The People's Pharmacy

This week, we get in-depth information on Lp(a), the heart risk no one talks about. You have heard of cholesterol, and you may even know what your cholesterol level is. The compound lipoprotein a may be equally dangerous when it is elevated, but you have probably heard very little about it. 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 on Sept. 5, 2026, or get the live stream at 7 am EDT on your computer or smart phone ( wunc.org ). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Sept. 7, 2026. What Is Lp(a)? Lipoprotein a, or L-P-little a for short, circulates in the bloodstream, where it picks up and carries cholesterol and oxidized phospholipids. Scientists believe that blood levels are determined mostly by genetics and change very little over the course of our lives. Roughly 20 percent of people have high levels of Lp(a), above 30 ng/dL or 75 nmol/L. The two different figures are because tests use different units to measure the blood concentration, either nanograms per deciliter or nanomols per liter. While we don’t know if Lp(a) has or perhaps once had some important functions, we do know that elevated levels of this chemical is associated with heart disease. People with higher levels are more likely to suffer blood clots and inflammation. That puts them at risk for heart attacks or even strokes. So why hasn’t your doctor ordered a blood test to learn your level? Is Lp(a) the Heart Risk Doctors Can’t Treat? Perhaps doctors have been reluctant to measure or discuss lipoprotein a because they don’t have good interventions. That is beginning to change with the development of antisense oligonucleotides, a new category of prescription drugs that can cut levels sharply. The FDA has not yet approved any of these new medications, though. The first of these, pelacarsen, is still in Phase 3 trials needed before the agency can consider the evidence. However, it can bring down lipoprotein a by an estimated 80 percent. Cardiologists’ favorite drugs, statins, do not help Lp(a) levels. In fact, Lp(a) the heart risk rises when people are taking statins to lower their cholesterol. Other cholesterol-lowering drugs such as evolocumab ( Repatha ) and alirocumab ( Praluent ) can bring Lp(a) levels down modestly. One really old cholesterol-lowering drug, high-dose niacin, also helps moderate Lp(a). Some people do not tolerate it, however, as it can cause very uncomfortable flushing. So far as we know, no scientists have run studies to see whether niacin reduces the risk of heart attacks and other complications because of its effects on Lp(a). Other Complications of Lp(a): Our guest, Dr. Sam Tsimikas, is among the country’s leading experts on lipoprotein a. We asked him whether Lp(a) the heart risk factor causes other problems as well. Dr. Tsimikas described heart failure, potentially resulting from a heart attack, as well as peripheral artery disease (PAD), which can make it painful to walk. Lp(a) seems to cause plaque in arteries throughout the body. As a result, it can increase the chance of a stroke. In addition, it contributes to calcification of the heart valves. This condition interferes with their ability to function properly. What Can We Do If Lp(a) Is Too High? Dr. Tsimikas runs a unique clinic for cardiology patients with high levels of Lp(a). We asked him how he helps them. One approach is to collect additional information about their level of risk. A coronary calcium score can be a useful indicator. If it is high, he and his patients work to control all the potential risk factors that they can. He discusses the potential benefit of aspirin with them. Because Lp(a) the heart risk factor increases the chance of dangerous blood clots, the anti-clotting activity of aspirin can sometimes be helpful. Offering dietary advice can be tricky if a patient has high cholesterol as well as elevated Lp(a), since the ideal diets for each are nearly opposite each other. A ketogenic diet tends to raise LDL cholesterol, for example, while it may modestly lower Lp(a). We think by the end of this episode, you’ll join us in hoping that scientists can learn a lot more about Lp(a) in the next few years. This Week’s Guest: Sotirios (Sam) Tsimikas, MD, FACC, FAHA, FSCAI, is Professor of Medicine/Cardiology and Director of Vascular Medicine at the Sulpizio Cardiovascular Center. That is part of the Division of Cardiovascular Medicine at the University of California, San Diego. His website is https://profiles.ucsd.edu/sotirios.tsimikas Sotirios (Sam) Tsimikas, MD, FACC, FAHA, FSCAI, UCSD Listen to the Podcast: The podcast of this program will be available Monday, Sept. 7, 2026, after rebroadcast on Sept. 5. You can stream the show from this site and download the podcast for free. In addition to what you heard in the broadcast, the podcast includes additional information on calcium scores and the benefits and risks of statins to lower cholesterol. Download the mp3 , or listen to the podcast on Apple Podcasts or Spotify .

A new school year is about to start in many parts of the country. Going back to school can be exciting, but some students may dread it. Perhaps they are struggling with attention deficit hyperactivity disorder, abbreviated ADHD. How can you recognize the symptoms of this problem? What are the most common misconceptions? In short, what are we still getting wrong about ADHD? When we talk about distractibility, trouble missing deadlines, forgetting where you left your keys, it is easy to relate. Likewise, when we look at kids with wiggles and short attention spans, do we see a child with ADHD or just a normal youngster? What constitutes ADHD? Does everyone have it, or is it an all-or-nothing condition? Expert John Mitchell explains that many people have some symptoms from time to time, but once a person is suffering from enough that it is affecting their ability to function, that is when a yes-or-no ADHD diagnosis is made. 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, August 29, 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 August 31, 2026. What We Get Wrong About ADHD One of the most common misconceptions about ADHD is that it primarily affects little boys who can’t sit still. While hyperactivity can certainly make a parent or a teacher uncomfortable, the inattention aspect of ADHD could be more disabling in many instances. Moreover, girls too may suffer with ADHD. Though they are less likely to be hyperactive, they can often have difficulty focusing. Another popular myth about ADHD is that it is a pediatric condition. People think kids grow out of it. What we are beginning to see with more research into ADHD is that some people learn effective coping skills they can use as adults. Nonetheless, many older people who were not recognized as having ADHD when they were children may discover that their impulsivity and lack of follow-through, accompanied by anxiety, depression or migraines perhaps, could be a manifestation of this disorder. Failing to recognize the suffering of neurodivergent adults is another thing we get wrong about ADHD. How Do You Treat ADHD? A third misunderstanding about ADHD is that prescribing a stimulant medication is the only treatment necessary. While drugs such as methylphenidate ( Concerta , Ritalin ) or mixed amphetamines ( Adderall ) can be really helpful, there is a saying in the ADHD community: the pills don’t teach skills. They do allow a person to focus well enough to learn some new skills they will need. Nonpharmacological approaches are important in conjunction with prescription medicine. However, adolescents with ADHD are much less likely to turn to drugs of abuse if they are taking properly prescribed stimulant medicines in the context of a thoughtful treatment plan. What Is the Role of Emotional Regulation in ADHD? Pediatric ADHD expert Paul Rosen describes another assumption that we can get wrong about ADHD. A child may appear to be doing fine, bringing home As, getting along well in school. But he describes “duck syndrome,” in which you see a duck gliding along the surface of the water. The motion looks effortless, but the duck is paddling like crazy. If it gets into an eddy or a current that’s too strong, it can’t keep up. These students are working much harder than is apparent and at some point, they encounter demands they can’t meet. How will they respond to that frustration? Trouble with emotional regulation is not always part of the ADHD picture, but it isn’t unusual, either. Some kids with ADHD respond pretty much as other youngsters do, but some seem like a super bouncy ball. Their emotions go very high and very low quickly, but they bounce back quickly as well. Still other children may be more like volcanoes. When faced with frustration, they explode, and it may take them many hours to return to baseline. Focusing on Warm and Fuzzies Parents sometimes assume that impulsive or explosive behavior is willful, but that is another thing we often get wrong about ADHD. Most of the time, such behavior is emotional. The child wants to be a “good kid” but may not know how to deal with these extreme emotions. Dr. Rosen recommends unconditional positive attention. He suggests that when parents tuck their ADHD children into bed at night, they appreciate one thing the child has done that day and one aspect of the child, separate from the behavior, that is wonderful. This kind of affirmation can help a youngster keep striving for the skills they will need. (In fact, it sounds like a helpful idea for any parent and child, regardless of whether either of them has ADHD.) This Week’s Guests John T. Mitchell, PhD Dr. John Mitchell is an Associate Professor in the Department of Psychiatry and Behavioral Sciences at Duke University. His research and clinical work are focused on ADHD across the lifespan. He has published peer-reviewed articles and chapters on longitudinal outcomes and the treatment of ADHD, as well as recently co-authoring Mindfulness for Adult ADHD: A Clinician’s Guide . The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Dr. Paul Rosen Dr. Paul Rosen is an Associate Professor of Pediatrics at the University of Louisville School of Medicine, affiliated with Norton Children’s Medical Group. He currently serves as the Director of the ADHD Evaluation Services in the Division of Behavioral and Mental Health with Norton Children’s Medical Group. Listen to the Podcast The podcast of this program will be available Monday, August 31, 2026, after broadcast on Aug. 29. In this week’s podcast, Dr. Mitchell explains why people without ADHD react so differently to stimulant medication. He also describes the multimodal treatment ADHD study for which he served as investigator. What kind of career counseling could help young people find a good fit with the way their brains work? We also discuss the benefits and the challenges of mindfulness as a complementary approach to ADHD treatment. 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 .

Do you suffer with anxiety, depression, or another mental illness? Millions of people do. The usual treatment is a prescription medication. If that doesn’t work, the healthcare provider may offer a different one. Diet is certainly not the first topic on the provider’s mind. But what if, in addition to appropriate pharmacological treatment, you were able to nourish, protect and energize your brain with your diet? Our guest offers evidence that you can heal your mind with a ketogenic approach to eating. We need to acknowledge that this approach is quite different from the plant-rich eating pattern advocated by last week’s guest, Dr. Will Bulsiewicz. Humans around the world have adopted a wide range of dietary regimens that support health. Listen to Dr. Georgia Ede explain why she thinks a paleo or ketogenic diet is helpful for bolstering brain health. 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, August 22, 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 August 24, 2026. Can You Heal Your Brain with Food? We live in stressful times. More than 50 million Americans take prescription antidepressants, and millions more are on anti-anxiety medication. Unfortunately, while these drugs can be life savers, they don’t always work as well as we would like. In some cases, antidepressants are only about 10 percent more effective than a placebo. Dr. Georgia Ede is a psychiatrist who began her investigation into how food affects mental health serendipitously. She was experimenting with her own diet to address some physical health issues. She used a food and symptom journal to discover the best dietary choices for her own health. To her surprise, the “upside-down” diet that helped her feel better physically also improved her sleep and her ability to focus. She started looking into evidence that a paleo or ketogenic diet could benefit people with mental health challenges. What Is Metabolic Psychiatry? There is evidence that people consuming unhealthy diets full of fast food or ultra-processed products are more susceptible to symptoms of anxiety ( Nutrition Neuroscience , May 19, 2026 ). On the other hand, people participating in a supervised weight-loss program using either a low-carbohydrate ketogenic diet or a low-fat diet reported improvements in mood ( Obesity , Jan. 2007 ). Those on the ketogenic (Atkins) diet reported less hunger and fewer unpleasant symptoms. Researchers have also tested a ketogenic diet in people with schizophrenia or bipolar disorder ( Psychiatry Research , May 2024 ). These volunteers also had metabolic disorders, including obesity, which is often an unwanted effect of the ant-psychotic drugs they take to treat their condition. This four-month pilot study saw participants lose weight, reduce insulin resistance and lower their triglycerides. Even more impressive, they had a 32 percent reduction in the Brief Psychiatric Rating Scale. They also reported better sleep and improved life satisfaction. You may find this recent article from National Geographic of interest: https://www.nationalgeographic.com/health/article/metabolic-psychiatry-keto-diet-brain-science . Unfortunately, it might be behind a paywall. How Does Food Affect Our Brains? Most of our body tissues are accustomed to getting energy from glucose, with the help of insulin. However, years of exposure to high levels of these compounds often makes the tissues less sensitive to the effects of insulin. The consequence is that the body–and therefore also the brain–is flooded with high levels of glucose. This exposure can result in the formation of advanced glycation end products in the brain, which can be harmful. The brain evolved to use either glucose or a flexible mix of glucose and ketones. These are the result of burning fat rather than sugar. A paleo diet will naturally provide more ketones and less glucose. Dr. Ede and colleagues have found that a ketogenic diet can be very helpful even for people with relatively serious mental problems. In one study (which was not placebo-controlled), patients hospitalized with severe persistent mental illness were given a ketogenic diet. Most did well and had significant improvements in their depression and psychosis symptoms ( Frontiers in Psychiatry , July 6, 2022 ). Is Ketosis Dangerous? Ketosis itself simply means that you are burning fat as fuel rather than sugar. This can be achieved by following a diet that is high in animal fat, with moderate amounts of animal protein and low amounts of carbohydrate derived from plant foods. Ketosis is not inherently dangerous. However, Dr. Ede urges anyone who wants to heal their brain with diet to ask a healthcare provider to monitor and supervise the process. Prescription drug doses may require adjustment, and people may need support as they adopt a paleo or ketogenic diet. That is why this is not a do-it-yourself approach. Is Coconut Oil Helpful to Heal Your Brain? Dr. Ede described the benefits of medium-chain fatty acids produced in digesting fat. You may recall a video from a few years back in which a doctor described helping her husband recover from Alzheimer disease, at least partially, by giving him coconut oil. Some researchers consider Alzheimer disease to be a form of diabetes because the AD brain does not metabolize sugar effectively. Dr. Ede suggested that the benefits may be real, but getting medium-chain fatty acids from the diet rather than be taking coconut oil might be preferable. After Dr. Ede told us about Fran, who overcame significant memory problems by changing to a ketogenic diet, we hope there will be trials on this. Future Trials on Diet to Heal Your Brain Dietary trials are notoriously difficult to conduct. People often don’t stick to the prescribed diet, and it can be difficult to find an appropriate placebo for comparison. Nonetheless, Dr. Ede is looking forward to results from a large trial of the keto diet for people with schizophrenia or bipolar disorder. This study is being conducted in Australia. This Week’s Guest Dr. Georgia Ede is a globally recognized expert in nutritional and metabolic psychiatry. Her 25+ years of clinical experience include 7 years at Harvard University, where she was the first psychiatrist to offer nutrition-based approaches to mental health conditions. Dr. Ede co-authored the first inpatient study of the ketogenic diet for serious mental illness, developed the first medically accredited course in ketogenic diets for mental health, and is a recipient of the Baszucki Metabolic Mind Award. Current research collaborations include pilot studies in pediatric bipolar disorder, adult ADHD, and PTSD. Her internationally bestselling book Change Your Diet, Change Your Mind: A Powerful Plan to Improve Mood, Overcome Anxiety, and Protect Memory for a Lifetime of Optimal Mental Health is being translated into 11 languages and is recommended by the New York Times Book Review. The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Dr. Georgia Ede, author of Change Your Diet, Change Your Mind Listen to the Podcast The podcast of this program will be available Monday, August 24, 2026, after broadcast on Aug. 22. In this week’s podcast, we’ll learn how vegetarians can follow a ketogenic diet. How does the evidence Dr. Ede has collected accord with the chemical imbalance theory of mental illness? We also discuss why the standard American diet is not good for mental wellbeing, and we find out what might be in Dr. Ede’s own shopping cart. 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 .

When you decide to grab a bite to eat, do you think about how to feed your gut microbes? Most of us don’t. Even if we did, their only means of stating their preferences is somewhat after the fact. Do you end up feeling less than well? Perhaps the denizens of your gut aren’t happy. In this episode, we consider how to support your microbiota and whether that can reduce the inflammation that seems to accompany modern life. 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, August 15, 2026, through your computer or smart phone ( wunc.or g). 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 August 17, 2026. Feed Your Gut Right to Fight Inflammation Dr. Will Bulsiewicz is a gastroenterologist who urges all of us to focus on a healthful fiber-rich plant-strong diet to maintain our microbiome in good shape. He has described his own evolution from a busy medical student relying heavily on processed food products to a whole-food plant-based enthusiast. Eating a wide variety of plants is one of the easiest ways to make sure we are getting the nutrients our gut microbes need. Why are the trillions of microbes in our large intestine so important? Dr. Bulsiewicz (aka Dr. B.) shares the story of a patient who was overwhelmed by a serious C. diff infection. A course of clindamycin for a skin infection had decimated her normal microbiome and left an open field for C. diff to flourish. Instead of treating her with surgery and even more potent antibiotics, Dr. B. and his colleagues utilized a fecal transplant. She got poop from a healthy person into her colon and left the hospital a few days later in good health herself. What Is the Link Between the Microbiome and the Immune System? Inflammation is one of the primary signs that the immune system has gone into action to fight off a perceived foe. There is a close relationship between the gut microbes, the gut barrier and the cells of the immune system. Between 70 and 80 percent of immune system cells are present in the gut ( Nutrients , March 9, 2021 ). There is just one layer of cells in the gut barrier, firmly attached to each other through tight junctions. If those tight junctions break down, pathogens and toxins can get from the gut into the bloodstream and activate the immune system into creating inflammation Medicines That Harm the Intestinal Barrier Diets that are high in salt have a negative impact on the integrity of the intestinal barrier ( Nutrients , Nov. 25, 2025 ). In fact, a diet high in salt can reduce the number of Lactobacilli in the gut by 90%. This also affects the permeability of the gut barrier, which can contribute to auto-immune conditions. When we asked about inflammatory bowel disorders such as Crohn disease or ulcerative colitis, Dr. B. told us he thinks it’s a mistake to classify them as auto-immune conditions. Instead, he suggests we should consider these conditions as due to the immune system rejecting the microbiome. Some of them might be initiated and perpetuated by failures in the gut barrier that allow certain organisms or their toxins into systemic circulation. A number of medications can also harm it, most notably the nonsteroidal anti-inflammatory drugs (NSAIDs). Agents like ibuprofen, naproxen, celecoxib and meloxicam may disrupt the tight junctions that keep the intestinal barrier intact ( Gastroenterology , Feb. 2018 ). In some cases, they may also upset the balance of microbes. Four Keys to an Anti-Inflammatory Diet There are several different dietary patterns that allow you to feed your gut and fight inflammation. Good evidence supports a DASH diet, a Mediterranean diet, pescatarian, flexitarian, vegetarian and some vegan diets. We asked Dr. B. to summarize the four features healthful eating patterns share. They include adequate fiber, plenty of polyphenols, healthy fat and fermented foods (think of sauerkraut or kimchi). Fiber and Flatulence One drawback of a high-fiber diet is that when microbes in the colon ferment the fiber we can’t digest, they produce gases. It has to go somewhere, or it will cause sensations of cramping and bloating. Consequently, fiber is often associated with flatulence. Dr. B. suggests that there may be more gas, and it may be loud, but it shouldn’t be stinky. Smelly farts are born of sulfur, which is more common in a diet containing garlic, onions, crucifers like broccoli or cabbage, fish, eggs or meat. Plant-Powered Plus We wondered what might be included in the “plus” category when you feed your gut and fight inflammation. Dr. B. offers a few things that you might not expect in a book about diet, but they are related to reducing inflammation. One is to go outside early in the day, every day, to get your circadian rhythm in sync. Another is to maintain your emotional connections with family and friends. Still another, just as important, is to nurture your spiritual core. This Week’s Guest Dr. Will Bulsiewicz describes how a plant-powered diet can fight inflammation Will Bulsiewicz, MD, is a New York Times bestselling author, award-winning gastroenterologist and internationally recognized health expert. Dr. Bulsiewicz directs the Gut & Microbiome Center for Excellence, a physician-led executive medicine and telemedicine practice based in Mount Pleasant, SC. Dr. Bulsiewicz is the author of several books, including his latest book, Plant Powered Plus: Activate the Power of Your Gut to Tame Inflammation and Reclaim Your Health . His website is https://theguthealthmd.com/books/ The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Listen to the Podcast The podcast of this program will be available Monday, August 17, 2026, after broadcast on Aug. 15. In this week’s podcast, you get to peek into Dr. B’s shopping cart. Are you buying the same vegetables he does? We also get insights on his favorite recipes for grains like farro. And we discuss the effect of coffee on the gut microbes. If you want to feed your gut to encourage certain microbes, remember that consistency is crucial. You can’t eat a specific food once and expect it to make a difference. But consuming it several times a week will ultimately add up. We also discuss antidotes for flatulence, if you are interested in that. 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 .

You may have heard about antibiotic-resistant bacteria. They can greatly complicate the treatment of infections. But have you ever heard of antifungal-resistant fungus ? Infectious disease experts knew nothing about a scary fungus, Candida auris, in 2008. But in less than two decades this dangerous fungal infection is making waves around the world. It has acquired resistance to a number of potent antifungal medications. Consequently, it now poses threats of hard-to-treat infections in many corners of the globe. At last count, 27 states in the US have reported cases. We first reported on this serious fungal infection in 2019. At that time it seemed worrisome, but not widespread. Now, thousands of people have been infected over the last eight months. The CDC consider this scary fungus an “ urgent threat .” Why is Candida Auris Making Headlines This week? We scan a variety of sources for our People’s Pharmacy “Health Headlines” newsletter. There are an amazing number of scary stories showing up around the country. The headlines from Forbes (June 30, 2026) really caught our eye: “A Drug-Resistant Fungus Is Spreading Through American Hospitals” “Candida auris, a drug-resistant yeast, saw clinical infections more than double from 2022 to 2024, reaching 6,197 cases. This fungus primarily threatens immunocompromised patients, resisting common antifungal treatments.” Researchers at the University of California, San Francisco describe in the journal Science , (August 6, 2026) why it is so hard to get rid of this infection once it has set up house keeping on a patient’s skin. When the fungus gets into and around hair follicles, it creates a kind of nest that protects it from an attack by our immune system. Once it is embedded, Candida auris can be extremely hard to eradicate. That’s true in hospital environments as well in a personal environment, such as a hair follicle. Most healthcare professionals believe that the problem exists primarily within nursing homes. Older people, who are immune compromised, are especially vulnerable. But millions of Americans are immunosuppressed. Many may not even realize they are at risk. What Is Candida Auris ? New York Times journalist Matt Richtel was looking for a suitable topic for a series of in-depth reports. When he asked the experts at the Centers for Disease Control and Prevention, they suggested he investigate Candida auris . They were more worried about this scary fungus than about most other health problems, and when you listen to his story, we think you will be, too! Candida auris was first identified in the ear of a Japanese woman almost two decades ago. It wasn’t making her sick. Nonetheless, before long infectious disease experts started finding people who were very sick with this fungus. Because several strains have developed resistance to multiple common antifungal medications, the infections can be quite difficult to treat. Who Is at High Risk? People whose immune systems are compromised seem to be at highest risk. That includes the elderly, especially those living in nursing homes. However, millions of people taking medications that can suppress their immune systems are also in danger. These are drugs used to treat autoimmune conditions such as rheumatoid arthritis, Crohn’s disease, inflammatory bowel disease or plaque psoriasis. What actions do we need to take to protect them? With the development of antifungal resistance, simple surgical procedures could pose life-threatening risks. This Week’s Guest: Matt Richtel is a reporter at the New York Times. He won the Pulitzer Prize for national reporting with a series of articles he expanded into his first nonfiction book. Ultimately, it became a New York Times bestseller, A Deadly Wandering . Matt Richtel’s latest book is An Elegant Defense: The Extraordinary New Science of the Immune System: A Tale in Four Lives. His website is www.MattRichtel.com/ You can find his series on Candida auris at The New York Times . The photograph of Matt Richtel is by Simona Deac. Listen to the Podcast: The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free. CDs may be purchased at any time after broadcast for $9.99. Download the mp3 You can also listen to the streaming audio by scrolling to the top of the page and clicking on the arrow under Matt Richtel’s photograph. Perhaps the best option would be to download the podcast from Apple at this link . That way you can listen at your leisure. I promise you that this is a memorable interview that you do not want to miss. And remember, The People’s Pharmacy was informing you of this threat years before most people had even heard of this scary fungus.

Our kidneys do an incredible job filtering our blood every hour of every day. Most of us have two kidneys, and each one has about a million microscopic filters called glomeruli. Unlike the filters in our HVAC system, though, these filters cannot be replaced. But they do their work so well and unobtrusively that most of us don’t even think about our kidney function. Although 37 million Americans have kidney trouble, the majority are unaware of their situation. Two tests could reveal how well the kidneys are working. What are they, and how often should you ask about them? 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, August 8, 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 August 10, 2026. What Are the Two Tests That Reveal Kidney Trouble? Chronic conditions like high blood pressure and diabetes put a strain on the kidneys. They are very common problems that signal the need for kidney function monitoring. Our guest expert, Dr. Samir Parikh, suggests that all of us should know our numbers. One is derived from the level of creatinine in the blood. This is normally part of a basic metabolic panel. Usually, the panel results will include a number for the estimated glomerular filtration rate (EGFR) calculated from the value for blood creatinine. The other crucial test is a urine test for protein. Keeping Kidneys Healthy by Staying Properly Hydrated One of the simplest tactics to keep kidneys healthy is to provide them with enough liquid. We get some fluid from the food we eat, which may be one reason eating fruits and vegetables seems to be good for us. They are full of water! We also need to drink fluid, and plain water is probably the best choice. It would be smart to use thirst as a guideline and make sure to drink when thirsty. We do avoid overdoing water consumption, though, as overloading the kidneys with more fluid than they can handle is dangerous as well. Medicines That Are Hard on the Kidneys We mentioned to Dr. Parikh the experience of an older friend, a devoted runner, who discovered that taking ibuprofen after a run reduced the likelihood of having to get up overnight to urinate. He reminded us and our listeners that nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, celecoxib or meloxicam can be hard on the kidneys. That doesn’t mean we shouldn’t ever take such pain relievers, but perhaps we should try not to make it a habit. When we asked about other medicines that might be tough on the kidneys, he mentioned PPIs. Proton pump inhibitors such as omeprazole ( Prilosec ) or esomeprazole ( Nexium ) are often used to treat heartburn or other digestive symptoms. Regular use can put a strain on the kidneys, although the gastroenterologist recommending the medicine might not warn you of that side effect. We asked about environmental toxins and learned that heavy metals such as lead or arsenic can harm the kidneys along with other organs. We should make sure that the food we eat and the water we drink are not contaminated with such compounds. The Possible Benefits of Vitamin B Dr. Parikh has been studying how the kidneys respond to the B vitamin nicotinamide. The preliminary work he and his colleagues have done so far is promising. However, they have not conducted clinical trials to find out whether the vitamin could help people with early kidney disease. Because kidneys work so hard, they need a lot of energy to be produced by the mitochondria in their cells. Those mitochondria need NAD+ (nicotinamide adenine dinucleotide) to function at their best. Providing additional nicotinamide appears to help ( Nature Reviews. Nephrology , Feb. 2020 ). One to three grams a day appears to be safe and may be beneficial. Medications That Can Promote Kidney Health Some medicines initially developed for other conditions are proving to be helpful in treating kidney disease. In particular, these include diabetes drugs known as SGLT2 inhibitors like dapagliflozin ( Farxiga ) or empagliflozin ( Jardiance ). They help slow the decline of kidney function ( New England Journal of Medicine , Nov. 4, 2022 ). GLP-1 agonists may also be familiar because they too are used to treat diabetes. Medications such as semaglutide ( Ozempic , Rybelsus , Wegovy ) and tirzepatide ( Mounjaro , Zepbound ) have made headlines as weight loss and diabetes meds, but they also can reduce the risk of kidney failure and other bad outcomes ( Lancet. Diabetes & Endocrinology , Jan. 2025 ). The benefits of these types of drugs should give us hope that we can go from slowing the progression of kidney disease to stopping it in its tracks Taking Care of Your Kidneys We asked Dr. Parikh what we should be doing to care for our kidneys and keep them healthy. He urged us once again to know our numbers: most importantly, the numbers from the two tests we discussed, blood creatinine and urine protein. Other numbers that are important for kidney are our blood pressure and, for those with diabetes, HbA1c. In addition to paying attention to all those numbers, we need to embrace a lifestyle that will help keep them where they belong. That means following a heart-healthy diet, staying physically active and getting adequate sleep. This Week’s Guest Samir M. Parikh, M.D., FASN, is Professor of Internal Medicine and Pharmacology and Chair of Internal Medicine at the University of Texas Southwestern. He holds the Donald W. Seldin Distinguished Chair in Internal Medicine and the Ruth W. and Milton P. Levy, Sr., Chair in Molecular Nephrology. Dr. Samir Parikh, University of Texas Southwestern Listen to the Podcast The podcast of this program will be available Monday, August 10, 2026, after broadcast on Aug. 8. This week’s podcast has additional information on a possible role for sodium bicarbonate (baking soda) for kidney function. We also discussed medical silos, and how that leads to gastroenterologists overlooking the kidney risks from PPIs. Also, what should prospective kidney donors consider? 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 .

Millions of people suffer with foot trouble. Some have heel pain when they first get out of bed. Others complain of flat feet or bunions. Athlete’s foot is very common, though it doesn’t always respond as expected to antifungal medications. Speaking of fungus, toenail fungus can be extremely stubborn. What are your feet trying to tell you about what they need? How can you keep them healthy, especially in the summertime? 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, August 1, 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 August 3, 2026. What Are Your Feet Trying to Tell You? Most everyone looks forward to summer vacation, but that special time away from the usual routine may pose challenges for your feet. Whether you are hiking in the mountains or running on the beach, you may need to pay attention to your tootsies. Time at the Beach Beach time can inspire long walks on the sand, but soft sand could really put a strain on foot muscles that aren’t accustomed to it. Our expert guest, podiatrist Jane Andersen DPM, recommends wearing good running shoes for walking long distances on sand. Choosing to walk where the sand is hard-packed when the tide is low can also be helpful. Possibly the most important but easily overlooked step to protect feet at the beach is to apply sunscreen. The tops of the feet are easily overlooked, but they can burn pretty readily. And if you are planning to spend time sunbathing prone, you might even want to apply sunscreen to the bottoms of your feet. They never see the sun, and walking on sunburned soles could be quite painful. Protecting Bare Feet Another consideration at the beach is how you will get from the parking lot or boardwalk to the water. How hot is the sand? If it is hot enough to burn the soles of your feet, you might consider using water sandals. In general, going barefoot can be risky. Whether you’re at the beach, at a campground, in your own backyard or even inside your home, there are potential hazards underfoot. Bits of glass shards, little pieces of wire, tiny pebbles or nails could all cause havoc if they end up embedded in a sole. Protecting your soles by wearing good flip-flops makes a lot of sense. To find a list of flip-flops that provide appropriate arch support as well as sole protection, consult apma.org . Treating Black Toenails During this episode, Joe describes a trip to the beach with a long walk. By the time he removed his shoes, his longest toe had a black toenail that was rather painful. Although the pain faded before too long, it took about a year for the dark color to disappear from the nail. Dr. Andersen suggests that it often takes at least nine months to regrow a toenail. She emphasizes that if the nail turns black due to sudden trauma (like dropping something heavy on the toe), a podiatrist should check it out. Sometimes there is a fracture under that discolored nail that requires medical attention for proper healing. What Is the Story on Flat Feet? Joe has always had flat feet. Perhaps your feet are flat, too. The condition is pretty common. If Joe gets out of a bathtub or swimming pool and leaves footprints, they are almost oval. There is very little indentation in the center. Other people with higher arches may leave footprints that are nearly C-shaped. Flat feet can benefit from arch support such as orthotic inserts for shoes. High arches can also cause trouble, especially if they are linked to a genetic condition called Charcot-Marie-Tooth. It is a nerve disorder that can also lead to muscle weakness. Consequently, people with high arches may also need podiatric care for their feet to stay comfortable and healthy. Plantar Fasciitis Is a Pain The bottoms of your feet have thick connective tissue called fascia that run from the heel to the ball of the foot. Inflammation of this tissue causes pain, typically at the heel but sometimes along the arch. Often, more supportive footgear or special orthotics can help. Getting a shoe with the correct heel drop is important. That is the difference between the height of the shoe at the heel and at the toe. A podiatrist can recommend the most appropriate heel drop for your feet. Stretching is also useful, particularly pulling the toes toward the knee or stretching the calf in a runner’s stretch pose and holding for 30 seconds or so. Rolling the bottom of the foot on a frozen water bottle helps with the stretch at the same time that the cold eases the inflammation. Plantar fasciitis is common and treatable. If left untreated, it may last a long time. What Can You Do About Stinky Feet? A couple of listeners shared their experiences with smelly feet, and we asked Dr. Andersen for her opinion. Jan described using a topical erythromycin antibiotic prescription that came as a roll-on. She also got rid of all her stinky shoes and is careful to wear socks that will wick sweat away. Dr. Andersen noted that erythromycin is very effective against a bacterial infection with Corynebacterium minutissimum. This organism glows coral under ultraviolet light and can definitely raise a stink. Sophia wrote about developing smelly feet after walking around in wet shoes. She finally solved the problem by treating her feet with rubbing alcohol. Dr. Andersen agreed that rubbing alcohol could be helpful. So can soaking the feet in a strong solution of tea. Other tips include cleaning the floor of the shower stall frequently and always wearing socks that wick–not cotton, which absorbs sweat but traps the moisture. Acrylic or wool work better. Another tactic is to alternate shoes; don’t wear the same shoes day after day but give them at least a day to dry out. How Should You Treat a Sprained Ankle? There has been controversy lately about the standard RICE protocol for a sprain: rest, ice, compression and elevation. Some experts now recommend warmth instead of ice and gentle motion rather than rest immediately after a sprain. Of course, the first step is to ascertain that it is really a sprain and not a fracture. The treatment for those two injuries is completely different and the person suffering the problem may not be able to tell just from the way it feels. An X-ray is prudent. Bunions and Hammer Toes If you don’t suffer from bunions, you might not know what they are. In a bunion, the bone that supports the big toe (the metatarsal) moves out of alignment and starts to point more towards the midline of the body. To compensate, the rest of the big toe ends up pointing back toward the rest of the foot. This creates a bump on the edge of the foot that might be painful. There doesn’t seem to be any clear correlation between the size of the bump and the amount of pain it causes. Bunions seem to be hereditary, at least to some extent. Conservative management entails choosing footwear with a roomy toe box, not pointy-toed shoes. Podiatrists also correct bunions surgically. They can choose from a wide range of surgical approaches. In hammer toes, one of the toes (typically the second toe) curls over so that the end that would normally face forward points downward. This too can be corrected surgically, but the recovery can be pretty lengthy. A roomy toe box is also a good bet for living with hammer toe. Taking Care of Your Feet We asked Dr. Andersen for general advice, and she suggested that one very important consideration is to buy your athletic shoes in person, preferably at a store that caters to athletes. Buy the proper shoes for your activity; in other words, don’t try to play pickleball in running shoes. One nationwide chain that does a good job fitting the shoe to the athlete is Fleet Feet. Locally, she recommends Bull City Running. This Week’s Guest Dr. Jane Andersen, Board Certified, American Board of Foot and Ankle Surgery, is in practice at Chapel Hill Foot and Ankle, part of FASMA, Foot and Ankle specialists of the Mid Atlantic, in Chapel Hill, North Carolina. Dr. Andersen specializes in Foot and ankle care for Children, Adults, Athletes and Geriatric Patients including surgery and conservative care. She is a Trustee of the American Podiatric Medical Association. January 18, 2025, Jane Andersen, DPM, was awarded the Edwin B. Martin, Jr., Award for Podiatrist of the Year. https://www.chapelhillfootandankle.com/dr-jane-andersen Jane Andersen, DPM, Chapel HIll Foot and Ankle Listen to the Podcast The podcast of this program will be available Monday, August 3, 2026, after broadcast on Aug. 1. This week’s podcast has additional information on smelly feet as well as foot and nail fungus. What remedies or medications work best? How long does it take for nail to grow out? What are the best toenail clippers? (Miltex) You can stream the show from this site and download the podcast for free.

One of the most basic pillars of health is good nutrition. A range of eating patterns might all be considered balanced diets, but in general people do better when they eat less processed foods and more whole foods. Vegetables and fruits play a starring role in at least two diets that have been studied extensively, the DASH diet and the Mediterranean diet. Americans might be healthier if we followed these eating plans, but fresh veggies can be pricey. If your doctor were prescribing produce, would your insurance plan cover it? Might this make healthful eating more of a practical possibility? 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, Jan. 24, 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 Jan. 26, 2026. Food Is Medicine Increasingly, healthcare providers are recognizing the critical role of diet in the development of chronic disease. An entire movement is organizing around the concept of Food Is Medicine, both for prevention and for treatment of conditions like diabetes, obesity and heart failure. Scientists have shown that diet makes a difference. Studies have confirmed what many of our grandparents or great-grandparents intuited. On the other hand, translating that knowledge into action that benefits patients has been difficult. One important barrier is the cost of groceries. Our interview with Peter Skillern and Dr. Seth Berkowitz focused on access to fresh fruits and vegetables for lower-income people in North Carolina. Since we spoke with them, we read about an intriguing effort to provide culturally and medically appropriate food for heart failure patients in Navajo Nation. Traditional Foods for Better Heart Health Food insecurity goes hand in hand with medical complications, as the authors of a new study note ( JAMA Internal Medicine , July 27, 2026 ). The results demonstrate that making sure people with heart failure have the food they need can cut hospitalizations. The Diné (Navajo) community helped design the intervention, named Medically Utilized Tailored Traditional Foods to Optimize Nutrition in Heart Failure (MUTTON-HF, probably a reference to a favored food among the sheep-raising Navajo). According to the investigators, “We partnered with local Navajo farmers and ranchers to source meat and produce and with Tocabe, a Native-run kitchen, to produce the medically tailored frozen meals, practicing whole animal utilization and Native first supply chain when possible.” The study provided intensive support, including refrigerators and microwaves to families that did not have them. The researchers recruited 206 heart failure patients at two Indian Health Service sites in Navajo Nation to participate. A total of 206 patients were randomly assigned to receive culturally and medically tailored meals along with their healthcare or to get usual care without meals. The meals were designed to follow DASH (Dietary Approach to Stop Hypertension) sodium-restricted guidelines. For example, one breakfast provided consisted of blue corn meal, blueberries, bison sausage, potatoes and butternut squash. A sample lunch included mutton, steamed corn, blue corn meal and wild rice. People in the control group, who got no meals during the trial, could opt for an equivalent number of meals to be provided after the study assessment was completed. This was deemed fair by the community. By the end of the two month trial, 40% of those getting meals had needed emergency care or hospitalization. In comparison, 57% of those who did not receive meals needed hospitalization or emergency intervention. The rate of hospitalization for heart failure was sharply different, 4% vs. 13%. The authors conclude: “Community-based interventions that leverage protective assets of Native communities are needed to advance Indigenous health.” What Should We Learn from the MUTTON-HF Trial? An editorial ( JAMA Internal Medicine , July 27, 2026 ) pointed to some of the unusual features of the experiment that contributed to its success: “Success required collaboration between local Diné (Navajo) community-based organizations, kitchens and food producers, working alongside Indian Health Services, clinicians, and academic partners. “Importantly, the study team prioritized listening to community and prepared meals using foods foundational to Diné cuisine.” The editorialists note that this food is medicine approach has the potential to be even more powerful than some potent medications: “The second takeaway is that healthy, Indigenous foods and a community-centered approach resulted in larger reduction in HF-specific hospitalizations than a recent trial of glucagon-like peptide-1 (GLP-1) receptor agonists, 2 a medication now driving a $100 billion industry. A medication with trial evidence showing the same results as this meal study, particularly one with such a favorable adverse effect profile, would be a major therapeutic achievement and likely covered by insurance. This framing is not to pit medically tailored meals and GLP-1 drugs against each other, but rather to highlight the scale of improvements observed in this study. Meals and other treatments such as GLP-1 drugs are not mutually exclusive and can have complementary benefits, as GLP-1 drugs do not necessarily improve dietary intake. One treatment represents a marvel of pharmaceutical innovation; the other reflects the power of healthy meals rooted in cultural celebration.” Doctors Prescribing Produce In North Carolina, the approach was different. In former times, people could get healthful food in a variety of ways. Past generations often had gardens and grew much of their own produce. That’s not always practical in urban settings or for families with multiple jobs struggling to make ends meet. Our guests today have tested two ways to get fresh food into people’s hands. One is a debit card that can be used to buy any WIC-approved food at more than 66,000 retail outlets across the country. WIC is the USDA supplemental nutrition program for Women, Infants and Children. WIC-approved foods include fresh fruits and vegetables with no added sugar or salt. In this model, the healthcare provider arranges for certain patients to get access to this debit card, providing $40 worth of purchasing power for healthy foods each month. They are essentially prescribing produce. The idea is to use a business model that supports good food and saves the health system money. This is termed a healthy food subsidy. The other approach is a food box. This includes vegetables and fruits, and possibly other foods, that providers decide the patients should get. In some initiatives, the person or agency deciding what goes in the food box might also take into account what is available from local farmers. The box may be distributed weekly, every two weeks or every month, but the individual who is going to be eating the food does not choose what is in it. How Does a Healthy Food Subsidy Compare to Food Boxes When Providers Are Prescribing Produce? When people don’t know if they will be able to pay for the groceries they need, they are said to be “food insecure.” This complicates a range of chronic conditions, making diabetes more challenging, for example. People with food insecurity have a harder time keeping their blood pressure under control. Our guests collaborated with other colleagues on a recent comparing the food box approach to the healthy food subsidy among North Carolina resident with high blood pressure and food insecurity ( JAMA Internal Medicine , Dec. 1, 2025 ). The study enrolled 458 individuals. Everyone in the study had a provider prescribing produce. Half the volunteers got the food subsidy debit card and half were provided with food boxes. Those getting the food subsidy had moderately lower blood pressure after six months compared to those getting food boxes. Their blood pressure was also lower after a year and a half. Food insecurity decreased in both groups over time. Tackling Food Insecurity One of the outcomes of food insecurity is that people are more likely to need emergency department services. This costs the insurance company dearly. If improving food security and diet quality could reduce ED visits, insurers might become quite interested in the food subsidy approach. This is currently being tested for participants with heart failure. Special Populations Who Might Need Providers Prescribing Produce During this conversation, we expressed concern about vulnerable populations that might suffer especially from cuts in government spending. We asked about school lunches and we learned about pilot programs focusing on expectant mothers. Children in foster care are especially vulnerable; a food subsidy program taking a Food Is Medicine approach could be helpful for them. This Week’s Guests Seth A. Berkowitz, MD, MPH, is Associate Professor of Medicine at the University of North Carolina School of Medicine. He is also Section Chief for Research, General Medicine and Clinical Epidemiology. Dr. Berkowitz is a general internist and primary care doctor, studying how food and nutrition interventions can improve health. Dr. Berkowitz is the deputy scientific director of the American Heart Association’s Food is Medicine initiative, Health Care by Food initiative. He is also the author of the recent book, ‘ Equal Care: Health Equity, Social Democracy, and the Egalitarian State .’ The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Dr. Seth Berkowitz of UNC promotes Food Is Medicine Peter Skillern has pursued a career dedicated to creatively and effectively addressing poverty and inequality in North Carolina and the nation. He serves as the CEO of Durham-based Reinvestment Partners, an innovative nonprofit that works with people, places and policy to foster healthy and just communities. Reinvestment Partners advocates for financial and health reforms to improve people’s lives. The agency has won numerous accolades and is considered a state and national leader in its field. In recognition of his leadership, he was selected as a William Friday Fellow for Human Relations and as an Eisenhower Fellow for International Relations. He holds North Carolina General Contractor and Real Estate Broker licenses. He received his B.A. from the University of California Santa Cruz with Highest Honors. A 1991 graduate of the Department of City and Regional Planning at UNC Chapel Hill, he was recognized as a Distinguished Alumni by the UNC faculty in 2020. Peter Skillern, CEO of Reinvestment Partners Listen to the Podcast The podcast of this program will be available Monday, Jan. 26, 2026, after broadcast on Jan. 24. 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 1459 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. Good nutrition is an undisputed pillar of health. Sadly, it seems to be out of reach for too many Americans. This is the People’s Pharmacy with Terry and Joe Graedon. Terry 00:34-00:40 What if modern medicine made nutrition a priority? How would that change what we eat? Joe 00:40-00:54 The food industry has learned how to make ultra-processed food tasty and accessible, even in food deserts. But is it contributing to our epidemic of obesity, diabetes, and heart disease? Terry 00:55-01:00 How is the Food is Medicine movement changing our approach to fresh fruits and vegetables? Joe 01:01-01:06 Coming up on The People’s Pharmacy, should your doctor be prescribing produce? Terry 01:14-02:11 In The People’s Pharmacy Health Headlines: The CDC is reporting that the flu season might have peaked. Laboratory testing suggests a downward trend in flu cases. That said, this federal agency is estimating that 18 million people have caught the flu so far and 230,000 patients have been hospitalized. We’re also nearing an approximate 10,000 deaths from the flu. The CDC has classified children as experiencing high severity influenza this season and adults moderate severity. Some experts are challenging the CDC’s numbers. That’s because the data are delayed by about two to three weeks. We may still be in the early stages of this influenza outbreak. Australia’s flu season, for example, started early and lasted a long time. In the U.S., February is often our peak month for flu. Joe 02:11-02:55 A report in JAMA Internal Medicine suggests that older people who get high-dose influenza vaccines are better protected against infection. Over 300,000 Danish citizens participated in a study that randomized to either high-dose or standard-dose flu shots. The investigation covered three flu seasons. This analysis considered how well the vaccination protected against heart failure and other cardiovascular complications, as well as influenza. Those who got the bigger dose had fewer hospitalizations for cardiorespiratory problems. People with diabetes also fared better on the high-dose vaccine. Terry 02:56-03:53 Measles continues to spread at an alarming rate. Earlier this year, there was a large, long-lasting outbreak that started in Texas. While that one has calmed, South Carolina is now in the midst of a serious outbreak. Cases have doubled over the past week or so, and the total number is above 560. While most cases have been seen among children, at least two university populations are also experiencing cases. Both Clemson University and Anderson University are dealing with confirmed measles cases in the student body. There are also cases being reported in North Carolina that seem to be linked to the South Carolina outbreak. Public health authorities point to vaccination rates below 90%, which is not enough to provide herd immunity for people unvaccinated against this extremely contagious and potentially dangerous disease. Joe 03:54-04:20 Last fall, the administration warned pregnant women to avoid acetaminophen because of concerns about autism. A new systematic review in the British journal The Lancet included 43 studies. The authors concluded that there’s no evidence that taking acetaminophen during pregnancy significantly increases the risk for autism spectrum disorder, ADHD, or intellectual disability. Terry 04:21-06:17 Falls are dangerous for older people and can result in injury, limited mobility, and even death. For decades, scientists have wondered whether vitamin D might help with muscle strength and balance and thus prevent falls. The results of studies have been inconsistent. Finnish researchers took advantage of an existing study called the Finnish Vitamin D trial to investigate this question. Nearly 2,500 healthy older participants were assigned to take vitamin D3 at 1,600 international units or 3,200 international units a day or placebo. The investigators collected data on falls and injuries at baseline and at 1, 2, 3, and 5 years. Blood levels of 25-hydroxyvitamin D increased among the individuals taking vitamin D supplements. Over 5 years, just over half of the volunteers had taken a fall and 11% had sustained injuries. Those proportions did not vary much between any of the groups, including those on placebo. The scientists concluded five-year vitamin D supplementation of 1,600 international units a day or 3,200 international units a day did not affect the overall risk of falls or fall injuries among generally healthy, largely vitamin D-sufficient men and women. And that’s the health news from The People’s Pharmacy this week. Welcome to The People’s Pharmacy. I’m Terry Graedon. Joe 06:17-06:43 And I’m Joe Graedon. Our topic today is food. And I have to admit that I’m biased. My earliest years were spent on a dairy farm in eastern Pennsylvania. Even after we moved, visiting Uncle Leo was a highlight because of the vegetables and super fresh whole milk. Uncle Leo and my mom, Helen Graedon, lived into their 90s and prized real food. Terry 06:43-06:55 Good fresh food is a delight that’s not available to everyone. Should we also be thinking of food as medicine? If so, how could we make it affordable and accessible? Joe 06:56-07:02 We have two distinguished guests today who are at the forefront of the food as medicine movement. Terry 07:03-07:37 Dr. Seth Berkowitz is Associate Professor of Medicine at the University of North Carolina School of Medicine and Section Chief for Research, General Medicine, and Clinical Epidemiology. He’s a general internist and primary care doctor studying how food and nutrition interventions can improve health. Dr. Berkowitz is the Deputy Scientific Director of the American Heart Association’s Food is Medicine Initiative. His book is “Equal Care: Health Equity, Social Democracy, and the Egalitarian State.” Joe 07:38-08:03 We’re also talking with Peter Skillern, CEO of the nonprofit agency Reinvestment Partners, an innovative nonprofit that works with people, places, and policy to foster healthy and just communities. In recognition of his leadership, Peter was selected as a William Friday Fellow for Human Relations and as an Eisenhower Fellow for International Relations. Terry 08:04-08:06 Welcome to The People’s Pharmacy, Peter Skillern. Peter Skillern 08:07-08:08 Thank you so much, Terry. It’s good to be here. Terry 08:09-08:12 Welcome to the People’s Pharmacy, Dr. Seth Berkowitz. Dr. Seth Berkowitz 08:12-08:13 Thank you. I appreciate the invitation. Joe 08:14-08:25 We are delighted to be able to talk about one of our favorite topics, which is food. And, you know, Terry’s grandparents were very involved with food a very long time ago. Terry 08:26-08:41 That’s true. My grandfather was the butcher in the little town in western Nebraska where they lived. And my grandmother had a huge garden and raised chickens. I mean, it wasn’t a hobby. It was just, you know, what you did. Joe 08:41-09:09 And my grandfather, at the early part of the 20th century, was a back-to-the-land kind of guy. He bought a farm in Pennsylvania, and my uncle Leo ran that farm for decades. He was a dairy farmer. And my mom and dad were always very big on gardening. They had a huge garden, and they prized their fresh vegetables. Like you would eat them in the garden because they were so delicious. Terry 09:10-09:43 Well, you know, most people today don’t have that experience. They don’t have the space. They don’t have the time to do a garden. They may not have the knowledge. So how

Are you concerned about your bone health? Do you worry about osteoporosis? According to the CDC, more than 10 million Americans have low bone density that makes them more vulnerable to fractures. For many older people, a fracture can be devastating, reducing mobility and possibly even leading to death. What does the latest medical science tell us about how you can maintain strong bones? 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 may have heard this interview when it was first broadcast on Saturday, Sept. 27, 2025. If you did not, you can download the mp3 using the link at the bottom of the page, or listen to the stream on this post by clicking on the little triangle in the green circle. We have added extra information to these notes, but not to the interview itself. Strong Bones You may have seen Halloween skeletons or even chewed the meat off a bone that you then dropped on a plate with a clatter. No wonder we usually think of bones as hard, unchanging objects. Dead bones are. But living bones are quite different. Strong bones are constantly undergoing change. Scientists call it remodeling. One set of specialized cells, osteoclasts, breaks bone tissue down and recycles it. Another set, the osteoblasts, builds bone back. Ideally, their activities are in balance. But if the osteoclasts start to get ahead, as they tend to do while we age, that can weaken bone. The result is low bone mass, known as osteopenia, or even serious bone loss called osteoporosis. This puts a person at risk for fractures. Who Gets Osteoporosis? Osteoporosis may have been less common a hundred years ago or more, when many people had to do manual labor that put stress on their bones. That helps for strong bones, so today’s sedentary lifestyles can undermine bone health. Although we think of osteoporosis as typically affecting postmenopausal women, men can lose bone mass too. Medications may contribute to the risk for bone loss. Steroids such as prednisone or methylprednisolone are especially risky if taken for a long period of time. Androgen deprivation therapy for prostate cancer is a risk factor specifically for men. Wait–MEN Can Get Osteoporosis? Q. My husband and I have two friends with significant disability largely due to spinal fractures as a result of osteoporosis. One man was always an avid exerciser, including running marathons. Both men are over six feet tall and have always appeared to be muscular. My husband is shorter and is physically active, playing tennis and going to the gym regularly. Because of our friends’ bone issues, I advised him to request a DXA scan to assess his bone health. The nurse practitioner told him that it was not recommended for men. I am still concerned that he may be at risk for osteoporosis. Are there medical studies that determine the risk factors for men? A. The nurse practitioner was mistaken. Men can develop osteoporosis, as your friends discovered. Many medical guidelines recommend that men over 70 be tested with a DXA scan to assess bone health. If your husband has low testosterone levels or has taken medications such as prednisone, he could be at increased risk for a fracture. He would be prudent to have the assessment. Diagnosing Osteoporosis Doctors assess bone mineral density with imaging called dual-energy X-ray absorptiometry, or DEXA for short. Then they compare the results on the scan to the results they would expect from a 30-year-old person. Results more than 2.5 standard deviations from that could result in a diagnosis of osteoporosis. A person who experiences a fracture without trauma, such as falling from standing height, is also suspected and often diagnosed with osteoporosis. Non-Drug Approaches to Strong Bones: People who want to keep strong bones need to focus on exercise. High intensity exercise can be helpful, but brisk walking may be enough. Tai chi and yoga are also popular. If you have been diagnosed with osteoporosis, be sure to check in with your doctor before you start a new exercise program. Building balance and core strength without increasing your risk of a fall (and thus a fracture) would be ideal. Our guest expert, Dr. Kendall Moseley, says the jury is still out on technology such as vibrating platforms, weighted vests or vibrating belts. More studies should show how valuable these could be. Following a diet that supplies adequate protein, vitamin D and calcium is also crucial. If you must take a calcium supplement, calcium citrate may be well tolerated and absorbed. How Do Doctors Treat Osteoporosis? Physicians prescribe several different types of medications to help curb bone less and perhaps even build it back. Some of the oldest and least expensive are the bisphosphonates such as alendronate (Fosamax). These slow bone break down and give the osteoblasts a chance to catch up. They can be hard on the digestive tract, though, and they have been associated with a few rare but alarming side effects: jawbone deterioration and atypical thigh bone fracture. Most people seem to do well on them. Doctors generally prescribe them for up to five years. Did You Forget Evista? Another type of osteoporosis medicine is called raloxifene ( Evista ). It is appropriate only for women, because it is an estrogen modulator. It acts like estrogen in the bones and reduces bone loss. In the breast and uterus, it opposes estrogen activity. Raloxifene does double duty in reducing the risk of breast cancer as well as osteoporosis. Like all drugs, though, it has some worrisome side effects. It can increase the risk of blood clots that cause deep vein thromboses and strokes. What About Prolia? Denosumab ( Prolia ) is a monoclonal antibody that also interferes with osteoclasts. That is how it improves bone density. One thing to keep in mind about Prolia is that stopping it requires careful planning and backup medication. Otherwise, a patient can lose all the bone that was built rather quickly and may suffer debilitating fracture. This Week’s Guest Kendall F. Moseley, MD, is Associate Professor of Clinical Medicine in the Division of Diabetes, Endocrinology, and Metabolism at Johns Hopkins University School of Medicine. She is also Clinical Director of the Division of Diabetes, Endocrinology, and Metabolism at Johns Hopkins University School of Medicine. In addition, Dr. Moseley is Medical Director of the Johns Hopkins Metabolic Bone & Osteoporosis Center. Kendall F. Moseley, MD, Johns Hopkins University School of Medicine Listen to the Podcast: The podcast of this program will be available Monday, Sept. 29, 2025, after broadcast on Sept. 27. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform. In the podcast for this episode, we discuss the pros and cons of estrogen for strong bones. You’ll also learn about a drug that builds bone, teriparatide (Forteo). And you’ll hear about the importance of preventing falls and how to do that. Download the mp3 , or listen to the podcast on Apple Podcasts or Spotify . Transcript for Show 1446: 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 00:06-00:13 You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Joe 00:14-00:27 Hypertension is often called the silent killer, but osteoporosis might be considered a silent and deadly disorder. This is The People’s Pharmacy with Terry and Joe Graedon. Terry 00:34-00:41 If an older person breaks a hip, the consequences can be disastrous. They often lose mobility and they may even die. Joe 00:42-00:50 The focus for osteoporosis is usually on older women, but we should remember that men can also lose bone and become vulnerable. Terry 00:51-00:57 There are drugs that hurt bone health as well as help build it back. What about supplements or exercise? Joe 00:57-01:06 Coming up on The People’s Pharmacy, the science of strong bones, lifestyle, medication, and movement. Terry 01:14-02:32 In The People’s Pharmacy health headlines, semaglutide has gotten a lot of attention over the past few years. If you don’t recognize this generic drug name, you probably do recognize the brand names. Ozempic for type 2 diabetes and Wegovy for weight loss. Both these medications are self-administered injections, but not everyone is enthusiastic about needles. There’s also an oral form of semaglutide called Rybelsus. The FDA has approved it for treating type 2 diabetes six years ago, and so far it has mostly gone under the radar. A new study published in the New England Journal of Medicine demonstrated that oral semaglutide at 25 mg a day helped people without diabetes lose significantly more weight than placebo. The randomized trial included more than 300 volunteers and lasted approximately a year and a half. This could be good news for people who have trouble accessing injectable semaglutide or keeping it cold. People taking semaglutide reported improved quality of life. They were also more likely to report side effects, especially digestive distress. Joe 02:34-04:17 Aspirin has been available for well over 100 years, but the active ingredient has been used by native healers for thousands of years. In 1991, a research article in the New England Journal of Medicine reported that regular aspirin users were 40 to 50 percent less likely to die of colon cancer. Now, 34 years later, another research paper in the New England Journal of Medicine reports that people taking aspirin had a significantly lower chance of colorectal cancer recurrence. Swedish scientists recruited patients after they’d had their tumors removed. The particular hotspot mutation called PIK3CA. The aspirin dose was 160 milligrams, or roughly half a standard strength tablet daily, for three years. 626 patients were randomly assigned to receive either aspirin or placebo. 7.7% of people taking aspirin experienced a recurrence of their colorectal cancer, whereas 14.1% of those on placebo had a recurrence. That was about a 50% relative risk reduction. 43% of the participants taking aspirin experienced a non-severe side effect compared to 35% of those on placebo. Serious adverse events occurred in 17% of aspirin takers compared to 12% of placebo recipients. The authors conclude that low-dose aspirin represents an effective, low-cost treatment approach to prevent colorectal cancer recurrence in high-risk, genetically selected patients. Terry 04:17-04:58 Nutrition experts have praised the Mediterranean diet as a way to reduce cardiovascular risk. It’s also been considered as a way to lower the likelihood of developing dementia and a natural approach to calming inflammation. Now, dermatologists have announced the results of a study showing that four months on a Mediterranean diet can reduce the severity of psoriasis symptoms. Almost half of the participants following a Mediterranean diet reduced their psoriasis score by 75 percent, and none of those on the control diet did so. The researchers conclude that this dietary strategy could be helpful along with medical treatment. Joe 04:59-05:41 A new study of acupuncture for chronic low back pain called Back in Action produced positive results. 800 patients were randomized to receive either standard acupuncture of 8 to 15 treatment sessions, enhanced acupuncture, which included 4 to 6 maintenance sessions beyond the standard, or usual medical care alone. Those in the acupuncture groups had significantly greater reductions in their pain-related disability than those in the usual care group. The authors conclude that, quote, these findings support acupuncture needling as an effective and safe treatment option for older adults with chronic low back pain. Terry 05:42-06:05 Do cocoa flavanols normalize blood pressure? In the COSMOS study, people with systolic blood pressure under 120 were significantly less likely to develop hypertension if they were taking cocoa flavanols than if they took placebo pills. People whose blood pressure started higher did not get the same benefit. 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 06:17-06:29 And I’m Joe Graedon. According to the CDC, over 10 million Americans over 50 have osteoporosis. That means their bones have become fragile and more vulnerable to fracture. Terry 06:30-06:40 More than 40 million Americans have low bone mass or osteopenia. What can be done to prevent fractures, disability, and death from weakened bones? Joe 06:41-07:00 To find out, we’re talking with Dr. Kendall Moseley. She is Associate Professor of Clinical Medicine in the Division of Diabetes, Endocrinology, and Metabolism at Johns Hopkins University School of Medicine. She also serves as medical director of the Johns Hopkins Metabolic Bone and Osteoporosis Center. Terry 07:01-07:04 Welcome to the People’s Pharmacy, Dr. Kendall Moseley. Dr. Kendall Moseley 07:05-07:10 Thank you so much for having me today. I’m very excited to chat with you both about a topic that’s near and dear to my heart. Joe 07:11-07:48 Well, it’s near and dear to our hearts as well, Dr. Moseley, but I suspect that there’s a tremendous amount of confusion when it comes to bones because we’ve all seen skeletons. We’ve all had interactions with bones, perhaps in food. And it just always seems as if bones are so solid. And yet, in reality, bones are constantly breaking down and building up. It’s a very dynamic process. Could you just give us a quick overview on bone physiology? Dr. Kendall Moseley 07:49-09:21 Absolutely. And I think you’ve highlighted something I always try to stress when I talk to groups of people is that bones are not these inanimate objects. I mean, we’re not these walking, kind of lumbering rocks moving down the street. In fact, we have this very important scaffold underneath our skin that enables us to walk and roll and twist and bend. And without a very strong scaffold, we’re kind of in trouble. So you’re right. Bones are dynamic. Our bones are always building up and they’re always breaking down. And it’s that process of kind of building up and breaking down that allows us to be flexible, right? If we didn’t have remodeling of our bones, we’d be very stiff and brittle. But it’s that balance, that key balance of how our bones build up and how they break down that really dictates how strong our bones can be. Clearly, you would prefer a lot more building up than breaking down. And at different parts in our life cycle or different times in our life cycle, we have different balances in that building up and breaking down. If you really want to get into the nitty gritty of the pathophysiology, which I think is important to understand because there are two very different types of cells that treatments for bone disease sometimes impact, we really boils down to these cells, one of which is called the osteoclast. It’s kind of like a little Pac-Man cell that’s responsible for breaking down our bone if it’s an area of injury or a little micro fracture. So that osteoclast will come in and kind of carve out a pit of bone so that the osteoblast, B as in build, can come in and fill in new bone. Again, to rejuvenate that area and to keep your bones flexible. Terry 09:22-09:34 And I’m assuming that as we get older, there are more osteoclasts or they’re moving faster than the osteoblasts building our bones back. Am I wrong? Dr. Kendall Moseley 09:35-10:58 No, I think that that’s a wonderful way to think about it. You know, the life cycle is complicated. You know, when I meet patients for the first time, and again, I’m in a metabolic bone clinic, so I see patients who generally come already with a diagnosis of osteoporosis or low bone density. And when we’re sitting there talking to one another, we say, gosh, why aren’t your bones perfect? And believe it or not, what we do is we go all the way back to childhood because changes happen throughout the life cycle to bones. We build or gain bone. We’re building more bone than we’re breaking down until about the third decade of life. So those osteoblasts are overtaking the osteoclast to give us nice, strong skeletons. So you might imagine how early childhood insults could impact the bones. In midlife, we have kind of a steady state where the blasts in the clasps are kind of remodeling at a usual rate, generally in balance with one another. At around the time of menopause that women go through, there is a steep decline in bone density, which is driven primarily by those osteoclasts, those Pac-Man cells that break down bone at a much more rapid rate than the osteoblasts are able to keep up with. And men have an inflection point later on in life. They don’t go through a menopause per se, but about the time, about 70 years of age or so, again, that imbalance starts to shift, which favors the osteoclast or bone breakdown, where again, it’s kind of like a tortoise and the hare story that the tortoise is no longer keeping up with the hare and the bones will break down. Joe 10:59-11:46 Dr. Moseley, I’m curious as to how things have changed, because I suspect that our ancestors, and when I say our ancestors, I’m not talking about Neanderthals. I’m talking more about our grandparents and our great-grandparents. they were probably spending a lot more time outdoors. You know, farmers and just workers and, you know, both men and women were just physically more active than we are today. Today, I think we spend a lot of time sitting. And I’m curious as to how our lifestyles have affected bone health over the last, let us say, 50 to 100 years. Dr. Kendall Moseley 11:47-13:01 Now, I think that that is a fair assessment. We know that activity movement is critical for bone health. You know, in fact, when we talk about the tenets of therapy for osteoporosis and low bone density, one of the things we always have to discuss in clinic is how can we get you more active? What kinds of exercises should you be doing? Because movement really stimulates those bones to kind of rebuild, grow, remodel. And so absolutely, you know, back in the days when we were out and about, you know, in the farms or, you know, pushing things, you know, down the street. I think we did have a lot more activity related to our bones. I will also counter, though, you know, we didn’t live as long back in the day. And so that graph that I just kind of talked about with this aging process kind of inevitably causing slow and steady bone loss as we get older, a lot of the implications for weakened bone really don’t occur until that later stage in life where women are postmenopausal or men are older. And so did we really see the full effects of osteoporosis and bone loss, you know, in prior generations when perhaps they didn’t live to be the older ages where the fracture started to manifest or people passed earlier from other conditions that we didn’t have treatments for? Terry 13:01-13:19 Dr. Moseley, I want to just revisit something yo

Do you have trouble sleeping? An occasional late night or early morning is probably not dangerous, but too many people get too little sleep on a regular basis. How does that affect their health? Even more importantly, what can they do to change the situation? You’ll want to listen to find out if you need a sleep reset. 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, July 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 July 20, 2026. The podcast will be available on Monday (July 20, 2026) Do You Need a Sleep Reset? Why is sleep so important for good health? Our guest is a sleep medicine specialist who uses a metaphor of Disneyland. Crucial maintenance on the theme park happens at night, when there are no visitors. Streets are cleaned, flower beds are weeded, and rides are inspected and, if needed, repaired. None of that can happen while the park is open for business. Our bodies and brains also need time for maintenance and repair, and some of that happens while we are sleeping. When we don’t get the rest we need, we may find ourselves at increased risk for diabetes, cardiovascular problems, cancer, cognitive challenges and even premature death. Unfortunately, anxiety about not sleeping can keep people awake all on its own. How can people break that cycle? We’ll also discuss ways that people can get help avoiding screens at night. That is an important part of a sleep reset. Blue light from the screen signals the brain to be alert instead of relax. Scrolling social media can often be emotionally upsetting, which also makes it more difficult to fall asleep. Is Your Diet Keeping You Awake? Most of us recognize that a big midnight snack, á la Dagwood Bumstead of the Blondie comic, is probably not conducive to sleeping well. How does nighttime eating affect our circadian rhythm? Are there diets that we should avoid because of their impact on sleep? Dr. Seheult describes a study in which volunteers had their sleep stages monitored closely during the time they were consuming different diets ( Obesity , July 2023 ). When they followed a high-fat, high-sugar diet, it disturbed the pattern of their brain waves during what should have been restorative sleep. How Do Sleep Problems Affect Eating Habits? A lot of us are aware that when we are sleep deprived, we are more inclined to become hangry and we may be less discerning about what we eat. A recent study shows that the sleep deprivation can have an effect even if it is fairly mild and short-term. Scientists recruited people who normally sleep seven to eight hours a night and asked them to stay up an extra hour and a half ( Annals of Internal Medicine , July 7, 2026 ). During the six weeks of that part of the experiment, people were less active during the day. They also ate more, so they gained about a pound, on average, during those six weeks. Presumably, disrupting sleep for a longer period of time would result in greater weight gain and metabolic disruption. Would a Ketogenic Diet Help with a Sleep Reset? A ketogenic diet, in which the body relies on ketones rather than glucose for energy production, may be helpful. In particular, fasting overnight for at least 14 hours helps the body do what it must during sleep time. To figure out when you should stop eating, identify when you usually start to feel sleepy. That should be your bedtime. Having your last meal of the day about three hours before that will generally offer enough time for digestion so that you don’t experience reflux in the middle of the night. Morning Light and Afternoon Naps Your sleep reset may depend on getting your own circadian rhythm to synchronize with the rest of the world. That is where early exposure to morning light comes in. It’s beginning to feel a bit like The People’s Pharmacy is on repeat: get morning light exposure! It sets your system up for feeling awake and alert during the day and starting to feel sleepy as the light fades in the evening. Obviously, this is most helpful for people who work during daylight hours. Those working overnight shifts would have to organize their days differently. People who have trouble falling asleep may be tempted to take a nap in the afternoon to make up for the lost sleep. That could be a mistake, as it relieves the sleep pressure that helps people fall asleep without trying. Learning to Fall Asleep If you interact with parents of very young children, you may have heard of sleep training. People have strong feelings about this, both pro and con. Adults rarely need sleep training, though. What we are more likely to need is “not-sleeping un-training.” Too many people approach the bedroom as though it were a stage, and sleep is the performance. No wonder they may develop some performance anxiety about sleeping! Other individuals have learned to associate the bedroom with tossing, turning and watching the clock. Consequently, their bodies tense up instead of relaxing when they get between the sheets. There is no easy quick fix for this problem, but cognitive behavior therapy for insomnia has been proven effective for most people. How About PM Pain Relievers? Even though there isn’t an easy fix for sleep troubles, many people want one. They reach for the PM pain reliever and hope it will offer them a good night’s sleep without a prescription. The “PM” part of that pain reliever is an old-fashioned antihistamine called diphenhydramine. You might be more familiar with its brand name: Benadryl . You’ll also find it in Tylenol PM , Advil PM and all the other PM meds because it tends to make people feel drowsy. What’s wrong with that? To start with, it isn’t clear that it remains effective after a week or two. In addition, people with restless leg syndrome often find that it makes their condition worse. Other folks report that diphenhydramine can result in an unpleasant “hangover” the next day, in which they feel drowsy though not asleep for a good part of their waking hours. What Wakes You Up at Night? If your sleep problem is waking in the wee hours and having trouble getting back to sleep, you should consider the possibility that you have sleep apnea. The REM sleep of those early morning hours is not as deep as some other sleep stages. Consequently, an alarm signal from your brain saying you haven’t taken a breath for 20 or 30 seconds may be more likely to wake you. Sleep apnea may be treated by providing air so that the pressure props the collapsing airway open. We discuss this in greater detail along with a new alternative to a CPAP machine in the podcast for this week. This Week’s Guest 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, July 20, 2026, after broadcast on July 18. 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 .

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