At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen:

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, May 2, 2026, through 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 May 4, 2026.

Why We Pay Twice as Much for Health Care

One reason Americans pay twice as much is the complexity of our health care services. We often call it a health care “system,” but it often doesn’t feel as coordinated as a system ought to be. Many other countries have universal health insurance coverage in one form or another (and there are many). That means the government has an incentive for keeping costs down. With so many different payers and players in the US, the incentives frequently go in the other direction.

You may notice this if you examine an explanation of benefits from Medicare or a private insurance company. There may be a sizable gap between what the provider charged and what insurance approved. Who pays the retail price? Only people who don’t have insurance, who are usually those least able to manage a big bill. If you find yourself faced with a hospital bill and no insurance coverage, it is important to talk with the billing department. Nonprofit hospitals should have a mechanism for patients without coverage to negotiate a lower total or a longer time frame in which to pay. Even some for-profit hospitals and medical practices are open to negotiation, but starting the negotiation as early as possible is key.

How Much Does an Emergency Cost?

Nobody plans for a medical emergency. That is the nature of emergencies–they are unexpected. If you need an ambulance to get you there, if you have to be transferred to another hospital with a better ability to care for your problem, if the doctors must do multiple tests to make a diagnosis will all influence your bill. As a result, emergency visits could cost from tens of thousands of dollars to a million or so. With high-deductible health insurance, a person or their family could end up owing more than they can pay. That is how some cases of bankruptcy are rooted in high healthcare bills.

We Pay Twice as Much Because Providers Make More

In the US, doctors were once in the same category of professionals as teachers or firefighters. Those days are long gone. Healthcare providers here are compensated more generously than providers in many other places, such as Canada, Japan or Israel. Moreover, just as there are middlemen in the prescription insurance business (called pharmacy benefit managers, PBMs), health insurance has its own middlemen. The result is a great deal of complexity, very little transparency, and a lot of parties trying to make money on each transaction. That also leads to a great deal of administration, which further increases the cost.

Why Don’t Market Forces Control Costs?

Some analysts suggest that the free market should be able to control costs. But for market forces to work, you need competition and transparency. Over the last decade or so, there has been increasing consolidation in every sector of health care. Competition is limited in most areas. Moreover, transparency is in very short supply in health care. For years we have been talking about how hard it is to do comparison shopping for health services like MRI scans or colonoscopies. If consumers cannot compare costs or value, they cannot make the rational decisions that would help moderate prices.

How Administrative Costs Increase Bills

Part of every insurance premium goes to paying administrative costs. Insurers pay people to review claims (and deny some). Preauthorization also adds to administrative costs.

Manage the Hospital Bill So You Don’t Pay Twice as Much as You Should

Years ago, we interviewed Marshall Allen, who titled his book Never Pay the First Bill.  Our guest for the current episode counters always request an itemized bill. That way you can check it to make sure that simple items such as names, dates and insurance policy numbers are correct. Then look at whether the services billed are actually the services received. An estimated nine of ten hospital bills contain mistakes. The sooner you catch them and contest them, the less likely you are to have to pay them. To determine what you must pay, you may need to review the summary of benefits on your insurance policy. That lays out in detail exactly what the insurance will cover.

What Can Patients Do So They Don’t Pay Twice as Much?

• Ask for an itemized bill and check it carefully in every detail.
• If you find a mistake, contest it. Sooner is better, even though you may be trying to recover from a serious illness.
• Ask the billing office about patient assistance or a negotiated payment plan.
• Check with the Patient Advocate Foundation. They may be able to help in an individual case.
• Find out if your state has a consumer assistance program in the department of insurance.
• Notify an intractable billing department that your story will appear in your social media feed. This should probably be the last step if the previous ideas don’t work. But hospitals really don’t like bad publicity, so it might give you leverage you wouldn’t have otherwise.

This Week’s Guest

Linda J. Blumberg, PhD, is a research professor at Georgetown University’s McCourt School of Public Policy. She is an expert on private health insurance (employer and nongroup), health care financing, and health system reform.

Linda J. Blumberg, PhD, describes why we pay twice as much for healthcare

Listen to the Podcast

he podcast of this program will be available Monday, May 4, 2026, after broadcast on May 2. On this episode, Dr. Blumberg discusses the importance of the summary of benefits in your insurance policy in greater detail. You’ll hear about a situation in which an emergency department overcharged a patient egregiously; the summary of benefits was key in resolving the problem. You can stream the show from this site and download the podcast for free.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Transcript of Show 1471:

A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:01

I’m Joe Graedon.

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of the People’s Pharmacy.

Joe

00:06-00:27

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com.

Medical bills can be mysterious or infuriating. How can you make sense of the complexity and pay a fair price? This is The People’s Pharmacy with Terry and Joe Graedon.

Terry

00:34

Here in the United States, we pay more for our health care than people in any other comparable country. Despite this, our longevity statistics are worse.

Joe

00:46

We’ll talk with an expert about how we got ourselves into this mess and what we might be able to do about it.

Terry

00:54

She’ll help us better understand medical billing and how to challenge mistakes.

Joe

00:59

Coming up on The People’s Pharmacy, why Americans pay twice as much for less care.

Terry

01:15

In The People’s Pharmacy Health Headlines: An estimated two-thirds of American adults drink coffee every day. Now scientists have an idea why coffee is so popular.

Researchers recruited 31 coffee drinkers and 31 people who do not drink coffee for a detailed study. They compared the composition of their gut microbiota and found some striking differences. Then the coffee drinkers abstained from coffee for two weeks. During this time, the investigators noticed changes in their gut microbiota. After two weeks, coffee drinkers were once again provided with their beverage. Half the volunteers got regular caffeinated coffee, the other half got decaf. Neither researchers nor participants knew who got which beverage. Non-coffee drinkers did not participate in this part of the experiment.

Coffee-drinking volunteers reported less stress and depression whether the coffee had caffeine in it or not. People drinking decaf had improvements in learning and memory, possibly due to the polyphenols. Those getting caffeine in their mugs reported less anxiety but better attention and vigilance.

The scientists note that coffee is much more than a caffeine delivery mechanism. Coffee consumption also has an effect on the immune response.

Joe

02:37

Vertigo can be a disorienting and disturbing symptom. A recent overview published in JAMA describes one of the most common forms, benign paroxysmal positional vertigo, abbreviated BPPV. It’s caused when calcium carbonate crystals inside the ear move out of position.

A sensation of non-spinning dizziness or lightheadedness occurs when people lie down or change position. The diagnosis of BPPV relies on observing eye movements called nystagmus that occur when the head moves. It can be treated with a set of prescribed head movements called the Epley maneuver.

Although physicians often prescribe the antihistamine meclizine for vertigo, this drug is not effective for treating BPPV. Patients can also self-treat this condition by performing the Epley maneuver at home with good results.

Terry

03:34

Levothyroxine is one of the most prescribed drugs in America. That’s because millions of people have a sluggish thyroid gland. The condition is called hypothyroidism. Medical experts have worried that it is being over-diagnosed, especially in older people, based solely on thyroid function blood tests.

The investigators set out to examine whether de-prescribing levothyroxine is feasible. Study participants were all 60 or older and had been taking levothyroxine at the same dose for at least a year. The doctors began gradual dose reductions. Over the course of a year, 25% of the 370 volunteers were able to get off levothyroxine without having TSH or T4 levels go out of range.

Joe

04:24

One of the most contentious issues among nutrition experts in recent years has revolved around fat, in particular, the benefits and risks of omega-6 polyunsaturated fatty acids, or PUFAs. The AHA has long promoted PUFAs found in vegetable oils because they’re heart-healthy. Critics suggest that an imbalance with excessive omega-6 fatty acids could be harmful. Nutrition scientists distinguished between one specific omega-6 fat, linoleic acid, and all the others.

Researchers used data from nearly 274,000 volunteers registered with the UK Biobank. These middle-aged, healthy people had no dementia when the study began. Blood tests revealed the balance between linoleic acid and other omega-6 fatty acids.

Over the next 15 years, 5,800 individuals developed dementia. Those with the highest levels of linoleic acid were almost 20% less likely to come down with dementia. In contrast, those with the highest levels of other omega-6 fats were about 20% more likely to have a dementia diagnosis.

The scientists call for research on whether increasing dietary linoleic acid might help protect people from dementia.

And that’s the health news from The People’s Pharmacy this week.

Terry

06:15

Welcome to The People’s Pharmacy. I’m Terry Graedon.

Joe

06:18

And I’m Joe Graedon. Have you ever received a confusing medical bill? Actually, let me correct myself. Have you ever received a bill from a hospital that was not confusing?

Terry

06:30

Most of us have had, oh, maybe a moment of alarm when we’ve had to try and decode a complicated medical bill. Why is the American system so hard to navigate and so difficult to afford? We pay far more for our health care than people in any other comparable country, and we have much less to show for it.

Joe

06:53

To learn more about health care in America and how it compares to other countries, we turn to Dr. Linda Blumberg. She is a research professor at Georgetown University’s McCourt School of Public Policy. Dr. Blumberg’s expertise is in private health insurance, health care financing, and health system reform.

Terry

07:17

Welcome to The People’s Pharmacy, Dr. Linda Blumberg.

Dr. Linda Blumberg

07:20

Thank you so much for inviting me today.

Joe

07:23

We are delighted to be able to talk to you about, I think, one of the most challenging issues facing health care in America, and that has to do with our system for paying. So perhaps you can explain briefly how our payment system in the U.S. compares to most other advanced countries.

Dr. Linda Blumberg

07:47

Well, it is much more complicated than in most other advanced countries, probably in all other advanced countries. And that’s because we have so many payers and so many different sets of prices that are used for providers, for insurers, for different plans, et cetera, and how employer plans work. So the variation is enormous, which causes a lot of confusion for consumers.

And frankly, it often causes confusion for the providers as well.

Terry

08:17

I wonder if you would explain, Dr. Blumberg, you say so many different prices, which implies that if I were to go in for a CT scan of something, I might get one price and somebody else who has the exact same procedure done maybe charge something completely different. How does that work?

Dr. Linda Blumberg

08:39

That’s absolutely correct. And it all boils down to what type of insurance you have and what plan you have.

So if you are somebody who is enrolled in Medicare, the program in the U.S. for those who are 65 and over or who have particular disabilities that qualify them, there are prices that are regulated by the federal government in terms of what a provider can charge for each service.

If you have private health insurance, however, there is no regulation on the prices. And so a lot of it depends on what the market will bear for the particular provider that you happen to be using and the negotiations that they have completed with the particular insurance plan you have.

And so you may have a United Health Insurance Plan and somebody else may have a United Health Insurance Plan, but they’re two different plans and those would pay different prices for the same procedure.

Joe

09:34

Well, we’ll talk about billing in a minute, but what has always confused me is the idea that if you have insurance and you have to go into the hospital for some sort of a procedure, you would get bill X if you have insurance company Y.

But if you have no insurance and have to pay out of pocket, it can be substantially greater. I mean, like dramatically more expensive, which seems like it’s just [bleep]-backwards. Pardon my language. I mean, it just seems upside down.

How do they figure out these crazy prices?

Dr. Linda Blumberg

10:20

Well, first of all, we do not have a rational basis for deciding the prices that an insurer is paying to a particular provider or what a particular provider is going to charge to someone who’s uninsured. And you’re right. If you walk in the door without any insurance coverage, you are likely to be charged the highest price of anybody that’s walking in the front door of a hospital.

And that is because there is no insurer or third-party administrator that is negotiating any prices on your behalf. So you’re basically being charged the, you know, the retail rate, which is the highest that there is.

What a lot… as you say, it makes no sense because usually people without insurance are the people with the lowest incomes, right? And they have the least ability to pay for these services.

And oftentimes the hospitals, in particular, the nonprofit hospitals are required to have programs that lower prices for people with modest incomes that are coming in without insurance. However, they often don’t even advertise that these programs exist. They’re hard to find even on their websites.

And so people who are walking in without insurance are being charged huge prices, and they have to know to say, “Listen, well, I have low income and I need to have access to someone who’s going to help me with whatever program you have for low income people walking in the door.”

So it is a lot of hit and miss in terms of what people understand about what might be available to them and what negotiated deals a particular hospital has made with a particular health insurance plan. And it’s often a function of how much market power the insurer and the health care providers, the health system have in that particular area is going to drive whether the prices are lower or higher.

Terry

12:22

Dr. Blumberg, you mentioned the retail price of a procedure or a hospitalization. And you also mentioned that Medicare prices are regulated, even though all these other prices are not. I’m going to mention, as a Medicare patient, I occasionally look at my explanation of benefits and I find them very confusing and/or alarming because what I see is that my provider, for example, might charge $355 for something. So that’s the retail price. And Medicare approves, let’s say, $128, you know, as that’s the approved payment, but it doesn’t pay that full amount. And then the supplemental, I happen to have Blue Cross, picks up usually most of what Medicare doesn’t pay on the amount that Medicare has approved. But there’s such a mismatch between that retail price and that approved price. How does that work?

Dr. Linda Blumberg

13:40

Well, that shows you that when somebody who walks in the door to get the retail price is being charged much more than somebody who’s coming in with Medicare. And that is by federal government law, is that physicians who take payments from Medicare, who participate in Medicare, have to agree to take the rates that are set out in federal law.

And these providers know they’ve made this agreement with the federal government. That’s why they’re participating. So this is customary for them. It’s not surprising to them that there is a disconnect between those prices. In fact, very few people end up paying the actual retail price.

But if you’re walking in with private health insurance, you’re likely to pay considerably more than or your insurer is going to be paying more and you are likely to pay some more also compared to the Medicare prices. So on average, and this is just on average, hospital payments under private insurance are in the neighborhood of two and a half times what Medicare pays. And for physicians, for clinicians, it’s more on average about 25% above what Medicare pays. So the variation is large even around that.

You know, for some procedures and for some clinicians, they may be getting 600% of Medicare or 900% of Medicare. It varies enormously through the system. And that’s why I say we’re not paying privately on any rational set of prices.

Joe

15:17

So what has really boggled my mind is that if, for example, you need a hip replacement, as I have had, or a cataract surgery, the provider may charge thousands of dollars. Let’s just make up a number and say, you know, $3,500 for this particular cataract surgery. But Medicare may only pay a few hundred dollars.

It’s like the discrepancy is so dramatic. It would be as if the sticker price for your car is $25,000, but you actually only have to pay $18,000. I mean, people are so shocked by these numbers. They seem to make no sense whatsoever.

And you kind of wonder, well, how can this system function if these billable numbers are two, three, four times more than the doctor actually gets paid? It seems insane.

Dr. Linda Blumberg

16:19

Except for the doctor doesn’t really expect to get paid the amount that they’re showing on the bill, they have negotiated particular rates of payment with insurance plans, and they have accepted the federal government fee schedule, which is public information.

So the retail prices that you see are really pretty meaningless because the real prices are the ones that have been negotiated with whoever the insurance company is, whether it’s public or private.

Joe

16:50

Unless you don’t have insurance, unless you’re not eligible for Medicare, in which case you’re on the hook for an unbelievable amount of money that you can’t possibly afford.

Dr. Linda Blumberg

17:02

Absolutely. But then, you know, I always suggest to consumers when they’re in that situation, first of all, if it’s with the hospital, to explore what programs they have for uninsured people with modest incomes. Because if it’s a nonprofit hospital, they’re required by law to have some kind of program. Whether a particular individual is going to qualify for it is up to what that program looks like. But you always explore that.

And absent that, or if you’re talking about care you’ve received from an individual physician, I always suggest that the consumer talk to the physician, talk to the financial manager for the practice and see if there’s some way to negotiate that rate down. Because as you said, it doesn’t make any sense and nobody with private insurance is paying for it.

Terry

17:51

You’re listening to Dr. Linda Blumberg, research professor at Georgetown University’s McCourt School of Public Policy. Dr. Blumberg’s expertise is in private health insurance, health care financing, and health system reform. She has analyzed the Affordable Care Act and studied strategies to address remaining health insurance coverage issues.

Joe

18:14

After the break, we’ll ask Dr. Blumberg how much an emergency might cost.

Terry

18:18

Are we getting any bang for our buck compared to other countries? How do health insurance middlemen affect the cost of care? Some people suggest that the free market should take care of the pricing problems.

Joe

18:29

Why haven’t market forces brought health care prices down?

Terry

18:43

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Terry

20:45

Welcome back to The People’s Pharmacy. I’m Terry Graedon.

Joe

20:48

And I’m Joe Graedon.

Joe

21:17

We’re talking about the high cost of health care in the United States. Are we getting our money’s worth? We pay far more than people in most other countries, but our health statistics are abysmal.

Terry

21:31

Many families in America go into debt because of huge medical bills. In some cases, people have lost their life savings and their homes because of a health care crisis.

Joe

21:42

Will cuts to Medicaid make this situation more challenging? Will hospitals close because of reduced financial stability?

Terry

21:52

Our guest is Dr. Linda Blumberg. She’s a research professor at Georgetown University’s McCourt School of Public Policy. Dr. Blumberg’s expertise is in private health insurance, health care financing, and health system reform.

Joe

22:10

Dr. Blumberg, in the event that you had an emergency, and let’s say you had to have an ambulance and then you had to go to the emergency department, maybe you thought you were having a stroke or a heart attack, and then you’ve seen multiple specialists and you have a whole bunch of tests, CT scans and goodness knows what else. And then you have to stay in the hospital with maybe a couple of procedures for, let’s say, three to five days. How much might your bill be at the end of this hospital stay?

Dr. Linda Blumberg

22:43

Well, a total bill for a hospital stay can be enormous. It depends upon the services you’ve received, how long you’re staying. But, you know, it can often be in the tens of thousands of dollars. But, you know, there are people who have inpatient stays in a hospital for a length of time in serious conditions that could be a million dollars, right?

So it all varies a lot, but an emergency department is a particularly expensive place to obtain care, and hospital stays are the most expensive costs that we face in our healthcare system.

Joe

23:17

I’d like to ask you about how much bang we’re getting for our bucks in the United States compared to other advanced countries, because, you know, we have done an amazing job at getting smoking down. I mean, turn back the clock about 40 or 50 years and like half of Americans, especially men, smoked. And today it’s down around 12 or 15 percent or lower, maybe around 10 percent. So we’ve made some real progress in terms of health behaviors. But that aside, our life expectancy has not improved dramatically.

Other countries, for example, Japan, South Korea, Sweden, and France are all about 83 to 84 years of age. In the U.S., our life expectancy is around 78 years. We spend annually over $12,000 a year per capita per person. In Germany, it’s 8,000. In France, it’s $6,600. And in Sweden, it’s $6,400.

So almost half of what we spend. And yet their longevity is much greater. I mean, substantially better. How? I mean, what?

Terry

24:37

What gives?

Joe

24:36

What is going on? How can it be that we’re paying so much more for so much less?

Dr. Linda Blumberg

24:45

Really good question. Part of what’s going on and probably the biggest difference in terms of what we spend compared to other countries, developed countries on health care, is the prices that are paid to the health care providers from, you know, who we’re receiving our care from.

So a hospital stay for the same services in the United States is typically going to cost considerably more than if those services were obtained in Canada or in Japan or in Germany or in Israel. So those are systems that… where all of the… There is regulation of the prices that are paid, are paid for medical procedures, regardless of the type of insurance coverage you have. And some of them have, you know, different plans, et cetera, not as much variation as we have here, but some variation.

But all of those prices are limited in those countries by government dictate. And we are, as I said, we’re only limiting the prices that we pay for medical care if you’re in a public insurance program like Medicaid or Medicare. If you have private insurance, which most people below age 65 have a private health insurance, those prices are not regulated.

In addition, when you think about longevity, we do have a more diverse population in a lot of respects than is the case in most other developed countries.

But in addition, we have the issue here of still having a significant number of U.S. residents without any health insurance coverage at all, which is not the case in these other developed countries where they have at least some level of universal health insurance coverage. And sometimes it’s considerably more comprehensive than the types of coverage we have here.

And so when you have a significant share of the population, even if it’s only at this point under 10%, about 10% of the population under age 65, you still have a considerable number of people who are not getting access to medical care when they need it. And that is going to affect longevity.

Other things like diet and pollution and, you know, various other different issues. We have a lot of gun violence here, which is not the case in the vast majority of other countries. So all of those things go into the difference. But the difference in our spending is completely on the prices that we’re paying to our health care providers on the commercial side.

Terry

27:25

Dr. Blumberg, you’ve written about health insurance middlemen. I wonder if you could explain what that is and how it affects the prices we pay.

Dr. Linda Blumberg

27:35

Sure. So when we are obtaining medical care in this country, we are paying for the particular services, right? And money is going to the providers who are providing these services to us. But we’re also paying administrative costs. And those administrative costs are built into the prices that we’re paying to hospitals and doctors and other providers. And it’s also built into the premiums that we’re paying for our health insurance coverage.

And increasingly in this country, we have moved our healthcare economy into a space where huge numbers of dollars are going for administrative fees that are associated with what I refer to as middlemen. People have heard a lot about prescription drug benefit managers.

But the same is true on the medical side. So a hospital is spending large amounts of money on a revenue cycle management company that is trying to figure out how to send in bills and code the services delivered to increase the revenue of the hospital. Same on the physician side. You have various different types of entities that are contracting with insurance companies to do particular types of tasks that the insurance company or the third-party administrator either doesn’t want to do themselves or finds more profitable to contract out to their subsidiaries.

So there is a lot of dollars that are going into making the prices higher on the claim side, on the medical service price side, and that are also being built into our insurance premiums through higher claims and through higher administrative loads that are attached by the insurer. So, I mean, we’re talking about an industry that is hundreds of billions of dollars every year that is really extractive, that’s pulling dollars out of every one of the transactions. And there’s billions of transactions that go through our system every year.

And so these entities, these administrative and financial entities have figured out how to extract dollars from the healthcare economy by adding some administrative costs to every single transaction that is being processed through the system.

Joe

30:07

Dr. Blumberg, I think most people have a real hard time dealing in billions and dealing with middlemen and all the other stuff, but they can relate to an office visit. So for example, if you had to go see a specialist in this country, maybe a gastroenterologist or a dermatologist or a cardiologist, those bills for just a quote unquote ‘regular visit’ could be in the hundreds of dollars.

In Sweden, it’s 40 bucks. That’s the maximum a specialist can charge in Sweden. Kids are free in Sweden. I think most parents know that a pediatrician’s visit can be pricey. They have no health care premiums in Sweden. It comes off their tax bill. The average hospital bill in Sweden for a day, this, you know, being in the hospital for a day, is $11. In this country, it can be thousands. And the maximum that a person would pay for all medical appointments annually in Sweden, everything lumped together would be $160. It can cost us $160 for just one visit in this country.

So I’m just wondering, when will the American public say enough is enough?

Dr. Linda Blumberg

31:38

So I think one important thing to remember is that, yes, when somebody is taking their kid to a pediatrician in Sweden, they’re not paying anything out of pocket. But their taxes are higher, right? Because those providers still have to be paid for the services they’re providing. It’s a matter of how the prices are, how they’re being paid. And in those countries, much more of the dollars are flowing through their national health system, which is funded by tax dollars.

And so the tax rates in Sweden, for example, are typically quite a bit higher than we face in the United States. But they, at the same time, obviously the country is regulating how much the providers can earn for providing the services that they’re provided. So there are some limits that lower the incomes, the revenue that the providers receive, but much more of the dollars are flowing through the government and from tax dollars than is the case here.

We have always struggled here in the United States with balancing, number one, regulation. How much do we want to regulate prices instead of letting the market decide what a private sector person like a health care provider or hospital is going to receive? And we also struggle with increasing our taxes, right? And so we could create a system where we have greater regulation of the prices and limits on prices that are paid to health care providers to lower our total spending. We can also finance more coverage through the federal government or through state government for more people.

But it is a real political struggle to convince people that while they feel like their… that health care is too expensive, they’re afraid of oftentimes of putting limits on what their particular doctor is going to make or their particular hospital is going to make. Because the hospitals and the physicians will let them will tell them whether it’s accurate or not, that their access and their quality of care is going to suffer if they do that.

And there are also people in this country are very much resistant to significant increases in their taxes, even if you tell them it’s going to lower other out-of-pocket expenses because they don’t really believe it, right? Or they think they’re going to end up paying more for somebody else to have lower prices. So it is a very complicated political balance here.

I think people are getting more and more frustrated with the way that the system works and the increase in the denials and the red tape and the complexity people have to jump through to obtain their medical care. But the political challenge is real in terms of more government regulation of prices and/or financing more care through the tax system.

Terry

34:43

Well, you’re absolutely right. It is very complicated politically. And you mentioned that one of the alternatives that is sometimes posited is: let market forces regulate prices, which is, I think, where we are, except that market forces are only making prices higher, not lower.

Why doesn’t health care in America work like a market should?

Dr. Linda Blumberg

35:12

We have had a tremendous amount of consolidation in our healthcare industries. And so when we talk about hospitals being bought, you know, buying other hospitals and creating hospital systems and, you know, sometimes often now buying medical practices, insurance companies, UnitedHealthcare is now the biggest employer of physicians in this country, right?

The insurers and the healthcare systems are buying up these middlemen that are making more money off of, you know, as I was saying, extracting dollars from the claims that are being processed. So there’s been a tremendous amount of complexity added in the financial relationships between all of these stakeholders, the providers, the insurers, the middlemen.

Very few of them are independent at this time. Very many of them have conflicts of interest, all directed in the direction of increasing prices on the commercial side and increasing spending.

Terry

36:15

Right. Lots of complexity, not much transparency.

Dr. Linda Blumberg

36:18

Right. It is basically capitalism run amok. And you’re talking about a product in health care that was already from the beginning of time, much more complicated to shop for than a refrigerator, right? You know, you don’t know necessarily what you’re going to need in terms of services or what it’s going to cost before you walk in the door at the doctor’s office or in the hospital.

It is not something that is easy to shop for, whereas I can, you know, spend 20 minutes and figure out what the best price I can get on the refrigerator I want is. That’s just not the way medical care works. And then when you take the consolidation and the hidden fees and the conflicts of interest that have arisen both between co-ownership in the healthcare industry and these financial deals that are being made between the insurers and the middlemen and the providers at this point, you have a situation where there is no competition in these markets or where there is, it’s extraordinarily limited.

And so you’re not going to… the more this is allowed to fester and expand, which is what it is doing year in and year out, the worse it’s going to get. You’re not going to have competition driving prices down. You’re going to have greater financialization of the system continuing to drive prices up.

And really the only way to interfere with that is for government to put limits on both what prices can be charged for particular services and to eliminate the financial dealings that are interconnecting all of these stakeholders with each other and encouraging higher intensity coding and hidden financial fees that are passing between different entities that are driving costs up for consumers and employers.

Terry

38:14

You’re listening to Dr. Linda Blumberg. She’s a research professor at Georgetown University’s McCourt School of Public Policy, and she is an expert on private health insurance, health care financing, and health system reform. Dr. Blumberg has provided technical assistance to states in their efforts to analyze and implement federal reforms and examine the implications of private equity companies’ movement into health care.

Joe

38:43

After the break, we’ll discuss why you need to examine your hospital bill extra carefully and with skepticism.

Terry

38:52

Hospital bills are complex and they often contain errors. To really figure out the charges, you need to request an itemized bill.

Joe

39:01

Surprisingly, your insurance company might not behave like an ally.

Terry

39:09

How do you contest a bill that is obviously wrong?

Joe

39:12

Sometimes media exposure of outrageous bills can make a big difference. Most hospitals hate bad publicity.

Terry

39:31

You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Welcome back to The People’s Pharmacy. I’m Terry Graedon.

Joe

39:46

And I’m Joe Graedon.

Joe

40:16

Are you the kind of person who pays bills as soon as you get them? Nothing wrong with that. But when it comes to hospital bills, you may need to slow down. It turns out they often contain errors that can be tough to track down.

Terry

40:33

Medical bills, especially hospital bills, can be extremely complex. And hospitals make mistakes all the time. You’ll need to scrutinize every charge.

Joe

40:44

We’re talking today with Dr. Linda Blumberg, research professor at Georgetown University’s McCourt School of Public Policy. Dr. Blumberg’s expertise is in private health insurance, health care financing, and health system reform. She has analyzed the Affordable Care Act and studied strategies to address remaining health insurance coverage issues. Dr. Blumberg has also analyzed approaches for setting standards of affordability for insurance coverage.

Terry

41:14

Dr. Blumberg, some years ago, we spoke with a fellow, I think his name is Marshall Allen, who wrote a book. He titled it: “Never Pay the First Bill.” And we found our conversation with him quite interesting. I’m wondering what you think of that advice.

Dr. Linda Blumberg

41:34

Well, I think my advice is always be skeptical and look carefully at a bill. Don’t just pay it, because the vast majority of them, whether they’re coming from a hospital, much more likely from a physician, also reasonably likely there’s mistakes in them. And so you do want to approach them with some skepticism and caution.

Joe

41:58

Well, actually, that’s not enough. And the reason I say that’s not enough is because most of us, when we look at a hospital bill or a clinic bill, we don’t know what to make of it. I mean, it is really confusing. And as you said, there’s like the bill that the doctor presents and the bill that the clinic presents or the hospital presents.

And then there’s what Medicare might pay or might not pay or your insurance. It’s like, how in the world do we make sense of our medical bills? How do we even get started?

Dr. Linda Blumberg

42:38

It’s rough and it takes a good deal of patience and time, unfortunately. Hospital bills in particular, I’ve heard estimates that nine out of 10 of them have errors. I’ve heard others say that there’s never a hospital bill that doesn’t have an error in it, right? And they’re the most complex of the bills that an individual is going to receive.

My advice is always the first thing you do is request an itemized bill from the hospital, because by and large, what the hospital will send out is a summary bill, not an itemized bill. And you can’t figure out what the errors are in general from a summary.

So request an itemized bill. If they don’t send it, you got to ask again, because sometimes they’re a little pokey about it because they just want you to pay. They don’t want you to look at the itemized bill.

Joe

43:26

Well, let me ask you this: let’s say you get an itemized bill and it says that you had an ultrasound done on such and such a date of, you know, such and such a part of your body and you go, “No way. I did not have an ultrasound at all.”

How did that happen? And then how do you contest something that’s obviously wrong?

Dr. Linda Blumberg

43:53

The first stop from my perspective is to call the billing department, to call the physician’s office of the physician that you’ve seen and contest it and say, there’s a mistake. I’m being charged for a service that I never received. An insurance company, if you have an insurer, can also often be helpful when you’re talking about something you’ve been charged for that is something you have not received. But it sometimes will take multiple calls and multiple interactions to resolve a problem like that.

You know, one of the most common errors that people see in hospital bills is being billed twice for the same thing or the number of, you know, something that was charged for, you know, some supply or something is, you know, somebody added a zero to it by mistake, you know, assumedly. And that needs to be corrected, and so engaging with the physician who you’ve received services from with your insurer and trying to contact the billing department directly at the hospital…

Joe

44:59

Let me ask you one follow-up to that, because you would think that since the insurance company, if you’re fortunate enough to have insurance, would be an ally, would be joining you in fighting an incorrect bill or a bill that was overcharged for some reason or a service that was never provided or a medication that you never got.

We’ve heard that insurance companies, they’re not as likely to be enthusiastic about challenging these bills because after all, they’re just going to pass those charges on to their customers and consumers. It’s like, well, why waste our time? Because you, you know, you, you were charged for aspirin, but you didn’t get aspirin. So how do we get the insurance companies fired up to actually challenge mistakes?

Dr. Linda Blumberg

45:55

It is sometimes a struggle for sure. One of the things that people should be aware of, and what I talk about when I talk about this complex web of interconnected financial interests across stakeholders in the healthcare industry, is that insurance companies, they can make greater profit the higher the claims. Under the law, they are limited in terms of what percentage of a premium can go to administrative costs, including profit. So since that’s limited as a percentage, the higher the total spend on claims, the bigger the amount of money they have left over for their administrative costs and their profit.

And so in a lot of ways, they’re disincentivized to hold down spending, which is contrary to what many people who are using, buying health insurance coverage expect of their insurer. They think their insurer is trying to get the best deal for them. That is not always the case.

And so you can talk to the consumer reps with the insurer, but sometimes you’ve really got to go directly to the provider and dispute. And there’s a nonprofit called the Patient Advocate Foundation that is particularly created to help people with chronic illnesses contest incorrect bills and deal with billing issues. There are others who will do it for a fee as a percentage of what savings created.

But it becomes sometimes a situation where the consumer themselves needs to do repeated calls and contacts and filing complaints in order to get a bill resolved. But I still always say contact the insurance company as well. They may be in a mindset to help out.

Terry

47:52

Dr. Blumberg, you’ve mentioned that patients can and probably should negotiate with whether it’s the physician’s office billing or the hospital billing, especially if they don’t have insurance, but even if they do. Can you tell us about a time when somebody did that? What was the outcome?

Dr. Linda Blumberg

48:17

Well, sure. I mean, I think it depends greatly on the health care provider, right? And if you have had a primary care physician for many years and then you’ve lost health insurance coverage or for some reason you have a gap or et cetera, you know, there are ways in which, you know, in circumstances where these providers will either set up a payment plan for you, or they’ll say, “Listen, you know, you’ve been a great patient and I want to help you through this rough spot.” And they’ll negotiate down, you know, hopefully to what at least at a minimum that the private insurer would have paid, right?

But it is very much [an] ad hoc kind of decision that’s being made by these providers. Now, in the situation of a hospital, particularly for people who have modest incomes, there are programs that nonprofit hospitals have, as I mentioned before, that are there to help people in financial straits. And those programs, sometimes they’re programs that are funded by state government dollars. Sometimes it’s… parts of it, the hospital themselves, but those are programs that exist explicitly for people in tough situations. And some… but some… The problem is you have to really push to get the information about them to figure out whether you’re eligible.

Joe

49:41

Dr. Blumberg, what about media exposure? I mean, every once in a while, somebody sort of blows the whistle on an outrageous bill that just blows everybody’s mind. It’s like, that’s ridiculous. And they contact their, their local TV station or their newspaper, and all of a sudden, you know, it goes, you know, wild on the internet, and it affects the hospital in such a way they say, “Oh, never mind, let’s negotiate a better bill.”

Is that something that people can actually do successfully?

Dr. Linda Blumberg

50:15

Yes, people have done it successfully. And there’s, you know, ‘bill of the day’ kinds of newspaper reporting, et cetera, where some experienced reporters are doing this repeatedly on behalf of people in particularly egregious circumstances. And it can be really effective at cutting through to the right people at the right moment to get a better deal created. And so, listen, if I was in that situation, I would use whatever options I had at my disposal.

You know, in some states, unfortunately, it’s not all states, but in some states, state governments have what are called consumer assistance programs. They were originally funded by the federal government across the country, but that funding has not been reappropriated in many years now. But those consumer assistance programs, if you’re lucky enough to live in a state that has one, can sometimes also be helpful if you contact them, file a complaint with the state. If it’s a problem with the insurance company and it’s a fully insured product, not a self-funded plan from the employer, you can file complaints with the Department of Insurance, et cetera.

So there are opportunities for going higher. And I always suggest to people, even if you’re contacting someone at the hospital, if you’re not getting any kind of satisfaction from a consumer rep, you want to escalate to a manager, to whoever. You want to just go as high as you can in the pecking order to try to get some resolution.

Joe

51:50

We are concerned about pharmaceutical prices, as you can very well imagine here on The People’s Pharmacy. And we have seen pharmacies disappearing in this country at an extraordinary rate, in part because private equity firms have bought up large chains, and those large chains are now closing not dozens but hundreds of pharmacies. And so the idea of a mom-and-pop pharmacy where the pharmacist was a sole operator seems to be disappearing very quickly. And drug prices, as everybody knows, are way higher in this country than any place in the world.

What do you suggest when it comes to the costs of medicine in this country, especially for people who have life-threatening conditions and their bills may be in the tens of thousands of dollars?

Dr. Linda Blumberg

52:43

It’s really, really difficult. And I wish I had a good answer for you. I know some people are trying to obtain medications at more affordable prices outside of the country. That’s always challenging and a little bit risky depending upon where you’re going to get the medications. But there are some programs that particular pharmaceutical companies have that lower prices for people with modest incomes or people who do not have health insurance coverage for brand-name types of drugs that they need.

And so, you know, I usually suggest to people, first stop if you can’t get satisfaction or help from your insurance company. And sometimes if it’s not on their formulary, you can get evidence from your… help from your physician about why that particular drug is so necessary to try to appeal and get coverage from your insurance company. If you’re without insurance or without good enough insurance to cover costs, I would suggest to people go to the website for the company that makes your drug and see if they have some programs that might be able to help.

There are also some states [that] have particular programs for providing financial support for prescription drugs.

Joe

54:04

Dr. Blumberg, we only have about two minutes left. If we were to put you in charge of the entire health care system, how would you change things?

Dr. Linda Blumberg

54:15

Well, first of all, I would put back a number of the coverage cutbacks that this administration has put in place or that they will be putting in place in the near future in the Medicaid program because every person in this country should have access to affordable, adequate health insurance coverage for their medical needs.

Beyond that, I would put limits in place on the prices that are charged by providers, and I would do it broadly across all prices, and hospital level, physician level. I would include prescription drug controls in that as well. I would then make sure that we are monitoring a system to make sure that everybody has the access that they need.

And I would do a lot to break up the kinds of integrated financial incentives from co-owned entities in the healthcare system to separate those financial incentives, create more competition and clarity in terms of what people are paying when they obtain care.

And I think we’ve also got to go a ways to your point about the prescription drug issues on the private equity side. There’s a lot of practices that private equity typically uses in the healthcare space that are extractive and damaging both to prices, quality, and sometimes the stability of the healthcare providers themselves. And we have to prohibit those kinds of high debt financing and other extractive practices that are often in place there.

Terry

55:50

Dr. Blumberg, did we miss anything that we should have asked you?

Dr. Linda Blumberg

55:54

No, I think we covered a lot. So, yeah, I think, you know, when people get their bills, they should always make sure that the names, the dates, you know, the insurance information is all correct. Sometimes that stops insurance companies from paying appropriately from like little minor like typo errors in addition to the kinds of things we talked about.

And everybody who has a health insurance policy by law has access to what’s called a summary of benefits and coverage or an SBC. This is part of the Affordable Care Act law. It’s an English-language summary of your benefits. And so I always suggest to people to have that in hand so you can make sure that when you get the bill that says this is what your insurance company pays, this is what you owe, that you’re clear that that is really what you owe.

So, for example, I had a situation where I was helping somebody and they had gone into the emergency room for urgent care that the doctor told them to go to the ER. And the hospital charged them $2,000 up front on a credit card when they walked in the door. Their summary of benefits and coverage very explicitly said that the only charge they should be charged when they walk into an emergency room for a real emergency is $200.

It took me about an hour and a half or two hours and maybe three or four different telephone calls to resolve that. But it was really clear from that summary of benefits and coverage that that person was overcharged. So, you know, knowing, being really on top of what your health insurance plan is supposed to cover and comparing that to what you’re being charged is a really important line of defense.

Joe

57:47

Dr. Blumberg, whenever we talk to healthcare professionals, they often complain these days. They complain that they have to see way too many patients in way too little time. They complain about the cost of their education, whether it’s a nursing school or pharmacy school or medical school, that it’s very expensive and that they had to go into debt. And then they complain about the whole fee structure and all the bureaucracy and all the time they have to spend sometimes arm wrestling insurance companies, and it’s not actually practicing medicine the way they would like to.

But at the same time, we hear that people earn rather extraordinary incomes. So a, for example, orthopedic surgeon is often making $500,000, $600,000, $800,000 a year. A family practice physician may be only making $150,000 to $200,000 a year.

How do the payments to healthcare professionals in this country compare to the healthcare professionals in, let’s just say, the UK or Germany or Sweden?

Dr. Linda Blumberg

59:20

We are paying our specialists in particular a lot more than are being paid in those other countries. I don’t have the statistics at hand on those specific salaries, but, you know, I’m not sure we’re paying our primary care physicians, you know, any more or not significantly more than they are paid in other countries. But, you know, those are at the highest levels, you know, as you said, the orthopedic surgeons, the interventional radiologists, the folks that are being paid for procedures at really high levels are paid much more than we see in other countries.

And I think my understanding is, and I’d have to look at this more carefully, but my understanding is that education in general, including education for medical professionals, is much more highly subsidized in most of these countries than we do here.

And so if you’re going to pay considerably less, then we also have to think about subsidizing the education for some more medical professionals than we do. And that should be part of the thinking if we’re going to put a lot of limits on what these providers can make.

Joe

01:00:38

And finally, our listeners learn from stories. And quite honestly, so do doctors. They call them case reports. But it makes the topic that we’re discussing come alive in ways that just talking in a more academic way [does not]. Have you had any experience over your career in which a patient or a family or some situation where the billing was so outrageous that it came to your attention and it was able to be modified?

You mentioned spending a couple of hours on the phone because the person was billed so much on their credit card when they entered the emergency department. Is there any other story you could share about billing that would be how I would describe it as helpful for our listeners to comprehend the scope of the problem?

Dr. Linda Blumberg

01:01:40

Well, you know, I am an academic researcher, right, and a policy researcher. And so I do not generally work as an advocate for patients. Every once in a while, a family member or a friend or somebody who sees a program that I’ve been speaking on will contact me and ask for help and I’ll do what I can. But that’s the most…

The situation with the $2,000 bill instead of the $200 bill is my most recent case of that. But, you know, the other thing that I’ve seen a lot in terms of what’s been in the media is stories of people who go in for an emergency room visit, and it’s a reasonably modest kind of situation. They’re not in there long. Maybe it’s for a child and they were worried, but it’s really not a big medical problem. And the intensity with which that bill is coded is way out of whack with the services that were provided because emergency room visits are coded by the intensity of the situation and the services needed.

And so those are situations where people can get bills in the huge range, tens of thousands of dollars for something that should have been a much more low-cost price. And seeing that and having to go back and appeal that is something that is becoming more common, I think, in emergency departments over time. So I don’t have a lot of individual stories where I have particularly intervened because that’s, you know, I’m a data and analytic person more than I am, you know, I’m not really a consumer advocate.

Terry

01:03:26

Dr. Linda Blumberg, thank you so much for talking with us on The People’s Pharmacy today.

Dr. Linda Blumberg

01:03:32

My pleasure. Thanks for having me on.

Terry

01:03:34

You’ve been listening to Dr. Linda Blumberg, research professor at Georgetown University’s McCourt School of Public Policy. She’s an expert on private health insurance, health care financing, and health system reform. Dr. Blumberg has provided technical assistance to states in their efforts to analyze and implement federal reforms. She’s also examined the implication of private equity companies’ movement into health care.

Joe

01:04:05

Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music.

Terry

01:04:14

This show is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy.

Joe

01:04:23

Today’s show is number 1,471. You can find it online at peoplespharmacy.com. That’s where you can share your comments about this episode. We’d love to hear your reports about hospital bills, interactions with the medical system. Please, you can reach us through email, radio at peoplespharmacy.com.

We’re also trying to enhance our YouTube channel with videos of our interviews. If you’d like to watch our interactions with guests you hear each week on The People’s Pharmacy, why not go to YouTube and search for People’s Pharmacy?

Terry

01:05:01

Our interviews are always available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning. In this week’s podcast, we also discuss how easy it is for errors to creep into the bill, even through simple typos. The summary of benefits for the insurance coverage is a crucial document. It lays out exactly what the hospital can and can’t charge you for. One reason health care costs so much in the U.S. is the high cost of specialized medical professionals. How does compensation in other countries compare to what health care professionals make here? You’ll also hear about emergency room coding errors.

Joe

01:05:48

At peoplespharmacy.com, you could sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast. We would be so grateful if you would write a review of The People’s Pharmacy and post it to the podcast platform you prefer. If you find our topics thought-provoking, please share them with friends and family. In Durham, North Carolina, I’m Joe Graedon.

Terry

01:06:18

And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to The People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

Joe

01:06:55

If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in.

Terry

01:07:04

All you have to do is go to peoplespharmacy.com/donate.

Joe

01:07:10

Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, April 25, 2026, through 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 April 27, 2026.

Would Your Doctor Prescribe Exercise for Depression?

Earlier this year, the Cochrane Collaboration published a review of 73 randomized clinical trials of exercise as a treatment for depression (Cochrane Database of Systematic Reviews, Jan. 8, 2026).  Most of these compared physical activity to antidepressants or to psychological therapy for depressed patients. Some of them compared the exercise prescription to no treatment or wait list.

Comparing exercise to no treatment revealed an advantage for exercise, although the quality of the trials left something to be desired. Ten trials compared exercise to psychological therapy. In addition, five trials weighed exercise against antidepressant medication. Neither comparison showed a clear tilt for or against exercise as a superior intervention against depression.

Exercise in the Cancer Center

Dr. Claudio Battaglini of the University of North Carolina at Chapel Hill was not surprised by this finding. The exercise program he oversees for cancer patients often results in lifting their spirits as well as improving their health. That may help explain the very high adherence in his program.

Will Physical Activity Reduce the Risk of Cancer?

According to a review of the evidence, regular physical activity can reduce the number of people who die prematurely. In addition, it helps with weight control, quality of life and bone health. Older people are less likely to fall or experience declining cognition if they exercise regularly. The review found that physical activity improves quality of life and promotes emotional benefits (European Journal of Cancer Prevention, Jan. 1, 2025).

If oncologists should prescribe exercise, don’t cancer patients deserve to have their insurance company cover the cost? Insurers rarely blink twice at cardiac rehab. Although cancer rehab is also super-helpful, insurance companies often don’t choose to pay for it.

What Role Could Coaching Play in Guiding Physical Activity?

Lots of doctors tell their patients to get more exercise. The patient wants to and intends to, but perhaps they just don’t know how. What activity should they choose? What is the proper technique? How often and how much do you need to move? All these questions can be answered by a coach. The coach will take into account your objectives and preferences as well as your prior experience. What do you love doing? Are there any moves you should avoid to reduce the risk of injury? That’s why when doctors prescribe exercise, they should include coaching to provide this sort of guidance.

If Doctors Prescribe Exercise, Will That Help Motivation?

Many of us know we should be active, but we don’t always follow through. How can we get motivated to move? According to Dr. Jordan Metzl, the first step is to find something you love doing. For Joe, for instance, having the doctor prescribe exercise of runniing a mile a day is not going to work. But he’ll cover much more than a mile–and quickly–if he is playing a competitive game of tennis. Joe loves tennis.

Terry is not a runner either. On the other hand, karate club is a highlight of her week, and she has worked to achieve some skill in it. Dr. Metzl advocates for finding the activity that gets you excited and making it a priority in your life. If you are having fun, that is a great motivation.

Reducing the Cost to Act

Another thing to consider is overcoming the cost to act. If your activity requires a lot of preparation that feels like a chore, the cost to act is high. If you can make it easier and break down that barrier, you are much more likely to accomplish your exercise.

External rewards can also play a role. Joe loves winning, so he likes to play with guys at about his same level of skill. That way, he has a chance to win if he tries. For Terry, there was a progression through belt levels in karate, from yellow to green to blue, and so on. Now, she looks forward to closing the rings in the fitness app on her watch.

When Doctors Prescribe Exercise, Does That Give You a Push?

For Dr. Metzl, the idea of pushing yourself and maybe your friends is a positive notion. We asked him about people who dig in their heels when pushed. What approach do they need to perceive and pursue their goals? He summarized the three ingredients of healthy motivation as knowledge, emotion and belief. That’s knowledge of the benefits of activity, an emotional response of appreciating and enjoying activity and a belief that you can achieve your goal.

This Week’s Guests

Claudio Battaglini, PhD., FACSM, is Professor in the Dept. of Exercise and Sport Science at The University of North Carolina at Chapel Hill. He is also Director Emeritus of the Get REAL & HEEL Breast Cancer Research Program and Co-Director of the Exercise Oncology Research Laboratory.

Jordan D. Metzl, MD is an internationally recognized sports medicine physician, bestselling author, and fitness instructor who practices at the Hospital for Special Surgery in New York City. He lectures around the world and founded the first physician-led online fitness community, IronStrength, with more than 50,000 members. He created the Ironstrength Workout, a functional fitness program for improved performance and injury prevention that he teaches in fitness venues throughout the country. An elite athlete himself, Dr. Metzl is also a 40-time marathon runner and 14-time Ironman finisher.

Dr. Jordan Metzl, author of Push, runs the New York City Marathon 2025

Dr.Metzl’s latest book is Push: Unlock the Science of Fitness Motivation to Embrace Health and Longevity

The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).

Listen to the Podcast

The podcast of this program will be available Monday, April 27, 2026, after broadcast on April 25. On this episode, Dr. Metzl talks about the joy of teaching medical students to offer an exercise prescription and the challenge of getting specialties other than cardiology to integrate physical activity into their rehab process. Dr. Battaglini discusses the contrast between cardiac rehab, which is covered by insurance, and cancer rehab, which is not. He also describes the value of swimming, especially for older people with sore joints. Walking is good exercise and easy for most people. What if the weather is bad? Perhaps an indoor walk around the mall would be a good alternative, and if you can recruit some friends to join you, so much the better. You can stream the show from this site and download the podcast for free.

A personal note: I worked in the Neuropharmacology Laboratory at the New Jersey Neuropsychiatric Institute from 1967 to 1969. My mentors were Dr. Carl Pfeiffer and Dr. Leonide Goldstein. Both were actively involved in basic research into psychedelic compounds such as LSD and psilocybin. Dr. Pfeiffer’s first paper on the topic was published on March 14, 1957 in the Annals of the New York Academy of Sciences.

I tested these hallucinogenic compounds in rabbits and rats using a quantitative EEG technology that Dr. Goldstein brought to the US from France. One of our papers was published in the Proceedings of the National Academy of Sciences (Oct. 1969). I share this in an effort to provide full transparency so that you will understand I was involved in basic psychedelic research before it was unacceptable to conduct such investigations.

What Scared the FDA and the NIH?

After 1970, if a researcher wanted to perform research on psilocybin or LSD, the FDA was not supportive. Neither were funders such as the NIH or private foundations. The memory of the 1960s with the slogan sex, drugs and rock and roll created a no-fly zone for scientific investigation after 1970. That was when the federal government passed the Controlled Substances Act (CSA).

The CSA made LSD and related compounds Schedule 1. The meant that LSD and related hallucinogens were categorized like heroin with “no currently accepted medical use and a high potential for abuse.” This made scientific research virtually impossible.

But over the last decade or so, there has been increasing interest in the use of such compounds to ease the anguish of post traumatic stress disorder, the existential crisis of a cancer diagnosis, drug dependency or even schizophrenia. But the hallucinatory potential of such drugs continues to discourage many researchers from studying such compounds.

President Donald Trump Signs the Psychedelic Drugs Executive Order

On April 18, 2026, President Trump signed an executive order titled:

“Accelerating Medical Treatments for Serious Mental Illness“

For the first time in decades, investigators will be encouraged to conduct research into the therapeutic potential of hallucinogens such as psilocybin, MDMA and ibogaine. Health and Human Services (HHS) will be encouraged to fund research into psychedelic programs. And eligible patients will able to access such compounds for therapeutic purposes under the “Right to Try Act.”

Here is the dramatic reversal:

“The FDA and Drug Enforcement Administration shall facilitate and establish a pathway for eligible patients to access psychedelic drugs, including ibogaine compounds, under the Right to Try Act (21 U.S.C. 360bbb-0a), including any necessary Schedule I handling authorizations for treating physicians and researchers, consistent with 21 U.S.C. 823, and any applicable waiver authority under the Controlled Substances Act.”

What Does This Mean?

First and foremost, it means that psychedelic drugs can now be studied without fear by researchers at prestigious medical institutions. Agencies can now fund such research. The head of the Food and Drug Administration, Dr. Marty Makary, is on the record encouraging the FDA to accelerate review of such compounds.

There is growing evidence that psychedelic compounds may help people dealing with severe mental health conditions. You will see research and have access to interviews with investigators that have been studying these drugs for years. Yes, there has been research, even if it was not sanctioned by federal agencies.

Current Research on Psychedelic Drugs

Over the past decade or so, investigators have been conducting research on the healing potential of psychedelic drugs. Dr. David Nichols, an international authority on these compounds, describes the history of this research. His son Charles Nichols, a pharmacologist, studies the molecular and behavioral effects of hallucinogens in animal models.

The Healing Potential of Mystical Experience

Dr. Matthew Johnson, associate director of the Center for Psychedelic and Consciousness Research at Johns Hopkins School of Medicine, has conducted a number of clinical trials utilizing psilocybin. He and his colleagues have been exploring the possible uses of psychedelic drugs as medicines for people with life-threatening cancer. They have also examined the possible benefits of a single dose of psilocybin for smoking cessation and overcoming alcohol misuse. Their research was highlighted in an episode of the CBS television show “60 Minutes.”

How Psychedelic Drugs Affect Existential Crises

When people are diagnosed with terminal cancer or other life-threatening conditions, many become extremely anxious or depressed. While this reaction may seem rational in the face of a frightening diagnosis and foreshortened life expectancy, it can interfere with people actually appreciating the days, weeks or months they have left.

Dr. Johnson and other scientists have found that a session with psilocybin that results in a mystical experience can alter people’s lives dramatically. They have far less anxiety and depression and seem to find more purpose in their lives, along with other positive changes. How does this work? Dr. Johnson’s most recent publication (with colleagues) explores the nature of these mystical experiences (PLoS One, April 23, 2019).

Our Radio Show Guests

David Nichols, PhD, is an adjunct professor at the Eshelman School of Pharmacy at the University of North Carolina, Chapel Hill. David Nichols had an active research program at Purdue University for 38 years prior to his retirement in June 2012. His research interests focused in two areas: the study of hallucinogens (psychedelics), where he was recognized as an international authority, and also discovery of novel D1 dopamine receptor full agonists, which showed efficacy comparable to levodopa in both animal models of Parkinson disease, and in human Parkinson patients.

In 1993 he founded the Heffter Research Institute, which has encouraged and supported modern clinical studies of the psychedelic agent psilocybin (from “magic mushrooms”) for treatment of depression, anxiety, and various addictions. His general interests continue in the medicinal chemistry and pharmacology of CNS-active agents.

Charles Nichols, PhD, is Professor of Pharmacology at Louisiana State University Health Sciences Center in New Orleans. As David Nichols’ son, he did not begin his career with the intention of studying hallucinogens. However, his current research interests include the molecular and behavioral effects of such compounds on the brain.

Matthew W. Johnson, PhD, is Associate Professor of Psychiatry and Associate Center Director of the Center for Psychedelic and Consciousness Research at Johns Hopkins School of Medicine. The photograph of Dr. Johnson is courtesy of Johns Hopkins Magazine. The website is https://hopkinspsychedelic.org

Listen to the Podcast:

The podcast of this program is available for free. The show can be streamed online from this site and podcasts can be downloaded for free.

Download the mp3

Want More?

Here is our radio show # 1317: Psychedelic Compounds for Healing

You can listen by clicking on the arrow inside the green circle under the photograph of Bryan Roth, MD, PhD at the top of the page. It’s super easy!

You will learn about conditions that may respond to psychedelic compounds:

• Cluster Headaches
• Substance Use Disorders
• Depression and Distress

Would You Consider LSD If There Were No Hallucinations?

Investigators at University of California, Davis have modified LSD so that it does not cause hallucinations. The new compound, called JRT, appears to have some therapeutic benefit, however. That’s because it increases neuroplasticity.

So far, the drug has only been tested in animals, but the initial responses appear promising. The hope is that JRT will have fast-acting antidepressant activity and may even be helpful against schizophrenia (Proceedings of the National Academy of Sciences, April 14, 2025).

The authors of this research point out that current treatments of schizophrenia leave a lot to be desired.

They don’t work very well:

“…for addressing the negative and cognitive symptoms, and evidence suggests that they are unlikely to rescue morphological or synaptic deficits.”

One of the negative symptoms of schizophrenia often includes the term anhedonia, which is described as an inability to feel pleasure or joy. It is also characteristic of depression. Another negative symptom of schizophrenia is avolition. It means an inability to get motivated to participate in goal-directed activities. That’s psych talk for profoundly disturbing blahs. People just cannot mobilized to get going or stay going. Social activities are just overwhelming.

Then there are the “impairments in attention and working memory.” It is hard to function when you have brain fog, little to no motivation, and few, if any, feelings of joy or happiness.

JRT and Neuroplasticity:

The researchers who helped create the new compound called JRT suggest that this nonhallucinogenic compound promotes “neuroplasticity” in the brain. So does LSD. What is neuroplasticity, you ask.

It is, according to Wikipedia:

“…the ability of neural networks in the brainto change through growth and reorganization. Neuroplasticity refers to the brain’s ability to reorganize and rewire its neural connections, enabling it to adapt and function in ways that differ from its prior state. This process can occur in response to learning new skills, experiencing environmental changes, recovering from injuries, or adapting to sensory or cognitive deficits. Such adaptability highlights the dynamic and ever-evolving nature of the brain, even into adulthood.”

The researchers who helped create JRT note that:

“Effective treatments for complex neuropsychiatric diseases like depression, substance use disorders, and SCZ [schizophrenia] are likely to involve multiple targets rather than a single site of action. However, the polypharmacology of such agents must be carefully tuned to maximize benefit while minimizing unwanted side effects. The unique polypharmacology of (+)-JRT might endow it with specific advantages compared to compounds currently in use.”

“Despite its lower hallucinogenic potential, (+)-JRT has demonstrated profound therapeutic effects.”

It’s a long and winding road before JRT could become available as a medication to treat challenging conditions such as PTSD or schizophrenia. In the meantime, there is a lot of new and intriguing research involving drugs that do induce hallucinations.

The Future of Psychedelic Drugs?

There is no good answer to that question. No one should undertake treatment with a psychedelic compound on their own. This approach requires well-trained healthcare professionals who actually know what they are doing. It requires a therapeutic setting with experienced therapists. Some people should not undergo such an experience.

Despite the fact that I worked in a laboratory that had one of the world’s largest collections of LSD and other psychedelic compounds, I was never interested in a hallucinogenic experience. Some people may not be helped and might be harmed by such a “trip.”

That said, I am pleased that the research doors (and funding) are beginning to open. After research was halted because of the “war on drugs,” we could now be entering a psychedelic renaissance. Let’s see what the research produces.

Please share your thoughts in the comment section below. If you think friends or family might be interested in this article, please send it along. Thank you for supporting our work.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen:

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, April 18, 2026, through 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 April 20, 2026.

Striving for Person-Centered Care

Wouldn’t it be great if healthcare facilities were specifically designed around the individuals they are supposed to serve? Fifty years ago, a group of physicians and former patients started Planetree to do exactly that. At first, Planetree provided information at a time when patients were rarely told what was wrong or how it could be addressed. There was also a Planetree ward in a hospital in the Bay Area that operated on principles of transparency and person-centered care.

Over the next several decades, Planetree developed as a network of more than 300 health care facilities in 30 countries that strive to provide a home-like environment for healing. The main value is person-centered care, in which they strive to treat the whole person as well as that individual’s family or significant others. We invited Planetree President Michael Giuliano to tell us about it. He mentioned that one feature is getting your care summary in real time, so you can ask questions and correct errors before you leave the clinic or office.

Fresh Air & Sunlight Built In

One of the things that sets a Planetree hospital apart from other facilities is the way the values are visible in the architecture. Planetree planners put a premium on access to nature and outdoor space, though of course each facility does it a bit differently, according to its own plan. Rooms are set up so that people have access to fresh air & sunlight. That makes them feel more comfortable, certainly. Might it also promote healing?

How Do Fresh Air & Sunlight Promote Healing?

More than 150 years ago, Florence Nightingale set standards based on what she observed of soldiers healing from battle wounds and horrible infections during the Crimean War. This was, of course, before the development of antibiotics, so nursing care was paramount. Nurse Nightingale insisted on the primacy of fresh air & sunlight for her patients. Was this just a quaint old-fashioned idea, or is there modern scientific support?

The Power of Near-Infrared

For more information on the science of fresh air & sunlight (yes, there is science), we turn to Dr. Roger Seheult of MedCram.com. https://www.medcram.com/ He began by describing the brand new Footscray Hospital in West Melbourne. The design is something of a modern take on Florence Nightingale’s hospital plan, since the architects figured out how to get natural light and real ventilation in every room. They prioritized fresh air & sunlight in this $1.5 billion hospital because of their healing properties. People exposed to sunlight leave the hospital sooner because they recover more quickly. So the patient gets better and goes home faster, the hospital has a better bottom line and the insurance company pays less. Everybody wins!

Probably a good part of the credit goes to near-infrared light. We can’t see it, but it penetrates our bodies and they react. Exposure to near-infrared at 850 nanometers improves mitochondrial function. You could get this from a device, but it is cheaper and arguably more pleasant simply to go outside and allow sunlight to fall on your skin soon after sunrise (or before 10 am) or just before sunset (probably after 4 pm).

An Amazing Story About Fresh Air & Sunlight

We’d be tempted to call this an unbelievable story, but Dr. Seheult provided all the details and checked the medical records himself, so we believe it. He told us about a 15-year-old boy with a serious blood cancer, acute lymphoblastic leukemia, ALL. This type of cancer undermines the immune response, and this young man had come down with a terrible fungal infection, mucormycosis. The fungus did not respond to medication, and it rampaged through his left lung. Ultimately, his doctors proposed removing the lung as a last-ditch method of controlling the infection.

Unfortunately, when they found that the fungus had invaded his right lung, they were out of options. They figured he probably couldn’t survive much more than two days, so they asked him his last wishes. All he wanted was to go outside; at this point, he’d been cooped up in the hospital for two months. They fixed up a wheelchair to hold all his drips and took him outside. The next day, they did it again. The youth didn’t die as expected. Instead, he recovered completely, over time. We can’t put sunlight in a bottle, but perhaps oncologists and other doctors should consider writing prescriptions to cover it.

This Week’s Guests

Michael Giuliano is the President of Planetree International, a mission-driven non-profit organization setting the global standard for person- centered excellence across the continuum of care. Michael joined Planetree in 2022 as Chief Operating Officer (COO) following a decade of leadership roles in Australia’s public and private healthcare sectors.
https://www.planetree.org/team-member/michael-giuliano

Michael Giuliano, President of Planetree International

Dr. Roger Seheult is an Associate Clinical Professor at the University of California, Riverside School of Medicine. He is also an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University. He 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. He is a critical care physician, pulmonologist, and sleep physician at Optum California.

Dr. Seheult lectures routinely across the country at conferences and for medical, PA, and RT societies. He is the director of a sleep lab and the Medical Director for the Crafton Hills College Respiratory Care Program. He is co-founder and presenter for MedCram.com, a site that offers concise and easy-to-follow medical videos on a range of topics.

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

Listen to the Podcast

The podcast of this program will be available Monday, April 20, 2026, after broadcast on April 18. On this episode, Dr. Giuliano discusses billing as part of person-centered care. You can stream the show from this site and download the podcast for free.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen:

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, April 11, 2026, through 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 April 13, 2026.

The New Science of Regenerative Therapies

What is the price of pain relief for aching, arthritic joints? We’re not talking about the drugstore sticker on a bottle of ibuprofen. Instead, we are referring to the potential negative consequences of utilizing such medicines for temporary symptomatic relief when the joint continues to hurt for weeks, months or years. Even more powerful treatments, such as corticosteroid injections into the sore joint, don’t heal the cartilage. In fact, they may contribute to further deterioration as they suppress the immune system. Our guest offers other ways to treat joint pain with regenerative therapies.

Immune Mechanisms That Resolve Inflammation

Dr. Tom Buchheit is a pain management specialist who has worked with elite athletes as well as seniors to get them moving well again after an injury. One of the reasons exercise can be so helpful is that the right kind and amount of movement creates good inflammation. Unlike chronic inflammation that causes further harm, good inflammation helps the immune system switch to a different phase, one in which destructive pathways are resolved. The three pillars of exercise are aerobic exercise, muscle building exercise and exercise to improve balance. Together, these types of exercise help recovery and healing and can even help heal damaged nerves. NSAIDs like naproxen, celecoxib or ibuprofen can interfere with the good inflammation exercise creates. Rather than taking such a pill before a game or workout, it makes sense to wait and take it afterwards if you need it.

Will Exercise Wear Out Your Joints?

Injury can damage the joints, but the idea of osteoarthritis as a consequence of wear and tear seems to be a medical myth. Instead, we might think of osteoarthritis as a chronic wound that may need regenerative therapies to heal properly. Immune system building blocks like omega-3 fats in the diet and a wide palette of colorful produce can help with the healing. Movement itself is part of the healing process.

What Are the Regenerative Therapies?

PRP

Some of the therapies we think of as “new” have actually been in use for several decades. One of these is platelet-rich plasma, which was initially developed to help wounds heal. In this treatment, the doctor uses the patient’s own blood. The plasma with as many platelets as possible concentrated in it is then carefully injected into the painful joint. The idea, again, is to cause “good inflammation,” alerting the immune system that healing is needed here and encouraging it to flip into inflammation resolution mode. Not all studies of platelet-rich plasma (PRP) have shown benefit, but some of that may be due to using plasma that is not truly rich in platelets. Properly prepared PRP works especially well for ligaments and tendons, according to Dr. Buchheit.

MSC

If you hear someone talk of getting a “stem cell” injection, they are talking about MSC. They were originally misnamed mesenchymal stem cells, but would be better termed medicinal signaling cells. They too are derived from the patient’s own body. Rather than rebuilding cartilage, they also signal the immune system to switch from long-term damaging inflammation to short-term healing inflammation. This is also the idea behind prolotherapy, in which the therapist injects sugar water into the joint. That may sound like a placebo, but it can be effective at easing pain and helping healing.

Autologous Conditioned Serum

Dr. Buchheit describes another of the regenerative therapies, autologous conditioned serum. Blood is drawn and encouraged to clot; then the serum is injected into the troublesome joint. Clotting helps create powerful signals that healing is needed. This therapy is not widely available, as only about ten places in the US have the dedicated laboratories required to prepare ACS properly.

Hydrodissection

Dr. Buchheit also describes how to use injections to free up trapped nerves in a process called “hydrodissection.” This is often very helpful in alleviating chronic neuropathy. We conclude the episode with a brief reminder of how to stay healthy once you get nerves and joints feeling good again.

This Week’s Guest

Thomas Buchheit, MD, served as Chief of Pain Medicine at Duke from 2013-2019 and led several NIH- and DoD-funded research studies. His focus is on immune mechanisms that resolve inflammation and pain.
In 2025, Dr. Buchheit completed his book, Healing Joints and Nerves: Immune Stimulation and the New Science of Regenerative Therapies, and founded Triangle Regen Medicine and Biologics Center. His overarching goal is to help patients understand and use regenerative therapies to activate their own healing and repair mechanisms. He continues to serve as adjunct associate professor at Duke and collaborates with colleagues at the Center for Translational Pain Medicine.

His website is https://triregenmed.com/

Dr. Tom Buchheit

The People’s Pharmacy is supported by readers and listeners. When you buy through a link on this site, we may receive a small commission, at no additional cost to you.

Listen to the Podcast

The podcast of this program will be available Monday, April 13, 2026, after broadcast on April 11. The podcast has additional information about how to use MSC as well as the cost of regenerative therapies. We also discuss the pros and cons of pharmaceutical pain relievers. You can stream the show from this site and download the podcast for free.

Download the show on mp3, or listen to the podcast on Apple Podcasts or Spotify.

Transcript of Show 1468:

A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:01

I’m Joe Graedon.

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of the People’s Pharmacy.

Joe

00:06-00:27

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com.

Exercise is critical for good health, but when your joints or nerves hurt, it’s hard to keep moving. What can you do? This is the People’s Pharmacy with Terry and Joe Graedon.

Terry

00:34-00:49

Most people rely on non-steroidal anti-inflammatory drugs. Millions take over-the-counter ibuprofen or naproxen every day. Others rely on prescription medicines such as celecoxib or meloxicam. What are the downsides?

Joe

00:50-00:54

Our guest today is an expert in regenerative medicine.

Terry

00:55-01:00

What does that mean? And how does it differ from the usual way to manage pain and speed recovery?

Joe

01:01-01:06

Coming up on The People’s Pharmacy, the new science of regenerative therapies.

Terry

01:14-02:05

In The People’s Pharmacy Health Headlines: flu season is pretty much over, but every year it takes a toll, especially among frail elderly people in nursing homes.

A new study published in JAMA Internal Medicine asked whether using Tamiflu preventively could reduce hospitalizations and death. Researchers reviewed records covering 404 flu outbreaks in 318 nursing homes. More than 35,000 residents were covered by the study.

When Tamiflu was given to at least 70 percent of the residents within two days of the first flu cases, there were dramatically fewer hospitalizations needed within the next two weeks. That’s in comparison to situations where Tamiflu was not provided as a preventive medicine.

Joe

02:05-03:06

If you ask most cardiologists what causes heart disease, the answer is likely to be LDL cholesterol. They might also mention triglycerides, lipoprotein A, and high blood pressure.

They probably won’t consider lead, but a study of over 42,000 American adults who participated in the National Health and Nutrition Examination Survey tracked lead levels over many years. Those with the highest levels of lead in their bones were more likely to die from heart disease or stroke.

People born in the 1930s and 1940s, before lead was removed from gasoline and paint, have the highest lifetime lead exposures. Further reduction in lead exposure should lead to lower rates of cardiovascular mortality. An editorial in the journal suggests that coronary heart disease is in part attributable to lead and other environmental exposures.

Terry

03:07-04:00

What is the cause of memory loss as people age? A recent study of mice suggests it might begin in the gut. Specifically, the scientists tracked microbiome aging throughout the lifespan. They found that gut bacteria producing medium-chain fatty acids accumulate with aging and drive inflammation. This, in turn, weakens the signal from the vagus nerve to the brain, with the result that the hippocampus falters. The hippocampus is critical to memory.

In this study, the scientists introduced phage viruses to target the parabacteroides, gut microbes, causing the trouble. They suggest such interventions might counteract age-associated cognitive decline, although, of course, mice are different from humans. We look forward to research that might demonstrate its feasibility in people.

Joe

04:02-05:08

Fibromyalgia is a painful and chronic condition that affects soft tissue. It also causes fatigue, brain fog, and sleep problems. Millions of Americans are affected by this somewhat mysterious condition.

A study published in JAMA Network Open reports that the combination of physical therapy and transcutaneous electrical nerve stimulation, also known as TENS, can reduce pain. Over 380 patients participated in the trial. Volunteers were randomized to receive PT plus TENS or physical therapy alone. After two months, those getting physical therapy plus electrical stimulation reported significantly less pain than those in the PT-only group.

The authors note that the findings demonstrate effectiveness of this non-pharmacological intervention in reducing movement-evoked pain and suggest that the benefits of TENS are clinically meaningful in this population.

Terry

05:09-06:17

With warmer weather, tick season is right around the corner. In fact, it’s already here in many parts of the country. Most people have heard of Rocky Mountain spotted fever and Lyme disease, but ticks can transmit over a dozen different diseases, from anaplasmosis and babesiosis to ehrlichiosis and alpha-gal syndrome. It’s estimated that more than 500,000 people could be treated for Lyme disease between now and the first freeze this fall.

But there is potentially good news on the horizon. Pfizer is teaming up with a French company to produce a vaccine against Lyme disease. It triggers your body to make antibodies to a protein on the surface of the Borrelia bacterium. These antibodies keep the Lyme-causing bacteria from infecting you and causing disease.

And that’s the health news from the People’s Pharmacy this week.

Welcome to the People’s Pharmacy. I’m Terry Graedon.

Joe

06:17-06:27

And I’m Joe Graedon. You’ve heard us praise the power of exercise for good health. But it can be hard to keep moving when your joints hurt.

Terry

06:27-06:44

The usual approach is to take a non-steroidal anti-inflammatory drug, such as ibuprofen or naproxen. That is a short-term solution, and it comes with a handful of side effects. What else could we do to alleviate joint pain?

Joe

06:44-07:11

To help us understand some new options, we are talking with Dr. Tom Buchheit. He’s done research on immune mechanisms that resolve inflammation and pain. He serves as an adjunct associate professor at Duke University and collaborates with colleagues at the Center for Translational Pain Medicine.

His new book is “Healing Joints and Nerves: Immune Stimulation and the New Science of Regenerative Therapies.”

Terry

07:13-07:16

Welcome to the People’s Pharmacy, Dr. Tom Buchheit.

Dr. Tom Buchheit

07:17-07:27

Thank you, Terry, Joe. It’s wonderful to be here.

I have to say, I’ve been listening to your show since 1998 when my wife and I moved to North Carolina, and it’s just a delight to be here. So thank you.

Joe

07:27-08:36

Well, thank you so much for joining us. You know, Dr. Buchheit, I’d have to say that if people ask us, and they occasionally do, what’s the one most important thing we should do for good health?

The answer is simple. We say exercise. Exercise is absolutely critical. Move your body. Even if it’s just for a walk every day, if you can. And if you can do more, so much the better. Terry is a black belt in karate. I love to play tennis. We love to move our bodies.

There’s only one problem. What interferes with exercise? Pain. Injuries. You know, when you exercise a lot, you sometimes hurt yourself, and then you have to take a break. And for people who really enjoy exercising and want to do it, that can be both psychologically and physically very challenging.

So help us understand your field and how to help people get back moving again once they hurt themselves.

Dr. Tom Buchheit

08:37-10:02

Well, Joe, you brought up a really good point. Exercise plays a very important part of health for all of us. And I think we increasingly know the reasons why. One of the core topics that I talk about and like to focus on is the importance of healing and our body’s innate ability to heal. We turn those healing mechanisms on by stimulating certain immune cells, and one of the most powerful ways of doing so is exercise.

Exercise does it. Good inflammation does it. Some other regenerative therapies do it. And these are all bound together by the same healing mechanisms. But you’re right, exercise is core to that.

The challenge a lot of people run into is that they have an injury. They have arthritis, a problem in a joint. They’re unable to do that. And their question is, how do they get back to that activity? What I use, I use the phrase orthopedic limbo. That individual is in orthopedic limbo. They have an issue that prevents them from pursuing their tennis or their karate or just walking the dog or spending time with friends. And they’re trying to figure out how to get beyond that and move again, but they’re not necessarily a surgical candidate.

So what can they do? And that’s one of the reasons I like to focus on these things that stimulate a healing response and stimulate recovery to function.

Joe

10:02-10:11

And we’ll talk a little bit more about some of those strategies because they’re really intriguing. But first, why is exercise so important?

Dr. Tom Buchheit

10:13-10:16

Exercise is important because it produces good inflammation.

Terry

10:18-10:21

Whoa, whoa, whoa, wait. Inflammation is good?

Dr. Tom Buchheit

10:23-11:23

That’s an important topic, right? I think a lot of people hear inflammation, they think immediately inflammation is always bad. We have to get rid of it. We have to suppress it. We have to drive it down.

And there are, and I think you’ve talked about this in your show before as well, but there are good components of inflammation. We have to be careful we don’t throw the wheat out with the chaff with that. So chronic inflammation is always bad, right? It damages tissues. It drives arthritis. It drives chronic pain.

But short-term, brief, and fairly strong inflammation is how we heal. If I had an ankle sprain and I bled into that ankle sprain, that injury, that inflammation is what heals that ligament eventually. You bleed, you release growth factors, you turn on these immune systems.

Exercise does that same thing, but it’s good inflammation. So I think of good inflammation as short, reasonably strong, and able to flip an immune switch that begins a healing cascade.

Terry

11:24-11:33

Dr. Buchheit, in “Healing Joints and Nerves,” you talk about the three pillars of exercise. What are the three pillars and why do we need three of them?

Dr. Tom Buchheit

11:35-12:23

Well, great question. There are certain tremendous advantages of aerobic exercise. We know that people who have a high aerobic capacity and who can exercise at high levels, it doesn’t matter if it’s running, swimming, playing tennis, that’s linked to longevity. We also know that muscle mass, and increasingly people talk about muscle mass being very important and strength being very important to strengthen joints. And we see this with studies of even arthritis patients who have less joint pain if they can strengthen the support structures of that joint.

And then, of course, balance is such a wonderful thing, whether it’s through balance exercises or yoga or tai chi, just such wonderful exercises that brings all this together of strength, stability, and the ability to stay on two feet without falling down.

Joe

12:24-12:52

I want to know how exercise helps recovery, because that’s, you know, we often hear, “Oh, ice and rest and, you know, just don’t do anything for a week or two,” because a lot of tennis players, they want to get back on the court as fast as possible, and they’re told, “No, no, no, no, no, no, you got to rest those joints, that you pulled a muscle, you better let it rest.” And you’re suggesting that exercise actually helps with healing.

Dr. Tom Buchheit

12:53-13:52

It absolutely does. And it helps with healing because it flips that immune switch and turns on this healing cascade. There was a study that I think showed this well. It was patients who had ankle injuries and they were immobilized in crutches after an ankle injury and they measured the cartilage in their knees as a marker after immobilization.

And they found out that those who were in crutches for long enough actually had less cartilage in their knees. Their knees were never injured, but it was the lack of exercise that decreased the health of their joint cartilage. So our bodies need this. They need intermittent stress.

And I think this… we have kind of fallen into this trap where we think all inflammation is bad. I would push back on that. I think we need to stress ourselves, whether it’s studying for an exam, whether it is playing a tennis match, whether it’s going for a brisk walk. Our bodies use stress and use these intermittent bouts of exercise to strengthen.

Terry

13:54-13:57

I’m assuming we stress ourselves appropriately.

Dr. Tom Buchheit

13:57-14:30

Exactly. And that’s the Goldilocks phenomenon, right? If you want enough stress. So to look at it kind of biochemically, if you look, there are a lot of inflammatory proteins that a muscle will release if it’s been exercised.

Matter of fact, some of those will go up a hundred fold and they cause some of the aches that we’re familiar with after a strong workout. But those same inflammatory proteins will then flip and help our bodies to produce some of the anabolic proteins and things that rebuild tissues and strengthen tissues.

Terry

14:31-14:35

How does exercise help nerves regrow? You’ve said it does.

Dr. Tom Buchheit

14:35-16:00

That’s a great question. And that came as a bit of a surprise to me when I started doing research on this a bunch of years ago. We all thought of, and I think a lot of the medical profession thinks of, well, once you have neuropathy, it’s just a done deal. You’re never going to recover from it. Your nerves are gone. And neuropathy is nerve pain. Right, nerve pain and nerve dysfunction from the nerve pain.

And it can be different kinds. There can be sciatica somebody experiences after a disc herniation in the spine. There can be dying back of the nerves somebody experiences because of diabetes or they’ve had chemotherapy in the past. Those nerves can recover. And exercise is actually one of the important tools to help those nerves recover.

It does a few… through a few things. Some of the growth factors I talked about that exercise releases. It also does it through these very small immune particles called exosomes that we researched in lab that I’ve researched and looked at for a long time now. And they also help nerves recover.

[If] we think about it, nerves are energy hogs. And anything we can do to improve their energy supply through mitochondria, mitochondrial function, is going to help the nerve to recover. And so exercise and some of these other therapies can improve nerve function. They may not help a nerve regrow from the back all the way down to the foot, but they can take the nerves that are already there and help them work better and help people function better.

Joe

16:00-16:36

One of the things that most physicians, not all, but most physicians, especially the orthopedists like to prescribe are the non-steroidal anti-inflammatory drugs. So if you sprain your ankle, if you hurt your shoulder, if your back is giving you trouble, out come the NSAIDs. And of course, they’re also available over the counter, Aleve, naproxen, ibuprofen, Advil. And so people have come to just love non-steroidal anti-inflammatory drugs. You’ve suggested that they might be counterproductive in some ways.

Dr. Tom Buchheit

16:37-17:20

Well, they can be. And anti-inflammatory medications, what we call NSAIDs, they can, in fact, impair the strengthening our body’s experience with a workout. And this has been looked at in patients, this has been looked at in laboratory studies of laboratory animal models, that if you slow down or stop the inflammatory response to exercise, you also impair the muscle building and the strengthening you get from that workout. So NSAIDs, sometimes we may need to take them for a severe headache or a pain that’s keeping us from moving.

But if we take them chronically, they impair the very healing mechanisms that our bodies need to stay healthy and recover.

Terry

17:20-17:26

Now, if you were to take an NSAID for a workout, when should you take it and why?

Dr. Tom Buchheit

17:26-17:30

That’s a great question. So I think the clear answer is after the workout, not before.

Joe

17:32-17:42

A lot of my tennis buddies call it vitamin “I” and they take it religiously before they go out on the courts. So you’re suggesting maybe not such a good plan.

Dr. Tom Buchheit

17:42-18:06

I think if one can hold off until after the workout and wait as long as you can, it’s better off than before. I think it’s probably better for our joints and our bodies to have a shorter workout without an anti-inflammatory than a longer workout with.

Now, that’s never been studied in a randomized controlled trial, but I think it’s a good idea to avoid taking it before whenever possible.

Terry

18:07-18:15

You’re listening to Dr. Tom Buchheit, an expert in pain management and founder of the Triangle Regen Medicine and Biologic Center.

Joe

18:15-18:28

After the break, we’ll learn about steroid shots in joints. What might work to ease osteoarthritis pain? You may have heard of PRP and stem cells. We’ll get the details.

Terry

18:39-18:42

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Joe

20:18-20:21

Welcome back to The People’s Pharmacy. I’m Joe Graedon.

Terry

20:21-20:39

And I’m Terry Graedon.

Joe

20:39-20:48

Today on The People’s Pharmacy, our topic is healing joints and nerves. What are regenerative therapies and how do they work?

Terry

20:48-21:14

Our guest is Dr. Tom Buchheit, founder of Triangle Regen Medicine and Biologic Center. Dr. Buchheit was chief of pain medicine at Duke University from 2013 to 2019 and is an adjunct associate professor there. His new book is “Healing Joints and Nerves: Immune Stimulation and the New Science of Regenerative Therapies.”

Joe

21:15-21:50

Dr. Buchheit, corticosteroids, very popular on the tennis court. You know, “Oh, my shoulder hurts. I need a steroid shot. Oh, my back aches.” Another steroid shot. “Oh, my knee is giving me trouble.” Another steroid shot. Doctors love them because people feel better oftentimes immediately after or within a few days and it lasts sometimes a couple weeks for some people maybe as long as a couple of months, but there’s a downside. What is it?

Dr. Tom Buchheit

21:50-23:48

Well, there is a downside, and it is true that a steroid injection can produce rapid pain relief, and can be helpful in some people to get them back to the gym, get them back to the workout.

My concern with steroid injections or corticosteroid injections is the repeated use of them. There was a study done now almost 10 years ago, and it was a randomized control trial looking at individuals who had osteoarthritis of both knees, and one group had saline injections into the knees. The other group had corticosteroid injections. And at the end of two years, there was no difference in the pain, which didn’t really surprise a lot of people because we know steroid injections tend to be shorter lived.

But the individuals that had repeat steroid injections actually had less cartilage in their knees than the ones that had saline. And I feel like that study was a bit of a wake-up call to all of us. And I did a lot of steroid injections at the time as well because patients seemed to do well with it. But it made me start rethinking how I was approaching this concept of how do you treat someone with joint pain, some arthritis, they don’t need surgery, again, the patient [in] orthopedic limbo.

We’ve relied on corticosteroid injections as a bit of a crutch, and I think we need to flip this paradigm and think about how do you improve cartilage health, how do you improve tissue health? This year is the 75th anniversary of the first corticosteroid injections that were done for arthritis pain. And it was a remarkable event.

But interestingly, I’ve gone back and I’ve read a lot of the historic literature on corticosteroids and their use in arthritis. And the physician who published the paper noted that 37 of 38 of his patients did extremely well after the steroid injections. But what he didn’t emphasize is some of the patients required up to 17 injections per year to maintain that.

Terry

23:48-23:49

Oh, my.

Dr. Tom Buchheit

23:49-24:00

And I think that’s the part that we’ve been missing within the medical world, is that a steroid injection can be an important tool, but I would argue it’s an overused tool in a lot of settings.

Terry

24:01-24:15

Well, 17 injections a year definitely sounds like it’s being overused. And one of the things that steroids do is they suppress the immune system. What’s the impact of long-term immune system suppression?

Dr. Tom Buchheit

24:17-25:22

Well, gosh, there’s a lot of things that [it] would do. Obviously, we could go into, you know, bone health and bone density. We could go to the endocrine system and looking at, you know, someone who is borderline diabetic who becomes frankly diabetic after repeated steroid injections.

We can look at tissue healing as well. But if I kind of focus on the cycle, I think we need to think of our bodies as cycles, right? We cycle day and night. We sleep. We wake up. And exercise and this immune stimulation that keeps our joints healthy is also a cycle. It’s a cycle of exercise and recovery.

And anyone who’s trained knows this inherently. You have hard workout days. You have recovery days. And I think if we use tools like steroids or anti-inflammatories continuously, we remove those necessary cycles of stress and recovery, stress and strengthening. And steroids, I think, act in some ways have similar effects as the anti-inflammatories do. And I can quote, we can talk about a study as well that dives into that.

Joe

25:23-25:52

Well, I’d like to talk about one of the reasons that a lot of people get steroid injections and one of the reasons why they take a lot of the anti-inflammatory drugs, and that’s osteoarthritis. And it can affect your fingers. It can affect your shoulders. It can affect your knees. It can affect your hips. It can affect just about every joint in your body. And I remember someone saying a long time ago, well, exercise is going to make it worse.

Dr. Tom Buchheit

25:53-27:48

Right, that’s the old wear and tear hypothesis and that was the hypothesis about osteoarthritis for years which is that well you just you’re just wearing your joints too much and they’re just wearing down.

That ignores the fact though that exercise restores cartilage health, and you know some people talk about well someone loses weight and they have less joint pain and it must be less weight on their joints and less wear and tear. But the hand arthritis also gets better if you lose weight.

And so I think it’s an issue of a systemic chronic inflammatory problem that’s improving with weight loss. We’ve then moved from the wear and tear hypothesis to the inflammatory hypothesis of arthritis. And it made sense. We can see inflammation on ultrasound if we do an ultrasound exam of a joint. You can pull out fluid, and it looks inflammatory if you look at it under biochemical analysis. The patients feel the inflammation, but if you treat the inflammation, it doesn’t improve the disease state. And that’s been shown so many times.

There have been at least four studies of strong inflammation suppressors in the rheumatoid arthritis drugs that have been looked at for osteoarthritis. They did not work. There have been studies of corticosteroid injections. Again, they tend to worsen the problem, not make it better.

The concept that I think we need to focus on is osteoarthritis is a chronic wound. And we need to think about how to heal the wound. If you heal the wound, the chronic inflammation also improves as well. And that explains, I think, the chronic wound concept explains why studies have failed in the past and why some of the therapies we do now, such as some of the regenerative therapies, can actually have a role.

Terry

27:49-28:09

Well, maybe you could tell us a little bit about what could work for osteoarthritis, because so far, we’ve talked about things that are less than ideal. The steroid injections, the NSAIDs, those are the most common. And there have to be things, maybe even a lot of things, that can be useful.

Joe

28:09-28:22

Well, first, what the heck is regenerative therapy? And second, why would exercise, because you’ve sort of alluded to that, be helpful for osteoarthritis? So give us the one-two punch.

Dr. Tom Buchheit

28:23-28:36

I always think of it as we start with a healthy diet, healthy fruits, vegetables, healthy fats, and exercise to that. And that is the core, I think, of keeping joints and nerves healthy.

Terry

28:36-28:37

And the rest of us.

Dr. Tom Buchheit

28:37-30:03

And the rest of the body as well, right? What’s good for your heart tends to be good for your joints as well, right? It’s enough for a lot of people, but it’s not enough for everybody. And it’s not enough for people who have had injuries in the past. It’s not enough people who have a systemic inflammatory issue going on.

And that’s when I think about layering on what some people call regenerative therapy. Some people may call it an ortho-biologic. These are ways of stimulating those immune cells I talked about and pushing them into a state where they are resolving and building tissues again, where they’ve been suppressed in the past and they’re kind of low level. They’re chronically inflamed. They’re not behaving well.

You need to push them into a new state, this resolving state. And I think of it not as suppressing inflammation but resolving it. And it might sound like a little bit like splitting hairs a bit. But if I think of suppressing inflammation or fighting inflammation, I think of you’re putting a drug on it to tone it down temporarily.

When I think of resolving inflammation, I think of our body’s natural processes that resolve it. There are some wonderful fats that do this. They’re called SPMs. They’re derivatives of omega-3 fatty acids. Our bodies use those and other compounds to naturally resolve inflammation. Matter of fact, in the lab, some of those compounds are more powerful than morphine in animal models of nerve pain to resolve inflammatory pain in models.

Joe

30:04-30:07

Wow, that’s amazing. Tell us, how do you do that?

Dr. Tom Buchheit

30:08-30:10

Well, our bodies make these compounds.

Terry

30:10-30:22

And you say they make them from omega-3 fats like fish oil or walnut oil or the fats that we get in very small quantities from dark green leafy vegetables.

Dr. Tom Buchheit

30:23-30:53

Precisely. If we eat a diet rich in healthy fats, as you pointed out, from walnuts, nuts, cold water fishes like salmon and anchovies and tuna, as long as it’s not too high in mercury, our bodies take those fats and they make other compounds from them. And those other compounds will resolve inflammation.

They work with the leafy green vegetables and all the colorful vegetables that you all have talked about that are so important to overall health.

Terry

30:53-30:55

We love talking about colorful vegetables.

Dr. Tom Buchheit

30:56-31:13

But that all works together. And that, to me, is the foundation of really regenerative medicine is what our bodies are already doing and how can we promote those activities themselves. A lot of people focus on a procedure and injection, and they can be helpful, but we have to start with our own bodies.

Joe

31:13-31:43

So it sounds like diet is critical and the healthy fats, the omega-3s are especially beneficial. So your body can do this resolving stuff. And exercise is also important, presumably if it’s, you know, mild exercise, if you’ve injured yourself so that you don’t re-injure yourself.

But what are some of these other agents, this regenerative process that you’re talking about that you practice when you see patients who have had injuries?

Dr. Tom Buchheit

31:43-33:05

Yeah, great question. I would put them in three different categories, things like platelet-rich plasma, which we’ll talk about, stem cells, or something called autologous conditioned serum. Some people know it as the Regenokine program. PRP or platelet-rich plasma is probably the one I’d start with because it directly activates our own healing cascade.

Interestingly, back to my analogy of the wound in a joint, PRP was first used to treat wounds. It was first used by a wound surgeon published in 1986. It’s been around for a while. Then it was used in the oral surgery field to heal non-healing wounds. And then it kind of leapt into the world of arthritis and nerve issues and things like that. But what it is, is if you take blood and you spin it down and you collect the platelets and the white blood cells there, they can act with the growth factors and act in a way to flip that immune switch I was talking about to start to rebuild tissues.

So it’s a way to almost use that, almost like exercise. It’s almost like exercise in a tube in a way. You take that blood product and you inject it onto a knee or a shoulder or hip, and it further turns on those healing mechanisms that our body can have, but aren’t always strong enough by themselves.

Joe

33:05-33:17

Now, let’s make it very clear. We’re not talking about someone else’s blood. We’re talking about our own blood is being removed. And I assume it’s not gallons. It’s just a little bit. How much?

Dr. Tom Buchheit

33:18-33:30

Well, actually, that’s a very good point. You need a fair amount. You need a fair amount because you have to make sure the PRP dose is right. So how much is 60 to 120 milliliters?

Joe

33:31-33:33

So for people who are not metric.

Terry

33:34-33:40

So a cup is roughly 250 milliliters. So we’re talking less than a cup.

Joe

33:40-33:44

Less than a cup. Right. So it’s not gallons. It’s a little bit of blood.

Terry

33:44-33:46

Maybe a half a cup, more or less. Half a cup, a cup.

Joe

33:47-33:57

And you’re removing that blood, and then you’re spinning it down, and you’re extracting the platelet-rich plasma.

Dr. Tom Buchheit

33:57-33:59

Exactly. Now…

Joe

33:59-34:00

And re-injecting it.

Dr. Tom Buchheit

34:00-34:20

And re-injecting it. PRP has become quite controversial. One of the reasons is because there have been a couple of very large trials that have shown it hasn’t worked.

But if you go back and analyze the studies, which I’ve done with some colleagues, it turns out that if the plasma isn’t rich in platelets, it doesn’t work. And it sounds a bit, you know, axiomatic.

Terry

34:21-34:26

Right. So you have to have the right stuff in order for it to work the way it’s intended.

Dr. Tom Buchheit

34:26-34:26

Exactly.

Joe

34:27-34:31

So is it a little less controversial now? Are there studies demonstrating benefit?

Dr. Tom Buchheit

34:32-34:44

There are with high doses, and I think that’s the key. If the dose isn’t right, it just doesn’t work. And that’s why it’s important. And one of the things that I do is I measure the doses of every PRP to make sure that dose is correct.

Joe

34:45-35:03

So our listeners and a lot of your colleagues learn from stories. Can you share a story with us about somebody who came to your practice in pain and maybe not able to exercise, and that person benefited from PRP?

Dr. Tom Buchheit

35:05-35:24

I think it’s a common scenario. I would use the scenario of someone who’s had a prior ACL tear or a lot of knee ligament tear. Especially young women athletes seem to have this quite commonly. The problem with these tears is that it sets them up for early arthritis.

Joe

35:25-35:28

And we know the surgery itself has some issues.

Dr. Tom Buchheit

35:29-36:15

Right. Well, joint replacement surgery can be very successful, but you also don’t want to do that when you’re 45 years old and still active because you may wear out your joint. You might wear out the replacement.

And that to me is a good candidate for what I would call regenerative therapy or biologic therapy, where you can turn this inflammatory process, this chronic wound of a knee that’s had a prior injury and can’t quite get into the healing mode, and you can add PRP or another therapy to it to really turn the corner of that knee and allow it to start healing.

What other joints benefit? Really any joint can benefit. Most of the studies have been done in knee osteoarthritis because it’s so common.

Terry

36:15-36:18

So common and so troublesome if you have it.

Dr. Tom Buchheit

36:18-36:39

Precisely. Precisely. But shoulder, hip, other joints, and actually some of… there’s some very good literature for PRP for ligaments and tendons.

So for the outside of the hip, the trochanter or tennis elbow is a very common, very common scenario. Again, that’s a scenario where a tendon is there and it’s just not healing up and you want to add growth factors to it to get it to heal.

Joe

36:39-36:45

Are the orthopedic surgeons embracing PRP these days or are they still a little resistant?

Dr. Tom Buchheit

36:45-37:06

Well, I think the orthopedic community is embracing this to a fairly significant extent. And it does compete. There’s a question of does it compete with surgery for some people, but I think it has a clear role.

And as we understand what makes a regenerative therapy more effective, they’re going to, I think, gain more and more acceptance.

Terry

37:06-37:09

What about side effects of PRP?

Dr. Tom Buchheit

37:09-37:25

The main side effect for PRP is a flare-up of pain. If you think about it, you’re turning on an immune system, you’re turning on these white blood cells. So I tell people it’s an expected side effect. They’re going to have oftentimes discomfort, sometimes even swelling for a few days afterwards.

Terry

37:25-37:30

So you’re creating short-term inflammation to overcome the long-term inflammation.

Dr. Tom Buchheit

37:30-37:31

Just like exercise.

Terry

37:32-38:05

You’re listening to Dr. Tom Buchheit, author of “Healing Joints and Nerves: Immune Stimulation, and the New Science of Regenerative Therapies.” Dr. Buchheit founded the Triangle Regen Medicine and Biologic Center.

His research has focused on immune mechanisms that help resolve inflammation and pain. From 2013 to 2019, he was chief of pain medicine at Duke University, and now he is an adjunct associate professor there.

Joe

38:05-38:14

After the break, we’ll consider the case of a long-distance runner who has developed hip arthritis that interferes with his running.

Terry

38:14-38:20

Do stem cells help cartilage grow back? If not, what are they doing to ease pain?

Joe

38:21-38:36

What is prolotherapy and how does it work? Injecting dextrose, that’s sugar water, sounds almost like a placebo treatment. Is it effective and how long has it been available?

Terry

38:36-38:45

It does sound like a placebo. You’ll also find out about autologous conditioned serum. What is that? How does Dr. Buchheit use it?

Joe

38:46-38:53

Some of the same therapies that work for joints can also help nerves. How do they work for that?

Terry

39:06-39:21

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Welcome back to The People’s Pharmacy. I’m Terry Graedon.

Joe

39:21-39:38

And I’m Joe Graedon.

Terry

39:39-39:57

Today, we’re discussing some new therapies for arthritic joint pain. We’ll also find out what can be done for trapped nerves. Have you ever heard of prolotherapy? It involves the injection of sugar water into an injured joint. How could that possibly be beneficial?

Joe

39:57-40:33

To learn more about prolotherapy and PRP, as well as other new options, we’re talking with Dr. Tom Buchheit. He’s done research on immune mechanisms that resolve inflammation and pain. He founded the Triangle Regen Medicine and Biologic Center. Dr. Buchheit serves as an adjunct associate professor at Duke University and collaborates with colleagues at the Center for Translational Pain Medicine. His new book is “Healing Joints and Nerves: Immune Stimulation and the New Science of Regenerative Therapies.”

Terry

40:34-41:33

Dr. Buchheit, I’d like to ask you about a scenario. I know a person happens to be related to me, not Joe, not Dave, but this individual actually dislocated his hip on a construction site when he was in his early 20s. He is now 75. He has been a long-term, long-distance runner, and he has recently had a problem with hip pain on the hip that he dislocated back when he was a young guy.

So he went to the doctor, and the doctor said, yeah, you’ve got a lot of arthritis there. What would you advise this fellow for relieving his pain? He said, well, I don’t think I’m going to be running anymore. He does walk. But what advice do we have?

Joe

41:33-41:37

And he loves to run. I mean, this is a long-distance runner for decades.

Dr. Tom Buchheit

41:37-42:08

It’s a common scenario. And to me, there are a couple of questions. What is their level of function they’re at now? What do they want to be? How much cartilage do they have? It’s easier to use some of these regenerative therapies for people who have some cartilage left.

And I always think of this as a way to improve tissue health, improve the health of tissues and cartilage that’s already there. It’s not going to regrow cartilage. Even stem cells don’t regrow cartilage. And that’s something we can talk more about, but that’s a misconception out there.

Terry

42:08-42:11

So people think that stem cells will regrow cartilage.

Dr. Tom Buchheit

42:11-42:27

People think that they do, but they don’t. And there’s, I think, a couple of reasons why. The stem cell story is a really interesting story of great science that’s been misinterpreted over the years, and we can talk a bit about the details of that but…

Joe

42:27-42:56

But I’d like to get back to the PRP alternatives. So you’ve made a strong case for plasma rich… for platelet-rich plasma, PRP.

What other regenerative strategies do you have and how else can they help either osteoarthritis or an injury or some other situation that is interfering with exercise?

Dr. Tom Buchheit

42:57-43:16

It all kind of depends on the severity, what’s going on, what the joint looks like. And when I say it looks like, what does it look like under MRI, under x-ray, under ultrasound? And what does it feel like to the patient?

It can be from a, if it’s a tendon or ligament issue, you can use things like prolotherapy to stimulate a healing response.

Terry

43:16-43:19

That’s great. We want to know what prolotherapy is.

Joe

43:19-43:20

What is it?

Dr. Tom Buchheit

43:22-43:27

Prolotherapy was commonly used. Now we use it… Dextrose, actually.

Joe

43:27-43:30

That’s sugar. Sugar water. Sounds like a placebo.

Dr. Tom Buchheit

43:32-43:41

Amazingly, it does sound like a placebo. But if you put sugar water in high enough concentration, it will set up an inflammatory reaction in that same immune response we’ve been talking about.

Joe

43:42-43:44

And prolotherapy’s been around for decades.

Dr. Tom Buchheit

43:44-43:49

It’s been around for, yes, it’s been around for 70, 80 years. Absolutely.

Joe

43:50-43:56

And a lot of times, I think some of your colleagues have said, “Yeah, that’s nonsense.” But you believe it works.

Dr. Tom Buchheit

43:57-44:08

I do. And I use it most often for tendons and ligaments that need, again, they need to flip that switch and they need to go into healing mode because it will set up that immune response.

Joe

44:08-44:13

So you’re injecting sugar water, dextrose, into the area that is painful.

Dr. Tom Buchheit

44:14-44:51

Exactly. Now, it’s partly what you’re injecting. It’s partly how you’re injecting because you do a technique that actually purposefully does minor injury to the tendon or ligament. People call it a fenestration. It has different words to it, but you do a little bit of a peppering technique of the tendon and you add this high concentration of sugar water.

The body responds to that inflammatory cascade and says, we have a problem here to fix. And the body sends in its messengers, just like it’s been an ankle sprain or another injury, sends in white blood cells, and then they start to get to work. So it’s really a calling card for immune systems.

Terry

44:51-45:06

So here again, you’re creating a short-term inflammation to overcome this chronic inflammation that is causing the pain.

You’ve said a couple times that the body needs to flip the switch. Can you tell us a little bit more about that, please?

Dr. Tom Buchheit

45:07-46:10

Yes. And your description is perfect. That’s exactly it. If we go back to the healing cascade and back to, say, the ankle sprain, there’s bleeding, there’s platelet release. The platelets not only release growth factors, but they pull in white blood cells.

One of those white blood cells is called a monocyte or macrophage. There’s been a lot of research into the macrophage that can change personalities. I liken it to the kind of the Incredible Hulk, Bruce Banner becoming Incredible Hulk. He’s uh mild-mannered in the bloodstream. He finds an injured tissue, becomes the Incredible Hulk and very angry.

But once he can resolve that anger, the anger of that macrophage, he can become kind of a subdued Hulk and start rebuilding these tissues. And so to me, it’s the work of the macrophage, which is this white blood cell that is key for healing. And when I refer to the switch, I’m referring to the macrophage switch.

Joe

46:11-46:24

So we’ve talked a little bit about PRP. You’ve mentioned prolotherapy, which is injection of dextrose into the area of pain and discomfort. What other regenerative therapies are there?

Dr. Tom Buchheit

46:25-46:31

There’s stem cells, and then there’s autologous conditioned serum, which is one that I’ve researched in lab and clinically as well.

Joe

46:31-46:32

What is that?

Dr. Tom Buchheit

46:33-46:51

That is a therapy that was developed in the 80s and 90s by a German orthopedic surgeon, Dr. Peter Wehling. And they were looking at ways to, again, resolve inflammation. And they found that if you take blood and let it clot over an extended period of time, again, the blood clot being important here.

Terry

46:51-46:52

Platelets.

Dr. Tom Buchheit

46:52-47:55

Exactly. Platelets and the things that the immune cells… Actually immune stimulation, if you stimulate that system in a test tube and then you pull off that serum, it has all kinds of inflammation-resolving proteins in it and growth factors.

And it’s been studied. It’s been used to… There are a lot of athletes that fly to Germany for this therapy. I use this therapy as well in my clinic now in Chapel Hill. But there was part of it that didn’t make sense because it was lasting longer than you’d expect just a growth factor or an anti-inflammatory protein to work.

So that’s when we started looking at the mechanisms. We found out that actually a lot of the effect of it is driven by these tiny immune particles called exosomes that can reprogram how cells behave.

So in a way, it’s kind of reprogramming tissues and how tissues behave. And that, to me, I think was the kind of the secret of the sauce, which is it’s allowing cartilage, allowing a tendon or ligament to become more youthful, for lack of a better term, because it’s being reprogrammed.

Joe

47:55-48:32

So how would somebody who’s either injured themselves, as Terry’s relative… [we] won’t mention any names… with his dislocated joint, and the osteoarthritis that has resulted, or an athlete who is elite, you know, one of the great basketball players at Duke University who comes to you and says, “Oh, I got to get back in the game next week.”

How do you do this autologous thing that you’re talking about? How do you make this stuff and how safe is it?

Dr. Tom Buchheit

48:32-49:06

Well, right now we make it in the lab. We built a lab for this and it’s actually quite safe. It’s been used for 20 years, a couple hundred thousand patients across the globe. It’s been used more in Europe than it has in the United States, but it has a very long track record, partly because the quality control of it is just so tight.

There are only a couple of places, there are only about 10 places in the United States where you can get it. And the lab, our lab technique, and everybody’s trained very highly. So I think the key to it is the standardization of processing and the quality control of the processing.

Joe

49:06-49:07

And what exactly is it?

Dr. Tom Buchheit

49:08-49:10

It’s a serum product, so serum from blood.

Joe

49:10-49:15

So again, we extract some blood from the individual and you do the magic sauce thing.

Dr. Tom Buchheit

49:16-49:27

Yes, exactly. And then occasionally things are added to that magic sauce, depending on the individual in front of you. And it’s injected in several different times, usually over the course of a week or so.

Terry

49:27-49:49

We have spent most of our time together talking about joints, bones, cartilage, and tendons and ligaments. And I would like to ask about nerves because healing joints and nerves, you’re talking about nerves, and nerve pain can be really awful. Why does it last so long?

Joe

49:50-49:51

And what can you do about it?

Dr. Tom Buchheit

49:51-50:16

Right, importantly. Why is it there and what do you do about it? A nerve will cause pain if it’s firing on its own. It has different names, autonomous firing. But if a nerve is compressed, strangled, or otherwise restrained, it tends to fire on its own spontaneously. And that spontaneous firing we feel is pain.

Terry

50:16-50:21

So sometimes we call that entrapment or impingement. They’ve got fancy terms for it, but it’s trapped.

Dr. Tom Buchheit

50:22-50:56

Exactly. If you trap a nerve, if you trap a nerve with a disc herniation in your spine, you’re going to have rip-roaring sciatica down your leg, and that’s an entrapped nerve. If you have carpal tunnel and you have a trapped nerve in your wrist, that’s going to cause nerve pain in your hand. If you have a nerve that’s entrapped around an old surgical scar, that’s going to become entrapped.

And so the key is there are ways to decrease the firing of the nerve with drugs. But to me, that’s an important part to free the nerve up so it’s no longer entrapped. And so that’s a lot of things that a lot of things that I do are freeing nerves up.

Joe

50:56-50:56

How do you do that?

Dr. Tom Buchheit

50:57-51:50

There’s a technique that’s called hydro-dissection that we do. And basically, it’s kind of gently injecting fluid of one of several different types around a nerve to open the space around that nerve so it can glide more freely through that space. And it’s a technique that makes sense.

You know, years ago you know I was… I’m old enough to have been done doing nerve blocks before ultrasound was ever used, and occasionally we’d see patients who got better longer term after a nerve block, and I kind of scratched my head trying to figure out why is this person better long term because all we did was shut the nerve off for a few hours.

In retrospect we were probably doing hydro-dissections without knowing it. Now we can see it. So under ultrasound, you place a needle very carefully around the nerve and you use a fluid to open the space up. So you don’t have to do it surgically now. You can just do it through a needle and through ultrasound.

Terry

51:50-51:54

So that’s what the ultrasound is for, to be able to visualize what you’re doing.

Dr. Tom Buchheit

51:55-51:55

Precisely.

Terry

51:55-51:56

How to do it right.

Dr. Tom Buchheit

51:57-52:04

Precisely. And to make sure you get good separation of the tissues with it. Because you can see it almost looks like a halo around the nerve when you’re done.

Terry

52:04-52:05

How well does it work?

Dr. Tom Buchheit

52:06-52:32

It depends on the nerve and depends on the entrapment. If there’s a true entrapment around a scar, it can work wonderfully. And once or twice, it can completely relieve pain. Other areas, if the nerve is sick for other reasons, for, you know, because of diabetes or other issues, it may work partially.

But my philosophy is if there’s ever an entrapped nerve, you want to release the entrapment first before you start adding drugs to it.

Terry

52:33-52:36

And one other thing, what about side effects?

Dr. Tom Buchheit

52:37-52:57

Side effects of hydrodissection are very low as long as the person doing it has a good view and experience doing it. Because if you put a needle into a nerve, you can injure the nerve. So you have to be very delicate and very confident in being able to place the nerve gently around it but not in it. And that’s the key.

Joe

52:57-53:02

Are there any nutritional supplements that can be helpful for people with neuropathy?

Dr. Tom Buchheit

53:04-53:14

I’m not an expert in supplements, but there are a few that I look at. I look at things that make nerves healthy and make mitochondria work better.

Joe

53:14-53:15

Such as?

Dr. Tom Buchheit

53:15-53:20

Well, one of my favorites, partly because so many people are taking statins, is making sure they’re on CoQ10.

Joe

53:21-53:21

Right.

Dr. Tom Buchheit

53:22-53:40

So I look at that. I am a big believer in omega-3 supplements unless someone is eating sardines daily, which most people don’t do. And I’m also a believer in things like turmeric and some of the other supplements, especially if they allow us to take fewer anti-inflammatory drugs.

Terry

53:42-53:52

Dr. Buchheit, I wonder if you could tell us a little something about stem cells. What are they and how should they be used? Are they useful at all?

Dr. Tom Buchheit

53:53-55:14

It’s a great question. And stem cells have captured the imagination of many Americans and people across the globe. That story started with a scientist named Dr. Arnold Kaplan. And he found these cells that were growing in our bone marrow that he could grow and turn into cartilage. And this was in the 1990s.

Everyone thought he had a cure for osteoarthritis at that moment. The challenge is that when you take those cells and inject them into a joint, they live for a while, but then they die off. And it’s really very clear now that what we call stem cells have a benefit for our immune response.

So, for instance, we talked about that macrophage that flips a switch. They will flip that macrophage switch, but stem cells are actually working through our own immune systems. So the cells that someone gets injected into a knee, a hip, or a shoulder, they’re not living long-term. They’re not growing new cartilage. They’re turning on our own repair systems.

And that’s the myth that’s been out there for a very long time is someone thinks that they’re going to have a stem cell injection. They’re going to grow new tissues. They may have much healthier tissues, but those cells that are injecting aren’t living long-term.

Terry

55:15-55:19

But what I’m hearing you say is there still could be benefit.

Dr. Tom Buchheit

55:19-55:50

Absolutely. Absolutely. The cells can be very beneficial in a lot of ways. There’s many ways to harvest them. You can harvest them from bone marrow. You can harvest them from adipose tissue. Now, stem cells have also become controversial because they can come from our cells, like PRP or the autologous conditioned serum, or they can come from a donor. And those donor products, you might imagine, need to go through a higher level of regulatory scrutiny to make sure that there’s no infection that occurs in that process.

Terry

55:50-55:52

I would want them to be regulated.

Dr. Tom Buchheit

55:53-56:12

Absolutely. And so there really are yet to be any approved stem cell therapies from donors in the United States. If you hear of people going overseas to overseas clinics, various countries around the United States, they can do those incubated products over there, but you really can’t do it in the United States right now.

Joe

56:13-56:43

I’d like to ask you about cost. I guess, but I could be completely mistaken, that insurance companies are going to do their best to deny things like prolotherapy or PRP injections, or maybe even the autologous conditioned serum. If they could say, no, no, no, no, no, we don’t really pay for that, how much would it cost if somebody had to pay out of pocket?

Dr. Tom Buchheit

56:44-57:07

Well, it’s a whole spectrum, right? There are certain things, prolotherapy is very inexpensive and stem cells and autologous conditioned serum are much more expensive.

And it is true, insurance doesn’t cover any of these right now. Now I think eventually they will. My way… I look at it is insurance covers therapies that suppress the immune system. They don’t cover therapies that augment the immune response.

Joe

57:08-57:09

That sounds crazy.

Dr. Tom Buchheit

57:10-57:56

But it’s true if you think about it, right? If you want a steroid injection, it’ll be covered. If you want an anti-inflammatory medication, it’ll be covered. But if you want prolotherapy or PRP or any of the other therapies we’re talking about, it’s not. We also need to redo some of the studies. I mentioned before some of the PRP studies that were negative because what they were using really wasn’t strong enough.

And the insurance company can very easily go to that… point to that study and say, “Look, here’s a large randomized control trial that says it doesn’t work. It’s experimental. We will not cover it.”

So it’s I think it’s incumbent on the field to redo these studies and redo them in a strong way, in a multicenter way with good products and then have the evidence. And I think that will happen, but I think it’s going to be a few years.

Terry

57:57-58:28

Dr. Buchheit, we’ve talked today about arthritis and what you do about it. We haven’t really talked as much about what causes it. We have talked about chronic inflammation. And so I want to ask you about one potential cause, which would be infection. For example, a Staph aureus infection, a Borrelia burgdorferi infection.

Do you have anything to say about that?

Dr. Tom Buchheit

58:28-59:24

It’s not an area that I know deeply. I know it is one of the things looked at, and it makes sense. Any driver of chronic inflammatory change is going to chew up cartilage. And if you think about it, so if you have a chronic inflammatory state, regardless of what’s driving that inflammatory state, your body’s going to produce enzymes that digest cartilage tissue. And that’s what osteoarthritis is. It’s the enzymes. The inflammation releases the enzymes. The enzymes digest the tissue.

And so we need to find a way to prevent that from happening. But any chronic inflammatory state would do that. A chronic infection would do that. A chronic inflammatory state would do that. An injury that hasn’t quite recovered would do that. So I’m not an expert in the infectious cause, but if a chronic infection causes chronic inflammation, absolutely it could drive osteoarthritis.

Joe

59:25-01:00:39

Dr. Buchheit, I’d like to ask about pain because pain gets your attention very fast. And people want relief and they can’t sleep. Their back hurts or their shoulder’s giving them trouble. They can’t lie on their shoulder.

It used to be that doctors prescribed opioids in massive quantities, Percocet, hydrocodone, oxycodone. And of course, now because of the opioid epidemic and all of the people who have died, there’s a tremendous reluctance for both physicians as well as patients to rely on opioids, especially long-term.

What’s replaced opioids, however, is gabapentin. It’s [an] anti-seizure drug. At least that’s how it was originally developed. And another medication that has both sort of antidepressant-like activity as well as some subtle opioid-like effect called tramadol. These are the big pain relievers these days.

Your thoughts about gabapentin and or tramadol and what we should be doing instead?

Dr. Tom Buchheit

01:00:40-01:01:36

That’s a great question. So I’ve been using and I’ve been using and seeing people on gabapentin since the late 90s when it came out, right? And it came out, as you pointed out, as a seizure drug. It does, and it can reduce nerve pain. We talked about nerve pain being from, if you have a nerve that’s entrapped, it starts firing on its own spontaneously and gabapentin can quiet that down.

The challenge with gabapentin, and the concern about gabapentin, though, is that it will affect the brain. It was designed to affect our brains as a seizure drug. And so I think it’s a bit of magical thinking to think that we’re not going to have cognitive side effects to gabapentin over time. And that’s my concern.

Some people can do very well with it. Some people need it because they cannot function because of a neuropathy or another issue. But a lot of people are on it, and I do have concerns about the cognitive side effects.

Terry

01:01:36-01:01:41

And the person who says gabapentin gives me such brain fog, I can’t function, they shouldn’t be taking it.

Dr. Tom Buchheit

01:01:42-01:01:45

If they can avoid taking it, it sounds like a good idea to avoid taking it.

Joe

01:01:46-01:02:28

We like to say that pain is personal. Everybody’s different. And my mom, for example, if she had a bellyache, it would be like a 10 out of 10. I mean, she was just incapacitated. Terry’s mother, on the other hand, you know, cut to the bone and she’d say, “Oh, maybe my pain’s at two.” You know, she was a tough old bird.

And so the idea that we can generalize about your pain is very challenging. Some people get great benefit from gabapentin. Other people say it didn’t work hardly at all. How do we find the right strategy for pain relief?

Dr. Tom Buchheit

01:02:28-01:03:56

Oh, it’s hard. It really is hard. And this has been decades and decades of pain research trying to identify therapies based on symptoms. I tend to look also at function.

The reason is that if I have someone who is having 6 over 10 knee pain and can walk a quarter of a mile, if we do a therapy on them and they can walk now 3 miles, but their pain is still 6 over 10, that’s still an improvement, right? Their function is better.

And my hope is that as the function improves, the pain will eventually follow. But it is hard because, right, pain is in us and it is subjective and no one can experience it outside of the individual. And that makes it hard to gauge, right?

But the other part of this is that we’ve tried to objectify osteoarthritis, for instance, by looking at an x-ray and saying this is grade 1, 2, 3, 4, depending on how big the space is between bones. And it turns out that there’s very little relationship between someone’s function, someone’s pain, and how much space is between the bones.

So our attempts at defining treatments based on x-ray is equally as poor. So I think pain is an important part of this. And it’s a very important part of helping someone to function better. And you’re right, there’s no other way of doing it other than just asking them and talking to the patient.

Joe

01:03:56-01:04:21

Well, we only have about two minutes left, and so this gives us the opportunity to summarize all the things that we should be doing and some that we should not be doing to allow us to keep moving which is critical to your game plan and to reduce our likelihood of ending up in pain for a long period of time?

Dr. Tom Buchheit

01:04:22-01:04:50

Well, I think first off is figure out where you’re starting. Everybody starts at a different place, but I like to say, you know, measure where you are and maybe you can walk a quarter mile. Maybe you can only walk a few steps. Maybe you can go and do aqua therapy, find out where your, where your level is of exercise and then work on building that, but build it slowly.

You know, if you have someone who can’t walk more than a quarter mile and they go walk two miles, they’re going to be in bed for three days and then they’ve lost ground, right?

Joe

01:04:51-01:04:58

And walking is good. You don’t have to be a marathoner to benefit from just plain walking.

Dr. Tom Buchheit

01:04:58-01:05:03

Exactly. And the studies for osteoarthritis are very convincing. Walking is good for joints.

Joe

01:05:04-01:05:05

What about diet?

Dr. Tom Buchheit

01:05:07-01:05:27

Live like the folks that are in the Mediterranean basin. So I always think of fish, fruits, vegetables, nuts, olive oils as the foundation for food. And that diet that’s good for our hearts is also very good for joints and nerves. And it’s been shown and studied to actually decrease arthritis pain as well.

Joe

01:05:27-01:05:42

And when we sprain an ankle or injure a shoulder or our back is hurting, what can we do to avoid taking all those NSAIDs or getting those steroid shots to ease the pain and get us back moving again?

Dr. Tom Buchheit

01:05:42-01:06:17

Well, that’s a great question. And I would argue that we should not soak ourselves in steroid injections and anti-inflammatories. And I had this personal experience of having had a couple of knee injuries. And one, the first one a bunch of years ago, I soaked in anti-inflammatories. And then the second one, I didn’t.

And I can tell from personal experience, it hurts more, but my healing was faster. And I would encourage when people can do it and go without the steroids and the anti-inflammatories to minimize or avoid them if they can.

Terry

01:06:17-01:06:24

Dr. Tom Buchheit, thank you so much for coming and talking to the People’s Pharmacy today.

Dr. Tom Buchheit

01:06:24-01:06:27

Thank you, Joe and Terry. It’s been a pleasure to be here. Thank you for having me.

Terry

01:06:28-01:06:48

You’ve been listening to Dr. Tom Buchheit, author of “Healing Joints and Nerves: Immune Stimulation, and the New Science of Regenerative Therapies.”

Dr. Buchheit founded the Triangle Regen Medicine and Biologic Center. He collaborates with colleagues at the Center for Translational Pain Medicine at Duke University.

Joe

01:06:49-01:06:58

Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music.

Terry

01:06:59-01:07:06

This show is a co-production of North Carolina Public Radio, WUNC, with the People’s Pharmacy.

Joe

01:07:07-01:07:23

Today’s show is number 1,468. You can find it online at peoplespharmacy.com. That’s where you can share your comments about this episode. You can also reach us through email, radio, at peoplespharmacy.com.

Terry

01:07:23-01:07:54

Our interviews are available through your favorite podcast provider, whichever one that is. You’ll find the podcast on our website on Monday morning. In this week’s podcast, you can learn more about stem cells and PRP. We discuss the pros and cons of pain relievers, including opioids and gabapentin. Pain is so personal. How can we find the right strategy for pain relief for each individual?

Joe

01:07:54-01:08:02

And because we are so individual, the one size fits all does not work. We have to individualize it.

Terry

01:08:02-01:08:02

Exactly.

Joe

01:08:03-01:08:32

At peoplespharmacy.com, you could sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast. We would be so grateful if you’d write a review of The People’s Pharmacy and post it to the podcast platform you prefer. If you find our topics thought-provoking, please share them with friends and family. In Durham, North Carolina, I’m Joe Graedon.

Terry

01:08:33-01:09:09

And I’m Terry Graedon. Thank you for listening. Please do join us again next week.

Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

Joe

01:09:09-01:09:19

If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in.

Terry

01:09:19-01:09:24

All you have to do is go to peoplespharmacy.com/donate.

Joe

01:09:24-01:09:37

Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen through your local public radio station or get the live stream on Saturday, April 4, 2026, 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 April 6, 2026.

Love Your Liver:

Nutrients don’t go directly from the intestines to the rest of the body. Instead, they pass through the liver first. There, this master organ breaks them down into compounds that can be recognized and utilized by individual tissues and cells. Moreover, if it finds nasty chemicals that shouldn’t be there, it utilizes its superpowers to transform them into less damaging compounds that can be more readily excreted.

You should also love your liver because it can store nutrients for unanticipated periods of fasting and hold off starvation. This was a tremendous benefit during earlier periods of human evolution. These days, we have less need for a hedge against starvation. In fact, when we overload our livers with alcohol or sugar, even its superpowers may not be adequate. The liver’s response to this kind of insult is fibrosis, a condition in which it stiffens and stores fat.

Liver Disease:

One of the liver’s superpowers is that it can regenerate itself so long as we remove the source of injury. That’s pretty remarkable! But what if we keep on eating ultra-processed foods (Nutrients, May 10, 2023) and drinking soda or alcohol?  In that case, the liver continues to try to repair itself. That can change the architecture of the tiny blood vessels that run through the liver, raising the pressure within them and ultimately leading to serious complications. Fatty liver disease, correctly termed metabolic-associated steatohepatitis (MASH), is the first step; cirrhosis and ultimately liver failure might follow.

How Do You Know If Your Liver Is Healthy?

The liver is so effective at maintaining the body in balance that most people don’t develop symptoms of trouble until liver disease is quite advanced. As a result, the best way to keep tabs on liver health is through blood tests. Tests for the liver enzymes called ALT and AST are common and often used to assess liver health.

Agents That Can Help or Harm the Liver:

If you love your liver, consider drinking a cup or two of black coffee daily. This has been shown to help the liver fight inflammation and overcome early-stage liver fibrosis (Redox Biology, March 2025).

Another precaution to take: avoid excess acetaminophen. This is the pain-relieving ingredient in Tylenol and hundreds of other over-the-counter medications. Doctors consider it safe for occasional use at doses under 4,000 mg in a day. Chronic use might call for lower doses yet. Because it is so widespread, people may mistakenly take several different medicines containing acetaminophen (paracetamol in the rest of the world) and end up exceeding the maximum dose by accident. Liver experts like our guest Dr. Ahmad treat such emergencies with a medicine called N-acetylcysteine.

Other pain relievers, such as NSAIDs, are less likely than acetaminophen to damage the liver. Dangerous reactions to such drugs are unpredictable, however, which can make them harder to manage. Fluoroquinolone antibiotics such as Levaquin and corticosteroids like methylprednisolone also fall into this category. Oral antifungal drugs can also be very hard on the liver.

Herbs That Can Challenge the Liver:

Pharmaceuticals are not the only compounds that may test the liver’s detoxifying superpowers. Botanical medicines can also cause challenges. Dr. Ahmad has treated people whose liver injuries were caused by green tea extract, turmeric, kratom or ashwagandha. Most people taking such supplements are attempting to improve their health, so discovering that instead they have developed liver damage is a nasty surprise. If you love your liver, stick with drinking green tea and eating curry rather than taking pills with concentrated extracts.

This Week’s Guests:

Meena Bansal, MD, is Professor of Medicine, specializing in liver diseases, at the Icahn School of Medicine at Mount Sinai. She is System Chief of the Division of Liver Diseases and Director of the MASH/NASH Center of Excellence at Mount Sinai.

Meena Bansal, MD, Professor of Medicine Mt. Sinai, photo courtesy of Mt. Sinai

Jawad Ahmad, MD, is a professor of liver diseases at the Mount Sinai School of Medicine. He is co Primary Investigator on the NIH/NIDDK research initiative to study cases of severe liver injury caused by prescription drugs, over-the-counter drugs, and alternative medicines, such as herbal products and supplements.

For more information on the Drug-Induced Liver Injury Network (DILIN) visit: https://researchfunding.duke.edu/drug-induced-liver-injury-network-dilin-clinical-centers-u01-clinical-trial-optional

Jawad Ahmad, MD, Professor of Medicine at Mount Sinai, photo courtesy of Mt. Sinai

Listen to the Podcast:

The podcast of this program will be available Monday, April 6, 2026, after broadcast on April 4. You can stream the show from this site and download the podcast for free.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, March 28, 2026, through 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 March 30, 2026.

Can You Disagree Without Fighting?

Dr. Goheen did her best to answer the questions her seatmate had. She also listened carefully to his description of life during the pandemic, particularly his objections to mandatory vaccination and his fears of a reaction to the vaccine. As a health care provider, she had been working in a hospital that was overwhelmed with COVID-19 patients. Far too many of them died, and at the height of the pandemic, most died alone rather than with family nearby. She was able to recognize that this had colored her perception of the pandemic and had led her not to give enough attention to the real economic hardship some public health mandates triggered.

The Value of Vaccines

Before the polio vaccine was developed, parents lived in terror of polio epidemics that would tear through communities, leaving some children paralyzed and a few dead. We no longer have to fear polio, pertussis, diphtheria or measles because vaccines can protect children from these common diseases. In a sense, though, their very success has led to skepticism of their value. Most Americans do not know anyone who has died of pertussis (aka whooping cough) because the majority of children have been vaccinated against this pathogen. Recently, there have been few birth defects caused by rubella because pregnant women can be protected from the infection.

Can Trust Be Regained?

During the pandemic, opinions became polarized. People who would once have trusted the FDA or the CDC became suspicious. Public health messages about masking were initially based on conjecture, because no one had conducted actual studies until later in the pandemic. The nature of this new virus and its transmission was not yet well understood. Yet authorities occasionally made dogmatic pronouncements, possibly out of fear. Some opportunities to build trust were squandered, and it will take time and patience to get it back. Learning to disagree without fighting is a great place to start.

Learning to Disagree Without Fighting

After talking with Dr. Goheen, we turn to Dr. Laura Gilliom. She is a clinical psychologist active in the Braver Angels movement. This organization brings people together to bridge the partisan divide. The volunteers run workshops in which people with divergent viewpoints discuss issues of the day. They model basic approaches to good communication, including treating the other person in the conversation with respect.

It is important to listen for understanding of the intellectual and emotional bases for their perspective. After all, people have reasons for their opinions. Even if you don’t understand them, those reasons make a lot of sense to them and are usually the result of significant life experiences. When you speak, the aim is not to win the argument, but to be heard and understood. That is also the goal as you listen–to understand where the other person is coming from.

When Braver Angels bring people together, all agree to state their views freely and without fear. That isn’t always the case in other situations. Sometimes people fail to speak out because they are afraid of the possible reaction. Another rule for Braver Angels interactions is that people treat each other, including those who disagree, with honesty, dignity and respect.

Curiosity and kindness are also critical when we talk with people whose views are very different from ours. In some situations, it may be appropriate to reflect back what you have heard and ask if that is a fair representation of what they said. Before sharing your own ideas, you might ask permission. One other point to keep in mind: humans sometimes make mistakes. That might apply to those on “our side” as well as to those on a different side. Humility can help.

This Week’s Guests

Morgan Goheen, MD, PhD, serves as faculty Instructor in the Section of Infectious Diseases within the Department of Internal Medicine at Yale School of Medicine. As a physician scientist, her current research focuses on the mosquito vector’s role in malaria transmission dynamics and drug resistance spread in sub-Saharan Africa with lab work based in the Epidemiology of Microbial Diseases Department in the Yale School of Public Health. Within her clinical specialty of infectious diseases, Dr. Goheen has specific interest in tropical medicine and helped start the Travel and Tropical Medicine Clinic at the Yale Center for Infectious Diseases. Dr. Goheen is a Public Voices Fellow of The OpEd Project in Partnership with Yale University.

https://www.theopedproject.org/fellowships.
https://www.huffpost.com/entry/infectious-disease-doctor-anti-vaccine-airplane_n_68d2e961e4b03fb4d93463e7

Laura Gilliom, PhD, is a licensed clinical psychologist in Chapel Hill, North Carolina, a State Coordinator for Braver Angels, and a member of the Central NC Alliance of Braver Angels.
https://nc.braverangels.org/

Listen to the Podcast

The podcast of this program will be available Monday, March 30, 2026, after broadcast on March 28. You can stream the show from this site and download the podcast for free.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen to this conversation through your local public radio station or get the live stream at 7 am EST on Saturday, March 21, 2026, through 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 March 23, 2026.

How You Can Watch our Interview with Nikki Schultek:

Here is the YouTube video podcast of our interview with Nikki. We think you will find it compelling. Treating the causes of chronic diseases instead of the symptoms makes sense to us.

How Could Hidden Infections Be Driving Chronic Disease? Nikki’s Story

We begin this episode with the personal account of Nikki Schultek. She is a patient who has transformed herself into a research leader after a horrendous experience with unexplained chronic disease. She was a healthy active young mother whose lifelong well-controlled asthma suddenly took a dramatic turn for the worse. She then developed atypical pneumonia, heart arrhythmia and interstitial cystitis, along with a slew of autoimmune conditions. All the doctors could tell her was that these were idiopathic conditions driven by inflammation. As she notes, “idiopathic” basically is doctor-speak for we don’t understand what is going on here. When she developed neurodegenerative symptoms that made her physician suspect MS, she was terrified.

That low point became a turning point. Her background had equipped her to read scientific studies, so she began trying to figure out what was driving chronic disease in her own situation. A search linking atypical pneumonia and interstitial cystitis led her to the clinician who was able to help her regain her health, Dr. Charles Stratton. He had conducted a small study linking both conditions to a respiratory infection caused by Chlamydia pneumoniae.

What Is Chlamydia pneumoniae?

When people hear “Chlamydia,” they think immediately of the sexually transmitted infection caused by Chlamydia trachomatis. Although the organisms are related, they have completely different modes of transmission. People catch C. pneumoniae (Noo-mo-knee-eye) simply by breathing in air that contains infectious respiratory particles.

These bacteria are extremely common, but it is difficult to detect an infection. That’s because C. pneumoniae hides out inside human cells. It doesn’t show up in blood tests or urine cultures. The study that caught Nikki’s eye used PCR, polymerase chain reaction, which detects DNA. That analysis revealed that 80 percent of the women in the study with interstitial cystitis had C. pneumoniae. The researchers concluded that this sneaky pathogen can lead to chronic inflammation.

The Link Between C. pneumoniae and Asthma

Remember that Nikki’s troubles started with a severe asthma exacerbation. Research has shown a link between that infection and hard-to-treat asthma (PLoS One, April 19, 2021). When Dr. Stratton tested Nikki, they discovered that she indeed harbored a C. pneumoniae infection. The treatment required multiple antibiotics over a prolonged period of time. Luckily, it eventually cleared the interstitial cystitis, the neurodegenerative symptoms, the other autoimmune problems and brought her asthma back under control.

Other Pathogens Causing Trouble

C. pneumoniae was not the only germ lurking in Nikki’s body. She discovered that she also carried Borrelia burgdorferi, the organism that causes Lyme disease. In addition, an examination of her red blood cells revealed both Babesia and Bartonella, possibly transmitted by the same tick bite that gave her the Lyme disease.

These experiences inspired Nikki to start the Intracell Research Group, the Pathobiome Research Center and the Alzheimer’s Pathobiome Initiative. All are aimed at discovering if hidden infections such as C. pneumoniae or Babesia or Borrelia burgdorferi could be driving chronic disease such as dementia.

More Research on Covert Pathogens Driving Chronic Disease

One of Nikki’s colleagues at the Alzheimer’s Pathobiome Initiative as well as at the Philadelphia College of Osteopathic Medicine is Dr. Brian Balin. He has spent more than 25 years studying the connections between C. pneumoniae infections and brain inflammation. This, in turn, has been linked to neuroinflammation and dementia.

Dr. Balin points out that respiratory pathogens like C. pneumoniae are accustomed to entering the body through the nose. The nose offers access not only to the respiratory tract, but also to the brain. However, it can be difficult to detect microbes in the brain while the patient remains alive. This has limited research on infection and cognitive impairment in the past (Alzheimer’s & Dementia, Nov. 2023).

The COVID pandemic poses another huge risk. Like C. pneumoniae, the SARS-CoV-2 virus often enters the body through the nose. From there, it has ready access to the brain (Frontiers in Aging Neuroscience, June 13, 2025). Further, when the immune cells called macrophages respond to these infections, they engulf the pathogen and may carry it throughout the body. Might long COVID be the latest example of unacknowledged infection driving chronic disease?

What Are the Implications for Treatment?

If it can be firmly established that pathogens trigger the inflammation driving chronic disease, that offers several different approaches for treatment. First, we would need to use a high level of suspicion and appropriate technology (such as PCR) to detect infection. These bugs don’t show up through urine cultures or other typical diagnostic techniques.

Secondly, we would need to figure out treatment strategies. Antibiotics can be useful, but they may not be the only tools. Vaccines could help the body fight off these pathogens. Specific antibodies might also be developed to block them. In addition, phage therapies targeted to specific bacteria may also work when antibiotics cannot.

If you are unfamiliar with the idea of phage therapy, you might want to listen to our radio shows on this topic. Just think of these viruses the way you think of the enemy of my enemy. That entity becomes your friend!

Here are some interviews you may find intriguing:

Show 1155: Can Bacteriophages Save Your Life?

Show 1407: Battling Superbugs with Nature’s Viral Warriors

This Week’s Guests

Nikki Schultek is Founding Director of the Pathobiome Research Center, and Research Assistant Professor at Philadelphia College of Osteopathic Medicine , Executive Director and Co-Founder of the Alzheimer’s Pathobiome Initiative (AlzPI), and Principal and Founder of Intracell Research Group, LLC. A former life sciences professional with Pfizer and Genentech, she now works to unite global researchers studying infection-associated chronic illnesses, including Alzheimer’s disease and other brain diseases.

Following her own recovery from Lyme Disease, Chlamydia pneumoniae and co-infections, Nikki builds and leads patient-centered interdisciplinary research collaborations to examine microbial drivers of chronic diseases. She has catalyzed philanthropic funding to launch AlzPI research at multiple academic centers and co-lead authored a 2023 roadmap in Alzheimer’s & Dementia outlining a rigorous strategy to investigate infections in brain disease.

www.PCOM.edu/research/pbrc
www.AlzPI.org
www.IntracellResearchGroup.com

Nikki Schultek, founder and director of Intracell Research Group, LLC

Brian J. Balin, PhD, is a tenured Professor of Neuroscience and Neuropathology at the Philadelphia College of Osteopathic Medicine. He directs the Center for Chronic Disorders of Aging (an Osteopathic Heritage Foundation Endowed Center), and the Adolph and Rose Levis Foundation Laboratory for Alzheimer’s Disease Research.

An internationally recognized Alzheimer’s researcher, Dr. Balin has spent over 25 years investigating links between infection—particularly Chlamydia pneumoniae—and neuroinflammation, blood–brain barrier dysfunction, and neurodegeneration. His NIH- and foundation-funded work has significantly advanced the “pathogen hypothesis” of Alzheimer’s disease and Dr. Balin is regarded as a global expert and pioneer in this research field. Dr. Balin is a Co-Founder of The Alzheimer’s Pathobiome Initiative (AlzPI).

Brian Balin, PhD, Philadelphia College of Osteopathic Medicine

Listen to the Podcast

The podcast of this program will be available Monday, March 23, 2026, after broadcast on March 21. You can stream the show from this site and download the podcast for free.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Transcript of Show 1466:

A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:01

I’m Joe Graedon.

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy.

Joe

00:06-00:27

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Chronic diseases continue to plague humans. We’re good at treating symptoms, but the root causes often remain a mystery. This is The People’s Pharmacy with Terry and Joe Graedon.

Terry

00:34-00:45

Are pathogens responsible for many of our most troubling and persistent conditions? We don’t think of heart disease, arthritis, or Alzheimer’s disease as having an infectious origin, but might they?

Joe

00:46-00:52

Our guests today are studying the connection between infection and chronic disease.

Terry

00:53-01:00

Not every pathogen is obvious. Some like to lurk inside cells where we have a hard time detecting and eradicating them.

Joe

01:01-01:07

Coming up on The People’s Pharmacy, how hidden infections can lead to chronic disease.

Terry

01:14-02:26

In The People’s Pharmacy Health Headlines: The American Heart Association and the American College of Cardiology have just issued new guidelines for preventing heart disease.

For one thing, the experts suggest starting cholesterol testing much younger, possibly even in childhood. Younger adults, between 20 and 30, should aim for LDL cholesterol levels below 100. People at higher risk will be encouraged to get their LDL level below 70.

Cholesterol is not the only risk factor addressed by the new guidelines. They also recommend testing for lipoprotein A, also known as LP little a. This is an independent risk factor for atherosclerosis. The cardiologists who compose the guidelines want their colleagues to use a new risk calculator that evaluates a much longer risk period than the previous calculator did.

People with heart disease and those with diabetes need more intensive treatment than those at low risk. The guidelines also suggest measuring coronary artery calcium in cases where there’s any question about starting a statin medication to lower cholesterol.

Joe

02:27-03:22

Harvard researchers and their Mongolian colleagues have just published a study of vitamin D3 supplementation during COVID infection. Patients from both the U.S. and Mongolia were recruited.

Over 1,700 volunteers with newly diagnosed COVID-19 infections participated. They were randomized to receive either vitamin D3 or placebo. The dose of vitamin D was 9,600 international units for the first two days and 3,200 IUs daily for the next month.

There was no difference in symptom severity or chance of hospitalization while people were taking the vitamin or placebo. There was, however, an intriguing hint that people who were taking vitamin D3 were less likely to develop long COVID after their infection. This reduction was not statistically significant, but the signal was strong enough that it deserves further study.

Terry

03:23-04:28

For decades, doctors have prescribed metformin to help people with type 2 diabetes control their blood sugar. Some studies have suggested that this compound may also help reduce the risk of developing certain cancers. Now, researchers have analyzed data from five Nordic countries to compare 13,050 people newly diagnosed with esophageal squamous cell carcinoma to 130,500 healthy people of similar age and sex.

Esophageal cancer is quite dangerous with low survival rates. The scientists report that people taking metformin had a 36% lower likelihood of being diagnosed with esophageal squamous cell carcinoma than those who were not. Higher doses were associated with even lower risk, about 48%. The authors note the observed association between metformin use and a significantly decreased risk of this cancer suggests a possible role of this drug in cancer prevention and treatment.

Joe

04:29-05:14

Influenza cases are trending down at long last, though the CDC reports overall seasonal influenza activity remains elevated nationally. The agency notes that hospitalizations from influenza were the third highest since the 2010-2011 flu season.

The CDC estimates that there were 27 million illnesses, 350,000 hospitalizations, and 22,000 deaths from flu so far this year. How well did flu shots work? Well, not so good. The H3N2 subclade K variant surfaced after the vaccines were in production, so the shots were far less effective than usual.

Terry

05:14-06:17

Americans have made some important health changes over the last several decades. In particular, smoking is down dramatically. Life expectancy has improved over that time, except during the pandemic. Even before that, though, life expectancy in the U.S. had kind of flattened.

Now, analysis shows that younger generations, born since 1970, have higher mortality from cancer, cardiovascular disease, and other causes than previous generations. If these trends continue, the U.S. could experience a sustained decline in life expectancy.

And that’s the health news from The People’s Pharmacy this week. Welcome to The People’s Pharmacy. I’m Terry Graedon.

Joe

06:17-06:34

And I’m Joe Graedon. Many of our most challenging conditions remain hard to cure. That’s because modern medicine has become very good at treating symptoms. We can ease the pain of arthritis, open airways for people with asthma, and overcome urinary tract infections with antibiotics.

Terry

06:35-06:43

But we often don’t know what’s actually causing these chronic health problems in the first place. Is there a connection with hidden infections?

Joe

06:44-07:18

To help us answer that question, we turn to Nikki Shultek. She’s founding director of the Pathobiome Research Center and research assistant professor at the Philadelphia College of Osteopathic Medicine.

Nikki is also principal and founder of IntraCell Research Group and executive director and co-founder of the Alzheimer’s Pathobiome Initiative. She worked as a life science professional for Pfizer and Genentech at the start of her career. Then she had a devastating personal experience with chronic illness.

Terry

07:19-07:22

Welcome to The People’s Pharmacy, Nikki Shultek.

Nikki Shultek

07:22-07:27

Thank you so much, Terry and Joe, for having me. I’m incredibly grateful to be here today with both of you.

Joe

07:28-07:43

Nikki, you have had quite a journey. Could you please share with our listeners your chronic illnesses associated with pathogens? Because I think this is still a field in evolution. What happened?

Nikki Shultek

07:43-09:52

Absolutely. So I like to say my journey began 10 years ago, closing in on 11 years. And I went from being essentially a relatively healthy, athletic, I was a runner, mother of two children, enjoying my early 30s to being someone who was just one diagnosis after another, chronically ill. And if anyone has seen that show Mystery Diagnosis, it was sort of like that.

I had about a dozen specialists helping me. And I, you know, really was unable to get a clear picture of what was actually driving the different diagnoses I had. So what I will fast forward with today is essentially I have what is known as infection-associated chronic illness. That is what was happening to me at the time.

But at the time, I was just being diagnosed with one autoimmune condition after another. And I ended up having this terrible respiratory symptom. So I’d had asthma my entire life, and I developed something that was different than my typical asthma. Yes, my asthma had become incredibly severe suddenly, but also I had a symptom called air hunger, which was truly like a desire for oxygen.

And this symptom came along with another odd symptom, which was one swollen joint in my finger.

Terry

09:03-09:04

Huh, just one.

Nikki Shultek

09:04-09:26

Mmm Hmm. At that time. And so I went to my asthma and allergy physician who had seen me for years. He said, oh, you must be having an asthma exacerbation. And I was totally, that’s a reasonable conclusion, right? Prescribed prednisone, which is not uncommon for people that have asthma.

And unfortunately, 20 milligrams turned to 40, 40 turned to 80.

Joe

09:26-09:27

Whoa.

Nikki Shultek

09:27-09:52

And I continued to go the wrong direction with my breathing. And I got this rattle in my lung and I’m going, oh, my goodness gracious, what’s happening here? So I ended up, to make a long story short, with multiple pulmonologists just on the lung issue alone, a scan to look for pulmonary clots, pulmonary emboli. I was then subsequently having strange heart palpitations, found out I had developed an arrhythmia.

Joe

09:53-09:55

And how old were you at that time?

Nikki Shultek

09:55-09:57

I’m 34 at this point.

Joe

09:57-09:58

So that’s pretty unusual…

Nikki Shultek

09:58-10:00

Well, 33, about to be 34, yeah.

Joe

10:00-10:04

…for a healthy, middle-aged woman who exercised?

Nikki Shultek

10:04-10:40

Non-smoker, actually a runner. I had taken up running half marathons, so probably the best physical shape of my life. And my asthma had been previously very well controlled on GlaxoSmithKline’s purple disc, the Advair, for like years. Didn’t have an exacerbation or a serious turn in my illness.

What happened next was systematically the illness spread around my body, essentially. And I went from having just respiratory symptoms to developing what is known as one of the top 10 most painful conditions someone can have, a bladder pain disorder called interstitial cystitis.

Terry

10:40-10:45

Oh, yes. We have heard of this. It sounds awful.

Nikki Shultek

10:45-11:37

Yeah, it’s essentially for the listeners that have had a urinary tract or bladder infection, it’s like walking around like that in perpetuity. And so when that happened to me, you know, I was quite frankly crushed. I had also started to become increasingly fatigued. I noticed cognitive symptoms. I noticed changes in my mood and my affect, which of course, now I’m walking around with difficulty breathing and bladder pain.

And at this point in time, you know, it was really scary. My kids were just three and five. And I remember vividly the day my bladder pain began was on a Halloween morning. And later that day, trying to focus on just enjoying taking the little guys trick-or-treating in their cute outfits. And just being, you know, deeply concerned over why I had this pain.

And the word idiopathic became my enemy. Idiopathic is a fancy way of saying we don’t know.

Terry

11:37-11:38

Exactly.

Nikki Shultek

11:38-12:23

Why, right? And I’m going, inflammation, inflammation. You know, I start thinking about this. And one thing that I noted was antibiotics. I ended up getting prescribed antibiotics for the terrible lung situation.

People are very familiar with the Z-Pak. So that drug is azithromycin. I was placed on it first for 10 days. My air hunger went away. And then I relapsed. So they treated me again and again. And then I got a month-long prescription for that drug. And that kind of got my breathing in sort of like a serviceable but not great place. But at least I wasn’t gasping for air every night.

And then the worst thing that happened to me during this horrible year was it was closer to my 34th birthday. I developed neurodegenerative symptoms that my primary care doctor thought could be MS.

Joe

12:24-12:24

Wow.

Terry

12:25-12:26

Oh, that’s scary.

Joe

12:26-12:37

Super scary. I mean, that’s kind of a challenging diagnosis. As bad as you were, now all of a sudden somebody’s saying, well, maybe you’ve got MS as well.

Nikki Shultek

12:38-14:14

Yeah, it’s one of the hardest things I’ve ever had to experience. I would truthfully go to church in sweatpants, sit out in the parking lot, and cry and pray in the parking lot because I felt like I was too much of an emotional wreck to go inside.

At this point, I was, you know, when I thought that MS could be, you know, waiting for a neurology appointment, of course, you can’t get those very quickly when you’re a new patient. I had had a brain MRI and I just, I’ve, I, it never felt more of a sense of terror in terms of fear. And it was mostly fear because I was a mom, not like fearing my own existence, you know, being, you know, very limited and painful, but more so how it would impact my children and my husband.

And so I started making plans someone in their early 30s shouldn’t have to make. I started, you know, writing things down that I, in case I lost more of my faculties, because I had previously worked for a pharmaceutical and biotechnology company. I knew a lot about medicine and health care, and I knew that I was an unwell person without a proper diagnosis.

So at this point in time, once the desperation part kind of faded, it turned into this like sense of resolve, right? Like I accepted that I might have MS. I actually came to terms with that. I don’t, by the way. You know, I had no lesions on my MRI and didn’t feel like a really beautiful answer. It felt like, why am I still so sick, right? I didn’t really have an answer. I had knowledge.

The neurologist said to me, well, it doesn’t mean you don’t have it. I see people like you all the time that may for 10 years have symptomatology, and then eventually they develop the lesions.

Terry

14:15-14:17

Oh, boy, how helpful is that?

Nikki Shultek

14:17-15:29

It was hurtful. It felt cold. And at that time, I remember saying, do you know anything about Lyme disease? And we’re in Connecticut. I was living in Connecticut at the time. I was at the Hartford Hospital. And he said, I don’t know much about that. And, you know, he could have just been having a terrible day. You know, I mean, health care is not an easy environment.

And so I try to, my experience has taught me to approach everything with kindness and curiosity. You never know what someone is experiencing.

But in a nutshell, what happened next was very important. I decided to turn into the researcher part of me. I was always an intensely curious person that loved science. And I wanted to live. So I did a Google search.

And the first thing I looked up was actually atypical pneumonia and interstitial cystitis. One of my diagnoses with the respiratory issue was atypical pneumonia. Okay.

And what came up was a study that saved my life. A small study. Dr. Charles W. Stratton from Vanderbilt, the late Charles W. Stratton, and a urology colleague of his, he had been studying this unusual bacteria transmitted through coughing and inhaling infected respiratory particles called Chlamydia pneumoniae.

Terry

15:30-15:39

People hear Chlamydia, they think sexually transmitted infection. But that’s a different bacteria in the same family, in the same genus.

Nikki Shultek

15:39-16:06

They’re relatives, and it’s the respiratory form. What people don’t realize is how common it is in the human population. It’s really ubiquitous, meaning we’re nearly all exposed to it in a lifetime.

And I had never heard of it. And I read the study and it was sort of startling. It was a small cohort, a small group of women with my bladder pain diagnosis tested using PCR, which we all became very familiar with during COVID, right? Looking for…

Joe

16:06-16:08

Polymerase chain reactions.

Nikki Shultek

16:08-16:26

Indeed, Joe. And then they didn’t do typical urinalysis, which would never pick up on something like chlamydia because it has to live inside our building blocks, the human cells. So it wouldn’t be just floating around, free floating in the urine, and it wouldn’t be detectable this way.

Terry

16:26-16:27

And you can’t culture it out of urine.

Nikki Shultek

16:27-17:34

No, you can’t. So they did this PCR of the urine, and 80% of the women had evidence of Chlamydia pneumoniae. And the conclusion was this. The study’s too small to have any really meaningful results come from it, but that this organism can lead to chronic inflammation.

And that got me deeply curious next. Oh, boy, I’ve had asthma my whole life. This is a chronic bacterial infection. So I did a search on PubMed for Chlamydia pneumoniae, the bacteria, and asthma. And I will say it changed the trajectory of the rest of my life.

You know, I decided to start reaching out to the people publishing in the space. There were hundreds of thousands of publications on Chlamydia pneumoniae and asthma, and quite a compelling association with severe asthma, which I had been diagnosed with.

And at this point in time, I ended up reaching out to some of the what would become today the founding members of a global team focused on interdisciplinary collaboration and the doctor, Dr. Charles W. Stratton, who saved my life, as well as the wonderful Dr. David Hahn, who spent his career studying infection and asthma.

Terry

17:36-18:06

You’re listening to Nikki Shultek, founding director of the Pathobiome Research Center and executive director and co-founder of the Alzheimer’s Pathobiome Initiative. She’s also research assistant professor at the Philadelphia College of Osteopathic Medicine and principal and founder of IntraCell Research Group.

As a former life sciences professional with Pfizer and Genentech, she’s now working to unite global researchers studying infection-associated chronic illnesses.

Joe

18:06-18:09

After the break, we’ll learn more about C. pneumoniae.

Terry

18:10-18:11

How did Nikki recover?

Joe

18:11-18:16

Some doctors are quite wary about sustained antibiotic treatment. Why did they object?

Terry

18:17-18:19

How long did she have to take the medicine?

Joe

18:19-18:28

We’ll also talk about silos in medicine. How could we break them down so doctors could treat the root causes of illness?

Terry

18:39-18:54

You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Welcome back to The People’s Pharmacy. I’m Terry Graedon.

Joe

18:54-19:11

And I’m Joe Graedon.

Terry

19:11-19:28

Many healthcare professionals have been taught that antibiotics can kill off most pathogens, such as Borrelia burgdorferi, within several days. That’s the bacterium that causes Lyme disease. For many patients, two or three weeks of doxycycline solves the problem.

Joe

19:28-19:44

But there’s growing evidence that 10 to 20% of people who catch this bacterial infection experience post-treatment Lyme disease syndrome. Could this kind of infection connection also be responsible for many other health problems?

Terry

19:45-19:59

The infection connection should not be a big surprise. People who catch chickenpox as children are susceptible to shingles many decades later. The virus hibernates in the body until conditions allow it to cause trouble again.

Joe

19:59-20:26

Our guest is Nikki Shultek. She’s founding director of the Pathobiome Research Center and research assistant professor at Philadelphia College of Osteopathic Medicine. Nikki is also principal and founder of the IntraCell Research Group and executive director and co-founder of the Alzheimer’s Pathobiome Initiative.

She has just described her personal experience with infection-related chronic illness.

Terry

20:27-20:52

Nikki, that sounds like a really amazing and frightening situation that you were in. And now, as you have found out that Chlamydia pneumoniae is very common, what else did you learn about it? And how did you recover? Because it looks to us as though you’re doing much better today.

Nikki Shultek

20:53-22:06

I am. So to fast forward a bit, Dr. Stratton, Charles Stratton from Vanderbilt, ended up diagnosing me officially with Chlamydia pneumoniae infection. I did have it. I also had Lyme disease and various co-infections that I acquired living in Connecticut.

So I believe it was a multi-hit for me, quite honestly, Terry. It was a tipping point. I’d likely had the Chlamydia and Mycoplasma pneumoniae infections my whole life, having childhood asthma and a lot of illness, a lot of strep infections.

And then, you know, multiple antibiotic therapy placed me in remission. And at the time, I was a little uncomfortable with the idea of using multiple antibiotics for a prolonged period of time.

However, Dr. Stratton, being an unbelievable educator, provided me with evidence to suggest that in certain severe cases, particularly when neurodegeneration was at hand, and that was the symptomatology that I was really most worried about, that it could be warranted when the risk of the disease outweighs the risk of the treatment.

And so I’m very lucky to be here and be well and have found an answer to it. Although I will say I’m not as well as I was before all of this happened to me. I have to take quite good care of myself.

Joe

22:06-22:23

The idea of sustained antibiotic treatment is a little challenging for most physicians, including some of the infectious disease experts, because it’s like, well, 10 days, one and done, you know, you should be fine. And you weren’t fine.

Terry

22:23-22:37

Well, and of course, they worry about antibiotic stewardship and what will we do when, not if, but when all of the antibiotics we currently have available lose their effectiveness.

Joe

22:37-22:47

So how long did you have to take, for example, azithromycin, Z-Pak, and some of the other antibiotics to finally rid yourself of these pathogens?

Nikki Shultek

22:49-25:12

You know, my answer will not be appealing to some. I’m not really of the belief based on the literature and our research that you can actually get rid of some of the infections once they have been on board. So people are very familiar with the use of long-term antibiotics and physicians are comfortable with it in certain settings. And it’s a bit nonsensical.

If you ask me as a patient, you can have prolonged doxycycline or minocycline for acne, many years of therapy. For chronic urinary tract infections that are recurrent, patients will be placed on antibiotics in perpetuity at times. They’re used for chronic obstructive pulmonary disease, which can be very serious. They are used for asthma. We have a 3,200 patient clinical trial enrolling. One of the study sites is Chapel Hill as we speak. That’s called I Treat PC.

But then for people suffering with neurodegenerative symptoms and crippling bladder pain and, you know, that it could be considered potentially controversial, and that comes to a bigger problem.

And Terry, you mentioned stewardship. So I had the privilege at Pfizer to work in the antibiotic space. I launched a drug for MRSA infections, which is that drug-resistant staph. And I used to attend ID grad rounds, which is the infectious disease specialists, you know, Uber meeting where they talk about tough cases and learning. And I loved it. I was very disturbed by the idea of taking prolonged antibiotics when it was suggested to me by Dr. Stratton. And he knew my background and he was an infectious disease specialist and a medical microbiologist.

But you have to actually, when you talk about stewardship, you have to stay in reality. 80% of antibiotics in the United States are used in agriculture. Okay. So the animals. Absolutely. So you should not prescribe antibiotics to people that have upper respiratory tract infections that are viral, right? That’s the low-hanging fruit for stewardship. And it’s not to say that it’s not important, but I do believe the emphasis on stewardship has led to under-treatment of certain very detrimental infections, including the bacteria that causes Lyme disease, Borrelia burgdorferi.

And it’s an economic problem. Antibiotics are not profitable. And so this has been a really, you know, where understanding the business side of things is critical for me in my current work, you know, building research collaborations to unravel how infections can drive chronic diseases with emphasis on the brain is understanding the economics that are at play and the politics.

Joe

25:12-25:19

And sometimes you have to take these antibiotics, not for weeks, but for months, and in some cases for years.

Nikki Shultek

25:19-26:19

Yeah. So for me, just to answer your earlier question, for a number of years, I had multiple antibiotics. My case has been constantly evolving like many patients like me. Because of my enrollment in a IRB study at North Carolina State, I learned I have chronic babesiosis, which is a chronic parasitic infection that is transmitted by the same tick that I likely got Borrelia burgdorferi, Lyme disease bacteria from.

This little sneaky parasite likes to hang out inside your red blood cells. And it is the likely culprit of my air hunger 11 years ago. That was a symptom that never made sense indeed, because asthma doesn’t normally, my asthma, the etiology of it, it had never had air hunger. And I remember saying to my doctor, something is different here.

And that is the thing that I’ll, I like to impress upon people listening that could have illnesses. You as the patient have an intuition and a level of intimacy with what your body is experiencing. And you need to find a clinician that listens and hears you and sees you.

Terry

26:19-26:28

So you have the experience of what your body has done before, and you need to pay attention when it does something different.

Nikki Shultek

26:28-26:59

Absolutely, you do. And for me, unfortunately, I have previously relapsed any time antimicrobial drugs have been removed. So I have a maintenance therapy plan with my doctor, and I’m very fortunate that I actually have because Dr. Charles Stratton passed away four years ago. I’m under the care of a ILADS physician, International Lyme and Associated Diseases, which is the only infection-associated chronic illness practitioner group in the world.

Joe

26:59-27:39

One of the problems that we’ve encountered over many decades of interviewing a variety of patients and physicians is the silo problem.

So there are specialists, super specialists. And the cardiologists may not be talking to the infectious disease experts. And the dentists may not be talking to the cardiologists.

And so you have all of these different specialties and the dentists are saying, well, yes, you do have gum disease, but they’re not talking to the cardiologist to say, well, if there’s a gum infection, that may be affecting the heart valves and that may be affecting the vessels in the heart.

Terry

27:39-27:46

And of course, we know, but cardiologists don’t always remember that Lyme disease can affect the heart as well.

Nikki Shultek

27:47-30:55

Absolutely. Joe and Terry, such an astute observation. And literally what you just said encapsulates my observation as a patient, a human hockey puck, as I call it, going through the medical system, being passed from one specialist to the next to address these different bodily systems that were all not working properly, you know, including my food stopped digesting properly during this horrible year. So now I’m having a colonoscopy.

No one was talking to each other. And I remember thinking, who’s going to piece it all together? There’s an underlying driver. And so when I found the information about chronic infection and illness, it made so much sense.

And then, you know, talking with Dr. Stratton, Dr. Hahn, and beginning to informally, in a grassroots manner, start bringing people together, I had this thought. It wasn’t a new thought for me. I had always been a collaborative person. And in my time in pharma and biotech, I was working in this manner, too, trying to connect stakeholders so that we could advance outcomes for patients.

Well, what I decided I could do to help when I went into remission on the multiple antibiotics, I knew I needed to help, right? This is a huge problem. I wondered how many MS cases were indeed infections that were undiagnosed. So I knew we needed to advance research around it and raise awareness. And I thought the best thing I could start doing was introducing these folks to one another if they didn’t already meet. So the infection and asthma people with the infection, looking at bladder pain disorders, looking at neurological disorders, looking at musculoskeletal or, you know, joint disorders. Let’s start there.

And I like to joke that we arrived to the space on the chlamydia train, this bacterial infection. Most of the people in the initial group, which was started in 2017, IntraCell Research Group, by me. And, you know, it was really to begin introducing folks to one another. I didn’t know what it would turn into, quite honestly. I’d been a stay-at-home mom for eight years. And, you know, I’d been extremely ill. And the idea of research collaboration was born, multidisciplinary research collaboration.

Fast forwarding to today, in 2023, I had the privilege with a number of amazing colleagues from around the world, incredibly diverse in experience in all ways, the Alzheimer’s Pathobiome Initiative.

And I guess I’ll start by saying, what is a pathobiome? So people know microbiome. And I think the word microbiome gives off kind of like a fuzzy, warm vibe of like everyone collaborating with one another, kind of like my team, you know, commingling happily. The pathobiome is your unhappy state. It refers to potentially, you know, different infections or organisms that might be in your body that now for one reason or the other are having a bad reaction with your immune system. They’re making your immune system angry.

And so the pathobiome, I sometimes refer to these as the organized criminals. You know, they’re infections that become disproportionate and can cause inflammation and other consequences. So this idea of a pathobiome takes into account each unique response that a person’s immune system can have to an infection. And we saw this with COVID. Some people got little to no symptoms, tested positive. Other people died.

Terry

30:55-30:55

Yes.

Nikki Shultek

30:55-30:57

Some people remain ill today.

Terry

30:57-30:58

Yes.

Nikki Shultek

30:57-31:48

It’s the number one pediatric illness. It surpassed asthma as the number one chronic illness in kids is long COVID.

So this research consortium of ours is comprised of, we have Dr. Ed Breitschwerdt, who’s a doctor of veterinary medicine. We have microbiologists, people focused on fungi, like Dr. David Corey, who’s also an immunologist. We have folks like Dr. Brian Balin, focused on intracellular bacteria, virologists like Kevin Zwezdaryk, neuroscientists like Dr. William Eimer, respiratory infection experts like Dr. David Hahn.

And our team has more than 30 people globally collaborating actively with one another in order to essentially accelerate innovation and raise awareness, but also to bridge silos.

Terry

31:49-32:05

Nikki, you have mentioned that you have this international collaboration. You’re looking at conditions that may be caused by the pathobiome. And I’m wondering if you could outline for us a few of those potential conditions.

Joe

32:05-32:08

And in particular, perhaps Alzheimer’s disease.

Nikki Shultek

32:09-34:24

Absolutely. So our Alzheimer’s Pathobiome Initiative team is actually working quite broadly in brain disease and infection. So over the holidays, we received a grant to study actually five brain diseases in relation to infection. ALS, Alzheimer’s, Parkinson’s, epilepsy, and conditions that affect children called PANS and PANDAS. These are pediatric neuroimmune infectious syndromes that can lead to perfectly healthy children having literally crippling anxiety, OCD, and some of these children die.

So we take this incredibly seriously. Some of the infections that have been associated with Alzheimer’s disease and other diseases, and this is an important distinction. We believe it’s so important to look at the whole human lifespan, at the diseases that are occurring that are associated with infections. That’s everything from MS to schizophrenia, you know, two diseases typically associated with advanced age.

And it’s literally pathogens from every category. Parasitic infections like Toxoplasma gondii have been linked with schizophrenia, have also been linked with Alzheimer’s disease. It’s organisms like herpes viruses, HSV-1 and HSV-2, the cold sore virus, that has been linked very strongly with Alzheimer’s disease and other chronic neurological and chronic illnesses. Chlamydia pneumoniae, of course, is strongly associated with Alzheimer’s disease, but also asthma, atherosclerosis, multiple sclerosis, reactive arthritis.

There are also fungi that have been associated. Indeed, when we published our research roadmap for the AlzPi team, the Alzheimer’s Pathobiome Initiative in 2023, we identified 86 cases of infectious dementias of all different types in which some of these were reversible with antimicrobial therapy. One of them was a stunning case of a person with a healthy immune system. They did not have HIV that got a rare fungal infection called Cryptococcus neoformans, and this person ended up getting antifungals and getting better. Their neurodegenerative symptoms went away.

Terry

34:24-34:51

Nikki, I’m so excited that you have taken your vast and deeply unpleasant and frightening experience, and turned into a researcher.

So you are a patient. You are leading a research collaboration. Tell us more about patient-led research because I think it’s not widely appreciated that patients can do this.

Nikki Shultek

34:51-36:25

Absolutely. I have had such a privilege to learn over the last decade and to try to turn, you know, pain into purpose, truly. And I’m not alone by any stretch of the imagination. There are quite a few people out there like me that have not only had these journeys, but then become subject matter experts in a domain, can even be rare disease. You see this quite a lot. You see parents like me, you know, looking for a better future for their children.

And thus, what is the greatest motivator? I think it’s love. And so out of love, I think patients can become an unbelievable tool to researchers and become researchers themselves, which is the case for me.

I was very privileged that our president, Dr. Jay Feldstein at PCOM and Dr. Brian Balin, with whom I’ve collaborated for nearly a decade, saw the value in, you know, me becoming a, you know, bona fide member of the research team. I’m publishing in the space with the researchers. I’m creating, you know, and generating hypotheses, serving as a principal investigator on NIH submissions. It is the gift and blessing of a lifetime.

And I think that, you know, more purposeful integration and patients having a seat at the table, knowledgeable patients. There’s a book that I read called Range by David Epstein that I’m absolutely obsessed with, and it talks about remaining a generalist and how patients, actually, there are chapters of the book, whole chapters, about how patients and their experiences led to transformative change in particular disease domains.

Joe

36:28-36:50

Nikki, there’s a term that is used throughout medicine that ends in “-itis.” And “itis” means inflammation. And so we’ve got arthritis, bronchitis, colitis, sinusitis, dermatitis, gastritis, myocarditis, which is the heart, and cystitis.

Terry

36:50-36:52

And lots of other “itises” as well.

Joe

36:53-37:15

You know, the pharmaceutical industry, of which you once were a part, has become extraordinarily successful at dealing with “itis” conditions. Not the root cause, mind you, but the inflammatory reactions. So there are IL-2s and IL-4s and IL…

Terry

37:15-37:17

What does IL mean, Joe?

Joe

37:17-38:10

Interleukins. These are anti-inflammatory drugs and they’re impacting the immune system, which is why when you look at the commercials on TV for the rheumatoid arthritis drugs and the inflammatory bowel drugs and, you know, name it. The psoriatic arthritis drugs, they all say, well, yes, you could catch a bad infection, and that infection could be very dangerous, oh, and possibly cancer.

And you’re talking about attacking the problem downstream, at its earliest phase rather than at its ultimate phase when people are already in terrible shape and in pain and inflamed.

Can you help us better understand what you’re trying to accomplish by ‘the root cause’ and dealing with that, rather than the end result?

Nikki Shultek

38:11-38:42

So what you said is so astute about the commercials on television, you know, with the various drugs. My children who, of course, you know, get to talk with me about various topics all the time in science. They both enjoy science and they drive me. You know, it’s my boys that really push me forward to help, you know, motivate me on a daily basis to make the world better. They’re 14 and 16.

They’ll go, “Mom, didn’t you say that some of these conditions can be triggered by infections? And the commercial says if you have an ongoing infection, not to take the drug. Isn’t that….?” So it’s so funny.

Terry

38:42-38:44

How smart of them.

Nikki Shultek

38:46-40:23

Another favorite question of my son, “Mom, if there’s a vaccine for human papillomavirus that can prevent cancer, wouldn’t we look at other viruses and other bacteria and cancer?” This was when he was 12. I was like, yes, and please do that for the rest of your life. Ask those questions.

So, you know, what’s really interesting is what we talk about isn’t just limited to infection, right? There are other potential root cause drivers. We talk a lot about the exposome, which is your exposures across the human lifespan, not just germs, but pollutants, toxins, your diet, etc. We think these things are all important root causes to look at, inclusive of infection. But infection is, just so you know, the number one driver of any “itis” in the human body.

And that is not me saying that. That’s in medical text sort of 101. If you look up inflammation in the National Library of Medicine on NCBI, you will see that the number one thing should be ruled out as an infection with any “itis.”

We believe, though, here’s an interesting caveat. So with diseases which have been accumulated over a lifetime, right, like Alzheimer’s disease, multiple hits potentially with different pathogens, different infections that come and go, relapses, we may indeed need some of those other drugs that were developed targeting various pathways as a multifaceted approach, because it’s not to say that the immune reaction isn’t harmful. It can be.

And that’s the caveat and the reason we believe it’s so important to have the immunology perspective and the diversity of these silos bridged while understanding infections because it may need to be a multifaceted approach like the way that we approach sepsis.

Terry

40:24-40:51

And as you’re talking, I’m thinking about the early part of your story in which you’re describing that you are having such difficulty breathing and they kept increasing the dose of prednisone that you were on. And I’m thinking prednisone. Prednisone interferes with the body’s ability to respond to pathogens. So counterproductive, no?

Nikki Shultek

40:51-41:23

Absolutely. In my case, it absolutely was that time. And again, I don’t fault the clinicians. Actually, you have to fault the whole system, right? So in Connecticut, the state where Lyme, the town of Lyme is literally situated, you know, if you ask the majority of clinicians, what would you think if you saw someone with air hunger that had prior asthma, but they’re telling you it’s different and one swollen joint? They should be thinking tick-borne illness. They should know that babesiosis has a hallmark symptom of air hunger.

Terry

41:23-41:26

And Borrelia, perhaps, or just babesiosis.

Nikki Shultek

41:27-41:51

Really it’s clinically significant for Babesia. And the most common one is Babesia microti. And that is what I have confirmed by North Carolina State, direct detection, so not antibody-based testing. So, you know, this is what’s key really is the education, but it’s across the whole spectrum. It’s patient awareness, it’s clinicians being educated in medical school. So there needs to really be a sea change.

Joe

41:52-42:34

So I do have a pet peeve, and that is the infectious disease experts should be embracing your research, should be really excited about the idea that infectious agents could be responsible for a great many chronic conditions.

And yet, a lot of the infectious disease experts seem to be obstructionists. Like, oh, no, there’s no such thing as long Lyme. And no, this thing about chronic fatigue syndrome, it’s all in your head.

Terry

42:34-42:45

And ILADS physicians, you’ve got to be very careful about them, right? That’s what some of the infectious disease experts have been telling us. They may be changing their tune now.

Joe

42:45-42:53

But how do you convert the ID, the infectious disease experts, from skeptics to allies?

Nikki Shultek

42:54-44:59

It’s such a great question. So if you look at medical history, it just sort of repeats itself. This is human nature 101. When doctors Warren and Marshall, you know, they eventually win the Nobel Prize for linking a bacteria in the gut called Helicobacter pylori or H. pylori to the development of ulcers; for like a decade prior, they were called madmen. And these are by the thought leaders in the GI space.

So thought leaders, human nature is, you know, to attach ourselves to something. If we have a hammer, we want to see nails. And we have to become super aware of this. We try to be aware of this all the time as a research team, not to drink so much of our own Kool-Aid that we don’t see other ideas as being important.

The infectious disease, you know, sort of gaslighting of the chronic Lyme issue, I believe is about to change. You know, we have the current administration, HHS, Secretary Kennedy, Dr. Jay Bhattacharya, Marty Makary, and Dr. Oz all saying, you know, they’re emphasizing Lyme. So there are some very exciting developments happening.

That was beginning December 15th, 2025. And I do believe that there has to be adequate patient pressure and advocacy, very much like how HIV is now something that one can even prevent getting, right? There’s a preventative. You can have HIV. There has been such a huge federal investment due to a patient-led movement, right? Now, HIV hurts people fast and really it’s very virulent and very quick if unopposed. And so it was so blatant, right?

But even if you read back on the history of that, that required quite a movement from patients. Lyme and these infection-associated chronic illnesses are more like the simmering pot not boiling over. You know, it’s a chronic inflammatory process. It makes the person miserable, may rob them of quality of life, but they may not imminently die from it. And thus, it sort of has been underemphasized. But I do believe it’s changing.

Joe

45:00-45:44

I do have a particular question about cardiology, because if you were to poll 100 cardiologists, 99 out of 100, maybe 100 out of 100 will tell you heart disease is caused by cholesterol, in particular, LDL cholesterol. And if you ask them, well, what about LP little a?

They’ll go, oh, yeah, yeah, that’s coming along, and we’re getting a drug for that. And so, yes, we’re paying more attention because one out of five patients, they do have elevated LP little a, lipoprotein A. And then if you ask the question, what about gum disease? What about those bacteria that cause…

Terry

45:45-45:46

Periodontal disease?

Joe

45:46-45:48

Yes. What about those bacteria that cause…

Terry

45:48-45:50

Porphyromonas gingivalis?

Joe

45:51-45:51

That cause, yes.

Nikki Shultek

45:52-45:52

Gingivitis.

Joe

45:52-45:53

Gingivitis.

Terry

45:53-45:53

Yeah.

Joe

45:54-46:00

They look at you like you’re from Mars. Like, well, yeah, well, that’s not that important.

Terry

46:01-46:04

But actually, the research establishes a pretty strong connection.

Joe

46:05-46:06

So this idea…

Nikki Shultek

46:05-46:06

Very compelling.

Joe

46:06-46:20

…that infection could be connected to cardiovascular disease, it seems alien to the cardiology community and to the infectious disease community. How do we begin to change that?

Nikki Shultek

46:21-47:15

We’re, I believe, and I am an eternal optimist, so take this with a grain of salt, we’re at a tipping point right now in history. There are so many favorable things happening in this space all at once, not just our work, but others. For example, a $49 million National Institute of Aging grant just went to a company developing a therapy targeting Porphyromonas gingivalis and targeting gingipains, which is the virulence factor that is believed to assault the brain.

Now, you mentioned gum disease. That bacteria, Porphyromonas, actually can affect how your blood-brain barrier that’s supposed to provide protection, it impacts it negatively. It also has been linked with, as you pointed out, other conditions. And so the federal investment for this, I think, is a big signal that this particular company, Lighthouse Therapeutics, has that support is evidence of a shift.

Terry

47:16-47:38

So the blood-brain barrier is supposed to keep stuff that doesn’t belong in the brain out of the brain. And you’re saying the impact of Porphyromonas gingivalis is to essentially make it more permeable, sort of like some infections make the intestines more permeable, and you get intestinal permeability, also known as leaky gut.

Nikki Shultek

47:39-48:30

Indeed, yeah. Permeability of barriers is a big issue. One of the things that we’re studying within AlzPi and we have grants to look at is why are women two-thirds of Alzheimer’s cases?

And we know that estrogen actually helps the immune system and that as women age, we lose estrogen and barriers of different types become less sufficient. We have not enough information on what happens to the blood-brain barrier.

But I want to add the caveat is this. I heard at the National Academies when I presented, one of the other speakers referred to it as a portal. Indeed it is. It’s not really a barrier as much as it is a passageway that should be selective.

Now our immune cells can traffic in and out through the blood-brain barrier. And if you have an infection like a virus or a Chlamydia pneumoniae or a Borrelia burgdorferi or Bartonella henselae inside your immune cell, it’s like a Trojan horse.

Terry

48:30-48:32

Right. It would be exactly.

Joe

48:33-48:49

So Nikki, as we wrap up our conversation, what would you like our listeners to take home as the message when we start speaking about the infection connection with all of these conditions and all of these nasty pathogens?

Nikki Shultek

48:50-50:03

You know, just to read and educate yourself as much as you can. I realize that having certain educational level is a great privilege. Our team tries to write op-ed pieces, not just medical literature. You know, it’s a passion of mine so that it increases the accessibility of information.

Always trust your gut. If you don’t feel heard by a physician, find another physician. You are, indeed, your instincts are, they can be very correct. And that if you need help with something that you think could be an infection-associated chronic illness, there are ILADS physicians, www.ilads.org. There’s a provider search with the caveat, many of these physicians do not accept insurance. That is a challenge.

That’s one thing that I really hope that Health and Human Services and RFK Jr. can help impact changes is how the payers, you know, reimburse for complex chronic illness triggered by infection so that other physicians can do what the ILADS doctors do and get training like the ILADS doctors have provided. And so really look for and consider root causes.

Joe

50:03-50:15

And if we put you in charge of medical education today, what would you like to tell all of the physicians and nurse practitioners and physician associates who may be listening, what should they be learning?

Nikki Shultek

50:16-51:31

I think they should have infection-associated chronic illness in the differential. When they are presented with a patient that has multiple idiopathic disorders particularly, and if they’re waxing and waning, not to immediately go to a purely psychiatric diagnosis.

Although I would argue that the field of psychiatry is riddled with evidence that infections can indeed impact our behaviors, such as the development of OCD from Streptococcus infection in kids with PANDAS. Overnight, suddenly, you have a kid that’s counting. So I think looking for infections, but then that gets to another caveat, which is what tests you order.

So we do need better testing for some of these infections, but serology or, you know, looking simply for antibodies, antibody-based testing for herpes viruses, for Mycoplasma pneumoniae, Chlamydia pneumoniae, a tick-borne panel, which is offered by Quest or LabCorp, it’s a place to start.

There are better labs, one right here in North Carolina, Galaxy Diagnostics, offering, you know, world-leading tick-borne infection testing. However, you know, it’s outside the bounds of insurance is a challenge. IGeneX, too, out in California. But, you know, again, these are barriers for patients where they won’t be able to access it, and that’s not okay.

Joe

51:33-52:00

As you begin to look to the future, because you’ve described a whole bunch of conditions where there are specialists in each area in their silos, not talking to one another very effectively. What would you like to see for the future?

What is your hope for your initiative, in particular around Alzheimer’s disease, but some of these other conditions as well? What does the crystal ball tell you?

Nikki Shultek

52:00-52:42

We really need a large federal investment from the National Institutes of Health. I don’t know that all Americans realize, but the most powerful engine for medical innovation in the entire world is our National Institutes of Health, our government. You know, the emphasis has to be on funding this type of work.

And we call that team science, and so does the NIH. There are certain mechanisms, you know, that allow research teams like ours that are incredibly diverse. And just to let everyone know, I did found a center at the Philadelphia College of Osteopathic Medicine a year ago. It’s called the Pathobiome Research Center.

We essentially need more philanthropists and the government to step up to fund work that allows teams like ours to unlock root causes of these diseases.

Joe

52:43-52:47

Why is the root cause so important in the 15 seconds we have left?

Nikki Shultek

52:48-53:11

It is that we stop focusing on the downstream effects. You know, a lot of drugs that you see today predominantly are targeting various pathways to intercept downstream effects that are largely inflammatory or pathology. You know, like let’s target the plaque in Alzheimer’s.

Targeting the root cause allows us to understand why the human immune system developed that response in the first place and allows us to intercept.

Terry

53:13-53:17

Nikki Shultek, thank you so much for talking with us on The People’s Pharmacy today.

Nikki Shultek

53:18-53:22

It has been an absolute pleasure. Thank you for helping us shed light on these issues.

Terry

53:23-54:02

You’ve been listening to Nikki Shultek, founding director of the Pathobiome Research Center and executive director and co-founder of the Alzheimer’s Pathobiome Initiative. She’s also a research assistant professor at the Philadelphia College of Osteopathic Medicine and principal and founder of Intracell Research Group, LLC.

She was previously a life sciences professional with Pfizer and with Genentech. Now she’s working to unite global researchers studying infection-associated chronic illnesses, including Alzheimer’s disease.

Joe

54:03-54:10

After the break, we’ll turn to Dr. Brian Balin, an internationally recognized researcher on Alzheimer’s disease.

Terry

54:10-54:23

We’ll find out how he took a different path from most Alzheimer’s disease scientists to focus on the infection connection rather than considering amyloid accumulation as the prime mover.

Joe

54:23-54:32

C. pneumoniae is bad for the brain, but it might not be the only pathogen with long-term impacts. What else has Dr. Balin studied?

Terry

54:32-54:38

Might there be bacterial origins for many chronic diseases? Could this change our treatments for heart disease and stroke?

Joe

54:39-54:42

Find out more about the pathobiome and the infection connection.

Terry

54:48-55:04

You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Welcome back to The People’s Pharmacy. I’m Terry Graedon.

Joe

55:04-55:20

And I’m Joe Graedon.

Terry

55:21-55:42

Can hidden infections lead to chronic disease? A few examples are quite well known. For example, the bacterium Helicobacter pylori causes stomach ulcers that in turn can lead to gastric cancer. And gum disease caused by Porphyromonas gingivalis has been linked to heart disease and even Alzheimer disease.

Joe

55:42-56:09

We just spoke with Nikki Shultek about her experience and her work on hidden infection and chronic disease.

We turn now to her colleague, Dr. Brian Balin, professor of neuroscience and neuropathology at the Philadelphia College of Osteopathic Medicine. He directs the Adolf and Rose Levis Foundation Laboratory for Alzheimer’s Disease Research and the Center for Chronic Disorders of Aging.

Terry

56:10-56:13

Welcome to The People’s Pharmacy, Dr. Brian Balin.

Dr. Brian Balin

56:14-56:16

Thank you very much for having me talk today.

Joe

56:18-56:56

We look forward to speaking with you. We have just spoken with Nikki Shultek about her experience. It was quite enlightening. But I’m wondering if you can put everything into perspective because for decades now, neuroscientists such as yourself and researchers within the pharmaceutical industry have focused on what I call the amyloid garbage disposal approach when it comes to Alzheimer’s disease. And you’re moving towards the infection connection approach.

Can you put us in perspective of what has changed?

Dr. Brian Balin

56:56-01:00:04

Yes. So years ago, we, through a lot of serendipity, came across an issue about [an] infectious agent. The one in particular that I’ve been studying is a respiratory Chlamydia organism called Chlamydia pneumoniae.

And we found that this organism was in brain tissues that were examined postmortemly from Alzheimer’s individuals, or people that died from Alzheimer’s disease. And we felt that there was some issue here with this particular infectious agent being in the brain tissues of these individuals. And over time, what we’ve realized is that this type of infectious agent can actually enter into brain tissues through our sense of smell, but also through the blood-brain barrier.

And we think that it actually acts as a trigger for the early pathology that occurs in Alzheimer’s disease. And the early pathology that shows up is in the area of the brain called the entorhinal cortex, where you have direct input from the olfactory system, which basically is coming from our… originating in our noses through our olfactory nasal epithelium, olfactory neuroepithelium.

And because of that issue, we think that infectious agents actually can be the triggering type of process or lead to a triggering type of process that can actually lead to early change in the brain. And in this case, leading to the pathology, the early pathology of Alzheimer’s disease.

Now, this is in contrast to others that have studied the amyloid hypothesis for years, the amyloid cascade hypothesis. And that all originated from evaluation of genetic Alzheimer’s disease or familial Alzheimer’s disease, which is about one to three percent of all the people that get Alzheimer’s disease having that form. And that originated from looking at those individuals and determining that there were genetic mutations that led to the deposition overall of the amyloid peptides that accumulate in Alzheimer’s disease very early on.

Well, in our work, we also see those same amyloid peptides accumulating early on in brain tissues. And we’ve also seen that infection can actually turn on cells to process the larger amyloid precursor protein into these peptide forms.

So now we have a contrast. One is a genetic process that leads to this pathology, and the other is an infectious process leading to pathology. And this is why we think this is an underrepresented arena of understanding how infectious agents, and there may be many, that actually can lead to the same type of disease entity.

Terry

01:00:06-01:00:18

So you’re suggesting that this bacteria, Chlamydia pneumoniae, is not the only pathogen that might be affecting the brain?

Dr. Brian Balin

01:00:18-01:01:45

That’s correct. So we think that of the work that’s been done over many, many years, there’s been evidence for the herpes simplex virus 1. There’s been evidence for Borrelia burgdorferi, the agent of Lyme disease. There’s evidence for SARS-CoV-2 to actually be involved as well. And then there are oral organisms. There could be systemic organisms. There could be gut organisms that could also be involved.

But what’s interesting about what we found was that this type of organism, this Chlamydia pneumoniae, is an intracellular bacterium. So it’s going to act very similar to a virus, actually, where it infects inside of our cells. Once it’s infected inside of our cells, it’s hidden from the immune response, just like the herpes virus would be or other types of viruses.

If these migrate into our brains, and also this would include also the SARS-CoV-2 virus, if these migrate in, they can then stimulate change in the cells within the brain proper. And this could be anywhere from changing the infected cell itself or getting response from the glial cells like the microglial cells that would lead then to an inflammatory response that would also then lead to more damage within the brain.

Joe

01:01:46-01:02:26

Dr. Balin, you just said something that sends shivers up and down my spine, and that is SARS-CoV-2, i.e. COVID. I mean, tens of millions of people in this country and hundreds of millions of people all around the world have caught COVID. And the question that you’re sort of raising is, well, will some of them develop Alzheimer’s disease as a result of this, what we’ll call viral infection that has really affected the whole wide world?

Dr. Brian Balin

01:02:27-01:04:00

Yes, this is one of our greatest fears is that this is opening the scenario that there could be millions on the globe that may be destined for this type of change. And it may be that it’s not just from the SARS-CoV-2 virus, but also from other agents like what we’ve also found that are acting in concert with one another. And then you have the inflammatory response itself. If it’s generated and it’s maintained in a chronic fashion, now we have a chronic, potentially smoldering type of process that is occurring quite readily, I think, could be occurring in our brains without us knowing it because we are not having obvious symptomatology. Now, with the SARS issue and COVID issue, brain fog, memory issues, long COVID, these are things that may be giving us a clue that something is more chronically developing, along with then these other insults that are potential in our environment. For instance, pollution, air pollution, particulate matter, the diets that we have, the genetic risks that we have. These may be acting in concert to now drive the process, unfortunately, into a neurodegenerative arena leading to a dementia.

Terry

01:04:01-01:04:07

Dr. Balin, I wonder if you would tell us about your recent research collaboration with Cedars-Sinai, please.

Dr. Brian Balin

01:04:09-01:06:22

Yes. So with the Cedars-Sinai’s work that was led by, or coming out of Tim Crother’s lab, we actually aren’t collaborating directly with them. However, our work really is compatible with what they’re finding with the Chlamydia pneumoniae organism in the retina.

So this organism, this goes to the organism’s ability, we believe, to actually become systemic as well. Once it’s inhaled into the lungs, this organism can be picked up by white blood cells that are surveilling all the vasculature in the lung tissues. And if it’s picked up this way, now you can traffic the organism within the white blood cell because the white blood cells will phagocytize the organism inside and traffic it around the bloodstream. So we think that that’s one of the ways that it’ll get into the vessels throughout the body and can also show up in the retina.

The other aspect of this is that in atherosclerosis, in cardiovascular disease, the Chlamydia pneumoniae organism has been recognized and involved and sought to be involved with aspects of that disease leading to the atherosclerotic process. So we know that this organism is one of those insidious types of organisms that can traffic around the body and use multiple mechanisms for actually getting into tissue sites.

So the Crother work is very significant and really follows from a lot of the early work we did where we found that the organism in human tissues, now we didn’t identify it in retina per se, but we found it in the olfactory regions of the brain, of human brains, and deeper in the brains themselves in Alzheimer’s disease.

But we also did animal modeling. And with animal modeling, we showed that the infection with this organism intra-nasally can get into the brain very quickly, but also they can get into the bloodstream fairly quickly.

Joe

01:06:22-01:07:15

Well, Dr. Balin, I’d like to just ask you the implications of this research, because it sounds like, well, if this nasty pathogen, C. pneumoniae, is getting into the brain, but also circulating through the body and maybe getting into the heart, there may be a bacterial origin for a lot of our chronic diseases.

I think most cardiologists blame you know, LDL cholesterol, but maybe there’s a bacterium that is also contributing to atherosclerosis and maybe to strokes.

How do we begin to change our mindset to recognize that chronic infection may be contributing to a lot of our ailments?

Dr. Brian Balin

01:07:15-01:08:53

Well, it’s an excellent question. And I think what we need to do is to start having a better diagnostic approach to this question. And this would be something that we need to actually start instituting into the population at a much earlier age before any symptomatology actually starts to accumulate or starts to manifest.

And this goes to the sampling issue. So how do we sample for these types of agents? The typical sampling approach would be to look for a presence of antibody responses in the bloodstream to these different types of agents to see if we’ve been exposed that way, to see if antibodies have been developed to the organism. But we should be also sampling saliva and urine along with blood and maybe even doing nasal swabbing as well for some of these organisms too, as these are routes of entry into our bodies.

The other could be even stool sampling, for instance, and for instance, with the COVID issue, we found that the SARS virus, SARS-CoV-2, was showing up in wastewater. And these are ways then that we could actually evaluate different types of fluids from an individual to actually evaluate what is on board in a particular individual and whether those ingredients that are on board have been identified with other chronic issues that have shown up in the population.

Joe

01:08:53-01:09:05

So really quickly focusing on the outcome, it sounds like if we can identify these pathogens, we might be able to come up with treatments such as antibiotics.

Dr. Brian Balin

01:09:05-01:10:25

Yes. And the antibiotic approach would be probably the original approach to be taken. I actually think, though, that we may be able to also manipulate our immune responses. Now, could that be through vaccines? It could be that as well.

It could also be through phage therapy, for instance, for some of the bacteria, where phage therapy, different types of bacterial phages or viruses that infect bacteria actually can be and are being designed, by the way, to actually change how an infectious agent could actually propagate in us so that it could be a phage that’s developed to kill off a particular type of bacterial strain.

There are many different ways of approaching this problem. Also, there’s novel ways of looking at the components of how bacterium and virus and fungi and parasites, how they infect our cells or our bodies, cavities or tissue sites, and blocking those capabilities through either potentially using antibody blocking to using protein-protein interaction types of blocking.

So these methodologies are being developed now beyond even the antibiotic approach.

Joe

01:10:26-01:10:39

Dr. Balin, I wonder if you could give us the historical perspective on Schopenhauer’s three stages of truth and why that might be relevant to Alzheimer’s research.

Dr. Brian Balin

01:10:40-01:13:56

Oh, OK. Wonderful. Well, the three stages of truth: First, the work being ridiculed, and then violently opposed, and then being self-evident.

Well, historically, we’ve actually seen this in the medical arena. And if we take the example of Warren and Marshall actually proposing that Helicobacter pylori, a bacterium, could live in the stomachs of individuals and cause severe disease such as ulcers, MALT lymphoma, gastric carcinoma, and actually being criticized when they came out with those types of findings, criticized to the point that they were vilified.

The gastroenterology world thought these people were absolutely crazy. Well, they’re not crazy, okay? It’s been shown that you have an organism that can live in the mucosal layer of the stomach and in the lining and can lead to all these severe diseases. And yet it took about 100 years for that to be accepted.

Now, if we look historically here with Alzheimer’s disease, even in the day of Alzheimer and Oscar Fisher, they were considering that infectious agents could be involved with what they were seeing in human brain tissues at autopsy. And yet we’ve gone now over 100 years later, and many of us have been studying this for decades in the more modern age. And yet we still don’t have great acceptance that this is even a possibility.

So originally, there’s been ridicule. And then, you know, there’s been opposition because of ignoring what we’ve been doing over time and what others have been doing. And there are a lot of people doing this work, by the way, not just coming from my laboratory or in collaboration with Nikki with the Pathobiome Research Center or the Alzheimer’s Pathobiome Initiative, etc. There are a lot of people that are working on this issue.

And now we’re forcing the issue here that we have to accept that there is involvement. Now, understanding the involvement as far as causation goes is the key. And now we’re trying to come up with consensus approaches of how you detect, of how you actually even approach the experimental designs to actually prove causation.

The problem we’re faced with is you have chronic diseases and you have chronic infections and you have a combination effect here happening with genetics and the exposome or what we’re exposed to with the environment. So it’s not an easy process. But not to accept that we have infectious components is just keeping one’s head in the sand, I believe. So with Schopenhauer, I think we’re getting close to this, what’s becoming more self-evident.

Joe

01:13:58-01:14:39

Dr. Balin, one would think that the infectious disease community would be so excited about your research. And in fact, the idea that infectious agents might be at the causative stage of a lot of our chronic conditions, you know, anything with an itis at the end of it suggests inflammation, whether it’s arthritis or cystitis or bronchitis, fill in the blank “itis.”

And so I keep wondering, why has the infectious disease community seemingly been pushing back rather than embracing this approach?

Dr. Brian Balin

01:14:40-01:17:21

I believe that one part of this is that with the infectious disease community, the traditional way of thinking about, for instance, a brain infection is that you would have a meningitis, an encephalitis, a meningoencephalitis, or an abscess that would be now forming from some type of infection in the brain.

What is not well accepted, I think, but should be, is that we have chronic infectious agents that can act in a very subliminal and very insidious manner to infect anywhere in our bodies, first of all. In the brain, we already know that there are a lot of organisms that can be harbored there, and you can get disease, and at times you don’t have disease.

A perfect example is progressive multifocal leukoencephalopathy, PML, which can arise after treatment, for instance, for multiple sclerosis. Well, this is a very severe disease. It is caused by a virus, ’cause the John Cunningham virus, which many of us actually harbor and probably the majority of the population harbors in their brains, but does not actually suffer from disease from that organism.

There are other organisms. The poliovirus, it’s an enterovirus, can be harbored in the brain and can lead to a post-polio syndrome, but it can also be harbored in the brain and you don’t have obvious deficit. The herpes simplex virus can be the same way. So we know that there are a number of different agents that can be harbored in brain tissues without obvious disease.

However, we also think that they can be activated to be involved with disease. The degree to which this is happening in our nervous system is something still in the discovery process. And that’s why the consideration of a pathobiome and even at times a microbiome, which I really still am questioning whether that could even exist in the brain. But a pathobiome for sure would be present there. But this falls outside of the typical designation an infectious disease person would actually be considering in this case.

Joe

01:17:21-01:17:36

We have one minute left. What would you like to see unfold over the course of the next decade with regard to this infection connection and this pathobiome? What’s your hope for the future?

Dr. Brian Balin

01:17:37-01:18:45

We have tremendous chronic disease throughout our population. We need to start considering how infections and infectious organisms and these microbes are actually interfering with us or competing with us or working with us, how that actually is happening to understand how we are staying healthy or becoming diseased.

So these chronic issues are key, I think, for us as a future to really understand our health. So we need to monitor much better than what we’ve ever done before, and we need to start accepting that this is a reality and not continually questioning cause and effect. We have these on board. We still have to understand causation. How are things caused in time?

But we are uncovering that to a point where we now have to start monitoring and diagnosing and start affecting change prior to disease onset.

Terry

01:18:45-01:18:50

Dr. Brian Balin, thank you so much for talking with us on The People’s Pharmacy today.

Dr. Brian Balin

01:18:51-01:18:55

And thank you so much for inviting me to talk as well. It’s been my pleasure.

Terry

01:18:56-01:19:21

You’ve been listening to Dr. Brian Balin, professor of neuroscience and neuropathology at the Philadelphia College of Osteopathic Medicine. He directs the Adolf and Rose Levis Foundation Laboratory for Alzheimer’s Disease Research and the Center for Chronic Disorders of Aging.

Earlier, we spoke with Nikki Shultek, founding director of the Pathobiome Research Center.

Joe

01:19:21-01:19:29

Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music.

Terry

01:19:29-01:19:37

This show is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy.

Joe

01:19:37-01:19:51

Today’s show is number 1,466. You can find it online at peoplespharmacy.com. That’s where you can share your comments about this episode. You can also reach us through email, radio at peoplespharmacy.com.

Terry

01:19:51-01:20:37

Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning.

In this week’s podcast, Nikki Shultek will talk more about patient-led research and help us better understand the root causes of some chronic conditions. Should cardiologists be considering gum disease as a factor in heart disease, as well as the levels of cholesterol and LP little a?

What should health professionals be learning about the infection connection during their years of education? Dr. Balin also uses Schopenhauer’s three stages of truth to shed light on Alzheimer’s research. You could watch the interview with Nikki Shultek on YouTube. Look for The People’s Pharmacy.

Joe

01:20:37-01:20:59

At peoplespharmacy.com, you could sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast. We’d be grateful if you’d write a review of The People’s Pharmacy and post it to the podcast platform you prefer. In Durham, North Carolina, I’m Joe Graedon.

Terry

01:20:59-01:21:34

And I’m Terry Graedon. Thanks for listening. Please join us again next week. Thank you for listening to The People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

Joe

01:21:34-01:21:44

If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in.

Terry

01:21:44-01:21:49

All you have to do is go to peoplespharmacy.com slash donate.

Joe

01:21:49-01:22:02

Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen:

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, March 14, 2026, through 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 March 16, 2026.

Why Flip the Food Pyramid?

Nobody has actually explained to us why they decided to flip the food pyramid on its head. The food pyramid itself debuted in 1991 as an illustration of what we should eat, but many people found it confusing. In 2011, it was replaced by a MyPlate graphic. So why return to the food pyramid now, especially upside-down?

Our guest, noted nutrition researcher Christopher Gardner, suggest that it might be a way of denoting dramatic changes from previous guidance. Spoiler alert: only a few details are dramatically different. The main changes are a commendable emphasis on eating real food and attention to red meat as a protein source and full-fat rather than low-fat dairy products.

Do Americans Need More Protein?

If you pay attention at the supermarket, you’ll probably notice that a lot of product tout their protein content. Even things that don’t seem like they’d stand out as sources of protein (granola, pancake mix) are being offered in containers emblazoned with the promise of protein. Surprisingly, though, this is not a response to an urgent need. Most Americans get adequate protein and don’t need to concentrate on increasing their intake. Might it be a marketing tool?

Should We Worry About Dairy as We Flip the Food Pyramid?

Generally, public health experts recommend that we avoid foods high in saturated fat such as butter or cheese and opt instead for lower fat items, like skim milk. Consuming excessive amounts of saturated fat can raise blood levels of dangerous LDL cholesterol. On the other hand, Dr. Gardner points out that dairy fat differs in some ways from the saturated fats in meat, for instance. We don’t have enough studies to evaluate health consequences of consuming full-fat dairy. Will that raise cholesterol? Might it increase the chance of heart disease? We still need more research to be able to tell.

What About Eggs?

Speaking of cholesterol, what about eggs? For decades, Americans were warned not to eat eggs. Experts thought these cholesterol-rich foods would raise the level of cholesterol in our blood. But although eggs are high in cholesterol, they are low in saturated fat. Joe describes an astonishing experiment in which a person ate two dozen eggs a day. After a month, his LDL cholesterol was lower than when he started. Dr. Gardner remarks that we need to know not only what we are eating, but also instead of what and with what. Eggs with sausage and cheese are quite different from a veggie frittata.

What’s for Breakfast?

Let’s consider what people might be eating for breakfast instead of eggs. Quick toaster pastries, sweetened cereal, orange juice and toast with jam are all popular options that are high in refined carbohydrates. At least for some people, such foods may make blood sugar and insulin spike. That could lead to a midmorning crash, which in turn could encourage someone to have a midmorning snack. Is that a bad idea? Maybe it is one reason to flip the food pyramid.

If We Flip the Food Pyramid, Will It Help with Weight Loss?

Dr. Gardner has run studies comparing the results of healthful low-carb diets to healthful low-fat diets. He and his colleagues found no significant difference in the weight loss people experienced on average. But none of us is an average person. The range of responses to these diets was huge, with some people losing a lot of weight and other losing none or even gaining.

How to Lose Weight

Based on this research, it seems no single diet will work for everyone. What makes a big difference is satiety. If what you eat makes you feel full and keeps you feeling full, it will help keep you from eating too much. No need to flip the food pyramid in that case. And, says Dr. Gardner, no need to rely on continuous glucose monitors unless your blood sugar is out of range. Just paying attention to how food makes you feel and to the maxim Eat Real Food will be a pretty good guide for most of us.

Dietary Guidelines That Flip the Food Pyramid Shape Food for Kids

One important way that the Dietary Guidelines for Americans are implemented is school lunch. Institutions receiving funds from the federal government must follow these guidelines. Substituting minimally processed foods for the inexpensive ultraprocessed foods that are currently found on many school menus will probably be more expensive. The new guidelines also recommend that kids not get any foods with added sugar until they are at least ten years old. That would be a big difference in children’s diets, at as big as when we flip the food pyramid. Is it practical?

This Week’s Guest

Christopher Gardner, PhD, is a nutrition researcher. He is the director of nutrition studies at the Stanford Prevention Research Center and the Rehnborg Farquhar Professor of Medicine at Stanford University.

Christopher Gardner, PhD, director of nutrition studies at the Stanford Prevention Research Center and the Rehnborg Farquhar Professor of Medicine at Stanford University

Listen to the Podcast

The podcast of this program will be available Monday, March 16, 2026, after broadcast on March 14. You can stream the show from this site and download the podcast for free. In this episode, Dr. Gardner discusses the types of fat he uses in his kitchen and why. What oils does he choose for sautés or salad dressing? What is his perspective on olive oil? what does he eat for breakfast, lunch and dinner, and what is he buying at the market?

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Transcript of Show 1465:

 transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:01

I’m Joe Graedon.

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy.

Joe

00:06-00:28

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com.

Americans keep flip-flopping on food. For years, experts recommended low-fat diets. Now, the pendulum has swung back. This is The People’s Pharmacy with Terry and Joe Graedon.

Terry

00:34-00:44

The new dietary guidelines for Americans prioritize protein, especially animal protein. They also encourage us to eat real food. What does that mean?

Joe

00:45-00:52

Our guest today is one of the country’s leading nutrition researchers. He will explain the changes in these new recommendations.

Terry

00:53-00:56

Will the new guidelines change the way you eat and feed your family?

Joe

00:58-01:06

Coming up on The People’s Pharmacy, learn about the food fight. Should we flip the food pyramid upside down?

Terry

01:14-02:47

In The People’s Pharmacy Health Headlines: Many medical professionals are skeptical about the value of multivitamins. A fresh analysis of data from the COSMOS trial of multivitamins and cocoa flavanols now suggests that the multivitamin-multimineral combination used in the study slowed aging.

The conclusion is based on almost 1,000 study volunteers with an average age of 70. Compared to those taking placebo tablets, those on the multi for two years aged more slowly according to two markers of biological aging. In addition to slower aging, those in the vitamin supplement arm of the study had lower inflammation and better cognitive function.

Epigenetic aging clocks are not perfect, but they do offer some sense of how fast a person is aging relative to chronological age. The slowing was small, between one-tenth and two-tenths of a year. People whose aging was accelerated before the study began got the most noticeable benefit from multivitamin action.

The researchers suggest that aging more slowly in this way could translate to a somewhat lower risk of cancer. The author summarized: In conclusion, we provide evidence from a large-scale and long-term randomized controlled trial that a daily multivitamin and mineral combination is a safe, readily accessible, and low-cost intervention that may slow epigenetic aging.

Joe

02:48-03:56

There’s something that might make you age faster at the cellular level. If you have difficult people in your life who create problems, they could be aging you at a faster rate than normal. These hasslers seemingly create biological aging in those around them. The study involved 2,345 participants ranging in age from 18 to 103 years old.

The researchers measured cumulative biological aging data. Hasslers were defined as people causing problems or making life difficult. The negative interactions could range from everyday irritations and criticism to exclusion, hostility, denunciations, or even violence.

The people who participated in the study reported that on average they experienced 8.1% of their network members as hasslers. The more hasslers in your life, the more pronounced the aging effect. People who make you feel bad may add roughly nine months of biological age to your life. The authors suggest avoiding hasslers whenever possible and seeking out people who are supportive.

Terry

03:57-04:43

There’s a common perception that getting older means you lose your edge and start to fall apart. But what if we viewed aging as an opportunity for improvement instead? A new study published in the journal Geriatrics suggests that some of us become healthier and more creative as we age.

The key seems to be in our attitude. Participants enrolled in the Health and Retirement Study and took tests of cognitive ability and walking speed. Their average age at the start of the study was 68 years. After a follow-up of up to 12 years, researchers repeated the assessment on more than 11,000 people. These volunteers had also recorded their beliefs about the aging process.

Joe

04:44-05:07

Almost half, 45% of the participants, showed improvement in either cognitive performance or walking speed, or both. If the investigators also included people who stayed the same after several years, the proportion of those who did not decline with age was over half. Significantly, more of the people who improved had expressed positive views of aging at the outset of the study.

Terry

05:08-06:17

Children in North America eat a lot of junk food. A study notes that nearly half of the calories consumed by Canadian preschoolers come from ultra-processed foods. The investigators wanted to know whether such a diet affects emotional and behavioral functioning.

They found that ultra-processed food consumption at age 3 is associated with greater anxiety, fearfulness, and depression at age 5. These results parallel those from a British study linking burgers, fried chicken, potato chips, and chocolate to hyperactivity at age 7.

The authors suggest that feeding young children less ultra-processed foods could result in better mental health as they grow older.

And that’s the health news from the People’s Pharmacy this week.

Welcome to The People’s Pharmacy. I’m Terry Graedon.

Joe

06:17-06:31

And I’m Joe Graedon.

Americans have been fighting about food for decades. First, eggs were bad. Now they’re good. Olive oil was too high in saturated fat. Now it’s a cornerstone of the preferred Mediterranean diet.

Terry

06:32-06:44

The latest version of Dietary Guidelines for Americans is controversial. It was presented with a graphic that turns the food pyramid upside down. What should you know about healthy eating?

Joe

06:45-07:02

To help us answer that question, we turn to Dr. Christopher Gardner. Professor Gardner is a leading nutrition researcher. He’s the Director of Nutrition Studies at the Stanford Prevention Research Center and the Rehnborg Farquhar Professor of Medicine at Stanford University.

Terry

07:03-07:07

Welcome back to the People’s Pharmacy, Dr. Christopher Gardner.

Dr. Christopher Gardner

07:08-07:10

Joe and Terry, thanks for having me back.

Joe

07:10-07:49

Christopher, it is so good to have you back on the People’s Pharmacy. It’s been far too long and so much has happened in the world of food.

So let’s just start at the beginning. There’s a lot of confusion and emotion around food in general. It’s so complicated. Our grandparents, they had it so simple. They went out to the garden. They cooked what was available. There was no controversy about good foods and bad foods.

So we’re going to start right off with the dietary guidelines. Who sets them up?

Dr. Christopher Gardner

07:50-08:10

Oh, yeah. So the secretaries of Agriculture and Health and Human Services have shared that responsibility since the beginning, which is a little odd because it seems like it should be Health and Human Services, given that the agricultural community has an obvious conflict of interest. But that’s the short answer.

Terry

08:11-08:19

That definitely makes it more complicated, I think, for them to be able to collaborate on these guidelines. What are the guidelines supposed to do?

Joe

08:19-08:23

Terry, before that, why do they have a conflict of interest?

Terry

08:23-08:23

Okay.

Dr. Christopher Gardner

08:25-08:52

Right. So you can’t, let’s say you represent the cattleman’s industry, and the pork industry, and the egg industry, and the scientists say you should eat less of something.

Wow, that would work against your interest to tell somebody that you represent that the whole American public should eat less of you. But if you’re a vegetable and fruit growing type person and the scientists say eat more veggies and fruits, well, it’s easy to suggest eating more of someone you represent, but not less.

Terry

08:54-08:55

Keep going.

Joe

08:55-09:02

I just wanted to know why it was [a] conflict. Back to your question.

Terry

09:02-09:19

Well, it sounds as though this dietary guideline project has been complicated right from the beginning if they’ve had to collaborate from the beginning.

What is the function of the guidelines? What’s the big idea?

Dr. Christopher Gardner

09:19-10:36

Yeah, so great question. So there’s a whole story that Marion Nestle is the best at explaining of why they originated in 1980. But when they did originate in 1980, they made a deal, or it was part of their write-up, that every five years, just in case there was new science, they would update them.

And so there have been updates every five years since 1980. And the way they’ve gone about this over the last 20 years or so, not necessarily in the beginning, was they would get together a group of scientists and refer to them as the Dietary Guidelines Advisory Committee. And for two years, that group would review any new papers that came out since the last time they were issued. And the group would submit an advisory report to the secretaries of ag and health and human services.

And as an advisory, they didn’t have to take the advice. And over time, there’s many times they did not take the advice, but many times they did take the advice.

And then it was really USDA and HHS that issued those guidelines sometime the next year after they got this report. And I have lots of details to share with you about what happened this time, but that’s the short answer.

Joe

10:36-10:48

Well, before we get to what happened, what’s the point? I mean, why do we even have dietary guidelines and what are they supposed to do for American health?

Dr. Christopher Gardner

10:48-12:47

I’m really glad that you started there. So it is kind of interesting that when you read these, every time they’ve been reissued, the very beginning says these particular guidelines are really not for the American public to read. A lot of scientific work went into this, a lot of the language is rather technical. So this is really for health professionals and policymakers. It’s a really long, boring document.

But at its best, what it does is it informs federal safety net programs. So if you’re thinking school lunch, school breakfast, women, infants, and children, there’s really about 20 to 25 federal safety net programs to help people who don’t have enough to eat. And so when you’re trying to provide more food for those in need, there’s some guidelines that say, well, you should make sure you emphasize this and try to avoid that because we would like these people getting federal assistance to get healthy choices. So the biggest impact of those dietary guidelines is actually on like kids getting school lunch and school breakfast, not so much the general public.

And it’s well known that if you look at what’s been stated in the dietary guidelines, because this is actually part of the advisory group’s responsibility every five years to get a hint of how America is eating. And that’s done by looking at something called the healthy eating index. And actually people go through group by group, the veggies, then the fruits, then the grains, then the meat, then the dairy.

And Americans for a long time have not followed the dietary guidelines, which is a super interesting part because quite often some social influencers have said, “Oh my God, the dietary guidelines as written are killing us. We have an obesity epidemic, a diabetes epidemic. Oh my God, we better change them.”

And the typical response among those who made them is, well, people aren’t following them.

Terry

12:47-12:48

Aha.

Dr. Christopher Gardner

12:48-12:59

It’s not following them that made them sick. We have them available, but most people don’t follow them. So that would be an interesting experiment if we check their health after they did.

Terry

12:59-13:13

So you can have good advice to look both ways before you cross the street. And if you fail to look both ways, you just ignore that and look at your phone instead while you’re crossing the street and you get run over. You can’t really blame the guidelines, right?

Dr. Christopher Gardner

13:14-13:23

Exactly. That’s been a very frustrating point to try to deal with with social influencers lately, and it’s actually just led to more confusion than is necessary.

Terry

13:24-13:46

Well, Dr. Gardner, you mentioned that these guidelines traditionally are long, boring documents. Long, I mean, 100 pages or so. And apparently, the most recent ones are a lot shorter, like maybe 10 pages. Can you tell us how they have changed the advice from the previous set of guidelines?

Joe

13:46-13:49

And why are they so controversial?

Dr. Christopher Gardner

13:52-14:52

Yep. Okay, so picture the last guidelines were 164 pages from 2020. But actually, the government put together all kinds of short versions of those, depending on who the audience was. There’s a five and a 10-page version. And if you look at all the marketers and the communicators, they set up different length documents depending who they were targeting.

And this particular one, I honestly thought it was 12, but maybe it’s 10 pages. I think the one I have is 12 pages long. That sounds much shorter, but there’s a 90-page document that goes with it. And there’s also a 400-page document that goes with it.

If you want even more detail and to put that in perspective, I worked on the 2025 Dietary Guidelines Advisory Committee. We generated a 421-page report with a 1,000-page supplement that went into the details. And I could probably pretty quickly explain why it’s so long if you want me to go there.

Joe

14:52-15:25

Well, you know, I think everybody has heard by now about the food pyramid. And so I think the food pyramid kind of boils down the dietary guidelines to something that doctors and patients and just the rest of us can kind of make sense of. But this new food pyramid has got everybody all excited. Why? What’s the big deal?

Dr. Christopher Gardner

15:25-17:27

Excited in both directions, like super happy and super sad.

So interestingly, the original food pyramid that came about in 1991, if you look into the history of it, nobody actually really liked the food pyramid from the beginning. And one of the reasons they didn’t like it is there were tiers to this pyramid. The base of it said six to 11 servings of grains, just as one obvious example.

And people thought that was bewildering. And so when you actually read the details behind the graphic, it said, well, if you’re a small, inactive person, you might need six servings. And if you’re a large, super active person, you might need 11.

And so after quite a few years, they actually got rid of the standard food pyramid and then made mypyramid.gov. And you got to go online for that one and say how big and how active you are. And then instead of getting a huge range, it said, oh, you should get six and you should get eight and you should get 10. And so that was a little bit better.

But at the end of the day, a lot of people didn’t understand the pyramid and they thought, oh, the tip of the pyramid, that’s the top. That must be the most important thing. So I’m going to go straight to the top and have the most of that. And the original intent had been that’s the smallest part of the pyramid is the tip. And that’s the thing you’re supposed to have the least of.

So in 2011, after 20 years, they completely abandoned the pyramid and came up with myplate.gov. And they said, oh, half your plate should be veggies and fruits. And the other half can be grains and protein sources and a little circular thing of dairy on the side. And they said, these are simpler.

Interestingly, if you clicked on either the pyramid or myplate.gov, there’s a mind-numbing amount of detail, and the architecture never changed. It talked about lots of different things in very specific language.

Joe

17:28-17:48

Well, I have to tell you, Dr. Gardner, we have a break. We’re going to stop for just a few seconds. But when we come back, we’re going to talk about the new food pyramid and why are people so excited. So get ready. We’re going to talk food pyramid 2026.

Terry

17:50-18:06

You’re listening to Dr. Christopher Gardner, Director of Nutrition Studies at the Stanford Prevention Research Center. He’s the Rehnborg Farquhar Professor of Medicine at Stanford University. Dr. Gardner has studied the effects of popular weight loss diets comparing low-fat to low-carb eating patterns.

Joe

18:07-18:12

After the break, we’ll find out more about the new food pyramid and why they got rid of my plate.

Terry

18:12-18:17

What does it mean that the new guidelines tip the food pyramid upside down?

Joe

18:17-18:21

The new guidelines put a stronger focus on protein, especially animal protein.

Terry

18:22-18:24

Is protein in short supply in the American diet?

Joe

18:24-18:27

We’ll also talk about breakfast. What’s your favorite?

Terry

18:39-18:42

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Joe

18:51-18:54

Welcome back to The People’s Pharmacy. I’m Joe Graedon.

Terry

18:54-19:11

And I’m Terry Graedon.

Joe

19:11-19:24

The new dietary guidelines for Americans from 2025 to 2030 emphasize protein, especially animal protein. Are Americans really deficient in protein?

Terry

19:25-19:32

The theme of the guidelines is that we should eat real food. That’s something we’ve been advocating here at the People’s Pharmacy for decades.

Joe

19:32-19:45

Our guest is one of the country’s leading nutrition experts. He’s studied vegetarian diets, garlic, ginkgo biloba, fish oil, and other omega-3 fats, as well as a range of weight loss diets.

Terry

19:45-19:57

We’re talking with Dr. Christopher Gardner, Director of Nutrition Studies at the Stanford Prevention Research Center. He’s the Rehnborg Farquhar Professor of Medicine at Stanford University.

Joe

19:58-20:09

Dr. Gardner, food pyramid, 2026. Why is everybody so excited? What’s the deal on meat and dairy and…

Terry

20:10-20:12

And why did they give up on the plate?

Dr. Christopher Gardner

20:13-21:06

Yep. So I have an opinion about that. It’s my personal opinion. So I don’t have any data to support this.

Interestingly, this administration has been really gung-ho for getting at ultra-processed food. They ended up calling it highly-processed food. At the end of the day, it’s basically junk food that Americans have been eating too much for a really long time.

And they said, you know, we are on a mission here and we’re going to take this more seriously than any administration before us. We are going to make the most dramatic changes that have ever been witnessed in rewriting and shortening these guidelines. And to show you how revolutionary this is, let us show you the new graphic. So this is the pyramid on its head. We have flipped the entire thing upside down.

Terry

21:06-21:09

So it’s teetering on the point of the triangle, right?

Dr. Christopher Gardner

21:10-22:49

And I think it was meant to show that this is a really, really dramatic shift. And you should take note, we are super proud that we are taking this on for the first time. So the challenge there is if you really look through all the details, most of it hasn’t changed.

So the very first recommendation is to not eat too many calories and to balance those out to watch your weight. That’s the same.

The second one, let’s come back to, it has to do with prioritizing protein every day. That is the one that has the most people curiously looking into the details.

But then it says eat veggies and fruits, eat four servings of whole grains, don’t eat too much added sugar, eat healthy fats. They added a cool thing about the gut for the microbiome. And most of the recommendations are really carried over from the past.

The red meat and the prioritizing protein are two of the big changes. And the other one was for dairy, it very specifically said whole fat dairy and three servings a day. And for so, so long, the dairy part recommended low fat dairy. So those are the big changes. And I think there’s about 12 different points if you go through each one, one at a time. Most of them are actually the same. It’s not very radical.

So my opinion of the flipped pyramid is it’s sensationalist. It’s to show how radically different things are. If you read through it, it’s not really that different except for the protein and the whole fat dairy and kind of focusing on ultra-processed food. But that’s a separate topic. Keep going.

Terry

22:50-23:11

Let’s talk about that protein focus, because my recollection is and, you know, my memory’s not perfect, but my recollection is that a long time ago when we talked to you before, you said most Americans are getting already plenty of protein and don’t really need to focus on getting more.

A, was that true? And B, is it still true?

Dr. Christopher Gardner

23:12-25:13

Was true, still is true, but it would be hard to know that going in any grocery store or crawling out from any rock and looking around right now because everything says high protein.

There’s protein water, there’s protein Pop-Tarts, there’s protein cereal, there’s protein soup. You would think as you go through the grocery store, I mean, tell me if you have experienced the same thing. I’ve seen so many foods in font 12. This is yogurt. This is grain. This is something else. But protein is in twice the size font of whatever the food is. Like it seems to be more important that they tell you it has protein than they tell you what the food is actually itself. It’s turned out to be an incredibly effective marketing tool.

And so after seeing all the protein powder, all the protein bars, the David bar, which crammed more protein in a bar than anybody’s ever managed to do before, only because of this bizarre undigestible fat that they added to it, which is super processed, they put all this protein in it.

And then I think because they’re saying, oh, you know what? The new target range is no longer, okay, now sorry for these units here, 0.8 grams of protein per kilogram of body weight. I don’t know if you want to stop and explain that, but that’s just the general way they refer to it. It’s no longer 0.8. It’s 1.2 to 1.6, which kind of sounds like double.

And my frustration as a public health person and a nutrition scientist is somebody’s going to look at that and say, that’s why there’s protein in everything at the grocery store. Oh my God, for all these years, it’s been wrong. They’ve only been telling us to get half the amount we need. And thank God they’re labeling all that food in the grocery store. And thank God they brought red meat back. Because as an American, for most Americans, when they think of protein, they think of meat. They don’t really think of beans, legumes, peas, lentils, and…

Terry

25:13-25:14

Peanut butter.

Dr. Christopher Gardner

25:15-26:51

Joe and Terry, yeah, that’s been my push for years is everything has protein in it.

The dietary guidelines have always pointed out what the nutrients of concern are, and those have typically been fiber and calcium and vitamin D, and for infants and young kids, iron.

Protein has never been a nutrient of concern that Americans aren’t getting enough of, and so it is bizarre that they chose to do that.

By the way, the National Academies is the one who comes up with the DRIs, the Dietary Reference Intakes, where they actually list amounts of nutrients that you get. The Dietary Guidelines for Americans is separate. It’s the USDA and Health and Human Services. And their main job is supposed to show you what servings of what foods would get those numbers for you. So technically [it] isn’t their purview to be putting numbers in with their recommendations.

So weird that they put numbers, weird that the numbers are double what they were when there isn’t a protein problem. Weird that they brought red meat back in their new flipped pyramid. It is at the very top in the upper left. And when Americans read top to bottom and left to right, that is the first thing that they see is this big thing of red meat followed by a huge turkey and some other meat, and whole fat dairy thing.

So that’s what has people questioning WTF. What happened? Was the science all wrong for all those years?

Terry

26:51-26:58

And of course, Americans have a hard time with the metric system. So trying to figure out grams per kilogram is a challenge.

Dr. Christopher Gardner

26:58-27:57

And so they just look for the big font. Oh, okay. All I really know is it’s protein. So I’m going to get my protein pop tarts and my protein soup and my protein candy bar. And if somebody says, no, no, no, they said eat whole food.

Oh, wait, no more junk food. Okay. And I personally, Joe and Terry, I do like the no junk food, less highly processed, less ultra-processed food.

But I think if they recognize how many of those high protein foods are junk foods, then they’ll say, oh, well, thank God you clarified that. Now I know to get my meat.

No, no, for the last 20 years, the Dietary Guidelines advisory committees have always said less meat, less red meat and processed meat in particular. And after handing it off to the Secretary of Ag, that was transferred to choose lean sources of meat instead of eating less red meat. So that went counter.

Joe

27:57-28:39

So, Dr. Gardner, let’s move on to fat. Because for years, we were told low fat, no fat, that’s the answer to good health. And there were all these dairy products. I mean, you had low fat yogurt, no fat yogurt, no fat cottage cheese. Oh, and milk, it’s got to be low fat. Or skim. Skim milk is so much healthier than whole milk.

And now they’ve turned that upside down. Did they get that right? Did they get that wrong? What does Dr. Christopher Gardner think about dairy?

Dr. Christopher Gardner

28:41-31:28

Okay. Well, take one step back because the fat thing was an oversimplification. They always meant saturated fat. And that seemed to be too much for the American public to handle.

So the marketer said, let’s just be more simplistic. Let’s say less fat. And then quite immediately, the health community pushed back and said, no, no, no, that was supposed to be less meat and lard and butter and things like that. It was supposed to be less saturated fat, but olive oil, avocados, nuts and seeds, the unsaturated fats are okay. So let’s just differentiate saturated from unsaturated.

But Joe and Terry, dairy fat is a little different. So all the different fats have different lengths of carbon chains. And part of the reason butter smells like butter is butyric acid only has four carbons. It’s a saturated fat. But there honestly aren’t that many studies that are well done of something as super practical as whole milk versus skim milk in our school kids.

So this is one of the main places where the battlegrounds lies, because one of those places where it really is having an impact is not, Terry, as you were saying, going to the street and looking both ways before you cross. This is like, what are schools allowed to buy? And it says schools can’t buy whole fat dairy.

Interestingly, schools could buy low fat dairy that was chocolate and full of sugar. And that’s actually appalled many of us in the health community for many years. But let’s say you got rid of the chocolate and the sugar and just had low-fat milk versus whole-fat milk, believe it or not, there’s almost no studies on that.

But think about this. One of the main issues of saturated fat is cholesterol in the blood, which leads to heart disease. How many 12-year-olds have heart attacks? None. How many 15-year-olds? Okay, maybe one or two. But the main way to look at that outcome of switching your saturated fat source for adults has been a quick blood draw to see what your LDL and HDL cholesterol are like. And nobody wants to let their kids go in for blood draws for drinking different kinds of milk.

So I’m actually working with a group right now that’s doing a really interesting low fat versus whole fat milk study in kids. But it’s not cholesterol that is the main outcome. It’s lots of other possible health outcomes. And so the people who are pushing back on the whole fat dairy and saying it’s okay are kind of within their right to do that cause there is not a strong evidence base against whole fat dairy and kids.

Terry

31:28-31:46

So they’re saying it’s okay, but what you’re saying is we don’t have the evidence to say it is or it isn’t okay. And there are some people who worry that a very low-fat diet, if you’re very young, you know, two, three, four, might not be good for your brain.

Dr. Christopher Gardner

31:47-32:03

Yes. And that’s actually what our Dietary Guidelines Advisory Committee found out, that some of that whole-fat dairy was better, especially for really young kids. So the idea is, what about middle school and high school? At what point does it switch over, if it switches over?

Joe

32:03-32:09

You’ve used that bad word, LDL cholesterol.

Dr. Christopher Gardner

32:10-32:11

Yeah, Ok.

Joe

32:11-33:07

With regard to whole fat dairy. Now I want to switch for a moment because we seem to demonize foods. There are good foods and there are bad foods. And for a long time, eggs were bad foods because they had cholesterol and because they would therefore cause heart attacks.

Well, there is this rather interesting fellow, Dr. Nick Norwitz, MD, PhD. You may have heard of him at Harvard. I think he was at Harvard. But in any event, he started eating an enormous number of eggs, 24 eggs a day, two cartons of eggs for 30 days. That’s a lot of eggs. 720 eggs, 133,200 milligrams of cholesterol over the course of a month.

Terry

33:07-33:10

And most of us would never want to see another egg after we’d done that.

Joe

33:11-33:16

But he measured his LDL cholesterol. It went down. How could that be?

Dr. Christopher Gardner

33:17-34:59

Oh, because they probably got less saturated fat in their diet. So the saturated fat in the diet has a more direct impact on the LDL cholesterol in your blood than the dietary cholesterol. And that’s been known for decades.

The liver actually makes a lot of cholesterol on a day-to-day basis. And all the cholesterol that you eat goes to the liver in your body before it goes anywhere else.

And for most people, and maybe for Nick in particular, he’s probably just a super efficient compensator. He says, “Oh, I don’t need to make any liver cholesterol today. I ate 24 eggs today. So I’m just not going to make any internal cholesterol.” And it’s kind of a wash.

So to be honest, Gerald Reaven, who’s a Stanford professor and who is the godfather or the father, whatever you want to call it, of insulin resistance as it relates to things like LDL cholesterol and triglyceride. And he has passed away, bless his heart.

He did one of the oldest studies where people had 900, 600, 300, or zero grams, milligrams of cholesterol a day, and it didn’t impact their blood cholesterol. And you can add that to a dozen other studies that showed it’s really not the cholesterol in your diet. It’s the saturated fat, but it’s kind of a moot point, Joe and Terry, because most things that have cholesterol also have saturated fat with two exceptions.

Are you ready? Drum roll, eggs and shellfish have a ton of cholesterol, but they don’t have much saturated fat. So they kind of got a bad rap from that whole saturated fat LDL cholesterol thing.

Joe

35:00-35:03

Well, I remember when we weren’t supposed to eat shrimp.

Dr. Christopher Gardner

35:04-35:49

Yeah, because of that. And so they’re kind of off the hook. Now picture, so I don’t know if you know this, Joe and Terry, but maybe when I was talking to you last, which was a while ago, my two favorite terms now are “instead of what” and “with what?”

And eggs are my favorite example. So picture scrambled eggs or picture egg McMuffin or picture eggs with sausage and bacon versus an omelet with veggies in it and sauce on top. Picture cheesy eggs with sausage and bacon. So is it really just the eggs or is it that you had eggs with cheese, with bacon, with sausage…

Terry

35:46-36:08

Or, Dr. Christopher Gardner, our favorite, Joe’s favorite breakfast specifically, is refried beans. I sauté some onions in a little olive oil, and then I put in the refried beans. And then when the refried beans are all nice and warm, I cook an egg on top. And that’s how we have our eggs.

Joe

36:08-36:11

And I like peppers as well.

Terry

36:11-36:11

Oh, yeah.

Joe

36:11-36:36

It’s like it gets me through at least half a day or longer. It’s wonderful.

Well, we do need to take another break. When we come back, we want to talk about weight loss. We want to talk about Christopher Gardner’s favorite foods. We want to talk about the future of the food industry. So keep those thoughts. We’ll be right back.

Terry

36:37-36:50

You’re listening to Dr. Christopher Gardner, Director of Nutrition Studies at the Stanford Prevention Research Center. He is the Rehnborg Farquhar Professor of Medicine at Stanford University.

Joe

36:51-36:59

After the break, we’ll talk about the obesity epidemic. Are there some dietary patterns that make it easier to lose weight?

Terry

36:59-37:06

Dr. Gardner’s research has shown that lots of different diets can contribute to good health throughout the lifespan.

Joe

37:07-37:11

How can people find out which diet works best for them?

Terry

37:12-37:22

The new dietary guidelines suggest that kids should not have any food with added sugar until they’re 10 years old. That would be a big change.

Joe

37:22-37:27

Find out about the risks and the benefits of the new food pyramid.

Terry

37:39-37:56

You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Welcome back to the People’s Pharmacy. I’m Terry Graedon.

Joe

37:54-38:10

And I’m Joe Graedon.

Joe

38:21-38:41

Have you ever tried to lose weight by focusing on a particular dietary approach? Did it work? Some people embrace the low-carb Atkins approach, while others sing the praises of the Dean Ornish low-fat strategy. Is there one best diet for everyone?

Terry

38:41-38:51

Today, we’re talking about the food fight over dietary guidelines for Americans. The food pyramid was flipped upside down. How will that affect your food choices?

Joe

38:52-39:07

We are talking with Dr. Christopher Gardner, a leading nutrition researcher. He’s the Director of Nutrition Studies at the Stanford Prevention Research Center and the Rehnborg Farquhar Professor of Medicine at Stanford University.

Terry

39:08-39:37

Dr. Gardner, it is no secret that one of the biggest problems for Americans in terms of diet and health is that there’s too much obesity. People are too fat. People are eating too much or else they’re eating the wrong things.

So are there dietary patterns that make it easier to lose weight? We know you have done some research in this regard.

Dr. Christopher Gardner

39:38-42:45

Oh, I did a lot. Yeah, so we’ve had 1,000 people across two different studies where we did a lot of focus on low-fat and low-carb. And we compared them head to head and drum roll, pretty much a wash.

They both on average lead to about the same amount of weight loss and almost everybody loses weight on them, especially if they’re healthy.

So our second of the two studies was one where we had a healthy low fat and a healthy low carb and the average weight loss was the same. But Joe and Terry, what was stunning was always the range of response to that. So some of the participants gained weight and some lost a lot of weight on both diets.

And so a lot of people have been looking for personalization of diets. So is there, oh, maybe insulin resistant people do better on low carb and insulin sensitive people do better on low fat. That was our main hypothesis in the study. And it failed when it was a healthy low carb and a healthy low fat.

At one point, we thought genetic predisposition might be part of this. And so we got what we thought were low-carb predisposed people and low-fat predisposed people, and that also failed.

So everybody’s been looking sort of for this magic bullet. Is it the carbs, fats, and protein? Let me just go to protein for a second. We never focused on the protein. But I will say that I looked at our two studies and several other studies, and I know protein is a huge craze and in theory protein is satiating and helping people out.

But when we looked at a bunch of studies a year or two years out, almost every group, no matter how good they were at getting lower in carb or lower in fat, ended up almost exactly at 20% protein.

Even the most famous study out there called POUNDS Lost that had a 15% protein diet and a 25% protein diet. In the beginning, when they were excited about it, they did that. But a year or two out, they were both at 20%.

So you could talk about whether high or low protein has a difference. But when you actually watch people over time, it kind of nullifies. They end up at the same level of protein. So I don’t think it’s a macronutrient thing.

I think you can do pretty much any of the popular diets out there and find that it works for someone.

And sadly, I wish the health professionals had better advice, but you’re kind of going to have to biohack and figure out which one works the best for you. A lot of health professionals say the best diet to be on is the one that you can maintain for a really long time.

So if this is culturally adapted to your preferences, you like the taste, it works in social settings, it works with your family. All those are probably, I think, more important than low-carb or low-fat or high-protein.

Terry

42:45-43:33

We just saw a study published in Science Advances that looked at five different types of healthful, presumably healthful diet, and found that actually people who did well on any of these diets were likely to live longer. So it looks as though there’s quite a range of diets that can be healthful, that can contribute to good health into your later years. And that kind of makes sense if you think about human evolution, I mean, humans around the world have eaten a pretty wide range of diets and done well on them until, of course, we got to the junk food.

Dr. Christopher Gardner

43:34-45:58

Absolutely. And really, that’s the key. It’s not, it really isn’t low carb or low fat or high protein. It’s how much, I mean, this is my biggest concern always, added sugar and refined grain–the carbs that have a lot of calories and very little fiber to no fiber, and not very many nutrients that come with it.

So one of my favorite publications is from the Harvard group that looked at NHANES, the National Health and Nutrition Examination Survey, over a course of 20 years to see if there were any trends, not just in protein, carbs, and fats, but type of protein, type of carb, and type of fat. And over 20 years, there were some very, very modest differences in all of those.

But what’s most stunning about the graphic that they show of this is when they say three types of fat, saturated mono and poly, is like 10% of calories from each one of those. It’s about 10% of calories from animal protein and maybe five to eight of plant protein. We’re still in the 10 range. About 10% of calories from good quality carbohydrates that have fiber in them. Okay, that’s 10, 10, 10, 10, 10. Oh, that adds up to 60. 40% of calories from added sugar and refined grains! That is the problem.

And that’s why low carb sounds very popular. If the low carb is getting rid of the added sugars and the refined grains, everybody wins.

The question is, what do you replace that 40% calories with? Hopefully you don’t replace them all. Then you’ll be in calorie deficit. That will help you lose weight. But let’s say you replaced 30 of the 40… here’s my biohack to it: I think somebody can do that in a healthy way and have 10 come from more carbs. 10 come from more protein, and 10 come from more fat. Or 30 from fat or 30 from carbs (as long as it’s healthy carbs or healthy fat).

So that actually gives you a whole bunch of different ways to go lower carb, but replace it all with healthy foods that are healthy sources of carbs, healthy sources of fat, and healthy sources of protein, which for me is beans, peas, and lentils, which bring fiber along with the protein.

Joe

45:58-46:50

We know that you are a peas, beans, and greens kind of guy, and we love that about you. I’m interested in how people can biohack their way to success. How do you find out what’s going to be best for you?

You talked a little earlier about insulin sensitivity and insulin resistance, and that’s a really big deal in metabolism these days. But how do you know what works best for you? There’s got to be some kind of a process. Some people are wearing CGMs, continuous glucose monitors to try and figure out what works.

And what I discovered, by the way, is that when I have oatmeal for breakfast, my blood glucose goes pretty high pretty fast.

Terry

46:50-46:56

And that’s even though I’m cooking steel-cut oats. It’s not like instant sugary oatmeal.

Joe

46:56-47:18

And we had a diabetes expert who said, don’t worry about it. That’s fine. Just eat your oats and you’ll be great. But if I have those refried beans with an egg, onions, and peppers, my blood glucose doesn’t go anywhere. It just stays rock solid. So help us figure out how to biohack our way to good health.

Dr. Christopher Gardner

47:19-47:23

And you sauteed those onions, right, and peppers in oil.

Joe

47:24-47:25

Yeah, olive oil.

Dr. Christopher Gardner

47:25-47:33

So you had fat. And if you had a fatty oatmeal breakfast, so what if you put a whole bunch of walnuts and nuts in there?

Terry

47:34-47:35

Actually, I do that sometimes.

Dr. Christopher Gardner

47:36-47:46

Right? And so the idea is it isn’t really just the one thing. First of all, so actually, Joe, let me just ask, do you have an issue with glucose?

Joe

47:47-47:47

Nope.

Dr. Christopher Gardner

47:47-47:48

Are you? Okay.

Joe

47:49-48:06

I mean, my glucose is usually pretty under control, like in the 90s to 100 range. And after breakfast, if I have my refried beans and egg, it may go up to 105 or 110. But if I have that oatmeal, it’ll go up to 130 or 140.

Dr. Christopher Gardner

48:07-49:53

So I’m worried that a lot of people who actually don’t have glucose problems are playing with the CGMs and taking it too seriously. And they’re trying to completely blunt any response, any glucose spike, which is ridiculous because your body is prepared to have carbs and fats and proteins. And when you have carbs, you will get a glucose spike. You will make insulin. You’ll put it away. And then the insulin gets broken down and the glucose is out of your blood.

If you try too hard to have no glucose spike at all, you’re going overboard. That’s too much. But when you’re just talking about how do you biohack, you know, in theory, you could make sure you don’t get a really high peak.

I actually think the bigger thing that we should try to biohack right now, Joe and Terry, is satiety. What makes you full? I actually asked this at a couple of conferences and I said, what would make you the most full and keep you full for the next hour or two? First, I’m going to tell you oatmeal with some fresh fruit and some nuts and maybe some whole fat yogurt on there and a bunch of people raised their hand versus eggs. That’s an omelet with some salsa and some veggies in there and a whole bunch of people raised their hand.

I said, “Isn’t there one breakfast that makes everybody full?” And I gave a couple options. And no, different people, different things are satiating for different people.

And so there’s two aspects of the satiety. One is when do you stop eating because you’re full? And when you eat again next, because you’re hungry again. So there are some things that because of bulk fill you up, but then an hour later, you’re hungry again.

Joe

49:53-49:57

I’m guessing you would not recommend Pop-Tarts for breakfast.

Dr. Christopher Gardner

49:57-50:40

The American breakfast for how many years has been carb on carb on carb. We have a sugary cereal, we have a piece of white bread, we put jelly on it with a glass of orange juice. That’s just simple carbs.

So yes, as soon as you switch from that to your beans and eggs, or to your cheesy eggs with bacon and sausage, you would be more full.

But I would say switch from that American sugary breakfast to your beans and eggs, not the cheesy eggs with bacon and sausage. But you’ll have to biohack that out for yourself and look at your numbers with your doctor for your cholesterol and your blood pressure and the things that we measure typically.

Terry

50:41-51:18

Dr. Gardner, I would like to go back to the new dietary guidelines for just a moment. It is related to what you’re talking about. We know that a lot of kids eat those Pop-Tarts and sugary cereals and so forth. And my understanding is that the new dietary guidelines suggest that kids should not be eating any foods with added sugar until they’re at least 10 years old. A, have I got it wrong? And B, is that a good idea? And is it practical?

Dr. Christopher Gardner

51:19-53:37

So it’s a great idea. The challenge is going to be, and this is what I’d really like to see. So I really admire the new administration for putting greater emphasis on this. It’s just obscene and obscene how much added sugar kids are eating and adults as well.

And also, you know, the deal with ultra-processed food and cosmetic additives and things like red color dye. And so I know the administration said, all right, no more of these dyes. And as far as I know, M&Ms and Skittles are still colored the same way.

And if they say no sugary things in schools, I have a feeling that if they recommend that, schools are going to need more money to buy more whole foods. And so part of the reason those are there, Joe and Terry, is because they’re inexpensive. They have a long shelf life for people with limited resources or for places like schools. They buy them because that’s what they have the budget for.

So I totally applaud this idea of getting rid of as many added sugars as we can. But it will really take some regulatory force that I haven’t seen yet to have more, for example, farm-to-table food.

I know that the administration took away a billion dollars of farm-to-school money recently, where it was going to come fresh from the farm. I know that some of the other safety net food money has been taken away.

So you’d have to say, yes, get rid of the sugars. And there’s going to be some regulations so that the food industry has its feet held to the fire and they can’t make these anymore. They can’t sell these.

And the immediate response, as has always been the case, is going to be: this is capitalism. We can make what we want and sell what we want, as long as people will buy it. That’s where the tension will be, not on the recommendation, not on the recommendation to avoid them, but on the power to change the food environment we all live in. That’s a, hey, if you come up with something clever and can sell it, that’s the way capitalism works. That’s a big lift.

Joe

53:39-54:22

Dr. Gardner, one of the most controversial areas in your field these days is fat. And I think a lot of people were told for a very long time, no fat, low fat is the answer. And so we saw all kinds of products that were marketed as low-fat, no-fat. And that has changed.

And so you now will see all kinds of products out there that will say, okay, we make our ice cream with avocado oil. It’s like, okay, instead of dairy, it’s avocado. Interesting.

Terry

54:23-54:24

It’s good.

Joe

54:24-54:51

But I want to get your feedback. What kind of oils are you cooking with? What do you put on your salad dressings? And what’s the deal on olive oil? Because I think everybody goes, yeah, yeah, yeah, olive oil is the greatest, but it does have some saturated fat in it.

So help us understand the Christopher Gardner perspective on oils and fat.

Dr. Christopher Gardner

54:52-56:42

Sure. I have very fatty foods. I put lots of avocado, lots of nuts and seeds. I drench my salads in olive oil or some kind of vinaigrette made with olive oil. Olive oil is pretty expensive, the good quality olive oil. So is avocado oil.

And so to be honest, canola, sunflower, safflower, there’s this whole bizarre seed oil debacle that’s just wrong. But it would take me more than 10 seconds to tell you why it’s wrong. All those unsaturated cooking, seasoning, salad dressing oils are fine, but please keep in mind that all of them have higher and lower quality, and the higher quality oils cost more.

So when you’re like, there’s this thing about seed oils that’s been going around and it’s true as you take a seed and you crush it in different ways you get the oil out, and if it’s a first press or if it’s a cold press, that’s the best quality. At some level, somebody goes along at the end of the day and squeezes the last little bit out of those seeds and puts in hexane and charcoal and bleaching to squeeze the last bit out. And that’s a lower quality oil and it will cost less.

And so all of those oils have higher and lower qualities and it’s pretty snooty to say only buy the high quality oils. So there’s a lot of things you can have that have unsaturated fat, like avocados and nuts and seeds. Those are not cheap either if you buy good quality avocados and nuts and seeds.

But, you know, I do a lot with the American Heart, and the American Heart for decades has embraced a high, unsaturated fat, Mediterranean-type diet that includes fatty fish, too.

Joe

56:44-57:14

If we were to sit down at your table invisibly and just watch what is Christopher Gardner eating on a regular basis, walk us through breakfast, lunch, and dinner, or perhaps just breakfast and lunch.

But just tell us, what are the foods that you’re putting into your groceries bag and taking home, and what are you making most often? What are your favorites?

Dr. Christopher Gardner

57:16-57:23

Okay, yeah. And did you know I actually have a book coming out soon, and I put all my favorite recipes in the book.

Joe

57:21-57:35

Oh well you’ve got to put us on your list because we would love to talk and and see that book. So make sure we get a hold of that book as soon as it’s available, but tell us the good stuff.

Dr. Christopher Gardner

57:35-58:44

Okay, coming out in October, you’ll see that I have a couple of very basic breakfasts.

One is steel-cut oats with berries, and nuts, and soy milk, and a little shaved dried coconut, and cacao beans.

And then another one is I make this scrambled tofu dish. So I put in onions and bell peppers, and I put some greens in there like kale or chard. And then I mash up some tofu. And even though I’m not trying to fool myself, I put turmeric in there and nutritional yeast. So it looks kind of like scrambled eggs with veggies in it.

Another one is an avocado toast with kimchi on it, because I actually study the microbiome now. And that’s one of the ways I get fermented food into my breakfast is to have avocado toast with kimchi. So those are three of my standard breakfasts.

Joe

58:27-58:29

Wait, tell me about the toast.

Dr. Christopher Gardner

58:29-58:44

And the toast is a whole grain bread, whatever the most whole grain thing that I can find is, which is way more expensive than the wheat bread in the grocery store that’s not really whole wheat bread. It’s just wheat.

Joe

58:44-58:49

Terry is taking to baking bread and her whole wheat bread is phenomenal.

Terry

58:49-59:06

And I’ve now, speaking of not inexpensive, I like to buy stone ground flour from a local miller at the farmer’s market. So I’m paying extra for my flour, but I’m putting the labor in myself.

Dr. Christopher Gardner

59:06-01:00:04

Yeah. Yeah, yeah, yeah. See, so that labor or that time or that money… it all costs. If you want to talk about lunches, I’m looking at my favorite lunch. So salad. Oh, because salad is anything. There’s a grain based salad. I make a really good wheat berry salad. Today, downstairs, I went and got the regular lettuce salad. I’m just looking right now what I have. I have shaved almonds. I have garbanzo beans. I have edamame. I have tofu. I have bell pepper, carrots, red bell pepper. I have beets in it. I have cucumber in it. Just a lot of veggies and nuts and seeds and crunch and color. My salads are really beautiful.

I make a really good squash eggplant tempeh dish that has a pomegranate glaze. That’s one of my favorites that I make at home. So those are some of the favorite kind of things that I make. Is that enough for now?

Terry

01:00:04-01:00:05

That’s great. Thank you.

Joe

01:00:04-01:00:10

That’s perfect. And when that cookbook is available, we’d love to talk to you about it.

Dr. Christopher Gardner

01:00:10-01:00:21

And it’s not a cookbook. It’s called Food Sense. And actually, it’s got a chapter on protein, a chapter on seed oil, a chapter on organic, [and] my journey as a food scientist. And at the end are my favorite recipes.

Joe

01:00:21-01:00:36

Christopher, we’ve got one minute left. And so I need you to summarize the benefits and risks of the new food pyramid and what you would like to see for the future.

Dr. Christopher Gardner

01:00:37-01:01:20

Yeah, I love the eat real food. So if everybody would eat real food, let’s do that. I think they really, one of our strongest recommendations from the Dietary Guidelines Advisory Committee was eat more legumes, beans, peas, and lentils, and less red meat. I think they really got that one wrong.

And for the dairy, I think we should all recognize that three quarters of the world is lactose intolerant. And so I don’t think the issue is whole fat versus skim. I think it’s that most of the world can’t handle dairy. And it’s pretty insensitive to suggest that everybody get three servings of dairy a day.

Fall back on more veggies and fruits, more whole grains, more beans, peas, lentils, more nuts and seeds, and we’ll be okay.

Terry

01:01:20-01:01:26

Dr. Christopher Gardner, thank you so much for talking with us on The People’s Pharmacy today.

Dr. Christopher Gardner

01:01:27-01:01:29

Pleasure to be back. Thanks for having me.

Terry

01:01:30-01:02:07

You’ve been listening to Dr. Christopher Gardner. He’s a nutrition researcher and the Director of Nutrition Studies at the Stanford Prevention Research Center. Dr. Gardner is the Rehnborg Farquhar Professor of Medicine at Stanford University.

He’s focused his research on the potential health benefits of various dietary components or food patterns using randomized controlled trials. The interventions have involved vegetarian diets, soy, garlic, omega-3 fats or fish oil, antioxidants, ginkgo biloba, and popular weight loss diets.

Joe

01:02:07-01:02:16

Lyn Siegel produced today’s show, Al Wodarski engineered, Dave Graedon edits our interviews, BJ Leiderman composed our theme music.

Terry

01:02:16-01:02:24

This show is a co-production of North Carolina Public Radio, WUNC, with the People’s Pharmacy.

Joe

01:02:24-01:02:39

Today’s show is number 1,465. You can find it online at peoplespharmacy.com. That’s where you can share your comments about this episode. You can also reach us through email, radio at peoplespharmacy.com.

Terry

01:02:39-01:03:08

Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning.

This week’s podcast also has information on the controversy over fats. Which oils does Dr. Gardner use for cooking or salad dressing? We’ll get hints on his favorite foods for breakfast, lunch, and dinner. You could also watch the interview on YouTube. Look for The People’s Pharmacy.

Joe

01:03:08-01:03:38

At peoplespharmacy.com, you could sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast. We would be grateful if you would write a review of The People’s Pharmacy and post it to the podcast platform you prefer. If you find our topics interesting, please share them with friends and family. In Durham, North Carolina, I’m Joe Graedon.

Terry

01:03:38-01:04:12

And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

Joe

01:04:12-01:04:22

If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in.

Terry

01:04:22-01:04:27

All you have to do is go to peoplespharmacy.com/donate.

Joe

01:04:27-01:04:40

Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, March 7, 2026, through 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 March 9, 2026.

How to Protect the Brain with Vaccination

Our guest, Dr. Pascal Geldsetzer, has led three impressive studies that took advantage of natural experiments to see if vaccination against shingles could protect the brain from dementia. The results were remarkably consistent and encouraging.

What Is a Natural Experiment?

In Wales, when the Zostavax shot against shingles first became available, public health authorities established eligibility criteria to get it through the national health system. Welsh citizens had to be born on or after September 2, 1933, to get the shot. This created a situation in which two groups of people differed only by birth date and by whether or not they were immunized. (Most people who were eligible for the shot got it.) This mimics a randomized clinical trial in which the only difference between two groups is the intervention. The absolute risk reduction over 7 years was 3.5%, which means that people who got the shot were 20% less likely (relative risk) to be diagnosed with dementia. That big difference is statistically significant (Nature, April 2, 2025).

Wales is not the only country that set up eligibility requirements. Australia did, too. In Australia, everyone between 70 and 79 years old as of Nov. 1, 2016, could get a free shingles shot and many people did. Here, too, you have a group of senior citizens who differ from each other only by whether they got vaccinated and whether their birthdays were slightly earlier or later. In this case, the absolute reduction in risk of dementia over 7 years was 1.8% (JAMA, April 23, 2025).  This difference was also significant.

One More Experiment Suggests Vaccination Can Protect the Brain

Another natural experiment comes not from a nation, but from a province of our norther neighbor, Canada. The province of Ontario decided that people born on or after Jan. 1, 1946, could get a shingles vaccination. People just slightly older were not eligible. Do you recognize a pattern? When the investigators analyzed health records from 1990 to 2022, they found that people eligible for the vaccine based on their date of birth were 2% less likely to get a dementia diagnosis. In other provinces of Canada that had different rules for vaccination eligibility, people don’t show a significant difference in dementia risk based on their birthday. (Lancet Neurology, Feb. 2026).

Which Vaccine Were Scientists Studying?

The original shingles vaccine, Zostavax, was the one available for all these natural experiments. For the most part it has now been replaced by a newer version called Shingrix, which uses different technology. Studies show that Shingrix is better at preventing shingles outbreaks and post-herpetic neuralgia, the lingering pain after shingles (Vaccines, April 28, 2025).  It is unclear whether it would also work better to protect the brain from Alzheimer disease. At least one study suggests it works quite well in reducing the risk of dementia (Vaccine, Feb. 5, 2025).

Was the Single-Minded Pursuit of Amyloid Misguided?

For decades, the pharmaceutical industry has focused its anti-Alzheimer efforts on amyloid plaques that are a pathological feature of brains afflicted with Alzheimer disease. They were apparent in the very first brain described by Alois Alzheimer at the turn of the 20th century. But the assumption that getting rid of amyloid plaque would solve the problem has not borne fruit. The FDA has approved three compounds that are quite effective at reducing amyloid plaque in the brain. Two, lecanemab (Leqembi) and donanemab (Kisunla), are still on the market. Their impact on cognitive decline and functionality of AD patients is unimpressive.

Other Infections That May Harm the Brain

It seems odd that neurologists might be resistant to the idea of an infection such as chickenpox (the virus behind shingles) or herpes (which causes cold sores and genital lesions) changing brain function. More than a hundred years ago, before the development of effective antibiotics, doctors were quite aware that tertiary syphilis could lead to dementia. Other infections such as Chlamydia pneumoniae may also interfere with brain function. The COVID pandemic demonstrated that the SARS CoV-2 virus can cause brain fog, and we worry that people with long COVID may be at higher risk for dementia.

Can the Shingles Vaccine Help with Treatment?

One immunization outcome that Dr. Geldsetzer’s team uncovered may help with treatment. In Wales, people with dementia who got the shingles vaccine had a slower progression of their cognitive decline. (Cell, Dec. 11, 2025).  This suggests that whatever it is doing to protect the brain may extend into the disease process itself. This definitely deserves more research. Dr. Geldsetzer would like to conduct a true randomized clinical trial to explore this possibility and to tease the differences, if any, between Zostavax and Shingrix with respect to their effects on dementia prevention.

This Week’s Guest:

Pascal Geldsetzer, MD, PhD, MPH is an Assistant Professor of Medicine at Stanford University and a Biohub Investigator. His research focuses on identifying and evaluating the most effective interventions for improving health at older ages. In 2026, he was named one of the 100 most influential people in health and medicine globally by TIME Magazine (The TIME100 Health list) for his work on the link between shingles vaccination and dementia. He is currently trying to raise funds from philanthropy for a large-scale clinical trial of shingles vaccination for dementia prevention. You can contact him by email: pgeldsetzer@gmail.com

Pascal Geldsetzer, MD
Courtesy Stanford Medicine

Listen to the Podcast:

The podcast of this program will be available Monday, March 9, 2026, after broadcast on March 7. You can stream the show from this site and download the podcast for free.

You can also listen to our previous interview with Dr. Geldsetzer. It is Show 1394: Viruses, Vaccines and Alzheimer Disease.

Download the mp3 of this show, or listen to the podcast on Apple Podcasts or Spotify.

Transcript of Show 1464:

A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:01

I’m Joe Graedon.

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy.

Joe

00:06-00:25

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Alzheimer disease is one of the cruelest conditions. It robs people of their memories and their personalities. This is The People’s Pharmacy with Terry and Joe Graedon.

Terry

00:34-00:42

For decades, drug companies have focused almost exclusively on removing amyloid plaque from the brain. That hasn’t worked very well.

Joe

00:43-00:55

Research has been accumulating that pathogens might be contributing to dementia. There’s growing evidence that the shingles vaccine might be able to reduce the risk of developing dementia.

Terry

00:55-01:03

Today, we’ll speak with Dr. Pascal Geldsetzer, the lead investigator behind that research. He’ll explain these natural experiments.

Joe

01:03-01:09

Coming up on The People’s Pharmacy, can vaccines protect the brain from dementia?

Terry

01:14-02:05

In The People’s Pharmacy Health Headlines: Measles cases continue to climb.

The CDC reported 160 new cases during the last week of February. The total in just two months is 1,136 confirmed cases from 27 states. That’s way more than last year at this time, and it may be an underestimate.

According to the Johns Hopkins University Center for Outbreak Response, the total is actually 1,189. Many measles cases go unreported. We are likely to beat last year’s record of 2,281 cases by spring and shoot way past it. States that have been hardest hit include South Carolina, Florida, and Texas. Utah, Arizona, and Ohio are also reporting new cases.

Joe

02:06-02:46

Many older adults maintain that measles is not that big a deal because they remember catching this highly infectious disease as children. But the CDC points out that one in five unvaccinated youngsters will be hospitalized. One out of every 10 children with measles will get an ear infection. One in 20 will develop pneumonia and one in a thousand will develop brain encephalitis.

Because measles is considered the most contagious virus known to man, it’s likely that this disease will continue to accelerate unless people begin to follow Dr. Mehmet Oz’s advice from last month: “Take the vaccine, please.”

Terry

02:48-03:45

GLP-1 drugs such as Ozempic and Wegovy have clear benefits in that they help control blood sugar and enable people to lose weight. Other possible outcomes include reduced cravings for alcohol, improved kidney and heart health, and reduced fatty liver disease.

But there are a number of gastrointestinal side effects that can be quite distressing. Now, two new studies suggest that GLP-1 drugs may also increase the risk for osteoporosis or bone fracture. An Israeli study included records for more than 46,000 older adults with type 2 diabetes.

Those on GLP-1 drugs were 11% more likely to experience a fragility fracture. Whether it’s caused indirectly by weight loss or directly from the medicines remains to be determined. Previous research has shown that exercise can help moderate the risk of bone loss.

Joe

03:46-04:28

Just as GLP-1 drugs have some unexpected side effects, such as osteoporosis, they may also have some unanticipated benefits. Researchers from Thomas Jefferson University in Philadelphia conducted an analysis of medical records.

People with chronic migraine were 10% less likely to visit the ER if they started taking a prescribed GLP-1 medication. The comparison group was people with chronic migraine taking topiramate, an anticonvulsant used to prevent migraine. In addition, those on GLP-1 medicines were 14% less likely to be hospitalized and 13% less likely to get a new triptan prescription for treating migraine.

Terry

04:28-05:16

A research letter in JAMA this week reports that American teenagers are not getting enough sleep. The study looked at trends from 2007 to 2023. The percentage of students reporting insufficient sleep increased from 68.9% in 2007 to 76.8% in 2023, the investigators write. The number of adolescents who sleep five hours or less a night increased dramatically.

An accompanying editorial notes that inadequate sleep is linked to academic struggles, cognitive difficulties, and depression. It recommends changes in school start times and reduced use of phones and tablets in the evening.

Joe

05:17-06:03

People have been paying increasing attention to the microbiome of their digestive tracts. To find out what bacteria and other microorganisms they’re hosting, some people turn to testing laboratories. How reliable are the results?

A study recently found a serious lack of quality control among direct-to-consumer testing services. The authors conclude that their rigorous assessment of seven microbiome testing companies has spotlighted the systemic issue of poor comparability that plagues the industry. They blame methodological variability.

Until this problem can be rectified, health care providers and patients can’t trust stool testing data to give them reliable results.

And that’s the health news from the People’s Pharmacy this week.

Terry

06:14-06:17

Welcome to the People’s Pharmacy. I’m Terry Graedon.

Joe

06:17-06:25

And I’m Joe Graedon. The Alzheimer’s Association states that there are more than 7 million Americans currently dealing with dementia.

Terry

06:26-06:38

The problem is likely to get worse, as the baby boomers age. The impact on families and society is daunting. Is there anything we can do to reduce the likelihood of developing dementia?

Joe

06:39-07:10

To help us answer that question, we turn to Dr. Pascal Geldsetzer. He’s an assistant professor of medicine at Stanford University and a Biohub investigator.

His research focuses on identifying and evaluating the most effective interventions for improving health at older ages.

In 2026, Time magazine named him one of the 100 most influential people in health and medicine globally for his work on the link between shingles vaccination and dementia.

Terry

07:12-07:15

Welcome back to The People’s Pharmacy, Dr. Pascal Geldsetzer.

Dr. Pascal Geldsetzer

07:16-07:17

Thanks a lot for having me.

Joe

07:18-07:51

Dr. Geldsetzer, it’s great to have you back. And since we last talked with you, you are now in the realm of superstardom because of your third study. We’ll get to your studies in a moment with vaccines against dementia.

But first, I’d really like to find out, how did you come up with this idea in the first place? The notion that there was a natural experiment just waiting to be tested. How did that get hatched?

Dr. Pascal Geldsetzer

07:52-08:30

Yeah, well, I had this NIH New Innovator Award to look at using this method that we’re using here in our natural experiments. And we came upon the Shingles vaccination program in the UK as this beautiful textbook example of this approach that we could use.

And then, of course, we knew about this growing literature around herpes viruses that preferentially target your nervous system and a potential link to dementia.

And in this older age group, we thought the natural outcome to look at for us would be dementia. And that’s really how it all started.

Terry

08:31-08:41

Dr. Geldsetzer, do explain to us the natural experiment. You mentioned the UK. I think it was in Wales. What constitutes a natural experiment?

Dr. Pascal Geldsetzer

08:42-11:33

So it’s essentially a different approach than we usually use in epidemiology and analyses of electronic health record data sets, medical claims data. Usually what we do in these studies is that we compare those who get a certain medication or a vaccine to those who don’t.

And the basic problem and why often these studies are only considered to be at best hypothesis generating or suggestive but can’t get at cause and effect is that these individuals, those who decide to get vaccinated to those who don’t get vaccinated, are often very different in terms of their health motivations, health behaviors. And we have very little information on these variables, right? Like your dietary behavior, your physical activity levels.

So it’s very hard to adjust for all of these differences. And we never really know whether what we’re looking at is an actual cause and effect or just that those who happen to live a healthier lifestyle of some sort or be healthier in general are the ones who decide to get vaccinated as well and therefore have a lower risk of dementia or other health outcomes.

What we do in this natural experiment is that we’re using different comparison groups where we don’t rely on having perfect information on your diet and physical activity levels. Instead, we’re trying to find comparison groups that must be similar to each other in all respects.

And here we have this beautiful situation in the UK and in some other countries as well in the way in which they rolled out the shingles vaccine. So specifically, for example, in the UK, they said, you are ineligible if you had your 80th birthday just prior to the start date of the shingles vaccination program, which happened to be September 1st, 2013. And you were eligible if you had it just after. So we have these beautiful comparison groups where all that’s different about them is whether they were born just a week earlier or a week later.

And we know if I take a thousand people born one week, a thousand people born a week later, there shouldn’t be anything different about them in their physical activity levels, diets, etc. So we have beautiful comparison groups. And all that’s different about them is this massive difference in their probability of ever getting the shingles vaccine.

And then we can look at health outcomes very similar to a situation in a clinical trial where you throw a coin and you assign people to control or intervention.

And here, essentially, by random chance, just like the coin, people are born just a little bit earlier or a little bit later. So that’s why we are so excited about this research and why we really think we’re much more plausibly able to get at cause and effect rather than just correlation.

Terry

11:35-11:43

And what you found was that there was a difference in the likelihood that people would develop dementia after they were 80, right?

Dr. Pascal Geldsetzer

11:44-13:05

Absolutely. So we see these strong protective signals. So that was our first paper published in Nature last year, where we show that shingles vaccination appears to avert one in five new dementia diagnoses over seven years. Then we show a similarly large protective effect in Australia using primary care data from Australia. That was published just a few weeks after in JAMA.

And most recently, we show this also in Canada, where Ontario was the one Canadian province that rolled out the vaccine using these date-of-birth cut-offs. Other Canadian provinces didn’t, and we only see this effect as expected in Ontario. We have got many other analyses, publications in the works.

We seem to be seeing these strong protective patterns in data set after data set from different countries that rolled out the vaccine using these specific date of birth cutoffs. And it just together provides, I think, a uniquely compelling body of evidence that we’ve never had really for an intervention from observational data because we usually never have these beautiful natural experiments that we can exploit like we’re doing here with shingles vaccination.

Joe

13:05-13:32

So Dr. Geldsetzer, you are three for three. You’re batting a thousand. It’s an amazing accomplishment. And you have other studies in the works. So can you just give us some sense of how they compare to one another? Are the results similar or substantially different?

Dr. Pascal Geldsetzer

13:33-13:54

No, they are similar. Of course, the data sources are always a bit different. There are advantages and disadvantages. So what exactly we can look at and how [it] differs a little bit between data sets. But generally speaking, they all show the same strong protective signals that we have shown in our published studies so far.

Joe

13:54-14:07

Now, one of the things that’s sort of fascinating about your research is that it used what we’ll call an old shingles vaccine. I think it was called Zostavax?

Dr. Pascal Geldsetzer

14:08-14:09

Yes, correct.

Joe

14:10-14:22

And that has now disappeared. We now have a, quote unquote, new and more effective shingles vaccine called Shingrix. It requires two shots.

Terry

14:23-14:30

We know it’s more effective against shingles. We don’t know if it would be more effective against dementia.

Joe

14:30-14:57

Well, we don’t know if it’ll even work against dementia. So that’s the big question. But we know that the old shingles vaccine was surprisingly effective at preventing an onset of dementia after several years.

What is your thinking when it comes to the new, high-powered, more effective shingles vaccine called Shingrix?

Dr. Pascal Geldsetzer

14:58-16:29

Yeah, that’s a very important question. I think it really comes down to what we think the effect mechanism is. If we think what links shingles vaccination to dementia is a reduction in reactivations of the chickenpox virus.

So we know the chickenpox virus remains with you for life, hibernated in your nervous system after you contract chickenpox, usually in childhood. And it’s in this constant interplay with the immune system.

It presumably causes some inflammatory processes. We know inflammation is a key process, a bad thing in many chronic diseases. So reducing these reactivations through shingles vaccination may well have benefits.

If that is the mechanism, then we would think the newer vaccine should have at least the same protective effects for dementia because it’s more efficacious at reducing these reactivations than the old shingles vaccine.

However, if we think that the effect mechanism might be through a potentially virus-independent, broader effect on the immune system, a boost to the immune system, if you like, which we know exists for many vaccines and particularly for these live-attenuated vaccines, which is the Zostavax, the old shingles vaccine, is a live-attenuated vaccine, while the newer one is not, then it’s an open question whether the newer vaccine has similar benefits or larger or smaller benefits.

Terry

16:31-16:36

Dr. Geldsetzer, how have your colleagues responded to your research?

Joe

16:36-16:52

And I’d like to follow up on that question because for decades, we have put all our chips on the anti-amyloid approach. This is completely new, and you have about a minute to finish that before the break.

Dr. Pascal Geldsetzer

16:53-17:35

Yeah, so it’s actually been a very positive and encouraging reaction. People really, I think, understand that what we are generating here is a body of evidence from observational data that is very different and much more compelling than what we usually have for vaccines, other interventions when we do these observational data analyses.

People understand this basic intuition that our comparison groups here are virtually perfect comparison groups because all that’s different about them is this tiny difference in each. And so there’s a lot of excitement now in the dementia research community around this.

Terry

17:37-17:50

You’re listening to Dr. Pascal Geldsetzer, Assistant Professor of Medicine at Stanford University and a Biohub investigator. His research focuses on evaluating interventions for improving the health of older individuals.

Joe

17:51-17:54

After the break, we’ll find out about the reaction to Dr. Geldsetzer’s research.

Terry

17:55-18:04

Has it spurred a new way of thinking about the development of Alzheimer’s disease? It certainly is a different path from the pharmaceutical focus on amyloid plaques.

Joe

18:04-18:11

The infection connection with dementia is not as new as it might seem. A hundred years ago, doctors knew syphilis caused dementia.

Terry

18:11-18:18

It seems that a range of microbes might be making trouble in the brain, from herpes and chickenpox to Chlamydia pneumoniae.

Joe

18:18-18:23

Will anti-vaccination sentiment have an impact on Dr. Geldsetzer’s work?

Terry

18:39-18:42

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Joe

20:51-20:54

Welcome back to The People’s Pharmacy. I’m Joe Graedon.

Terry

20:54-21:09

And I’m Terry Graedon.

Terry

21:23-21:51

Today, we’re talking about novel natural experiments that unexpectedly revealed a connection between infection and dementia. Policies that set arbitrary cutoffs on eligibility for vaccination with the first shingles vaccine, Zostavax, allowed researchers to compare people who were vaccinated with those who were not. This situation resembled a gold standard randomized controlled trial.

Joe

21:51-22:24

This natural experiment was conducted in at least three different countries, Wales, Australia, and Canada. In all of them, vaccinated individuals did better than unvaccinated people when it came to developing dementia. Would the newer Shingrix vaccine be even more effective? Research just published in Nature Communications suggests that people who received this recombinant shingles vaccine were 51% less likely to be diagnosed with dementia.

Terry

22:24-22:42

Our guest today is Dr. Pascal Geldsetzer, an assistant professor of medicine at Stanford University and a biohub investigator. His research focuses on identifying and evaluating the most effective interventions for improving health at older ages.

Joe

22:43-23:42

Dr. Geldsetzer, I would assume that the pharmaceutical industry would be incredibly excited about your research because up until now, they’ve spent billions, perhaps tens of billions of dollars down the anti-amyloid… I won’t say exactly what I think, but down that path that has not led to much in the way of real improvement or prevention of Alzheimer’s or dementia.

So along comes Dr. Geldsetzer and his colleagues, and they show that a vaccine might be effective and it might be some sort of infectious process. I mean, we’re talking about the virus that causes chickenpox. So how has the pharmaceutical industry responded to your research? And is it spurring a whole new way of thinking about Alzheimer’s disease and dementia?

Dr. Pascal Geldsetzer

23:43-25:47

I do think that it is playing into, but I think generally in the dementia research community, including in the pharmaceutical industry, there’s increasing openness, I think, to other hypotheses of dementia, of Alzheimer’s disease, than the amyloid cascade. Because so far, as you’re saying, some of the large investments really have provided relatively modest output.

And there’s increasing evidence that other pathways seem to also play an important role. And this year, of course, is one of these. There’s also increasing awareness of chronic disease consequences of infectious diseases more generally, for example, due to the COVID pandemic and some of the links between the SARS-CoV-2 virus and neurological consequences. So it’s certainly, I think, further opening up the openness to these possibilities.

And I think, you know, for us, the next step is really trying to generate funds to run a true clinical trial on this question to be able to more conclusively test this research question. But of course, we want to use the old live-attenuated vaccine, which is off-patent, because that is the vaccine for which we have all this evidence from our natural experiments.

But I think if we can provide this proof of concept that what we’re seeing in our natural experiments are true cause and effect relationships, it would be of such important implications for population health, for dementia research, that we must run this trial. And because it’s an off-patent vaccine, we are really hoping for philanthropy, private foundations to support us in getting this done.

Terry

25:50-26:38

I would like to point out that the infection connection with dementia is actually not quite as new as we are imagining. A hundred years ago, or more than a hundred years ago, doctors treating patients with dementia knew that one of the possible causes of dementia was tertiary syphilis.

Now, we think of syphilis as a sexually transmitted disease, which it is. It was, and it still is. But back in those days, before antibiotics, it could get to a state where it gets into the brain and actually causes pretty severe dementia. How did we forget that?

Dr. Pascal Geldsetzer

26:39-27:52

Well, I think it’s always been a hypothesis in the field. But generally, it’s always been very niche because we haven’t, well, the focus was on other hypotheses, particularly the amyloid cascade. And the evidence around infectious diseases and dementia was always just in the correlational realm.

So it was always comparing individuals who [were], you know, who fell sick from a certain infection or contracted a certain pathogen versus those who didn’t. And as I was saying earlier, these are always very different, usually, comparison groups, right? People who get a certain condition may have other differences to those who don’t in the immune system, in their exposure to other things in life.

So we’ve never had the evidence that we have now where we have natural experiment evidence and beautiful comparison groups to show this link potentially between here an infectious agent and dementia.

Joe

27:54-30:02

Dr. Geldsetzer, I’m fascinated by the idea that infections, a variety of infections, might in some way be causing dementia. So Terry mentioned neurosyphilis going way back over 100 years. But not that long ago, 30, 40 years ago, there was some suggestion that herpes simplex virus, HSV-1 and 2, might somehow get into the brain. And, you know, we know that cold sores, for example, it’s the virus traveling down the nerve to manifest itself. And, of course, sexually transmitted disease, herpes, too, can also do that. But it can also maybe go up into the brain.

And so this idea that there were herpes infections, and by the way, chickenpox, varicella zoster, that causes shingles is also a herpes virus. So there were these viral infections. And more recently, there have been some studies suggesting that bacterial infections, something called C. pneumoniae, Chlamydia pneumoniae, which is not a sexually transmitted disease. It’s a respiratory disease that affects the nasal passages in the lungs.

So you have C. pneumoniae, which is also easily transmitted. And then you have some other bacterial infections. I think there may be some other germs that are bad for our brains. And Dr. Geldsetzer may have a better sense of what they are. But the idea that there are a bunch of, we’ll call them pathogens, that might trigger inflammatory reactions in the brain, the neuroscience community has been somewhat resistant to that, even though it’s been out there for decades. Your thoughts?

Dr. Pascal Geldsetzer

30:05-31:52

True, but in the neuroscience community’s defense as well, um we’ve never had really strong evidence on the link between these infectious agents and dementia. But you can argue easily that we should have this evidence. We should have invested by now in clinical trials for example, that treat some of these pathogens that you’re mentioning and see whether it reduces your risk of dementia.

I will say, though, as well, that for the virus that causes shingles, we have a special pathogen, I think, in the sense that we know it preferentially targets your nervous system. And we know that it is in this constant interplay with the immune system and that these reactivations of the virus become more common with age.

And so the idea that it may sort of act as a chronic stressor to the immune system over life and accelerate some of these chronic inflammatory pathways, the weakening of the immune system with old age, and that this may be bad for dementia disease development, maybe potentially other conditions in the nervous system, is, I think, not far-fetched. It’s highly biologically plausible. And that is a case that we don’t have for many other pathogens.

So, yeah, I do think there’s something special to be said about the biological plausibility of the virus that causes shingles.

Terry

31:52-32:31

Dr. Geldsetzer, we have seen over the last five or six years or perhaps a little bit longer, the development of a great deal of polarization. We have political polarization, and it’s spilled over into public health so that we have some individuals with a fair amount of prominence who have become anti-vaccination.

How do you think this will affect both your research and any potential intervention that we might develop from your research?

Dr. Pascal Geldsetzer

32:33-33:23

It’s hard to say. So for me really, you know I’m focused on generating the most rigorous research evidence that I can. That is everything that that I’m focused on. And I, as I was saying I’m turning particularly to to private foundations and philanthropy to hopefully be able to get a true clinical trial on this question of shingles vaccination and dementia off the ground.

Because I think this would be such an important finding that we need this trial. And that’s really what I’m focused on. And I don’t think it’s my place to comment on broader societal and political issues.

Joe

33:23-34:25

One of the things that distresses me is that the pharmaceutical industry has poured, as I mentioned, billions of dollars into the development of anti-amyloid drugs. And we had the great honor to interview Dr. Moir at Harvard, who had come up with the idea that amyloid might be an immune reaction to infection.

In other words, it was the body’s natural immune system trying to fight off some kind of infectious agent. And unfortunately, he has died. But there are some researchers who sort of agree with him that maybe the amyloid hypothesis that if we could just get rid of amyloid, we could solve the problem, which doesn’t seem to have been the case, may have been somewhat counterproductive.

Your thoughts about that original research and where it stands today?

Dr. Pascal Geldsetzer

34:26-35:28

Yeah, I think it’s a very exciting line of research. And there has been more evidence generated in that line since Dr. Moir’s pioneering work on that front.

So, for example, recently, there has been a team around William Eimer and Rudy Tanzi at Harvard who have shown that P-tau, so the other hallmark of Alzheimer’s disease, are these tau protein tangles. That they also appear to be produced or generated at least partially in response to herpes virus infection.

So I think there is an increasing body of evidence that this antimicrobial hypothesis, as it’s called, of dementia, of Alzheimer’s disease, may well be an important line of evidence.

Joe

35:28-36:23

So as I’ve mentioned, billions of dollars have been spent to try and get rid of amyloid in the body. And you would think, I mean, I would think that the pharmaceutical industry would be knocking down your door saying, Dr. Geldsetzer, please take our money. We want you to do this extraordinarily important research on vaccinations.

So we’d like you to go back and look at that old vaccine that we have seen disappear from the marketplace. And, oh, by the way, we’d like you to test the new vaccine, the Shingrix vaccine, not so new anymore. But, you know, here’s $50 billion. Do this research immediately and gather your colleagues together. Why aren’t they knocking down your door?

Dr. Pascal Geldsetzer

36:24-37:22

Well, it is a large investment to run a clinical trial. And in fairness, we don’t fully understand the mechanism that links Shingles vaccination to dementia or Alzheimer’s disease. That’s, of course, important. It could lead to many new insights that could lead to other potential treatments, therapeutics, preventative tools.

And of course, one obstacle as well here is that the evidence from our natural experiments is for this old live-attenuated vaccine, which is an off-patent vaccine. It’s not used very widely anymore in most countries. And yeah, that’s really the main reason, I think, why I’m turning to hoping for philanthropy and private foundations to support the clinical trial.

Joe

37:22-37:48

You know, there is an old vaccine, a really old vaccine called BCG. It’s a vaccine that was developed primarily against tuberculosis. There’s a little bit of data that suggests that maybe BCG would have some, we’ll call it anti-dementia benefits.

In the minute we have before the break, your thoughts about BCG and the data that’s been created?

Dr. Pascal Geldsetzer

37:49-38:21

Yeah, so BCG is known. It’s also a live-attenuated vaccine, just like the old shingles vaccine. And it’s known to have strong indirect effects on the immune system that appear to be important for a variety of health outcomes.

So I don’t think it’s, you know, far-fetched to think that BCG may have effects on dementia disease development as well, particularly in older age.

Terry

38:22-38:40

You’re listening to Dr. Pascal Geldsetzer, an assistant professor of medicine at Stanford University and a biohub investigator. His research focuses on identifying and evaluating the most effective interventions for improving health at older ages.

Joe

38:41-38:48

After the break, we’ll consider whether antibiotics could play a role in reducing the risk of dementia.

Terry

38:49-38:57

Given Dr. Geldsetzer’s research, it seems that the shingles vaccine might be a therapeutic tool in addition to helping with prevention.

Joe

38:58-39:09

Scientists once thought that the brain was sterile, no bacteria, no viruses. But now it seems that it has a distinct microbiome of its own.

Terry

39:09-39:17

Well, one thing we worry about is the possibility that COVID could increase the risk for dementia. How will we find out?

Joe

39:17-39:24

What can we all do to reduce our chances of developing dementia? We’ll get Dr. Geldsetzer’s recommendations.

Terry

39:24-39:28

He’ll also tell us about the research he hopes to conduct going forward.

Joe

39:28-39:33

How does he plan to study the infection connection with Alzheimer’s disease?

Terry

39:38-39:42

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Joe

39:50-39:53

Welcome back to The People’s Pharmacy. I’m Joe Graedon.

Terry

39:53-40:07

And I’m Terry Graedon.

Terry

40:22-40:56

Our topic today is the infection connection with dementia. If vaccines could help delay or prevent the onset of Alzheimer’s disease or other dementias, might other anti-infective approaches also be valuable? Could vaccines help fight off dementia even after cognitive decline has begun? Dr. Geldsetzer’s research focused on the first-generation shingles vaccine called Zostavax. A new study suggests that the Shingrix vaccination might also provide protection. What about antibiotics?

Joe

40:57-41:16

If bacteria like Chlamydia pneumoniae are contributing to brain problems, is it possible that treating people for infection would be helpful?

Are there other bacteria or possibly even fungi that might make brain function worse? What else can we do to reduce our risk of dementia?

Terry

41:17-41:35

We’re talking today with Dr. Pascal Geldsetzer, an assistant professor of medicine at Stanford University and a Biohub investigator. His research focuses on identifying and evaluating the most effective interventions for improving health at older ages.

Joe

41:37-43:18

Dr. Geldsetzer, your research is really compelling when it comes to the issue of vaccines, especially the older vaccine, against the possibility of developing dementia, kind of what we’ll call a preventive strategy. And of course, there are literally 6 million Americans who would like to know, well, what can I do now about treatment?

And there was a fascinating study in Nature Communications just recently in which the authors quoted a study from Taiwan. And they said, and I’m going to read, notably, a recent nationwide cohort study in Taiwan demonstrated that the antibiotic treatment targeting Chlamydia pneumoniae significantly reduced the risk of Alzheimer’s disease onset.

These findings suggest that Chlamydia pneumoniae infection may exacerbate Alzheimer’s disease pathology and that therapeutic strategies targeting Chlamydia pneumoniae could potentially slow or mitigate AD progression. And the antibiotic in particular that they were looking at was something called a macrolide, azithromycin, Z-Pak.

And I’m curious if you’ve thought at all about antibiotics as a treatment or a preventive when it comes to dementia for people who may be infected with a bacteria such as C. pneumoniae?

Dr. Pascal Geldsetzer

43:21-45:10

Yeah, so I think it’s a very interesting study. Of course, as I was saying earlier, it also has this fundamental limitation that we always have in these observational data analyses usually, that patients who get this infection or patients who get this infection and then are treated versus those who don’t get the treatment for whatever reason.

You know, it’s hard to know whether these are good comparison groups and whether we can really say what we’re seeing here as correlation, or actually reflect cause and effect. So that is why I think this evidence to really show a cause and effect relationship would require a clinical trial. I’m not saying that this is not true. I’m just saying that really to provide rigorous evidence that there does appear to be a link would require, in this case, a clinical trial, because there’s no opportunity here to run a natural experiment on this particular question.

That is very different for Shingles vaccination, as I was saying earlier, of course. I would also say that for shingles vaccination, as you’re talking about therapeutics for dementia, we have shown in our paper in Cell in December that there are also benefits, it appears, from shingles vaccination for those who already have dementia at the time of getting vaccinated. So we see large reductions in your probability of dying from dementia in the future, which suggests that really the shingles vaccine isn’t just a preventative tool, but potentially also a therapeutic tool for dementia.

Joe

45:11-45:14

Whoa. Say that again. That’s incredible.

Terry

45:15-45:16

Yes, I think that’s really important.

Joe

45:17-45:21

So it’s not just preventing dementia over the next five…

Terry

45:21-45:24

Which in itself is a great thing.

Joe

45:24-45:33

That’s huge, but the idea that it could actually be beneficial in what we’ll call a treatment situation, that’s astonishing.

Dr. Pascal Geldsetzer

45:34-46:29

Yes. So I think it was for us a very important question to look at using our natural experiment approach. So we’re using the same data and same approach as we have for our first study in Wales, where we show this reduction in dementia diagnosis. And we show that there appear to be benefits across the disease spectrum as far as we can ascertain it from electronic health record data.

So we show that among those without any record of cognitive impairment in the electronic health records, there is a reduction in your diagnosis of mild cognitive impairment, sort of a pre-dementia stage, if you like. And we show that among those who already have dementia, there is this large reduction in your probability of dying from dementia, really suggesting that the Shingles vaccine appears to act across the disease spectrum and not just for this prevention of dementia.

Joe

46:29-46:56

Now, there are some people who may have tuned in late and they keep hearing you say this natural experiment. Could you very quickly summarize what made this a natural experiment and why it’s so critical because it’s not just one country. It’s not just the UK, Wales, but it’s also Australia and now Canada.

So you’re, like I said earlier, you’re hitting a thousand, three for three. Just give us that synopsis, please.

Dr. Pascal Geldsetzer

46:58-48:22

Yes. So to show in clinical medicine that a new medication or a vaccine works for a certain indication, what we always need is a clinical trial. So we throw a coin and assign participants that way to a control group or an intervention group. And the power of this approach is that we know these comparison groups must be similar to each other on average, because all that’s different about them is whether the coin landed on heads or tails.

In our natural experiment, we are using the same approach. And so we are using or looking at individuals who were born just a little bit earlier and were therefore ineligible for the shingles vaccine in a number of countries. And very few people of these groups got vaccinated versus those who were born just a little bit later were eligible and a high proportion of them were vaccinated.

And so just like with a coin toss, we now have two beautiful comparison groups where essentially by random chance, people were born just a little bit earlier or a little bit later. And that’s why we’re able to generate evidence that’s not just correlational in nature like we usually have with observational data analysis, but actually likely reflect cause and effect.

Terry

48:22-48:56

Dr. Geldsetzer, I’d like to perhaps state the obvious. Sometimes that’s my position. But not all that long ago, we could talk to people who know a lot about the human body, and they would tell us, well, the brain is sterile, does not have a microbiome. And I think what we’re seeing with your research and some of the other related research we’ve been talking about this hour, there appears to be a microbiome in the brain. What do you say?

Dr. Pascal Geldsetzer

48:59-49:56

Yes, so there’s definitely an increasing body of evidence that appears to show what you’re saying, that the brain is not sterile. But it’s also important to realize that what may link the virus that causes shingles to dementia may not be a direct invasion of the brain by the virus, but could be through chronic inflammatory processes. There’s lots of intertalk between different parts of the body and certainly between the peripheral nervous system, where we know the virus hibernates and your central nervous system, so the brain, and that these inflammatory processes may play a role in many chronic diseases. I think there’s increasing evidence, convincing evidence that this is a key process.

Joe

49:57-50:43

Dr. Geldsetzer, I’m curious what you think about COVID. Here is the SARS-CoV-2 virus that has invaded the bodies of hundreds of millions of people all around the world, billions by now. And for some people, it does produce brain fog as one of the symptoms. Is it possible that some of the people who have been infected with COVID will be at higher risk in future years? And when I say higher risk, I’m talking about cognitive issues.

Dr. Pascal Geldsetzer

50:44-51:23

Right. It certainly is possible. I think we still don’t understand long COVID very well from a research perspective. But I think it’s a very important area of research, as you’re saying, because it’s such a widespread infection.

And, you know, even if it’s a small proportion of individuals in absolute numbers, it’s still a very important population health issue. And, yeah, certainly further investments in that area could provide really, really important insights for population health and not just for individual patients.

Joe

51:22-51:28

We here at The People’s Pharmacy like to give people news that they can use.

Terry

51:28-51:29

When we can.

Joe

51:29-52:28

Whenever that’s possible. And so if you were to look into your crystal ball to the future, but also what people can do here and now to reduce their risk of coming down with dementia.

First of all, your thoughts about shingles vaccine, even though your research was with the prior vaccine, which is no longer available, do you think the current vaccine, which is more effective, the Shingrix vaccine, is something that people should consider if they’re of a certain age? And what about other strategies?

I mean, we always hear that exercise, yes, of course, that’s very, very valuable in preventing dementia. And Terry, there are some other strategies as well. But what are your recommendations these days, Dr. Geldsetzer, to prevent this debilitating, horrific condition called dementia?

Dr. Pascal Geldsetzer

52:30-53:45

Right. So the shingles vaccine is a recommended vaccine for older adults in the United States because it prevents shingles. And so, you know, the evidence that it may also have benefits for cognitive health in older age, for dementia disease development, I think only provides additional motivation to get vaccinated.

And yes, as you’re saying, you know, lifestyle interventions are also an important tool to reduce your risk of dementia in the future. But I think, you know, the beauty about the shingles vaccine is that it’s a one-off, relatively inexpensive, readily available, readily scalable and safe intervention. It’s not a lifestyle regimen that we know is hard to adhere to, that you have to maintain for decades. It’s not a monoclonal antibody therapy, which is what we currently have in the Alzheimer’s disease space, that has important risks as well for patients. We know this vaccine is a safe vaccine. So I think that’s what makes this particularly exciting about shingles vaccination.

Joe

53:46-54:06

If we were to put you in charge of the National Institutes of Health and give you a huge pot of money and say, okay, Dr. Geldsetzer, what else should we be doing to try and reduce this risk of dementia and Alzheimer’s disease? What kinds of research would you like to fund?

Dr. Pascal Geldsetzer

54:08-54:37

I would certainly like to fund a large-scale clinical trial on shingles vaccination and dementia, as I was saying before, because it would have such important implications for population health and dementia research. And if there’s anyone out there, philanthropists who think this would be an exciting project and would help us get this off the ground, I’d be incredibly grateful.

Joe

54:37-54:39

How do they get in touch with you?

Dr. Pascal Geldsetzer

54:37-54:55

So you can, probably email is the easiest. If you Google me, you’ll find my profile and my email. And, you know, I’ve been very excited to talk about our research, our plans, what we have in the works, et cetera.

Joe

54:56-55:18

Well, we will make sure that your email address at the university is on the show notes for today.

Dr. Pascal Geldsetzer

55:04-55:06

Great. Thank you.

Joe

55:06-55:18

Are there any other areas, if you were to look into your crystal ball, when it comes to the infection connection with Alzheimer’s disease, that you would like to see pursued going forward?

Dr. Pascal Geldsetzer

55:21-56:17

Certainly more mechanistic research would be really important here for us to try to understand particularly how shingles vaccination appears to be reducing your risk of dementia, and this dementia disease development.

I don’t think I take the position that we must fully understand the mechanism before we run a clinical trial, because that’s something that will take a lot of money and a lot of time and will never have certainty. I think to me, having this proof of concept, and we don’t need to fully understand the mechanism to use this tool for reducing the risk of dementia.

So to me, you know, my priority is getting this clinical trial off the ground of the old, off-patent live-attenuated vaccine for dementia. But having said that, of course, mechanistic research is an important area of investment as well.

Terry

56:18-56:23

Dr. Pascal Geldsetzer, thank you so much for talking with us on The People’s Pharmacy today.

Dr. Pascal Geldsetzer

56:25-56:27

Thank you for having me. Had a lot of fun.

Terry

56:29-57:22

You’ve been listening to Dr. Pascal Geldsetzer. He is an assistant professor of medicine at Stanford University and a biohub investigator. His research focuses on identifying and evaluating the most effective interventions for improving health at older ages. In 2026, Time Magazine named him one of the 100 most influential people in health and medicine globally for his work on the link between shingles vaccination and dementia.

He is currently trying to raise funds from philanthropy for a large-scale clinical trial of shingles vaccination for dementia prevention. You’ll find links to the research that we’ve been discussing in the show notes. That’s at www.peoplespharmacy.com.

Joe

57:23-57:33

Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music.

Terry

57:33-57:42

This show is a co-production of North Carolina Public Radio, WUNC, with the People’s Pharmacy.

Joe

57:42-58:14

Today’s show is number 1,464. You can find it online at peoplespharmacy.com. That’s where you can share your comments about this episode. You can also reach us through email. It’s radio at peoplespharmacy.com. We would be very grateful to hear from you. Has anyone in your family dealt with dementia? What was it like? If there were a vaccine that lowered your odds, would you get the vaccine?

Terry

58:14-58:24

Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning.

Joe

58:24-58:51

At peoplespharmacy.com, you could sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast. We would be grateful if you would write a review of The People’s Pharmacy and post it to the podcast platform you prefer. If you find our topics interesting, please share them with friends and family. In Durham, North Carolina, I’m Joe Graedon.

Terry

58:51-59:27

And I’m Terry Graedon. Thanks for listening. Please join us again next week. Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

Joe

59:27-59:37

If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in.

Terry

59:37-59:42

All you have to do is go to peoplespharmacy.com/donate.

Joe

59:42-59:55

Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.