Q&A with Leyla, Part 1: Niacin

New weight loss drugs may portend end of “Fat Acceptance” movement; Celebs and Southerners embrace GLP-1s; Trump clears path for more access to diet drugs; Mid- and late-life exercise slash dementia risk; “Ethicists” urge more tick-borne meat allergy to save planet—as alpha-gal syndrome claims first fatality; What’s wrong with the melatonin study that claims it leads to heart failure? How to detox 9-11 first-responders? Can weekend warriors obtain same benefits as regular exercisers? 

Can natural herbs aid recovery from anorexia? What an analysis of Hitler’s DNA tells us about how genes shaped his personality; Can surgical anesthesia accelerate memory loss?  Bananas could be interfering with your smoothie’s health benefits; Not just sun, but pesticides and herbicides increase risk for melanoma; Chemical residues on produce impair male fertility; Proliferation of fast-paced social media videos are dumbing us down; Doctors aren’t less resilient, the demands of medicine are just fostering unprecedented levels of physician burnout.

Registered dietitian nutritionist Leyla Muedin discusses a New England Journal of Medicine paper (July 2024, cited via Holistic Primary Care) warning about drug-induced magnesium depletion, especially from diuretics, proton pump inhibitors (e.g., Nexium, Prilosec), and certain antibiotics. She notes magnesium is often not routinely measured despite links between deficiency and cardiovascular, metabolic, and neurological problems, including arrhythmias (AFib, long QT, torsades), endothelial dysfunction, and longer ICU stays. Prevalence estimates range from 7–11% (up to 20%) in hospitalized patients and 2–4% among outpatients, with higher rates among long-term PPI and diuretic users. She reviews symptoms and causes, explains limits of serum magnesium testing, highlights associations with diabetes, alcohol use, low potassium and calcium, and outlines evaluation options and oral repletion approaches, favoring better-absorbed forms like magnesium glycinate over oxide due to diarrhea risk.

A discussion of the book "Rethinking Diabetes" by Gary TaubesCORRECTION: Transcatheter Mitral Valve Replacement (TMVR)The impact of hops on the microbiomeA listener's suggestion on avoiding microplastics

What do you think of continuous blood pressure monitors?Should certain supplements be taken at different times of day or apart from each other?My pediatrician couldn't provide a list of calcium-rich foods for my kids with dairy intoleranceWhat are your thoughts on the HPV vaccine?Remembering a long-ago debate with a Quackbuster

Harvard-trained psychiatrist Dr. Georgia Ede is the author of "Change Your Diet, Change Your Mind: A Powerful Plan to Improve Mood, Overcome Anxiety, and Protect Memory for a Lifetime of Optimal Mental Health." She links diet to the mental health crisis and dementia risk. Ede explains that conventional psychiatric training ignored nutrition, and she later incorporated dietary strategies alongside medication and psychotherapy after personal health experiences. She emphasizes focusing on metabolic and nutritional quality—especially stabilizing blood sugar and insulin—rather than simplistic plant-vs-animal messaging. She argues some animal foods are needed for brain nutrients like B12 and EPA/DHA. She discusses ketogenic diets as a way to lower insulin, produce ketones, improve brain energy, and reduce inflammation, citing case reports and a study of hospitalized patients where many improved and 44% reached remission. She critiques nutrition epidemiology as unreliable and outlines three “quiet” dietary tiers: whole-food low-glycemic, ketogenic, and carnivore, plus practical issues like electrolytes and gradual transition.

Dr. Hoffman continues his conversation with Harvard-trained psychiatrist Dr. Georgia Ede, author of "Change Your Diet, Change Your Mind: A Powerful Plan to Improve Mood, Overcome Anxiety, and Protect Memory for a Lifetime of Optimal Mental Health." 

Dr. Bret Scher, medical director of the Coalition for Metabolic Health, discusses making metabolic health the foundation of medicine amid rising obesity and type 2 diabetes and reports that 93% of Americans have suboptimal metabolic health. Scher defines metabolic health using markers including glucose, insulin, triglycerides, HDL, blood pressure, and waist size, and cites evidence linking insulin resistance to heart disease, stroke, cancer, psychiatric illness, and other complications. They discuss simple self- and lab-assessments (waist-to-height ratio, fasting insulin with glucose/HOMA-IR, triglyceride-to-HDL ratio, CGMs). Scher critiques the Eat Lancet report for assuming one optimal diet, reliance on low-quality nutrition epidemiology, potential nutrient shortfalls, and environmental oversimplification, while supporting newer dietary guidelines that allow lower-carb approaches. Part two covers contradictory nutrition studies, distinctions between low-carb and ketogenic diets, emerging “metabolic psychiatry” and ketogenic therapy for mental illness and cognitive decline, limits and rebound risks of GLP-1 drugs, and Coalition efforts to improve school food and influence policy.

Dr. Hoffman continues his conversation with Dr. Bret Scher, medical director of the Coalition for Metabolic Health.

The Havana Syndrome coverup—for years, bizarre symptoms were labeled “mass hysteria”, until a covert CIA op secured a portable device capable of delivering brain-scrambling sound pulses; A report card on this year’s flu shot; Omega-3s combat “neuroticism”, dementia—they also tame depression and improve cognitive function and memory in adolescents; A caller with duodenitis wants to know if she should follow advice to take Prilosec for the rest of her life; Is the shingles vaccine worth taking?