. During the follow-up period, women who were active were less likely to develop breast cancer than those in the control group. Similarly, men in the intervention group had a lower chance of a prostate cancer diagnosis. The most exciting part of the story, however, is about their colorectal cancer treatment. Not only did patients in the physically active group have longer overall survival, they also had longer disease-free survival. Remember, these two groups have the same type of cancer and got the same kind of treatment, except for the exercise prescription. The overall 8-year survival was 90.3% in the exercise group and 83.2% in the health education control group. That means the exercisers lowered their chance of dying during those eight years by 37%. The Number Needed to Treat (NNT) was 14 exercisers to prevent one death. That is a remarkable statistic. How Did Cancer Patients Get Motivated to Move? If you’ve ever started an exercise program only to drop it a few weeks later, you are not alone. Keeping ourselves motivated to stay active isn’t always easy unless you really love what you are doing. (Joe needs no extra motivation to show up for tennis.) Consequently, it is impressive that a very high proportion of the cancer patients in the CHALLENGE trial kept exercising. Part of that perseverance might be due to the motivational coaching. No doubt another big part was the relationship with the personal trainer. Meeting with a person every two weeks for a year can help build friendships and creates a relationship in which accountability is a factor. After the first year, patients and trainers met every month for the next two years. Being able to increase physical activity was empowering for patients, giving them a sense of control that can otherwise be missing in a cancer patient’s life. What Did Cancer Patients Do? The exercise prescriptions were personalized, so people undertook a wide range of activities. Jogging and walking were popular, but some people swam, and others kayaked. There were patients who bicycled, and possibly some who rode horses. (Dr. Booth does not mention that.) The point was to find an activity you love and stick with it religiously, which they did. The most popular activity by far was also the simplest: walking. The idea was to walk at a pace so you looked like you were late for a meeting. Is It Feasible to Help Cancer Patients Survive & Thrive? One of the most exciting aspects of the CHALLENGE trial was to see that people responded to coaching. Personalized exercise prescriptions with accountability could be instituted into many cancer treatment programs. After all, if insurance pays for cardiac rehab, why shouldn’t it pay for cancer rehab? The cost of a personal trainer is about $3,000 to $5,000 over three years. That is a lot less than the next-level chemotherapy drug is likely to cost, and unlike chemo, the side effect is that the patient feels better. Not only is it feasible to help cancer patients survive through targeted exercise, it should be a part of most cancer treatment protocols, In Summary: Dr. Booth offered us this explanation of how the treatment works: “Exercise is inducing physiologic, hormonal, inflammatory, immunologic changes in the body that are helping the body eradicate a proportion of these cancer cells. ‘ Learn More: Dr. Booth is a medical oncologist. To complete this trial, he called on the expertise of a lot of colleagues, including exercise physiologists. Next week, we will speak with Claudio Battaglini, PhD, to get the exercise physiologist’s perspective on this important approach. This Week’s Guest: Christopher Booth, MD, is a medical oncologist and health services researcher at Queen’s University in Kingston, Ontario, Canada. • Director, CCE Division, Queen’s Cancer Research Institute (QCRI) • Medical Oncologist • Clinician-Scientist, Cancer Centre of Southeastern Ontario • Professor, Departments of Oncology and Medicine, Queen’s University • Canada Research Chair in Population Cancer Care https://scri.queensu.ca/faculty-staff/christopher-booth Christopher Booth, MD, Queen’s University Listen to the Podcast: The podcast of this program will be available Monday, August 18, 2025, after broadcast on August 16. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

We may not often stop to think about it, but our water, food, furniture and other ordinary items are frequently contaminated with toxic chemicals. In this episode, Dr. Aly Cohen describes these threats to our health. You may have heard of compounds that can disrupt hormonal balance (endocrine disruptors). Everyday toxins like these can also interfere with the ability of the immune system to function properly. What can you do to reduce your exposure? How You Can Listen: You could listen through your local public radio station or get the live stream on Saturday, Aug. 9, 2025, at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Aug. 11, 2025. Doing an Environmental Assessment: As a rheumatologist, Dr. Cohen frequently treats patients whose immune systems have turned on them to produce conditions like lupus or rheumatoid arthritis. As an integrative medicine practitioner, she has learned to look at the patient’s environment for clues about the toxic compounds that may be causing the problem. The first environmental assessment she conducted was actually for her beloved family dog, Truxtan. When he developed autoimmune liver disease, she tried to figure out why. How Everyday Toxins Disrupt the Immune System: Dr. Cohen wasn’t able to save her dog, but the experience made her realize just how many potentially toxic chemicals we are exposed to in the course of our daily lives. If you look around your kitchen, you may discover that most of your food containers might be suspect. Plastic is incredibly convenient, since it is lightweight, break-resistant and cheap. But it often contains plasticizers such as bisphenols or phthalates that are endocrine disruptors. Some can disrupt the immune system as well. After all, immune system cells interact with the endocrine system on a regular basis. The two are tightly linked. Other food packaging can also contribute undesirable compounds such as PFAS. Exposure to these may lead to chronic inflammation. Dr. Cohen tells about a patient, Massimo, who ran a pizza shop. A young man, he had troubling fatigue. Changing his routine so that he wore nitrile gloves while handling pizza boxes helped a lot. So did bicycling to work. Everyday Toxins in Our Water: How safe is your water? One of Dr. Cohen’s patients had moved to New York from a Latin American country. Although she had filtered her water in her home country, she believed the tap water in New York was safe. It turned out the old plumbing in her building was contaminated with lead. In addition, she was relying on rice as a food staple, and it was contaminated with arsenic. Lead and arsenic are well-recognized as toxic chemicals. Filtering her water and washing her rice helped her feel much better. How do you make sure your water is free of everyday toxins? Dr. Cohen says several types of filtration devices can be useful, if they are used according to instructions. That means changing the filter medium on the recommended schedule. Any filter is better than no filter, but by far the best approach is known as reverse osmosis. This results in clean water you can trust to be free of toxins. Can You Avoid Plastic? The topic of water is almost inextricably linked to the question of plastic. Much of the water sold for consumption away from home is bottled in plastic. In addition to environmental considerations, this can expose us to plasticizers such as phthalates or even to tiny bits of plastic known as microplastics. These are accumulating in our bodies and may be harming our immune system. Bottles are not the only source of plastic in our food supply. Most cans are lined with a resin to prevent corrosion. This frequently contains BPA, bisphenol A, as a plasticizer. Some manufacturers have switched to another bisphenol instead. Thus, they can claim that the can is BPA-free, but it isn’t necessarily safer. Don’t Use Plastic Containers in the Microwave! One simple rule that can cut down on a lot of exposure to immune-disrupting plasticizers is don’t microwave food in plastic containers. Heat tends to speed leaching of plasticizers from the containers into the contents. Yes, we know a lot of frozen meals come in plastic containers that are supposedly microwave-safe. Don’t believe them. Instead, transfer the food to a glass or ceramic dish or bowl and heat it in that. That way you know you’re not getting any extra plasticizer in your snack. Prioritize! Dr. Cohen points out that to get the best results from efforts to avoid everyday toxins, we need to figure out where the exposure is greatest. That’s why she usually likes to start with cleaning up the water supply, since for most of us that is our top exposure. Analyzing your diet and focusing on foods you eat often is another way to prioritize. Those are the foods that should be free of toxins if at all possible. She recommends using the EWG (Environmental Working Group) lists of the “Dirty Dozen” foods that often contain pesticides and the “Clean Fifteen” foods that are generally safe.  For the Dirty Dozen, it makes sense to purchase USDA Organic produce whenever possible. Removing Pesticides: Dr. Cohen offers some simple, inexpensive ways to wash your produce and get the pesticide off. Add 1 part vinegar to 3 parts filtered water and let the fruit or vegetables soak in that for several minutes. Then rinse it off well with filtered water. The 21-Day Plan: To make it easier for people to implement the changes and avoid everyday toxins, Dr. Cohen offers a 21-day plan. It offers steps to avoid lots of harmful chemicals including obesogens (chemicals that make us fat). One simple way to take the first steps, after filtering the water you drink, is to carry a metal spoon and fork. That way you won’t have to resort to using plastic utensils to eat hot food, especially soup. Another step is to be cautious with skin care products. Using the online EWG guide SkinDeep can help you find sunscreen or moisturizer that is mostly free of undesirable agents. When shopping, make it a habit to seek out USDA Organic certified products for those items you eat most. Learn More: Dr. Cohen is not the only doctor concerned about toxic exposures. A summary of research into the “exposome” was published in JAMA last spring. Here’s a link. This Week’s Guest: Dr. Aly Cohen is a board-certified rheumatologist and integrative medicine physician. A member of the faculty of the Academy of Integrative Health and Medicine, Southern California University of Health Sciences, and the University of California, Irvine, she is a leading medical and legal expert in environmental health. Dr. Cohen is creator of TheSmartHuman.com social media platform, and the co-author of the bestselling consumer guidebook Non-Toxic: Guide to Living Healthy in a Chemical World. Her latest book is Detoxify: The Everyday Toxins Harming Your Immune System and How to Defend Against Them. Her website is https://alycohenmd.com/ Aly Cohen, MD, author of Detoxify The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Listen to the Podcast: The podcast of this program will be available Monday, August 11, 2025, after broadcast on August 9. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

In this episode, our guest, Dr. Andrew Armstrong of Duke University, discusses recent advances that men should know to overcome prostate cancer. We ask about former President Joe Biden’s diagnosis. What does it mean to have Stage IV prostate cancer and a Gleason score of 9? News outlets have reported that Mr. Biden’s previous prostate screening test was in 2014. How often should men be tested for this common cancer? What does the PSA (prostate specific antigen) test really tell us? How You Can Listen: You could listen through your local public radio station or get the live stream on Saturday, Aug. 2, 2025, at 7 am EDT on your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Aug. 4, 2025. How Do We Detect Prostate Cancer? Prostate cancer affects one man out of every eight in the course of a lifetime. Fortunately, if it is caught early and treated appropriately, most men do not die of this disease. They die of something else, even if they may still have prostate cancer cells. For years, the mainstay of prostate cancer screening has been the level of PSA, prostate specific antigen. Although it is specific to prostate, it is not really specific to prostate cancer. All prostate cells make it, so doctors watch for unusual increases in PSA. That suggests a rapid growth of the prostate, which could be caused by prostate cancer. Not every prostate cancer produces large amounts of PSA, though. That’s why urologists watch for changes rather than using a threshold number. Men with a family history of prostate cancer are at higher risk for developing it themselves. Ideally, they would start screening at a younger age and possibly have it done more frequently. In men who have a limited life expectancy, doctors may not recommend prostate screening. PSA alone is just the first step. If PSA is elevated or if it is rising, men will need further workup. What Is Next to Overcome Prostate Cancer? Often the next step is imaging. Magnetic resonance imaging of the prostate can be very informative. If there is a suspicious area on the MRI, the doctor will schedule a biopsy. Current practice is to use the MRI and ultrasound to guide the biopsy, so that the tissue examined is from the area thought to harbor the tumor. Grading the Tumor: The tissue removed during the biopsy will be examined by a pathologist. That expert will use the characteristics of the cells in the tissue to assign it a Gleason score. These range from 6 (not very worrisome) to 10 (the most aggressive). Former President Biden’s cancer had a Gleason score of 9, which is serious. Doctors also want to know if the tumor has spread beyond the prostate gland itself. To find out, they may conduct a PSMA PET scan. This picks up prostate-specific membrane antigen (hence PSMA) wherever it may be in the body. Stage IV, like former President Joe Biden’s cancer, has spread outside the prostate to other parts of the body. In his case, the cancer has metastasized to his bones. In some cases, prostate tissue will be sent for genetic testing. BRCA2 is associated with breast and ovarian cancers, but men who carry this gene are more vulnerable to prostate cancer as well. Approaches to Preventing Prostate Cancer: The risk of prostate cancer appears to be roughly half hereditary and half environmental. That means there are things that men can do to reduce their risk. Avoiding environmental toxins is crucial. Plastics and plasticizers don’t belong in our food or our bodies. Diet matters, of course. Not everyone loves broccoli, Brussels sprouts, cabbage and cauliflower, but getting plenty of these cruciferous vegetables can help reduce the risk of prostate cancer. Another important step is to focus on exercise. Not only can regular vigorous physical activity reduce the chance of developing prostate cancer, it also is very useful in counteracting the side effects of the powerful drugs used to overcome prostate cancer. Options for Treating Prostate Cancer: Blocking Testosterone: Often the doctor prescribes leuprolide (Lupron) to shut down testosterone production. That part of the protocol is referred to as “androgen deprivation therapy” or ADT for short. An even more powerful androgen blocker such as abiraterone (Zytiga), apalutamide (Erleada), darolutamide (Nubeqa) and enzalutamide (Xtandi) may be added. These drugs can help men overcome prostate cancer, which seems to thrive on testosterone. Blocking the androgen receptors with one of these medicines has made treatment for prostate cancer more effective. Androgen blockers stop testosterone formation even further and thus discourage the growth of the cancer. That’s the benefit. The downside is that men suffer the effects of “low T.” Here is where exercise stars, helping men feel better even when their testosterone levels are nonexistent. Other Treatments for Prostate Cancer: There are nonhormonal approaches to treating prostate cancer that may be used in conjunction with androgen blocking or in some cases independently. One is surgery, in which the prostate is removed. That used to be the standard treatment. With new approaches available, it is one option among many. Another is radiation. Dr. Armstrong describes some of the different types of radiation, which can be very effective when used together with androgen blocking medication. There are also immune therapies. One exciting new therapy, called Pluvicto uses radioligands that seek out and attach to PSMA. Because it can find prostate cancer cells wherever they are in the body, it is being considered for treating metastatic prostate cancer when ADT may no longer be working well. What to Know to Overcome Prostate Cancer: Dr. Armstrong wants men to know that prostate cancer can be detected early; when it is, it is often curable. Even in the case of advanced disease, there is hope. He urges men to ask for second opinions on treatment and take advantage of a multidisciplinary team when possible. Above all, he says: “The good news is that treatment can extend life often dramatically, and that many men, most men in fact with prostate cancer, don’t die of prostate cancer. They die of other stuff.” This Week’s Guest: Andrew J Armstrong, MD, ScM, FACP, is Professor of Medicine, Surgery, Pharmacology and Cancer Biology at Duke University. He is Director of Research at the Duke Cancer Institute Center for Prostate and Urologic Cancers. His appointments are in the Division of Medical Oncology in the Departments of Medicine and Urology at Duke University. Dr. Armstrong is one of the country’s leading prostate cancer researchers. Andrew Armstrong, MD, Professor of Medicine, Surgery, Pharmacology and Cancer Biology at Duke University. Listen to the Podcast: The podcast of this program will be available Monday, August 4, 2025, after broadcast on August 2. In this week’s podcast, Dr. Armstrong describes how to find trustworthy information online. We discuss diet, exercise and natural approaches that can be helpful in preventing and recovering from prostate cancer treatment. When will medical centers recognize the value of personalized, structured exercise for cancer rehab, as they already do for cardiac rehab? You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

In this episode, two experts draw on the latest research about avoiding Lyme disease and other infections that may be transmitted through tick bites. Why are these conditions so difficult to diagnose? Most importantly, how can people with lingering symptoms from Lyme get help and start to feel better? We consider both conventional and alternative approaches. You may want to listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on July 26, 2025. The Basics of Lyme Disease: We begin with a quick review of the history of Lyme disease, which was first identified in Old Lyme, Connecticut, in the 1970s. Researchers eventually identified the pathogen causing the symptoms as Borrelia burgdorferi and means of transmission as bites from a black-legged tick (aka deer tick). Even though it was originally thought to be limited to New England, epidemiologists now recognize that Lyme disease is widespread across the country. Half a million people will come down with Lyme disease this year. Many others will suffer symptoms from other pathogens transmitted through tick bites. Persistent Symptoms of Lyme Disease: For much too long, doctors thought that any symptoms persisting after a course of antibiotics were psychosomatic. Patients were understandably distressed by this dismissal of their suffering. Many people report fatigue, body aches and brain fog. Some have difficulties with balance or feeling weak or faint when they stand and have been diagnosed with POTS (postural orthostatic tachycardia syndrome). Headaches, rashes, heart palpitations and joint pain may also be part of the picture. If you think some of these symptoms ring a bell, you are right. Many people with long COVID or even chronic fatigue suffer with similar problems. Avoiding Lyme or Treating It Over the Long Term: One of our expert guests, Dr. John Aucott, does research on Lyme disease and directs the Johns Hopkins Lyme Disease Clinical Research Center. His study utilizing functional MRI was very revealing. When regular imaging studies are done on people with persistent Lyme disease symptoms, the results are not particularly striking. But functional MRI results, when people are asked to do cognitive tasks while undergoing magnetic resonance imaging, show a different picture. These people’s brains are not functioning normally. No wonder they are upset about brain fog or struggling to concentrate! There are several possible explanations for why Lyme disease symptoms may persist. The spirochete responsible for these symptoms does not require oxygen and is very good at “hiding out” within tissues. When reactivated, it could cause symptoms. On the other hand, the immune system may become hyper-activated and have a hard time calming down. That too could contribute to symptoms. Non-governmental organizations have funded the Study of Lyme Immunology and Clinical Events (SLICE). In this trial, researchers have identified some risk factors associated with post-treatment Lyme disease (PTLD, aka long Lyme). They are also enrolling patients in a treatment trial. Standard of Care for Lyme Disease: Naturopathic doctor Alexis Chesney points out that there are different standards of care for Lyme disease. The CDC has published guidelines for treating “four important manifestations of Lyme disease.” Those are erythema migrans (the classic “bulls-eye” rash), neurologic Lyme disease, Lyme carditis and Lyme arthritis. The International Lyme and Associated Diseases Society (ILADS) offers its own treatment guidelines. Both experts agree that early treatment is preferable to late treatment. Dr. Chesney describes the ability of the Borrelia spirochete to protect itself by changing to a “round form” as well as by forming a biofilm that wards off antibacterial medicines. One way to combat this is by utilizing herbs that can counteract biofilm formation, such as cats’ claw or Japanese knotweed. She also pays attention to supporting patients experiencing a Herxheimer reaction, in which dying spirochetes release toxins. This can make a person feel very ill indeed. Natural ways to mitigate this response include milk thistle, burdock or Epsom salt baths. Avoiding Lyme Disease by Preventing Tick Bites: Even better than early treatment is prevention. The best prevention is to avoid tick bites. Wear shoes and socks that have been treated with permethrin. (Do not apply permethrin directly to the skin.) Using an effective insect repellent also helps, and a thorough tick check upon coming in from outdoors is indispensable. It takes ticks some time to transmit Borrelia, so prompt tick removal can help prevent illness. This Week’s Guests: Dr. John Aucott is the Barbara Townsend Cromwell Professor in Lyme Disease and Tick-borne Illness at the Johns Hopkins University School of Medicine. An infectious diseases specialist and Lyme disease expert in the Division of Rheumatology, he is the director of the Johns Hopkins Lyme Disease Clinical Research Center. https://www.hopkinslyme.org/ John Aucott, MD, Johns Hopkins University Alexis Chesney, MS, ND, Lac, is a naturopathic physician, acupuncturist, author and educator. Since 2010, Dr. Chesney has worked with people of all ages on chronic disease, general wellness, nutrition and lifestyle counseling. She has dedicated herself to working with clients who have complex chronic illness, and who often have diagnoses such as Lyme and vector-borne diseases, mold toxicity, mast cell activation syndrome, among other conditions. Dr. Chesney is the author of Preventing Lyme & Other Tick-Borne Diseases: Control Ticks in the Home Landscape; Prevent Infection Using Herbal Protocols; Treat Tick Bites with Natural Remedies. Dr. Chesney offers an online course, Preventing Lyme and Tick-Borne Disease: Ticks and Tick-Borne Diseases, Prevention, and Acute Lyme & TBD Treatment. Here is the link: https://health-transformations.teachable.com/p/preventing-lyme-and-other-tick-borne-diseases. Her website is https://www.dralexischesney.com/ Alexis Chesney, MS, ND, Lac, author of Preventing Lyme and Other Tick-Borne Diseases Listen to the Podcast: The podcast of this program will be available Monday, July 28, 2025, after broadcast on July 26. You can stream the show from this site and download the podcast for free. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

This week, we welcome dermatologist Dr. Chris Adigun to our studio to answer your questions about summer skin problems. You can call in your stories and questions about bites, burns and blisters between 7 and 8 am EDT on Saturday, June 21, 2025, at 888-472-3366. Or you can send us your question or story ahead of time by email: radio@peoplespharmacy.com. You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on July 21, 2025. The Link Between Sun Exposure and Skin Cancer: Intense summer sunshine can cause sunburn and skin damage. The most worrisome consequences are skin cancers that may show up on cheeks, ears, noses, lips or other unexpected places. How can you recognize a potential skin cancer? What will the dermatologist do about it? Even more important, can you reduce your risk for basal or squamous cell carcinoma? (Those are technical terms to describe skin cancers that are not melanoma.) What are the best ways to avoid harming your skin while you are enjoying the great outdoors, whether you are at the beach or on the hiking trail? Are there criteria you can use to choose the best sunscreen without spending a fortune? How often do you need to apply it? Can you get enough vitamin D compounds if you wear a high SPF sunscreen? Are there skin conditions that might actually benefit from a bit of sun and salt water? Lowering Your Chance of Melanoma: The relationship between sun exposure and melanoma is less clear than that between sun and basal or squamous cell cancers. Find out what might make a spot suspicious. Where should you be checking your skin? What can a dermatologist do to help? Heat and Humidity Challenges: In addition to sun, heat and humidity can challenge our skin. Fungal infections may proliferate under those conditions, resulting in athlete’s foot, jock itch or under-breast rash. Can we make our sweaty skin less hospitable to fungi? Have you been troubled with heat rash? We’ll find out what it is and what to do to get rid of it. Other Summer Skin Problems: Long summer hikes can result in more trouble than sunburn or sore muscles. Unless you are very careful with your shoes, sweaty feet can develop blisters. Are there good preventive strategies? If you get a blister anyway, what can you do to ease the pain–and keep it from getting worse? Bug bites may also be the bane of your existence. Chiggers hang out in grass or brush waiting to take a bite of a tasty mammal walking by. Can you avoid or discourage them? And if you do get chigger bites, how can you manage the dreadful itch? We also want to avoid bites from ticks and mosquitoes. They may have different niches and behaviors, so avoiding them may require different tactics. What works best? How can you choose a good insect repellent for outdoor activities, and will it interact with your sunscreen? Poison Ivy and Its Cousins: Poison ivy, poison oak and poison sumac all contain the resin urushiol, which can be extremely irritating to sensitive skin. Do you know how to identify these plants so you can avoid them? If you find yourself in the middle of a poison ivy thicket, can you take quick action and reduce the chance of a rash? If you end up with a rash–it happens–we’ll find out how you can ease the suffering. Call in Your Questions About Summer Skin Problems: Dr. Chris Adigun will be in our studio to answer your questions about bug bites, blisters, burns and other summer skin problems from 7 to 8 am EDT on July 19, 2025. Give us a call to ask a question or share a story: 888-472-3366 or email us ahead of time: radio@peoplespharmacy.com This Week’s Guest: Chris G. Adigun, MD, FAAD, is a board-certified dermatologist who practices both general dermatology and cosmetic dermatology at the Dermatology and Laser Center of Chapel Hill, NC. Dr. Adigun is devoted to increasing public awareness of skin cancer and the harmful effects of UV rays—both medical and cosmetic. She specializes in both nail disorders and laser treatments. Dr. Chris Adigun, dermatologist, with People’s Pharmacy hosts Joe & Terry Graedon Listen to the Podcast: The podcast of this program will be available Monday, July 21, 2025, after broadcast on July 19. You can stream the show from this site and download the podcast for free. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

In this episode, we acknowledge the many reasons that people may be feeling anxious or depressed. It often seems that current conditions are designed to break our brains. Perhaps that’s why 60 million Americans suffer from depression or anxiety. Not everyone who might be feeling nervous or down in the dumps deserves a diagnosis. However, they can benefit from the practices we discuss in this hour. Pharmaceutical approaches such as antidepressants can be helpful for people with depression, especially in the short term. Over the long haul, though, we might want to consider whether changing our habits could help us develop the resilience we need. After all, antidepressants frequently result in side effects. Moreover, many people find it difficult to discontinue an antidepressant. Anti-anxiety agents carry similar risks. Scientific research has shown us the importance of neuroplasticity. Can we tweak our neurochemistry by embracing some simple tenets for living? We don’t really have broken brains, but we might be lacking the skills we need to pursue robust mental fitness. Where will we learn them? How You Can Listen: You could listen through your local public radio station or get the live stream on Saturday, July 12, 2025, at 7 am EDT on your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on July 14, 2025. Staying Connected Protects Our Brains: Good nutrition, adequate sleep and regular exercise are all pillars of mental as well as physical health. Our guest, integrative psychiatrist Drew Ramsey, says staying connected with others is equally important. Cultivating a variety of connections is crucial for our mental health, including friends, family and even casual acquaintances. We should keep in mind that building community is different from building friendships; we need both for mental fitness. Social isolation can be damaging both for teenagers and for older individuals. Can we use social media to bolster our support systems rather than allowing them to wither? What skills can we help our teens acquire? Dr. Ramsey described a study, the AMEND trial, that combined social connection through social media with learning to cook. The young men in the study posted their cooking experiments on Instagram and bonded with each other over the experience. Adopting a more healthful diet also reduced the youths’ risk for depression. Maybe Ultra-Processed Food Breaks Our Brains: One aspect of nutrition that is important to consider is how our food affects our microbiota. Our gut microbiome has a powerful influence on inflammation in our bodies. After all, the immune system is in part anchored in the gut, especially in the gut microbiome. When the microbiome gets disrupted and inflammation rises, our mood and mental health can suffer. What should we be eating to feed our microbes and keep them happy? Dr. Ramsey offers a little rhyme as a mnemonic: “Seafood, greens, nuts & beans…and a little dark chocolate.” We admit the last line breaks the rhyme, but it isn’t too hard to remember! When we asked what foods to focus on for healthy gut microbes, he suggested lentils. Although they are not technically beans, as in the rhyme, they are legumes and contain lots of fiber that helps gut microbes flourish. Dr. Ramsey also extolls the benefits of microgreens, another food that gut microbes love. The microbiome acts as a master dial on our immune system and inflammation levels. Beyond Diet and Activity: Dr. Ramsey provides nine tenets for reclaiming robust mental health, even when we may feel like our situation breaks our brains. In addition to thoughtful nutrition, adequate sleep and reliable physical activity, he also stresses the importance of unburdening yourself of past trauma. This need not have been anything as major as a traffic accident or losing a parent, though such experiences are certainly traumatic and deserve attention. Even minor traumas like being picked on as a child can affect our sense of well-being. Unburdening is the process of acknowledging those and trying to understand where our past is tripping us and blocking our efforts to be mentally healthy in our present. Unburdening yourself can leave you feeling freer to pursue your goals. It helps ground you so that you can pursue your purpose. Journaling, therapy or creative pursuits could all help with unburdening. How Can You Find Your Purpose? Finding your purpose might not sound like a step towards better mental fitness, but it is. How do you know when you have found your purpose? Focusing on a sense of identity and of fulfillment will help you with this. Finding a sense of purpose is important at every stage of life, but it may be especially important for older individuals. A job is not synonymous with purpose, although at times they may overlap. Sometimes, people who have relied on work to provide their sense of purpose find themselves at loose ends when they retire. This Week’s Guest: Drew Ramsey, MD, is a leading board-certified integrative psychiatrist, best-selling author and leading proponent of Nutritional Psychiatry and Mental Fitness. He served as an Assistant Clinical Professor of Psychiatry at Columbia University in the Vagelos College of Physicians and Surgeons for twenty years. Dr. Ramsey is founder of the Brain Food Clinic in New York City and Spruce Mental Health in Jackson, WY. He is the author of several books, including his latest book, Healing the Modern Brain: Nine Tenets to Build Mental Fitness and Revitalize Your Mind. The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Drew Ramsey, MD, author of Healing the Modern Brain Listen to the Podcast: The podcast of this program will be available Monday, July 14, 2025, after broadcast on July 12. In this week’s podcast, Dr. Ramsey offers further discussion of the idea of finding your purpose and how to do that even after retirement. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.