This week, we offer the second of a two-part series on the pros and cons of water fluoridation. Last week we discussed the practice of adding fluoride to drinking water to prevent tooth decay. This week we hear from a researcher who has found that early exposure to fluoridated water may affect youngsters’ IQ.

You could listen through your local public radio station or get the live stream at 7 am EDT (February 15, 2025) 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 February 17, 2025.

Some people are opposed to any municipality putting fluoride in its water supply simply because it means the residents have little choice but to use it. On the other hand, many people embrace a “no harm, no foul” philosophy. What are the potential cons of water fluoridation?

Dr. Bruce Lanphear studied the effects of lead on children’s developing brains for decades. There is no longer any doubt that lead harms their intellectual capacity. When someone asked him about fluoride, he realized that he did not know what the potential impact on infants might be. He took advantage of an opportunity to study it, and what he and his colleagues found is rather alarming (JAMA Pediatrics, Aug. 19, 2019).

There were 512 pairs of mothers with their babies in the study, which evaluated fluoride in drinking water and also tested the mothers’ urine during pregnancy. As the levels of fluoride rose, the IQ scores of the boys, tested between age three and four, dropped. Girls did not demonstrate such an association.

We encounter fluoride in toothpaste, in medications and in food packaging, among other sources. However, water fluoridation is far and away the main source of fluoride. As a result, if a community decided that the cons of water fluoridation outweigh the benefits, it would be relatively easy to lower levels for everyone. Simply stop adding fluoride to the water!

Another disquieting discovery from Dr. Lanphear’s research is that there are multiple interactions among the various compounds we encounter every day. For example, little boys whose mothers were able to get access to adequate iodine during pregnancy were much less likely to suffer IQ deficits than those whose mothers did not have adequate iodine (Science of the Total Environment, April 15, 2023).  Hypothyroidism may be an important link.

Another interaction is with lead. Not only does lead itself harm children’s brains, it appears to be a risk factor for tooth decay. Would that lead parents to increase the fluoride exposure for their youngsters? How do lead and fluoride interact in the body? We don’t yet have answers for these important questions.

In addition, women exposed to higher levels of pesticides are more likely to give birth to children with autism if their folate levels are subpar. That is another area where researchers are striving to learn more about interactions that put babies at risk.

During the interview, we mentioned a recent meta-analysis of 74 studies of water fluoridation. You can find it in JAMA Pediatrics (Jan. 6, 2025).  As with the study Dr. Lanphear describes, children exposed to higher levels of fluoride as measured in their pregnant mothers’ urine were more likely to have deficits in IQ.

We asked Dr. Lanphear about the precautionary principle applied by European regulators. He suggested that it is easier to understand when stated as the medical precept, “First, do no harm!” The idea is that we should know as much as possible about hazards as well as benefits of new compounds before broad populations are exposed to them.

Gary D Slade, BDS, DDPH, PhD, is the John W. Stamm Distinguished Professor of Dentistry at the University of North Carolina Adams School of Dentistry in Chapel Hill, NC. He conducts epidemiological studies of oral diseases including public health interventions for prevention of dental decay. His website is https://dentistry.unc.edu/people/gary-slade/ Dr. Slade was the featured guest in last week’s episode emphasizing the benefits of water fluoridation.

Gary Slade, BDS, DDPH, PhD, is the John W. Stamm Distinguished Professor of Dentistry at the University of North Carolina Adams School of Dentistry in Chapel Hill, NC.

Bruce Lanphear, MD, MPH, is Professor of Health Sciences at Simon Fraser University in Burnaby, BC. He is the featured guest this week on our episode examining the cons of water fluoridation. His website is https://www.sfu.ca/fhs/about/people/profiles/bruce-lanphear.html

Bruce Lanphear, a health sciences professor at Simon Fraser University and an expert on lead toxicity.

The podcast of this program will be available Monday, February 17, 2025, after broadcast on Feb. 15. You can stream the show from this site and download the podcast for free.

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This week, we offer the first of a two-part series on water fluoridation. The practice of adding fluoride to drinking water to prevent tooth decay has been controversial for some time. Why? What should we know about 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 February 10, 2025.

Tooth decay is uncomfortable. When it leads to periodontal disease and tooth loss, it can have a negative impact on cardiovascular and cognitive health, as well as quality of life. Fluoridation has been employed as a public health intervention to improve dental health. What is fluoride and how does it work? Our guest, Dr. Gary Slade, explains the mechanisms that help fluoride strengthen tooth enamel. In particular, it becomes incorporated into the crystalline structure of the enamel in places where it has been attacked by acid.

It is very difficult to determine exactly how effective water fluoridation may be at reducing dental problems because it started before there were randomized controlled trial conducted. Comparing countries that use this technique to those that do not is imperfect, since there are often many other differences among them. One important difference could be the rigor of data collection and analysis. The only way to overcome that problem is to conduct a randomized controlled trial.

Dr. Slade and his colleagues have already begun exactly such a trial in Lenoir County, North Carolina. Families are assigned to either fluoridated or unfluoridated water. Because each household is provided with big 5-gallon jugs of water for their consumption, they have no way of telling which group they belong to. Nor does anyone else. This creates an effective “double-blind” situation for the trial. The investigators don’t yet have data on dental outcomes. That will be forthcoming, and it will provide a much better assessment of exactly how well fluoridation protects teeth.

Joe recalls the dentist of his childhood cautioning him to avoid sugar. Dr. Slade agrees that limiting the number of times a day that one consumes sweet snacks or sugar-sweetened beverages can make a difference in reducing tooth decay. We asked him to explain the difference between “caries” and “cavities.” Caries is the term for the process of tooth surface deterioration. A cavity is the result of that process. Cutting the amount of sugar we eat can definitely discourage that process.

Clearly, brushing teeth is critical to keeping them healthy. We discussed the amount of fluoride toothpaste we need to put on the toothbrush. It’s not nearly as much as depicted in toothpaste commercials. Dr. Slade also explained that flossing is most impactful when it comes to gum health rather than preventing caries. That is important, too. Healthy gums make it easier to keep your teeth and also promote general health.

Fluoridated water is the primary source through which we are exposed to fluoride. On the other hand, it is not the only source. Next week’s guest points out that formula-fed infants get a much higher dose, relatively speaking, than adults if their formula is made with tap water. In addition, we are all exposed to fluoride from nonstick pans and stain-resistant fabrics, antidepressants and anesthetics and a host of other sources. Next week, Dr. Bruce Lanphear will explain why he thinks this is a problem.

Gary D. Slade, BDS, DDPH, PhD, is the John W. Stamm Distinguished Professor of Dentistry at the University of North Carolina Adams School of Dentistry in Chapel Hill, NC. He conducts epidemiological studies of oral diseases including public health interventions for prevention of dental decay. His website is

Gary Slade, BDS, DDPH, PhD, is the John W. Stamm Distinguished Professor of Dentistry at the University of North Carolina Adams School of Dentistry in Chapel Hill, NC.

Bruce Lanphear, MD, MPH, is Professor of Health Sciences at Simon Fraser University in Burnaby, BC. His website is https://www.sfu.ca/fhs/about/people/profiles/bruce-lanphear.html

Bruce Lanphear, a health sciences professor at Simon Fraser University and an expert on lead toxicity.

The podcast of this program will be available Monday, February 10, 2025, after broadcast on Feb. 8. You can stream the show from this site and download the podcast for free. Next week, the show will focus on Dr. Lanphear’s research.

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This week, we explore the evidence that some respected researchers in the field of Alzheimer’s disease took shortcut or even manipulated their data to get the results they wanted. How did our guests detect fraud and arrogance in this research?

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 February 3, 2025.

With nearly seven million Americans currently suffering from Alzheimer’s disease, the effort to understand what causes it and how it could be treated effectively is urgent. Over the last several decades, research on this dementia has focused largely on amyloid plaque (also called amyloid-beta) in the brain as the sole cause. Consequently, drug companies have developed medications that can pull plaque out of the brain. Medicines like aducanumab (Aduhelm), lecanemab (Leqembi) and donanemab (Kisunla) do that pretty well. Unfortunately, though, the patients don’t get better. At best, they decline a little more slowly. Could putting all the focus on amyloid-beta have been a mistake?

Dr. Matthew Schrag is a neurologist who has been examining images in scientific papers independently of his university duties at Vanderbilt. His initial investigations were of studies of a drug called simufilam being developed by Cassava Sciences. He detected signs suggesting that some of the images (termed “Western blot”) indicating proteins present in certain tissues had been altered. To interpret such images appropriately, a person needs a high level of expertise. Changing the picture can change the interpretation of the data as well.

An investigative journalist for Science magazine, Charles Piller, heard about Dr. Schrag’s discoveries and wrote an in-depth story about it. Dr. Schrag had not set out to be a whistleblower. Both he and Mr. Piller were well aware of the hazards whistleblowers can run, especially if they are early in their careers. However, they are both curious people and dedicated to research integrity. Dr. Schrag had found some disturbing signs in foundational papers of the field. Charles Piller thinks of him as the most important whistleblower in the history of Alzheimer disease research.

The two men teamed up to take a closer look. What could account for the apparent image manipulation that they uncovered? As Mr. Piller observes, the incentives for scientists encourage data manipulation if one is so inclined. Getting journals to retract published papers is difficult. Universities are likewise not eager to investigate prominent investigators. Mr. Piller and Dr. Schrag are careful not to imply that the field is rife with fraud and arrogance. However, they found far more than we should be comfortable with.

Mr. Piller invited other experts to review the images that Dr. Schrag had flagged as questionable. In most cases, they agreed that someone had apparently tinkered with them. In some cases, images reappeared in multiple papers. Since they are an important form of data, they should not be replicated in papers describing different experiments.

It seems very odd that the FDA approved aducanumab (Aduhelm) despite the recommendation of its expert panel not to do so. Aduhelm has since been removed from the market. Like other drugs in the class, it has a small benefit–almost imperceptible from the perspective of the patients or their families. The side effects could be consequential, however. In some cases, the drug causes swelling or bleeding of the brain. It also can result in ARIA, amyloid-related imaging abnormalities. Over time, these medications end up shrinking people’s brains even more than the disease itself does.

Once fraud and arrogance have been exposed, suspicious findings could be excised from the scientific literature. This should permit research to flourish on a range of approaches to understanding Alzheimer’s disease.

Matthew Schrag MD, PhD, is Assistant Professor of Neurology at Vanderbilt University School of Medicine and Director of the Cerebral Amyloid Angiopathy Clinic. 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

Charles Piller is a prominent investigative journalist, primarily known for his work in the field of science. He writes in-depth stories for Science magazine, where he often exposes misconduct and problematic practices within scientific research, particularly focusing on public health issues like the study of Alzheimer’s disease. Charles Piller is the author of Gene Wars and The Fail-Safe Society. His most recent book is Doctored: Fraud, Arrogance, and Tragedy in the Quest to Cure Alzheimer’s.

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).

You can read an essay by Charles Piller recently published in The New York Times: “The Devastating Legacy of Lies in Alzheimer’s Science.” The photo of Charles Piller is by Mike McGee.

Charles PIller, author of Doctored: Fraud, Arrogance and Tragedy in the Quest to Cure Alzheimer’s

The podcast of this program will be available Monday, February 3, 2025, after broadcast on Feb. 1. You can stream the show from this site and download the podcast for free. This week, you’ll hear Charles Piller describe why the operation of FDA’s Center for Drug Evaluation and Research might raise some red flags. We also discuss the monoclonal antibody drugs that the FDA has approved to treat Alzheimer’s disease. In a shift of focus, we examine the incentives that power a nonprofit organization such as the Alzheimer’s Association.

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This week, Joe & Terry invite listeners to share their favorite home remedies for colds. No one expects a remedy to shorten the duration of a cold–although perhaps one or two could! But many may help people feel better for a few hours if they alleviate symptoms. You can call in your suggestions to 888-472-3366 between 7 and 8 am EST on Saturday, January 25, 2025. Or you can send them by email: [email protected]

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 27, 2025.

If you start to come down with a cold, what do you do? A lot of people reach for acetaminophen or ibuprofen, especially if they are running a mild fever. We suggest saving the pain relievers for when you have pain and welcome a fever. It is your body’s way of fighting off infection and shouldn’t need treating unless it gets really high. Does your family have a remedy like piling on the quilts designed to get the cold victim to actually run a fever? Some people turn to hot liquids to warm up when they have a cold.

Around the world, people rely on chicken soup when they have a cold. Inhaling the steam from a bowl of soup can help ease congestion temporarily. If you make your soup with lots of thyme, it may reduce coughing for a while. In China, grandmothers often make chicken soup with astragalus root, because that has a reputation for bolstering the immune response.

Vegetarians avoid chicken soup, of course, but some embrace golden milk. This traditional Ayurvedic cold remedy includes the yellow spice turmeric mixed into warm milk and sweetened with honey to taste. Just as with chicken soup, people who grew up with this remedy find it a true comfort when they are under the weather. Researchers have found that curcumin, a key component of turmeric, has definite antiviral activity (Molecules, July 8, 2022).

We have some favorite types of tea that we like to use if we feel a cold coming on.

Ginger tea is a lovely way to address both cough and congestion. You can make it from dried ginger, but we think it is best made by grating fresh ginger root and steeping it in hot water. If you like, it can be sweetened with honey. Some people prefer to add a bit of hot pepper, livening an already spicy drink even more.

When we start to cough, we rely on a cup of fresh-brewed thyme tea. Using a half teaspoon of dried thyme leaves in a tea infusing spoon, we steep 6 ounces of hot water for about five minutes. This is delicious when we add lemon (and honey!). We find it really calms a cough quickly for several hours. There haven’t been many studies of this herbal remedy, but one randomized, triple-blind, placebo-controlled trial in kids with asthma found that thyme syrup reduced activity-induced cough (Allergologia et Immunopathologia, Jan. 2024). These youngsters have asthma, so it is not directly applicable to people with coughs due to colds; still, it suggests there is some activity.

Extracts of dried flowers of elderberry shrubs (AKA elder flower tea) contain high levels of polyphenols (Journal of Agricultural and Food Chemistry, Feb. 11, 2015).  Some scientists are interested in developing medicinal compounds to treat respiratory infections based on the components of elderberries (Molecules, June 22, 2024).  Traditional herbalists recommend elder flower tea for a cough associated with a cold. Have you tried this approach?

The Sambucus fruit, elderberry, has been having a moment lately. A systematic review of its use of viral respiratory illnesses found that it doesn’t seem to prevent colds, but it may reduce the duration or severity (BMC Complementary Medicine and Therapies, April 7, 2021). As with nearly all our remedies, more research is needed.

When we talk with Dr. Tieraona Low Dog, she frequently recalls that when she was a child, her grandmother would prepare sage tea when there were colds in the household. Rather than consume it as a hot beverage, the youngsters let it cool and used it as a gargle to ease the pain of a sore throat.

When it comes to vitamin C, are you pro or con? The benefits of this vitamin against the common cold have been quite controversial for decades. Nobel laureate Linus Pauling was a fan, but many doctors are skeptical, to say the least. The latest review shows that high-dose vitamin C can prevent colds in people doing intense physical activity and decrease the severity of colds by about 15 percent (Polish Archives of Internal Medicine, Jan. 13, 2025).  That seems like it might be worth a try, given that vitamin C doesn’t often cause side effects. The authors suggest a self-experiment using 6 to 8 grams a day starting at the earliest hint of cold symptoms. Some people will experience diarrhea at that dose and will need to lower it for their personal protocol.

Back in 1979, a little girl with cancer refused to swallow the zinc tablet she was supposed to take. She sucked on it for hours instead. Surprisingly, the cold symptoms she had been developing disappeared. Subsequent research has confirmed that zinc has antiviral and anti-inflammatory effects (European Journal of Clinical Nutrition, April 2023). Have you tried zinc lozenges to treat your cold symptoms? Tell us how it went.

The flavonoid quercetin is available as a dietary supplement. It has a reputation for fighting off viruses, possibly because research has demonstrated that it can inhibit the early stages of viral infection and reduce inflammation (Phytotherapy Research, Jan. 2022).  Perhaps this helps explain the popularity of onion syrup as a cold remedy. Many listeners have reminisced about this, which appears to have broad popularity. Have you tried it?

No discussion of cold remedies would be complete without mentioning Vicks. It actually was developed (more than a hundred years ago) specifically to help with cough from upper respiratory infections. While the usual approach to using Vicks calls for it to be applied to the chest, a lot of listeners have found that applying it to the soles of the feet is also quite effective for a nighttime cough. Be sure to put on some thick socks so the sheets don’t get greasy from the petrolatum. We suspect the menthol that contributes to its distinctive aroma helps explain why it could work for a cough.

The podcast of this program will be available Monday, January 27, 2025, after broadcast on Jan. 25. You can stream the show from this site and download the podcast for free.

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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.

Download the mp3.