This week, two distinguished exercise physiologists tell us why we each need an exercise prescription for life. Dr. Benjamin Levine has worked with the Dallas Bed Rest and Training Study to discover that three weeks of bed rest hurt fitness more than 30 years of normal life. Dr. Claudio Battaglini provides exercise prescriptions for cancer patients so that they will be in better health once they recover from their malignancy.

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 January 20, 2025.

A lot of people think they should exercise, but they just don’t feel like it most of the time. Perhaps when you first started flossing your teeth, that’s how you felt about it. Many of the things we do every day as part of our daily hygiene–shower and shampoo, wash the dishes, change our clothes–aren’t exactly fun, but we feel better when we do them. Dr. Levine argues that we should approach physical activity in much the same way. If we build activity into our daily routine rather than make it a special event that requires extra scheduling and effort, it has the power to improve our health.

No question here–the best exercise is that one you actually do. Perhaps, like Joe and Dr. Levine, you love playing tennis. Because that is fun, you make time for it whenever you can. Maybe you love running, or dancing, or swimming or walking in the woods. Whatever you most enjoy is a good place to anchor your exercise prescription.

Tennis is great for those who love it, but it isn’t enough all by itself. We also need to pay attention to the “dose.” We each need a time in the week when we exercise intensely. Dr. Levine likes a Norwegian approach called 4 by 4. You exercise as hard as you can for four minutes, then rest for three minutes. Repeat that sequence four times. There are other ways of getting intense activity as well: running up stairs works for some folks. Others like cycling. If you can’t manage it on your own, recruiting friends or signing up for a class may help.

All of us need to strengthen our muscles and bones as well. Consequently, we should find a way of challenging them with resistance training. This could be pushups, pullups, squats or burpees. Or it could be working out with weights or on machines designed to help you build strength.

Back in the 20th century, heart attack patients were often told to avoid exerting themselves. The current thinking is that people need to start moving as soon as possible after a heart attack, gently at first, walking around the room or in the hospital corridors. Once they are ready for discharge, the exercise prescription will probably be for a cardiac rehabilitation exercise program with careful cardiac monitoring. For most people, that will last about three months and insurance pays for it. Then they can graduate to un-monitored exercise.

When people are recovering from an injury, they also need an exercise prescription so they won’t lose too much fitness before they are better. This probably will mean 20 to 30 minutes a day of physical activity that doesn’t put stress on the injured limb.

Our conversation with Dr. Battaglini began with him clarifying the roles of the different types of exercise specialists. The exercise physiologists, like him, are research scientists. Trainers and physical therapists put the data the exercise physiologists discover into practice. The trainer helps athletes achieve their best performance while the physical therapist helps an injured person recover to the best of their ability. In both cases, they are using evidence to provide an exercise prescription.

Dr. Battaglini’s area of practice and research has been with cancer patients. Staying physically active throughout our lives can help reduce our risk for many cancers. However, if a person develops cancer, the treatment can be grueling and lead to fatigue. As with heart disease, thinking has changed. Oncologists used to think that physical activity would make their patients’ fatigue worse. Now, however, the evidence shows that appropriate activity can actually reduce fatigue. The exercise prescription must be personalized to the patient.

In the course of his work, Dr. Battaglini was providing exercise programs for breast cancer patients. Each patient had one-on-one attention from a student or intern who served as the coach. But when he read the evaluations from the patients, many wished they could be exercising in a group with other patients. When he made that change to the program, it was a great success. Each one followed her individual exercise plan, and the group provided each other with strong emotional support.

One barrier to using exercise more broadly in the treatment of cancer patients is that insurance companies have not gotten on board. The lack of reimbursement makes it more difficult for cancer centers to provide this important healing service.

Benjamin Levine, MD, FACC, FACSM, FAPS, FAHA, is a Professor in the Department of Internal Medicine at UT Southwestern Medical Center and a member of the Division of Cardiology. He holds the Distinguished Professorship in Exercise Sciences. He is the founding Director of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, where he also holds the S. Finley Ewing Jr. Chair for Wellness and the Harry S. Moss Heart Chair for Cardiovascular Research. https://utswmed.org/doctors/benjamin-levine/

Dr. Benjamin Levine

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.

The podcast of this program will be available Monday, January 20, 2025, after broadcast on Jan. 18. You can stream the show from this site and download the podcast for free.

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This week, we hear a first-hand account of what a stroke feels like, from neuroanatomist Dr. Jill Bolte Taylor. Then we learn from a neurologist, Dr. Matthew Schrag, about the risk factors for such a brain attack. What treatments could be helpful?

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 January 13, 2025.

According to the Centers for Disease Control and Prevention (CDC), almost 800,000 Americans suffer a stroke each year. We are calling this a brain attack because, like a heart attack, it is preceded by risk factors and may be followed by lasting damage. How can we reduce our risk?

We spoke with Dr. Jill Bolte Taylor in 2021 about her book, Whole Brain Living. During that interview, she described her experience with a bleeding stroke and explained the unusual anatomical connection between artery and vein that led to the devastating hemorrhage in her brain. We include part of that interview in this episode. If you would like to hear her entire account, you can listen here.

There are two different types of brain attack, both involving the blood vessels to the brain. In Dr. Taylor’s case, the blood vessels broke open and bled into the brain. Such a hemorrhagic stroke is less common, but it can be even more damaging than an ischemic stroke caused by a blood clot in an artery serving the brain. Such blood clots account for 87% of strokes. Thus, reducing the likelihood of blood clots is an important step to reducing the risk of a brain attack.

Beyond the type of congenital malformation that was responsible for Dr. Jill Bolte Taylor’s bleeding stroke, we need to pay attention to the integrity of the blood vessels in the brain. Some medications such as fluoroquinolones weaken blood vessels.  People who are on anticoagulants, sometimes termed “blood thinners,” may also be at increased risk for bleeding in the brain. Pre-existing conditions such as cerebral amyloid angiopathy may also boost the chance of bleeding into the brain.

As mentioned, the other type of brain attack is caused by a clot in the blood vessels leading to the brain. Conditions that can lead to clot formation raise the likelihood of this type of stroke. These include atrial fibrillation, a heart rhythm abnormality in which blood may pool in a portion of the heart rather than rushing through it out into the body. Such stagnant blood is prone to clot, and after it does, the clot may be pumped into the circulation to the brain. That is why people with Afib, as it is often called, usually take prescribed anticoagulants.

Some medications may also increase the risk of clotting. These include birth control pills, especially when women are also taking NSAIDs. These pain relievers such as diclofenac, ibuprofen or naproxen can also trigger the formation of blood clots on their own.

Perhaps the most important step to take is to keep blood pressure under control. That may be easier said than done, but it has a big impact. People with well-controlled blood pressure reduce their risk for a stroke of either type by about 70%. As a result, we should all know our blood pressure. Just as we have a home scale to keep track of our weight, a home blood pressure monitor is an essential piece of home health equipment. The ideal blood pressure measurement is within 10 points of 120/80. Blood pressure that is consistently higher deserves a doctor’s attention.

There are other preventive steps as well. People who smoke should cut back or quit. Smoking is bad for blood vessels, but you knew that. We discussed Afib as a risk factor. Smart watches can now detect this heart rhythm so that it can be addressed in a timely fashion.

Elevated cholesterol is also bad for blood vessels in the brain as well as around the heart, so a careful doctor will address that, too. Two important factors that are under our personal control are physical activity and diet. Keeping active on a regular basis is a foundation for good health, including brain health. A diet that emphasizes less processed foods with plenty of produce, such as a Mediterranean-style diet, can also bolster health and reduce the risk for a brain attack.

Time is of the essence when it comes to treating strokes. The sooner a brain attack is treated, the better the outcome is likely to be. That’s why we should all be aware that sudden onset of symptoms such as slurred speech, vision problems (especially on one side), facial drooping or asymmetric expression, weakness or trouble with movement should prompt a call to 911. Do NOT drive yourself to the ER but get there as quickly as possible and let triage know you are concerned about a stroke.

Bleeding and clotting tend to cause similar symptoms, but determining the type of stroke is crucial. Once a person shows up at the emergency department, the staff there will arrange a CT scan to see what is happening. For a stroke caused by a clot, an anticoagulant can be very useful, but it would be exactly the wrong thing for someone who is already bleeding. If the problem is a clot, the image should tell the doctors where it is. There is now a device that can be threaded into the blood vessels to fish the clot out. This approach is showing great promise. Another treatment is for people with Afib to prevent them from forming clots. It is a surgical procedure called a left atrial appendage closure that eliminates a pocket in the heart where blood tends to pool before it clots.

People used to think that stroke victims would not make much progress beyond the immediate aftermath. We now know that is far too pessimistic. Rehabilitation requires hard work, but physical therapy and speech therapy can make a huge difference. People who are conscientious about their rehab can continue to make progress for a long time, as Dr. Jill Bolte Taylor demonstrated. She had to re-learn to walk and talk, but as you can hear, she did that very well. Dr. Schrag suggests that in some cases experimental treatments such as nerve graft or stem cell transplantation may also be helpful. In the future, doctors should know far more about when and how to apply such therapies.

Jill Bolte Taylor, Ph.D., is a Harvard trained and published neuroanatomist. Dr. Taylor has been the national spokesperson for the Harvard Brain Tissue Resource Center (Brain Bank). She was one of Time magazine’s 100 Most Influential People in the World for 2008, and her TED talk ‘My Stroke of Insight’ was the first TED talk to go viral on the internet. Dr. Taylor is the author of the memoir My Stroke of Insight: A Brain Scientist’s Personal Journey. Her most recent book is Whole Brain Living: The Anatomy of Choice and the Four Characters That Drive Our Life.

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Matthew Schrag MD, PhD, is Assistant Professor of Neurology at Vanderbilt University School of Medicine and Director of the Cerebral Amyloid Angiopathy Clinic. His specialty is the overlap between vascular and cognitive neurological diseases. The Schrag Lab is focused on discovering shared molecular pathways between Alzheimer disease and cerebral amyloid angiopathy. His website is https://medschool.vanderbilt.edu/brain-institute/person/matthew-schrag-m-d-ph-d/

Matthew Schrag, MD, PhD, Vanderbilt University

The podcast of this program will be available Monday, January 13, 2025, after broadcast on Jan. 11. You can stream the show from this site and download the podcast for free.

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This week, we hear from pulmonologist Roger Seheult, MD, about ways we can strengthen our immune responses to respiratory infections. Seasonal influenza activity is high and still rising in most parts of the country. In addition, wastewater surveillance shows that COVID-19 cases are on the rise. Cold viruses are also circulating. Find out what strategies you can take to stay healthy and what to do if you catch the flu.

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 January 6, 2025.

Sometimes it can be challenging to tell whether a sore throat with a cough or a stuffy nose is the first sign of a cold, influenza or COVID-19. Perhaps that’s because these symptoms are not determined by any specific virus, but rather by our immune reaction to infection. When immune cells detect any of the hundreds of rhinoviruses, adenoviruses or coronaviruses that can cause colds, they tell the body to start pumping out interferon. This compound, one of the first lines of defense, keep viruses from replicating. They can also cause fever, chills, congestion, sore throats, headache and sometimes muscle aches.

While you can lower a fever with over-the-counter medicine such as acetaminophen, aspirin or an NSAID, you’d be handicapping your immune response. Fever is an important tool the body uses to fight off infection.

In fact, in past eras, before antibiotics, people used to heat up the body to help it overcome infections. During the influenza pandemic of 1918, the sanitariums that practiced hydrotherapy (hot baths or compresses) had a lower mortality rate than the Army hospitals using the newly introduced wonder drug, aspirin.

One old-timey therapy that would be worth a try if you catch the flu or a cold is steam inhalation. Get a pot of water boiling on the stove and direct the steam so you can breathe it in for several minutes. This approach does require care so that the patient does not get burned by the steam. Warm steam can ease congestion and make people feel better while discouraging viral replication in the nose and airways.

Another feature of sanitariums was an emphasis on fresh air and sunlight. Dr. Seheult points out that sunshine helps keep our immune response robust. (Of course, the dose is important; too much sun can impair the immune response.) When we expose our skin to sunlight, it makes vitamin D. This is crucial for the immune system. Maybe the popularity of sauna baths in Finland and many other northern countries is a way of compensating for the lack of sunshine during the winter. In addition, the old-fashioned practice of using cod liver oil as a winter-time tonic may be related to its vitamin D content.

Dr. Seheult is not aware of scientific studies showing that vitamin C can help us fight off colds or flu, Linus Pauling notwithstanding. Zinc supplements, on the other hand, have been proven to help people recover more quickly. Taking more than 4 mg of elemental zinc daily could interfere with the balance of copper in the body. Actually figuring out how much elemental zinc is in the supplement could prove quite a challenge, though. Manufacturers don’t often supply that information on the label. Taking quercetin along with zinc may improve its efficacy.

Since Dr. Seheult is a pulmonologist, we asked about chronic lung conditions that might make people more susceptible to infections. Both asthma and chronic obstructive pulmonary disease (COPD) can interfere with breathing, especially breathing out and making room for fresh air to enter the lungs. The medications used to treat these conditions, such as inhaled steroids, can also set the body up for fungal infections.

Testing can be helpful to figure out if what you have is actually the flu or something else, like COVID or a cold. If it is the flu, there are antiviral drugs such as Tamiflu (oseltamivir) that can help speed recovery if taken early in the infection. Maintaining good ventilation at home is crucial, especially if you don’t have a good way to quarantine yourself from the rest of the household. You can try hydrotherapy at home; one approach is to take a hot shower, finished with a blast of cold water at the end. While this may not sound pleasant, it really wakes the immune system up. Consider steam inhalation, and make sure you get adequate sleep and get out into the sunshine as much as possible

Dr. Seheult is an Associate Clinical Professor at the University of California, Riverside School of Medicine, and an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University.

Dr. Seheult is quadruple board-certified in Internal Medicine, Pulmonary Diseases, Critical Care Medicine, and Sleep Medicine through the American Board of Internal Medicine. HIs current practice is in Beaumont, California where he is a critical care physician, pulmonologist, and sleep physician at Optum California.

He lectures routinely across the country at conferences and for medical, PA, and RT societies, is the director of a sleep lab, and is the Medical Director for the Crafton Hills College Respiratory Care Program.

In 2012 he and Kyle Allred founded MedCram L.L.C., a medical education company with CME-accredited videos that are utilized by hospitals, medical schools, and hundreds of thousands of medical professionals from all over the world (and over 1 million YouTube Subscribers). His passion is “demystifying” medical concepts and offering people the tools for staying healthy.

We have found Dr. Seheult’s MedCram videos amazing. He has done an extraordinary job explaining COVID and the science behind various treatments. But he also makes many other complex medical topics understandable. This is a skill that few of my professors in the University of Michigan’s Department of Pharmacology could claim.

Dr. Seheult was the recipient of the 2021 San Bernardino County Medical Society’s William L. Cover MD Award for Outstanding Contribution to Medicine and the 2022 UnitedHealth Group’s The Sages of Clinical Service Award. In 2022 both Roger Seheult and Kyle Allred received the HRH Prince Salmon bin Hamad Al Khalifa Medical Merit Medal from the Kingdom of Bahrain for their contribution to health policy in the Kingdom of Bahrain.

Roger Seheult, MD, MedCram, Loma Linda, UC-Riverside

The podcast of this program will be available Monday, January 6, 2025, after broadcast on Jan. 4. You can stream the show from this site and download the podcast for free.

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This week on our nationally syndicated radio show, we discuss the importance of fiber and phytonutrients in our food for keeping our intestinal microbes healthy. We’ll also find out why encouraging a varied and thriving microbiome in the soil is critical for producing healthy food crops.

Do you know what is the best diet for you? If you are a regular listener, you will have heard that many different diets can be beneficial. But the best ones have at least two things in common: fiber and phytonutrients from a meal plan full of plants. The DASH diet, the Mediterranean diet (in any of its multiple incarnations) and the MIND diet all feature a plate full of plants that provide plenty of fiber and lots of vitamins, minerals and a range of other compounds that plants make for their own purposes. These phytonutrients often have anti-oxidant or anti-inflammatory activities that help our own bodies achieve good health.

Our guest, gastroenterologist Will Bulsiewicz, had an epiphany while struggling with his own health. He discovered that switching from a diet full of convenience foods to a more plant-based diet helped him lower his blood pressure, lose weight and improve his digestion. Intrigued, he looked into the underlying reasons and realized that feeding the intestinal microbiome what it wants–fiber–is a path to keeping it healthy. Good health for gut microbes can translate into better health for us. When the microbes consume fiber, they produce anti-inflammatory compounds called short-chain fatty acids such as butyrate and propionate.

A meta-analysis from 2019 included 58 clinical trials and 185 prospective studies (Lancet, Feb. 2, 2019). Altogether, the investigators had 136 million person-years of data on diet and health. They documented reduced rates of cardiovascular disease, type 2 diabetes, breast and colon cancer among people consuming more fiber.

“Implementation of recommendations to increase dietary fibre intake and to replace refined grains with whole grains is expected to benefit human health.”

We first interviewed Dr. B, as his patients call him, about his book explaining this connection, Fiber-Fueled. (Check out Show 1222: How Can You Optimize Your Microbiome?) Now, to help people figure out how to accomplish the goal of increasing the fiber in their diets, he is offering The Fiber-Fueled Cookbook with lots of practical advice for those in the kitchen or at the table.

Some listeners may worry about the consequences of eating more fiber. Certainly, a sudden and dramatic increase of the fiber in a diet can cause some digestive disruption. The microbiome may need time to adjust so that fiber doesn’t cause too much flatulence. Treating it like a weight-lifting program and increasing just a little at a time might work best.

Many people with irritable bowel syndrome try to avoid foods that will make their symptoms worse. These Fermentable Oligo- Di- & Monosaccharides and Polyols (FODMAPs) are natural sugars that, like fiber, may be difficult for humans to digest. (Humans can’t digest fiber; that task falls to the microbes.) Dr. B describes how to manage food intolerances and improve the ability to handle FODMAPs.

Beyond fats, carbohydrates and proteins, even beyond vitamins and minerals, the plants in our diets provide us with phytonutrients. Plants make these compounds to protect themselves from environmental hazards like insects, but our bodies put them to multiple uses. Some help bolster our immune response. But how does the soil plants grow in affect their ability to produce these chemicals? Without healthy soil, plants have a hard time creating phytonutrient compounds.

You may not have thought much about what makes soil healthy. Anne Biklé, gardener and environmental planner, points out that without a good range of microbes, soil isn’t healthy. Although plants can grow in such soil, they won’t thrive and they may need a lot of assistance from chemicals like fertilizers and pesticides. Instead, soil full of helpful fungi and a balance of bacteria is best. To achieve that, practices of regenerative farming are essential for health, both for plants and for humans.

Will Bulsiewicz, MD, MSCI, is a gastroenterologist and author. He has contributed to more than 20 articles in gastroenterology journals. In addition, his books include Fiber Fueled and his most recent, The Fiber-Fueled Cookbook.  His website is: https://theplantfedgut.com/about/

Will Bulsiewicz, MD, MSCI, author of Fiber Fueled

The photo of Dr. Bulsiewicz is by Margaret Wright.

Anne Biklé is a biologist and environmental planner whose writing has appeared in Nautilus, Natural History, Smithsonian, Fine Gardening, and Best Health. She and her husband, David Montgomery, are the authors of a trilogy of books about soil health, microbiomes, and farming—Dirt: The Erosion of Civilizations, The Hidden Half of Nature, and Growing a Revolution. Their most recent book is What Your Food Ate: How to Heal Our Land and Reclaim Our Health.

The podcast of this program will be available Monday, December 30, 2024, after broadcast on December 28. You can stream the show from this site and download the podcast for free.

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This week, we look at the new pharmaceuticals that the FDA has approved for treating Alzheimer disease. Although they are effective at removing amyloid plaques from the brain, they don’t seem to help patients function better. Is it time to turn away from an exclusive focus on amyloid to consider other factors that might affect cognitive decline and change the course of Alzheimer disease?

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 December 23, 2024.

Even though pharmaceutical firms have spent billions of dollars developing drugs to reduce amyloid in the brain, they haven’t changed the course of Alzheimer disease. Perhaps we need to be looking beyond amyloid at other risk factors. Dr. Dale Bredesen says he and his colleagues have identified more than 36 risk factors. He asserts that when these these are addressed, people can slow or sometimes even reverse their cognitive decline. According to Dr. Bredesen, Alzheimer disease is multi-factorial and it needs a multi-pronged approach.

The plaques and tangles that are characteristic of the brain disease first identified by Alois Alzheimer more than 100 years ago only show up in pathology slides. Past studies have hinted that some individuals who have plaques or tangles in their brains don’t have serious cognitive difficulties. Dr. Bredesen urges us to look beyond amyloid pathology and use a physiology lens. What are the main drivers of problems?

Our bodies need to make, use and transfer energy efficiently. That involves the mitochondria, the energy factories within the cells. Nutrition is also critical here, as missing vitamins can block appropriate metabolism. The cardiovascular system is also crucial for the transfer of energy within the body and to the brain. Sleep apnea, which interferes with oxygen uptake overnight, is another big culprit.

Inflammation in the brain or even elsewhere in the body puts a huge strain on the neurons. Identifying and removing the sources of inflammation is important in treating someone struggling with cognitive problems. Where is the inflammation coming from? It might be an infection. Treatment can make a difference there. It might be dietary, in part. Changing the diet could change the course of Alzheimer disease. Wouldn’t that be worth the effort?

Heavy metals such as lead or mercury are definitely neurotoxic. However, other substances can also put neurons at risk. Toxins produced by mold are common and very difficult to treat.

There are at least three additional categories that should be considered. Do we have the essential ingredients to create the neurotransmitters we need? One example would be choline for acetylcholine, an essential neurotransmitter that may be in short supply in Alzheimer disease. Most American diets are not rich in choline. Second, how are the neurotrophins doing? These are substances such as BDNF, brain-derived neurotrophic factor. It supports the growth and differentiation of neurons. Third, and possibly most common, is chronic stress. Occasional acute stress is expected and shouldn’t be considered harmful. But chronic stress can damage neurons and make it harder to think even if your neurons are not damaged. High cortisol levels are associated with brain atrophy, which is a clear indication of damage.

Dr. Bredesen uses a metaphor of the brain as a house with a leaky roof. If you have a lot of places where the roof leaks, you need to fix all of them to stay dry. But your roof may leak in different places from your neighbor’s roof. Finding the weaknesses and addressing them with personalized medicine is key to changing the course of Alzheimer disease, in Dr. Bredesen’s opinion. It may require attention to diet, exercise, sleep (with adequate oxygen saturation), stress management, brain training, detoxification and possibly supplements such as omega-3 fats or vitamin D. You can learn more from his books and his recent publication in Biomedicines (Aug. 6, 2024).

Dale Bredesen, MD, is an internationally recognized expert in aging and neurodegenerative diseases. He is the Senior Director of Precision Brain Health at Pacific Neuroscience Institute, and former Professor of Molecular and Medical Pharmacology at UCLA. Dr. Bredesen is also the founding President and CEO of the Buck Institute for Research on Aging and the Co-founder of MPI Cognition. Dr. Bredesen is the author of the New York Time’s best seller The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline and The First Survivors of Alzheimer’s: How Patients Recovered Life and Hope in Their Own Words.

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The podcast of this program will be available Monday, December 23, 2024, after broadcast on Dec. 21. You can stream the show from this site and download the podcast for free.

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This week, our guest discusses how to prevent and treat a surprisingly common condition, chronic kidney disease. One in three Americans faces the risk factors for kidney disease; one in seven is actually living with the condition, although they may not be aware of it.

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 December 16, 2024.

According to the CDC, 36 million American adults have some form of chronic kidney disease. There are six stages of this condition, with stages 1 and 2 so mild that they don’t warrant treatment. Doctors start paying attention to stages 3a and 3b. Dr. Emily Chang describes how kidney disease is diagnosed and why we need to pay attention. In the earlier stages, kidney disease does not cause symptoms, so doctors rely on blood and urine tests to monitor function.

Most people are aware that the kidneys produce urine, primarily by filtering the blood and removing chemicals that are not needed. However, the kidneys also have numerous other functions that are critical for our health. They are vital to blood pressure control, and they regulate hormones essential to the preservation of bone strength.

We wondered why the rates of chronic kidney disease are increasing. The answer is fairly simple. More people have one or more of the factors that increase a person’s probability of experiencing kidney problems. These include high blood pressure and diabetes.

In addition, there are numerous medications that can contribute to trouble for your kidneys. Just imagine how many of us take an NSAID such as ibuprofen or naproxen multiple times a week. That can put a significant strain on the kidneys. If ibuprofen upsets your stomach–as it could–you might turn to a PPI such as omeprazole (Prilosec) or lansoprazole (Prevacid). These medications can also pose challenges for the kidneys.

In general, blood pressure medicines are a help to the kidneys, because blood pressure control is so important. But certain blood pressure meds, especially ACE inhibitors like lisinopril or ramipril or ARBs like losartan or irbesartan, are considered “sick day meds.” They should not be taken on days when a person is under the weather and may be dehydrated. Under those circumstances, they might do as much harm as good.

Another potential hazard for the kidneys is the contrast medium used in medical imaging. Sometimes this can be tough on the kidneys. That’s especially true for cardiac catheterization where the doses are higher and the exposure longer.

Besides controlling risk factors, we can all help protect our kidneys by making sure we stay hydrated. What and how much should you drink? Plain water is always great. Caffeinated soft drinks are not particularly helpful, and neither are dark sodas or tonic water. As for how much, that is individual. Most people can rely on thirst, but as we age, thirst may be a less sensitive indicator. Older people may need to make sure they are drinking enough fluid to produce a reasonable amount of light-colored urine.

According to Dr. Chang, most of us don’t need to obsess about the amount of protein in our diets. Except at the most severe stages of chronic kidney disease, your kidneys can handle the protein you need for good nutrition. She recommends that people follow a DASH diet or a Mediterranean diet. Both are loaded with fresh produce, low in salt and sugar, and rich in whole grains. Scientists have studied the effects of the DASH diet thoroughly, and they know that it can help with blood pressure control. Likewise, following a Mediterranean diet can also promote healthy blood pressure and blood sugar management.

Doctors are adopting a type of medicine called SGLT-2 inhibitors to treat chronic kidney disease. One example is dapagliflozin (Farxiga), a drug initially developed to treat type 2 diabetes. It may keep kidney disease from worsening. Other drugs in the same category may also prove helpful. Scientists are also looking at GLP-1 agonists like semaglutide (Ozempic, Wegovy) to see if they might also benefit your kidneys.

The podcast includes a discussion with Dr. Glenn Preminger of Duke University Health System about a related topic, preventing and managing kidney stones.

Emily Chang, MD, is Associate Professor of Medicine in the

Emily Chang MD

Glenn Preminger, MD, is the James F. Glenn, M.D. Distinguished Professor of Urology at Duke Medicine.

The podcast of this program will be available Monday, December 16, 2024, after broadcast on Dec. 14. You can stream the show from this site and download the podcast for free.

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This week, we talk with an expert on cancer epidemiology. Surprisingly, though, our discussion centers on the health aspects of practicing kindness and compassion. In our polarized world, anger and hostility are rampant. But kindness is not only good for the person who receives a kind gesture. It also has a biological impact on the person providing it.

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 December 9, 2024.

Dr. Immaculata DeVivo studies biological effects of behaviors. One of the ways she assesses their impact is through the response of telomeres. These are part of our chromosomes, rather like the little plastic tips on our shoelaces that keep them from raveling. Chronic stress shortens telomeres. On the other hand, long-lived people, like centenarians, tend to have longer telomeres. Is it because they avoid stress, or have they learned ways to dissipate it?

Optimists live longer, and they have longer telomeres and less cardiovascular disease. Is that because they practice random acts of kindness? Research shows that women practicing loving-kindness meditation have longer telomeres. Since this is generally a marker of lower inflammation and better health, it seems likely that meditators may be promoting their own health as they concentrate on loving kindness for others.

If kindness has biological benefits–and it does seem to–what are the implications for cancer patients? How can health care professionals practice kindness, and can we expect that practice to benefit them?

People often talk about Darwin’s work as demonstrating the survival of the fittest as if he meant the biggest, loudest or meanest. In truth, Darwin was talking about adaptability. Practicing kindness and related behaviors helps us be more adaptable. Dr. De Vivo also discusses the advantages of optimism, gratitude and forgiveness along with kindness. Practicing kindness doesn’t have to be a major effort; she tells about a stranger putting coins in her parking meter on a day when she was having a hard time finding the right change. How have you been practicing kindness?

Dr. Immaculata De Vivo is the Melanie Mason Niemiec ’71 Faculty Codirector of the Sciences at Harvard Radcliffe Institute, Professor of Medicine at Harvard Medical School and Professor of Epidemiology at the Harvard T.H. Chan School of Public Health and the Editor-in-Chief, Cancer Causes and Control. Her research focuses on how genetic variants interact with the environment to influence susceptibility to hormonal cancers, especially endometrial cancer. Dr. De Vivo, with Daniel Lumera, is the author of The Biology of Kindness: Six Daily Choices for Health, Well-Being and Longevity.   Her website is https://www.radcliffe.harvard.edu/people/immaculata-de-vivo-faculty-director

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).

Dr. Immaculata De Vivo, photo credit Kevin Grady

The podcast of this program will be available Monday, December 9, 2024, after broadcast on Dec. 7. You can stream the show from this site and download the podcast for free.

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In this week’s interview, Dr. Robert Waldinger of Harvard University explains why overcoming loneliness is essential for our health. His research, summarized in The Good Life, shows that close relationships are crucial for a satisfying life. In addition, the Surgeon General has issued a comprehensive report on the epidemic of loneliness and its effects on physical as well as mental health. How do we reach out to others and vanquish their loneliness as well as ours?

You may want to listen to it 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 December 2, 2024.

Loneliness may not seem like an urgent health issue, but it is. That was clear even before US Surgeon General Vivek Murthy MD issued his 2023 report: Our Epidemic of Loneliness and Isolation. This report summarizes the research linking lack of social connection to serious health outcomes like heart disease, diabetes, high blood pressure and dementia. A graphic on page 25 demonstrates that social isolation is as dangerous to a person’s health as smoking half a pack a day or drinking too much.

These findings do not surprise our guest, Dr. Robert Waldinger. He is the director of the Harvard Study of Adult Development at Massachusetts General Hospital, the world’s longest-running scientific study on what makes a satisfying life. What Dr. Waldinger and the research team found is that relationships of all sorts–friendships, romantic partnerships, family ties, even casual acquaintances–are critical for a meaningful life. Warm relationships seem to provide a buffer against stress. Without them, we are literally on our own.

The United States is not the only country in the world where people are experiencing social isolation or loneliness. But there are some cultures where people place a higher priority on maintaining social connections with extended family or classmates. Our emphasis on maximizing productivity may interfere with placing a value on spending time with others.

This is not an entirely new phenomenon. Ever since most American homes acquired television, people started spending more time at home rather than interacting with neighbors. The small screens that currently scream for our attention are even more likely to result in isolation, even as we scroll through our “social media” feeds.

For the past century, at least, many Americans experienced social connection simply by showing up at work. Accomplishing a shared task might be one bond, but hanging out together around the water cooler is also a way to make work friends. The pandemic accelerated a trend towards working remotely and not interacting with coworkers casually. Companies might want to re-think their policies. People are more productive as well as happier and healthier if they have friendly interactions with others at work, and that means not being chained to the computer all day long.

Some people are introverts. They may find it hard to get to know new people. Extroverts, on the other hand, often make friends easily. However, they may also need more friendships to feel socially satisfied. Some schools are starting to teach children much-needed social and emotional skills. Even older people may find it useful to practice such skills. Both young people, between 16 and 24, and the elderly (over 65 in this context) are among the groups most likely to suffer social isolation.

There are some things we can do as individuals to help protect ourselves from the stressors of everyday life. Dr. Waldinger quotes Thich Nhat Hanh to the effect what we put into our minds becomes the content of our minds. He makes the argument that we should be mindful about how much news we consume every day as well as how we consume it.

Another practice that flows from the Buddhist teacher is to pay attention to what is good in your life. Acknowledging gratitude, whether by speaking or journaling, can help buffer the feeling of living on the edge of catastrophe. Being grateful for your friends, and letting them know it, is another approach to overcoming loneliness.

Finally, spend time with people who make your hands warm. This is a quick way of judging whether you are comfortable with them. Dr. Waldinger recognizes that we often let our busy lives get in the way of connecting. When he gives talks, he frequently invites the audience to send a text or email to someone they like but haven’t seen in a while. Sometimes, this results in plans to get together soon. Most of the time, people get a heartwarming response. His advice for all of us as we face the new year: turn toward people who make you feel hopeful.

Robert Waldinger, MD is a professor of psychiatry at Harvard Medical School, director of the Harvard Study of Adult Development at Massachusetts General Hospital, and cofounder of the Lifespan Research Foundation. Along with being a practicing psychiatrist and psychoanalyst, Dr. Waldinger is also a Zen master (Roshi) and teaches meditation in New England and around the world. Dr. Waldinger, with co-author Marc Schulz, PhD, is the author of The Good Life: Lessons From the World’s Longest Scientific Study on Happiness.

Robert Waldinger, MD, author of The Good Life

The podcast of this program will be available Monday, December 2, 2024, after broadcast on November 30. You can stream the show from this site and download the podcast for free.

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This Saturday morning, November 23, 2024, an expert from Australia helps us examine the hidden risks of healthcare. Healthcare providers have the best of intentions, but they simply cannot truly uphold the (apocryphal) part of the Hippocratic oath that urges “First, do no harm.” How can patients and their families become more familiar with the pitfalls of modern medicine and avoid them as much as possible?

You could listen through your local public radio station or get the live stream at 7 am EDT (11/23/2024) 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 live 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 audio stream on this post starting on November 25, 2024.

Historically, medical students were expected to take the Hippocratic oath upon graduation. Although the original Greek does not actually contain the warning to do no harm, the oath is widely believed to carry that intent. Yet it may be difficult for doctors to avoid harming some patients. We’ll examine where patients should be especially vigilant and how the evidence from careful studies can help. Other portions of the Hippocratic oath are also routinely violated in the context of current medical practice.

One problem is that we don’t always have evidence for the medicines or other interventions physicians are using. For a long time, rheumatologists prescribed hydroxychloroquine for their patients with lupus, expecting that it would be helpful. They had no real evidence that it would help until finally scientists conducted a randomized clinical trial. This showed that hydroxychloroquine is, in fact, better than placebo for treating lupus. That original lack of evidence, though, is one of the most serious hidden risks of healthcare.

Knee arthroscopy is another example. Surgeons assumed that looking into the knee joint and removing any bits of collagen debris they found there would reduce knee pain and improve function. But when a study was eventually done to confirm that assumption, it turned out not to be true.

When drugs are tested prior to approval, many people may be excluded from the clinical trials because their conditions might make the findings harder to interpret (or potentially make the benefits harder to see). Once a drug is available, do doctors also avoid prescribing it for those who were not included in clinical trials? Usually not. Also, if it was approved for a fairly narrow indication, healthcare providers may start using it far more widely.

Dr. Rachelle Buchbinder is Coordinating Editor of the Cochrane Musculoskeletal, Back and Neck division, along with many other responsibilities. Many people have not heard about the Cochrane Collaboration, so we asked her to describe it. Volunteers trained in objective methods of assessing clinical trials examine all the clinical trials that have examined a specific intervention. Quite often, what they find is that the existing studies have a lot of flaws. But occasionally, their high-quality systematic review shows that, yes, the research shows that this approach works for this problem. Or possibly, no, we should not use such an intervention for that problem. For example, a Cochrane review demonstrated that despite popular opinion, medical cannabis is NOT effective against chronic pain.

Americans can’t watch television without being bombarded by commercials for powerful prescription pharmaceuticals complete with lengthy lists of terrifying adverse effects. No worries, though: the people in these ads are all having a marvelous time as the side effects are listed. This does not happen in Australia. New Zealand and the United States are the only two countries in the world that allow drug companies to advertise prescription drugs directly to consumers. Isn’t this among the hidden risks of healthcare?

Dr. Buchbinder and her co-author also look at problems with getting an appropriate diagnosis. When a patient’s condition is not diagnosed correctly, they can’t be treated properly. That’s why missed diagnoses are problematic. Wrong diagnoses are also a problem. Sometimes serious conditions are underdiagnosed because the stereotype directs the provider’s attention elsewhere. For example, women may not be diagnosed with heart disease when the provider has been taught that it’s primarily a male problem. Conversely, men might suffer with horrible migraines and not get the correct diagnosis because these headaches are seen as far more common in women. Dr. Buchbinder also describes the problem of overdiagnosis, using as an example, thyroid cancer in South Korea.

Chances are you know something about the numbers that could be used to describe your health. Your blood pressure might be 120/80…or not. Your cholesterol may be over 200. Doctors use blood tests to measure HbA1c (a marker for blood sugar over time), TSH (a way of determining thyroid function), PSA (prostate-specific antigen, a way of tracking a man’s prostate gland) or any of hundreds of other markers. These can all be helpful, but providers need to be careful not to treat the numbers without looking at the big picture.

Just getting blood pressure down to 120/80 might make some individuals too dizzy and put them at risk for falls. Prescribing a statin to lower cholesterol makes sense for someone with heart disease. To tell if it is appropriate for a healthy person who is physically active and finds that the medication interferes with exercise needs to be determined with more attention to the patient than to the number.

The United States is not the only country where drug manufacturers have a lot of influence over doctors. The experts who serve on committees to draw up guidelines for doctors often have conflicts of interest. Sometimes these are disclosed, but not everyone reads the guidelines carefully enough to pick up that fine print. In addition, hospitals, clinics or individual providers may also be paid by pharmaceutical firms. In the US, patients can find out whether their own doctor has been paid (and how much) by going to the CMS website OpenPayments. This offers us the opportunity to evaluate just how objective a provider might be when recommending a procedure or prescribing a drug.

Professor Rachelle Buchbinder AO

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).

The podcast of this program will be available Monday, November 25, 2024, after broadcast on Nov. 23. You can stream the show from this site and download the podcast for free.

Download the mp3.

This week, we discuss how making your own herbal medicine at home can provide you with safe, inexpensive and effective ways to ease symptoms of common problems like colds, cuts and scrapes or heartburn. Our guest is a long-time People’s Pharmacy favorite, Dr. Tieraona Low Dog. Learn about leaves and roots in remedies you can make at home.

You could listen through your local public radio station or get the live stream at 7 am EST on your computer or smart phone (wvtf.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 November 18, 2024.

Utilizing herbal medicine may seem complicated or exotic, but it doesn’t have to be. Herbal medicine is based on plants, and there are lots of plants that are easy to grow in a patch of backyard or even in a planter. Consider peppermint, for example. It grows readily–a little too readily. If you plant it in your garden, it may take over, so be sure to keep it confined to a pot or planter. The leaves are cooling in the summer. Frozen cubes of mint tea can be used to calm a fever, soothe a bug bite or relieve a headache. Many cough drops contain menthol, so we expect peppermint tea might ease a cough as well.

Other handy plants include thyme and sage. Their utility goes way beyond Thanksgiving dinner. A gargle made with sage leaves can make a sore throat feel better, and thyme tea or thyme syrup is a great way to manage a pesky cough.

Dr. Low Dog describes how her travels to other parts of the world have broadened her knowledge and appreciation for herbal home remedies. She observes that in many regions, people let their exploration of roots and remedies be guided by the local animals. Primates, in particular, are similar enough to humans that watching how they use particular plants can point people in the direction of potential helpful herbs. People living in the Bwindi Impenetrable Forest of Uganda have learned a good deal by paying attention to plants the gorillas use, for example.

The most important thing to take along when you travel is your curiosity. That has stood Dr. Low Dog in good stead over the years. In Mexico, for example, she witnessed the wild yams originally used to source the building blocks for steroid medications. These include progesterone used in oral contraceptives.

A bit further south, in Costa Rica, she participated in a cacao ceremony. While we can’t grow wild yams or cacao trees in our gardens in the United States, we can still take advantage of some of the medicinal effects of these plants. Did you know that dark chocolate, with as little sugar as you can stand, is an excellent cough remedy? Of course, if you want to get the benefits of cacao without the sugar and fat in chocolate candy, you might want to take the proven, concentrated cacao flavanol extract found in CocoaVia. Full disclosure: CocoaVia provides financial support for our radio show and podcast.

A round trip brings us back home. For Dr. Low Dog, that is New Mexico, where Diné people on the Navaho reservation use dock, a common weed, for healing. In other regions, the healing weed may be plantain. For wounds, a poultice of yarrow or calendula can be very helpful. Dr. Low Dog describes treating a serious cut on her mare’s leg with honey in which sage leaves had been steeped.

Dr. Low Dog reminds us, “We have the potential in every moment to open our hearts to each other.” Focusing on the meaning and purpose behind our acts can make them stronger.

She offers a free tutorial on her website about making simple herbal medicine at home. Be sure to check it out, and don’t miss the list of offerings from Medicine Lodge Ranch.

Tieraona Low Dog, MD, is a founding member of the American Board of Physician Specialties, American Board of Integrative Medicine and the Academy of Women’s Health. She was elected Chair of the US Pharmacopeia Dietary Supplements/Botanicals Expert Committee and was appointed to the Scientific Advisory Council for the National Center for Complementary and Alternative Medicine. Her books include: Women’s Health in Complementary and Integrative Medicine; Life Is Your Best Medicine and Fortify Your Life: Your Guide to Vitamins, Minerals and More. Dr. Low Dog’s latest eBook is Healing Heartburn Naturally.

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).

Dr. Tieraona Low Dog

The podcast of this program will be available Monday, November 18, 2024, after broadcast on Nov. 16. You can stream the show from this site and download the podcast for free.

When you listen to the podcast, you will hear us suggest Gaia Herbs as a source for the herbal medicine you don’t make at home. Their onsite laboratory ensures quality control that few other companies can match. As a result, the quality is outstanding; they grow many of the herbs they sell on their Regenerative Organic Certified farm in Western North Carolina and source others thoughtfully from around the world. The promo code PEOPLE15 will get you a 15% discount through Dec. 31, 2024, at GaiaHerbs.com.

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