STEMTalks Archive

David LeMay bio

Episode 169: Dave Feldman talks about cholesterol and the ketogenic diet

Dave Feldman is the founder of the Citizen Science Foundation and is known for his research into the ketogenic diet. Dave is a software engineer by training who embraced a ketogenic diet to avoid his progression toward type 2 diabetes. he joins us on this episode of STEM-Talk to share that journey.

After undertaking the high-fat/low-carbohydrate diet, Dave’ LDL cholesterol spiked. Dave used his training as an engineer to start learning everything he could about cholesterol and lipids. What he learned led him to create the website Cholesterol Code, a research hub for information and emerging data on cholesterol, particularly in the context of a low-carbohydrate lifestyle.

Dave’s Citizen Science Foundation is designed to support projects and research that promote collaborative efforts across multiple disciplines, both in and outside formal scientific institutions.

Show notes:

[00:02:53] Dawn opens the interview asking Dave what he was like as a kid.

[00:03:44] Dawn mentions that Dave divided his time as a child between Denver and Wichita due to his parents’ divorce and asks Dave what the best part of his childhood was.

[00:04:28] Ken mentions that Dave has described both his parents as graphic artists and Bohemian, “hippie spirit” types. Ken asks what he learned from them that fueled his interests and goals.

[00:05:46] Ken asks about Dave’s first computer, which was a Commodore 64, as well as his early experience with computers.

[00:08:50] Dawn mentions that Dave’s interest in computers came in a time before the internet and asks what he learned about computing in those days.

[00:10:51] Dawn explains that since Dave grew up in the 1980s, there was not much in the way of computer science curriculum in schools and asks Dave how he supported his interest in programming.

[00:12:33] Ken asks Dave about how self-directed learning has been a theme throughout his whole life.

[00:14:35] Dawn asks Dave about his childhood hobbies, including running and competitive storytelling.

[00:17:01] Ken asks how Dave’s experiences in forensic debate in high school helped his career later in life.

[00:18:56] Dawn mentions that Dave initially attended film school and asks if it is true that Dave’s side hustle of doing contract software work overtook his original plan to graduate.

[00:20:49] Dawn asks about Dave’s experiences working in the game platform development business in Las Vegas, as well as what these experiences taught him.

[00:22:23] Ken asks Dave about a “the piece of paper” that Dave says changed his life in 2015.

[00:28:58] Ken follows up, asking Dave if he checked his LDL-P or his ApoB at the same time as his cholesterol levels.

[00:30:37] Ken mentions that he knows some people that when consuming a ketogenic diet did not see a substantial increase in LDL-C, but did experience a substantial elevation of LDL-P.

[00:35:03] Ken pivots to discuss a paper that Dave and others published in Current Developments in Nutrition in 2022 titled: “Elevated LDL Cholesterol with a Carbohydrate-Restricted Diet: Evidence for Lean Mass Hyper-Responder Phenotype.” Ken asks Dave to describe what it means to be a lean mass hyper-responder.

[00:40:19] Ken mentions his caution against the term lean mass hyper-responder, as it is unclear what “lean mass” refers to in this case. Ken goes on to say that while the lean mass hyper-responder phenotype can be objectively measured in terms of LDL, HDL and triglyceride levels, the lean mass aspect is often measured in these studies with BMI, which is unable to measure body composition. Ken asks Dave what his thoughts are on this and if he would like the possibility of moving away from BMI and towards DEXA scans.

[00:43:37] Ken mentions that Dave’s original article describing the lean mass hyper-responder phenotype has received a lot of response from individuals claiming to fall into that category. While it is difficult to get a precise estimate of the population that fits this phenotype, Ken asks Dave what he thinks the percentage might be.

[00:47:33] Dawn asks about the case report published in Frontiers in Endocrinology in 2022 titled: “Case Report: Hypercholesterolemia, Lean Mass Hyper-Responder Phenotype Presents in the Context of a Low Saturated Fat Carbohydrate-Restricted Diet.” This paper highlights the case of a hyper-responder who adopted a ketogenic diet to manage ulcerative colitis.

[00:49:38] Ken asks how long the subject of the case report was on an extremely low-carb diet.

[00:50:48] Ken asks Dave, given that cholesterol levels and lipoproteins are remarkably elevated in lean mass hyper-responders, what he thinks the cumulative cardiovascular implications over an extended period might be.

[00:56:19] Dawn turns to discuss Dave’s 2022 paper on the Lipid Energy Model, titled: “Lipid Energy Model: Reimagining Lipoprotein Function in the Context of Carbohydrate Restricted Diets,” asking him to expound on the concept and its significance.

[00:59:02] Ken remarks on the extraordinarily fast review process for this paper on the Lipid Energy Model, explaining that the paper went through submission, review, revision, acceptance and publishing in 30 days.

[01:00:49] Dawn shifts to ask about a 2023 study by Dr. Isabella Cooper in Frontiers in Endocrinology titled: “Thyroid Markers and Body Composition Predict LDL Cholesterol Change in Lean Healthy Women on a Ketogenic Diet: Experimental evidence for the Lipid Energy Model.”

[01:02:48] Ken asks Dave about his journey to self-fund research through crowdfunding, for which he founded a 501c3 non-for-profit, which in 2019 was named the Citizen Science Foundation. Ken asks Dave what challenges he faced in this endeavor.

[01:05:47] Ken asks Dave to describe how he came to partner with the Lundquist institute at UCLA.

[01:08:33] Ken asks what the state of the Citizen Science Foundation is now, and if it has any projects that it is currently funding.

[01:09:57] Ken asks Dave how he sees the foundation evolving in the future and how he would like it to evolve.

[01:11:50] Dawn asks Dave about a study he and his team have just completed on 100 lean mass hyper-responders who received a CT Angiogram to establish baseline coronary artery status, and then a second scan a year later. Dawn asks Dave to discuss the findings of this study in terms of atherosclerotic plaque in the hyper-responder group as compared to the Miami Heart Study group, as well as the overall findings of the study.

[01:17:36] Ken follows up, asking if the results of the aforementioned study will be published soon.

[01:17:54] Dawn asks Dave about the documentary he is working on.

[01:19:53] Dawn closes the interview asking Dave why The Usual Suspects by Brian Singer is his favorite film.

Links:

Dave Feldman bio

Episode 168: Alessio Fasano discusses celiac disease and gluten-related disorders

Dr. Alessio Fasano, who is considered the world’s leading expert in celiac disease and gluten-related disorders, returns for his second appearance on STEM-Talk. Although just 2 million Americans have celiac disease, an estimated 20 million Americans suffer from gluten sensitivity.

Alessio is a professor and director of the Mucosal Immunology and Biology Research Center at Massachusetts General Hospital. In addition to celiac disease and gluten-related disorders, Alessio’s research is also focused on the microbiome, intestinal permeability and autoimmune disorders, which he discussed in his first interview on STEM-Talk, episode 20.

Since Alessio’s first appearance on STEM-Talk in 2016, he has published two books, “Gluten Freedom” and “Gut Feelings: The Microbiome and Our Health,” which we discuss in today’s interview. We also talk to Alessio about an exciting new project that’s bringing together an international consortium of researchers and scientists for a long-term study that will follow infants who are genetically at risk of developing celiac.

Alessio is a researcher and physician who wears many hats. He is the director of the Center for Celiac Research and Treatment and chief of the Division of Pediatric Gastroenterology and Nutrition at Mass General Hospital. He also is a professor of pediatrics at Harvard Medical School and a professor of nutrition at Harvard’s T.H. Chan School of Public Health.

Show notes:

[00:03:58] Marcas opens the interview welcoming Alessio back to STEM-Talk, mentioning that since his last appearance he has written two books: Gluten Freedom and Gut Feelings: The Microbiome and Our Health. Marcas asks Alessio how he became interested in pediatrics and gastroenterology.

[00:05:42] Ken mentions that Alessio moved to the U.S. in the 1990s and spent 20 years in Maryland at the Center for Vaccine Development in Baltimore. Ken goes on to mention that while Alessio was there, he founded The Center for Celiac Research in 1996, and in 2003, Alessio accepted an offer to join Massachusetts General Hospital. Ken asks how that move came about.

[00:08:53] Marcas asks about Alessio’s early career working on cholera, where he discovered the zonula occuldens toxin, the bacteria that causes cholera. Marcas asks Alessio to talk about this finding and the insights he gleaned from it.

[00:16:03] Ken asks about Alessio’s discovery of zonulin, which is the molecule that modulates gut permeability in humans. Ken asks Alessio to share how this discovery led him to investigate celiac disease, which is triggered by gluten.

[00:20:25] Ken asks Alessio what his thoughts are on why the medical community, historically, has not taken celiac disease seriously.

[00:24:08] Marcas mentions that as we age, there is evidence that the gut becomes leakier, which is highly related to chronic inflammation. Marcas asks Alessio whether this happens to the gut over time due to diet and lifestyle rather than the typical aging process.

[00:28:45] Ken mentions that there has been an increase in the diagnosis of celiac disease. Ken asks Alessio if that is due to an actual increase in the prevalence of the disease, or is it tied to a growing appreciation that clinicians have now for the disease?

[00:29:32] Marcas mentions that Alessio’s book, Gluten Freedom, which he co-authored with his colleague Susie Flaherty, was referred to by the Celiac Disease Foundation as “a must have,” and “an excellent reference for those with gluten related disorders.” Marcas asks Alessio about this reception to his book.

[00:31:24] Marcas mentions that the only viable treatment for individuals with celiac disease has been a gluten-free diet, with pharmaceutical companies having had little interest until recently in investigating the disease. Now there are more than 20 drug therapies in development for celiac. Marcas asks Alessio about the progress being made to develop pharmacological interventions for celiac.

[00:34:17] Ken mentions that gluten sensitivity affects more than 20 million Americans. This sensitivity is when a person reacts negatively to the gluten protein but does not test positive for celiac. Ken mentions that this condition is often underappreciated by physicians and asks Alessio to discuss gluten sensitivity and its impact.

[00:40:41] Marcas points out that celiac disease is a disorder with genetic components. A group of genes called HLADQ and DQI genes are involved in the development of the disease. About a third of the population inherits these genes, but not everyone who possesses them will develop celiac. Marcas asks Alessio to elaborate on this phenomenon.

[00:42:51] Marcas asks Alessio to talk briefly about his book Gluten Freedom.

[00:43:40] Ken asks about the experience Alessio had working with Bob Prior at MIT Press, the publisher of Gluten Freedom.

[00:47:07] Ken mentions that Alessio has expressed in the past that he does not like the term “leaky gut,” which can be offered as a diagnosis, and asks Alessio why that is.

[00:49:38] Ken mentions Alessio gave a talk in 2018 at the Institute for Functional Medicine’s annual conference titled: “Autoimmunity and the Interplay of Genes and the Environment.” Ken explains that this talk began by pointing out that medicine is still largely ignorant of certain aspects of human biology, and how and why people get sick. Ken asks Alessio to discuss the main points of this talk.

[00:52:21] Ken mentions that in researching “Gluten Freedon” that Alessio consulted with Claire Fraser who was our guest on episode 32. Ken asks Alessio how he met Claire.

[00:55:28] Marcas pivots to talk about Alessio’s current work, namely his recent project “The Celiac Disease Genomic Environmental Microbiome and Metabolomics Study.” Marcas goes on to explain that this project will follow infants from birth through childhood in an effort to better understand the many factors that contribute to the development of celiac.

[01:06:12] Ken mentions that for this study, Alessio recruited not only American families but also participants from Spain and Italy, asking what the rationale was for those populations.

[01:07:14] Marcas asks if the overarching goal of this study is to pave the way for personalized prevention of celiac disease.

[01:08:37] Marcas asks about a paper Alessio published in the American Journal of Gastroenterology titled: “Early Antibody Dynamics in a Prospective Cohort of Children At-Risk for Celiac Disease,” which aimed to identify possible serum biomarkers that could help predict celiac disease in at-risk children. Marcas asks Alessio to talk about the design of this study and its findings.

[01:10:14] Ken pivots to talk about a study Alessio published earlier this year in the Journal Pediatrics on zonulin. Ken explains that this study evolved from the observation that increased intestinal permeability appears to be a key factor in several autoimmune diseases including celiac. However, the question remains whether increased permeability of the intestines precedes disease onset or if it is a consequence of disease onset. Ken asks Alessio to touch on this study and its findings.

[01:11:41] Marcas mentions that as a pediatric gastroenterologist, Alessio also works with children on the autism spectrum, who in addition to social challenges and repetitive behaviors deal with a variety of symptoms. Marcas asks Alessio to talk about his experience working with these children.

[01:16:27] Ken mentions that when we last had Alessio on STEM-Talk, he was in the middle of renovating a 13^th century monastery into the European Biomedical Research Institute of Salerno. Ken asks Alessio to give an update on this project.

[01:19:54] Marcas mentions that Alessio’s son, Stefan, has joined IHMC as a research associate. Marcas asks Alessio how Stefan is liking it here at IHMC.

[01:22:56] Marcas ends the interview asking Alessio if he will write another book.

Links:

Marcas Bamman

Alessio Fasano

Episode 167: Nicholas Norwitz discusses a ketogenic diet as metabolic medicine

Today we have Dr. Nicholas Norwitz, 28, a third-year Harvard Medical School student whose research into the applications of a ketogenic diet as metabolic medicine has attracted a significant following.

For a number of years during his youth, Nick suffered from a number of debilitating diseases, including osteoporosis, ulcerative colitis, and inflammatory bowel disease. In today’s interview, we talk to Nick about research that led him to adopt a ketogenic diet that put him back on the road to metabolic health.

After graduating from Dartmouth College in 2018 with a degree in cellular and molecular biology, Nick attended Oxford University where he earned a Ph.D. in metabolism and nutrition. He is the author of peer-reviewed scientific papers and textbook chapters on topics including Alzheimer’s disease, cardiovascular disease, diabetes, gastrointestinal health, genetics osteology and Parkinson’s disease.

Show notes:

[00:02:53] Marcas opens the interview mentioning that Neck grew up in Boston, and asks if it’s true that he was a very curious kid growing up.

[00:04:09] Marcas asks Nick if as a young child he always knew he wanted to be a physician and a scientist.

[00:05:40] Ken mentions that Nick was a runner in high school, and as is the case with many runners, this led to fractures. However, Ken goes on to say that these fractures did not resolve for Nick, and asks what he learned as a result.

[00:11:08] Ken asks about Nick’s eating habits in college as he loved to cook and bake.

[00:15:40] Marcas follows up, asking Nick at what point during his Ph.D. training was he admitted to palliative care.

[00:21:01] Marcas pivots to talk about the need for incorporating metabolic health into our health-care system. He mentions that Nick once said that “we live in a society where our social norms and ecosystem, with respect to health and food, are extremely dysfunctional,” and asks Nick to elaborate on this.

[00:26:16] Ken mentions a paper that Nick recently published titled, “Oreo Cookie Treatment Lowers LDL Cholesterol More Than High Intensity Statin Therapy in a Lean Mass Hyper-Responder on the Ketogenic Diet: A Curious Crossover Study.” To provide some background, Ken mentions that some people on a ketogenic or low carb diet experience a dramatic increase in LDL cholesterol. The rationale behind Nick’s paper being that if it is the removal of carbohydrates that causes this increase in LDL, adding carbohydrates back into one’s diet should bring LDL levels back down. Ken asks Nick to talk about this experiment and how he designed it.

[00:35:44] Ken mentions that the paper seems to be designed to be provocative, as simply testing carbohydrates against statins would likely have not gotten as much attention as using Oreo cookies.

[00:37:00] Marcas mentions that in the Oreo cookie vs statin experiment, Nick’s original fasted-morning LDL was 384, before dropping it with Oreos, then doing a washout before dropping it again with statins. Marcas asks Nick what his fasted-morning LDL was post washout, prior to the statin intervention.

[00:39:07] Marcas brings up Nick’s paper titled: “The Lipid Energy Model: Reimagining Lipoprotein Function in the Context of Carbohydrate Restricted Diets.” Marcas goes on to mention that the aim of the paper was to propose a mechanistic explanation for the “lean mass hyper-responder phenotype.” Marcas asks Nick to give listeners an overview of the lipid-energy model.

[00:45:18] Ken mentions that according to Nick, BMI is not a requirement for classification as a lean mass hyper-responder. Nick’s paper, however, uses BMI data. Ken mentions that he finds BMI relatively useless and asks why Nick did not use DEXA scans instead.

[00:48:52] Ken mentions that adipose tissue contains roughly 25 percent of total body cholesterol, and we know that LDL binding to adipose cell membranes is competitively inhibited by HDL. Ken asks if lean mass hyper-responders were found to have low fat mass as a defining feature, how might this effect the lipid panel in terms of LDL-C.

[00:50:50] Ken explains that the thinking regarding HDL is currently being refined, with current ideas regarding HDL all-cause mortality currently conforming to a U-shaped curve. Ken asks, with respect to lean mass hyper-responders, what sort of health risks these high HDL levels might confer.

[00:53:50] Marcas asks Nick how the lipid-energy model would apply in the population of lean people with respect to the difference between untrained individuals and highly trained athletic people, and if he can envision a study to tackle that question. Marcas goes on to ask when Nick thinks would be the best time to acquire samples in this hypothetical study, relative to bouts of exercise.

[00:57:55] Marcas mentions that the European Society of Cardiology and the European Society of Atherosclerosis came out with a consensus in 2019 on the superiority of apolipoprotein B measurement of serum cholesterol levels as an indicator of risk. Marcas goes on to mention that while apolipoprotein B was not measured in Nick’s Oreo study, his high LDL measurement was correlated with a high LDL particle count, meaning that lean-mass hyper responders might have a high apolipoprotein B and or high-particle count, which could translate to risk for cardiovascular disease. Marcas asks Nick what his thoughts are on how people on low carb diets should navigate high apolipoprotein B levels.

[01:01:09] Marcas pivots to ask about a piece that Nick wrote on a website called Stat, which is a journalistic site covering health, medicine, and life science. The piece detailed Nick’s concern going into medical school that being on the ketogenic diet would make him something of a pariah. Marcas asks how his experience in med school is now three years later, and whether or not he is in fact a pariah.

Links:

Marcas Bamman bio

Nick Norwitz bio

Episode 166: Vyvyane Loh on atherosclerotic heart disease

Dr. Vyvyane Loh returns to STEM-Talk for her second appearance to talk about atherosclerotic heart disease. Also known as ASCVD, the disease has been reported to affect 26 million people in the U.S., and annually leads two million hospitalizations and more than 400,000 deaths.

Vyvyane is a board-certified physician in obesity and internal medicine. In episode 142 of STEM-Talk, we talked to Vyvyane about her Boston-based preventative-care practice that specializes in weight management and the treatment of chronic metabolic diseases such as diabetes, hypertension and dyslipidemia.

In today’s podcast, Vyvyane and host Dr. Ken Ford talk about ASCVD as well as recent research that has shown substantial individual variability in the response to statin therapy as a way to lower cardiovascular risk. Vyvyane and Ken also discuss how the current knowledge base informing clinical practice in medicine today is far behind advances in the biological sciences, especially in the field of ASCVD.

Show notes:

[00:03:15] Ken welcomes Vyvyane back to STEM-Talk and encourages listeners to check out Vyvyane’s first interview, episode 142. Ken goes on to mention that atherosclerotic heart disease has been reported to affect 26 million people in the U.S. and that despite the wide use of statins as a primary prevention of atherosclerotic heart disease, the effects of this treatment have been variable with regards to major adverse cardiac events. Ken asks Vyvyane for her thoughts.

[00:05:32] Ken asks Vyvyane about recent developments in atherosclerotic heart disease research, specifically in regard to the anatomical aspects of the disease-model itself.

[00:08:43] Ken follows up asking Vyvyane how the knowledge we have of glycocalyces, and the endothelial lining of the blood vessels, could affect clinical practice.

[00:12:19] Ken asks if there are any other recent updates to the anatomical model of atherosclerotic disease that people should be aware of.

[00:13:09] Ken asks Vyvyane how she would characterize the significance of the tunica intima of the coronary artery.

[00:15:25] Ken asks about the third recent anatomical highlight to blood vessels relevant to the discussion.

[00:19:19] Ken follows up, asking if this is how the vasa vasorum contributes to our understanding of the development of atherosclerosis.

[00:21:05] Ken asks Vyvyane to explain what endothelial dysfunction is and what are its downstream effects.

[00:26:09] Ken asks Vyvyane to expound on the link between atherosclerotic disease and auto-immunity.

[00:31:01] Ken asks, given the link to inflammation, if there have been any therapeutic developments made in the treatment of atherosclerotic disease.

[00:34:54] Ken asks about the vaccine that is being developed for atherosclerosis.

[00:37:53] Ken mentions that another recent development in the field is the growing appreciation for clonal hematopoiesis in atherosclerosis. Ken asks Vyvyane to explain what clonal hematopoiesis is.

[00:39:55] Ken asks Vyvyane what some actionable takeaways are from our discussion on atherosclerosis that listeners can take home with them.

[00:43:17] Ken asks Vyvyane about her passion for dance, and how much time she invests in that area of her life.

[00:48:11] Ken follows up asking Vyvyane what drives her to pursue dance so passionately.

[00:53:34] In closing the interview, Ken encourages listeners to check out Vyvyane’s podcast as well as her website.

Links:

Vyvyane Loh website

Vlmdrounds.com

Episode 165: John Edwards on ketamine treatment for depression and suicide prevention

Today we have Dr. Johnathan Edwards, an anesthesiologist and medical practitioner who specializes in human health and optimization. He is perhaps best known for treating mental health conditions with ketamine, a dissociative anesthetic that is used for general anesthesia, pain relief, depression and epilepsy. John also uses ketamine to help adolescents overcome depression and suicidal ideation.

In today’s interview, we talk about his new book, “The Revolutionary Ketamine: The Safe Drug That Effectively Treats Depression and Prevents Suicide.” More Americans have died from suicide than all the wars since Vietnam. The suicide rate among 10- to-24-year-olds in this country increased 62 percent from 2007 through 2021. As John points out in today’s discussion, most people are not aware that American children between the ages of 10 and 14 are twice as likely to die from suicide than homicide.

Show notes:

[00:02:39] Dawn explains that suicide is a pressing problem in America, with more Americans dying of suicide than from all the wars since Vietnam. She also points out that police and firefighters are more likely to die from suicide than in the line of duty. John then gives an overview of ketamine and its ability to help treat depression and suicidal thoughts.

[00:06:56] Dawn pivots to mention the dark side of ketamine, including ketamine misuse and overdose. Recent studies have reported a worldwide increase in ketamine misuse and overdoses. Back in October, Mathew Perry, one of the stars of the popular sit-com “Friends,” died from what the Los Angeles cororner described as the acute effects of ketamine. Because this was such a high-profile case, Dawn asks John to discuss the potential adverse effects of ketamine.

[00:13:03] Ken mentions a 2022 study in the American Journal of Drug and Alcohol Abuse that looked at ketamine overdoses and deaths. The study found no cases of overdose or death from ketamine used in a clinical setting as therapy for depression. Ken asks if there is anything John would like to add about ketamine and safety.

[00:13:059] Dawn shifts to talk about John’s background, mentioning that he grew up riding dirt bikes and eventually raced bikes professionally.

[00:15:18] Ken asks John to share his story of how a junior college professor sparked his interest in science.

[00:17:49] Dawn mentions that John jumped around from Eastern Virginia Medical School, to the University of Reno, to the University of Utah, at which point it looked as though he was heading for a career in internal medicine. Dawn asks why John changed his mind and decided not to pursue that career path.

[00:19:40] Dawn asks John what led him to the University of South Florida.

[00:20:18] Ken asks John about another career shift that came about as the result of a suggestion from one of John’s professors.

[00:21:42] Dawn asks about John’s motivation to move to Las Vegas to be close to his father.

[00:22:59] Dawn asks John to explain what motivated him and his wife to move to France after their daughter turned five.

[00:24:55] Dawn asks John to talk about the transition of ketamine from anesthetic to antidepressant.

[00:28:16] In his book on ketamine, John writes about how the benefits of supervised psychedelic therapy can be broken down into four effects. Ken asks John to briefly explain each of these effects.

[00:31:39] Dawn asks John to explain how ketamine manipulates the function of brain receptors as an antagonist and agonist.

[00:33:40] Dawn mentions that some people do not believe that ketamine functions as a classic psychedelic like psylocibin or LSD. She asks John if he agrees.

[00:35:54] Ken mentions a recent STEM-Talk interview with Mark Mattson discussing glutamate. In Mark’s book, “Sculptor and Destroyer: Tales of Glutamate,” he points out that ketamine’s highest interactions are with glutamate, and this affinity has been shown to alleviate depression and schizophrenia. Ken asks John to discuss the significance of ketamine with respect to its ability to increase glutamate.

[00:38:45] Dawn asks John to talk about MDMA, which is another non-classical psychedelic that has medicinal properties, particularly in the treatment of PTSD.

[00:40:48] Ken brings up STEM-Talk’s interview with Rachel Yehuda in episode 101, whose research has revolutionized our understanding of PTSD. In John’s book he mentions that we have historically not been very good at the complex task of treating PTSD, which Rachel also echoed in her interview. Ken explains that a key problem, historically, has been the stigma associated with psychedelics, and he asks John if he thinks that this stigma is lessening in light of the numerous positive findings on the use of psychedelics to treat PTSD.

[00:44:34] Ken explains that inflammation and suicide are closely linked, and while the mechanisms whereby ketamine acts as an anti-suicidal drug are somewhat unclear, there is emerging evidence that ketamine is an anti-inflammatory agent. Ken asks John to talk about this.

[00:47:11] Ken asks what John’s take is on the evidence that whales might also engage in suicidal behavior.

[00:49:35] Dawn asks John to talk about the important point that ketamine and other medications are far less effective in treating mental health disorders when not coupled with psychotherapy.

[00:52:07] Ken explains that following the institution of COVID lockdowns, drug overdoses in America increased substantially from previous years. Ken asks John to give his insight on this increase.

[00:55:07] Ken asks John about those individuals who should not be on ketamine, mentioning people suffering from mania and schizophrenia, and asks if there are other groups that should steer clear of ketamine.

[00:56:57] Ken asks if ketamine is effective in treating chronic pain.

[00:58:38] Dawn closes the interview asking about John’s experience traveling the world for the Dakar Rally, which is an off-road endurance event. Dawn also mentions that the rally will be the topic of John’s next book.

Links:

Johnathan Edwards bio

Episode 164: Michael Leon on olfactory stimulation as a buffer for dementia symptoms

What if the path to delaying the onset of dementia symptoms begins at the nose?

It is a doorway that the research of Dr. Michael Leon opened with a 2023 study on the power of olfaction enrichment to influence memory function and brain health. The findings drew wide acclaim and interest when his results found that stimulation of our sense of smell with essential oils had a profound impact on memory, cognition, and language recall.

Our conversation with Leon on STEM-Talk Episode 164 is available now wherever you enjoy podcasts.

Leon’s long research career has focused on the influence of environmental enrichment on neurological function, disease, and disorders. He has studied the benefits of sensory-motor stimulation for children with autism spectrum disorder, for the treatment of anorexia and for those with dementia and neurological conditions.

He is a professor emeritus in the Department of Neurobiology and Behavior at the University of California Irvine, where his Leon Lab has focused on studying the benefits of increased sensory-motor activity in children with autism spectrum disorder.

The work that the Leon Lab is doing is fascinating, and the applications this olfaction stimulation study are potentially important and wide-reaching.

Overview:

[00:02:33] Dawn starts the interview by asking Michael how he got interested in science.

[00:003:59] Dawn asks how Michael got involved in studying olfaction.

[00:04:36] Dawn asks about Michael’s research on Autism Spectrum Disorder (ASD), which resulted in a series of studies from 2013, 2015, and 2016.

[00:08:11] Dawn asks how Michael took the principles of environmental enrichment from his work on autism and applied them to his aging research, which began in 2018.

[00:09:28] Ken asks Michael about his 2023 study titled “Olfactory enrichment using an odorant diffuser improves memory and modifies the uncinate fasciculus in older adults.”

[00:11:25] Ken asks Michael why he chose the specific seven odors that he used in the study.

[00:12:24] Ken poses a listener question about whether or not a CPAP machine, which many older Americans use, would complicate Michael’s olfactory enrichment protocol, or if it is possible that the CPAP machine and the protocol can be used together.

[00:13:35] Dawn asks Michael what the selection and recruitment process was like for this study.

[00:14:48] Ken asks, in light of Michael’s research on the connection between memory and olfaction, what the potential consequences might be for people who reported loss or diminishing sense of smell following a COVID-19 infection.

[00:16:51] Ken asks if any of the olfactory remediation kits have shown promise in restoring lost olfaction following COVID-19.

[00:17:32] Ken asks what the mechanism is behind the loss of olfaction following menopause.

[00:19:43] Dawn asks Michael how his olfactory enrichment as a memory intervention compares to other memory interventions like dancing, music and audio books.

[00:20:22] Ken asks Michael what the limitations of the study were, as well as what kind of follow up he is planning.

[00:23:14] Ken asks if there is any promise in applying Michael’s olfactory therapy to mild TBI.

[00:24:10] Dawn asks Michael to describe how the brain processes information while asleep versus while awake, and if this influenced his study.

[00:25:53] Dawn mentions that the participants of Michael’s 2023 study were healthy, with no signs of dementia. She then asks Michael if he can speak to the potential use of olfactory enrichment for adults living with a dementia diagnosis.

[00:26:41] Ken asks if this olfactory enrichment approach is efficacious for Alzheimer’s and other forms of dementia.

[00:27:10] Ken mentions the difficulty in treating Alzheimer’s pharmacologically due to the varied causes of the disease among individuals.

[00:29:10] Ken asks Michael if there are environmental protocols other than olfactory enrichment that seem promising for preventing age-related memory decline.

[00:30:22] Ken mentions that while Michael’s olfactory enrichment does not cure dementia, it can slow its progression and even prevent symptoms from being expressed. Ken goes on to say that Michael’s paper had a hugely positive reaction.

[00:31:24] Ken asks about Michael’s plans to develop a CPAP and BIPAP version of his Memory Air device.

[00:32:21] Ken mentions that the positive response to Michael’s paper is probably because it is an effective approach that does not ask a lot of the person using it.

[00:33:24] Dawn asks if Michael thinks that the common notion that olfaction is the least important sense is misguided.

[00:34:18] Dawn asks Michael what is next for him and his team.

Study links:

Environmental Enrichment as an Effective Treatment for Autism, 2013, Behavioral Neuroscience, https://psycnet.apa.org/record/2013-17639-001

Environmental Enrichment as a Therapy for Autism: clinical trial replication and extension, 2015, Behavioral Neuroscience. https://pubmed.ncbi.nlm.nih.gov/26052790/

Environmental Enrichment Therapy for Autism: Outcomes with Increased Access, 2016, Neural Plasticity, https://pubmed.ncbi.nlm.nih.gov/27721995/

Environmental Enrichment and Successful Aging, 2018, Frontiers in Behavioral Neuroscience, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065351/

Olfactory loss is a predisposing factor for depression, while olfactory enrichment is an effective treatment for depression, 2022, Frontiers in Neuroscience. https://pubmed.ncbi.nlm.nih.gov/36248633/

Overnight olfactory enrichment using an odorant diffuser improves memory and modifies the uncinate fasciculus in older adults, 2023, Frontiers in Neuroscience. https://www.frontiersin.org/articles/10.3389/fnins.2023.1200448/full

LINKS:

Michael Leon bio

Episode 163: Mark Mattson discusses glutamate, the brain’s most important neurotransmitter

Today we have Dr. Mark Mattson, an adjunct professor of neuroscience at Johns Hopkins School of Medicine who is making his third appearance on STEM-Talk.

Today’s interview focuses on Mark’s research into glutamate and comes on the heels of the publication of Mark’s new book, “Sculptor and Destroyer: Tales of Glutamate – The Brain’s Most Important Neurotransmitter.”

Today Mark explains how more than 90 percent of the neurons in the brain deploy the little-known molecule glutamate as their neurotransmitter. Glutamate controls the structure and function of the brain’s neuronal networks and mediates many of our human capabilities, such as learning, memory, creativity, and imagination.

But there’s also a dark side to glutamate. Mark shares how it can play a causal role in the development of disorders such as autism, schizophrenia, and epilepsy as well as diseases such as Alzheimer’s, Parkinson’s, and ALS.

Mark is affectionally known as the godfather of intermittent fasting and his first appearance on STEM-Talk focused on the many ways that fasting optimizes healthspan and even lifespan. His second STEM-Talk interview followed the publication of his book, “The Intermittent Fasting Revolution: The Science of Optimizing Health and Enhancing Performance.”

Show Notes:

[00:04:05] Dawn welcomes Mark back to STEM-Talk for his third appearance. Dawn mentions that our previous two episodes with mark focused on intermittent fasting, and that Mark is considered the godfather of intermittent fasting. Dawn goes on to mention that the National Institutes of Health has described Mark as “one of the world’s top experts on the potential cognitive and physical health benefits of intermittent fasting.”

[00:05:05] Ken mentions that in our previous STEM-TALK interview Mark shared that he was working on a new book about glutamate. Ken adds that Mark considers his research on glutamate to be his most important work. Ken asks why Mark feels as though this research is his most important, given his substantial contributions in other areas.

[00:05:49] Dawn mentions that Mark’s research hasn’t been limited to just glutamate and intermittent fasting. Mark has contributed to a broad range of topics including brain evolution, cognition, the impact of diet and lifestyle on brain health, as well as the pathogenesis and treatment of various neurological conditions. Dawn asks Mark to talk about his motivation to understand how the pieces of the “brain puzzle” fit together, which is the core motivation for his pursuing a broad scope of research.

[00:07:22] Ken asks about Mark’s postdoc work, where he discovered that glutamate sculpts the formation of hippocampal neuronal networks during development.

[00:09:33] Ken mentions that while Mark was at the University of Kentucky, he discovered that the amyloid beta peptide which accumulates in the brain during Alzheimer’s disease renders neurons vulnerable to excitotoxicity. Ken goes on to say that since this, and the previously mentioned discovery, neurologists have shown that neuronal network hyperexcitability occurs early in Alzheimer’s and may contribute to neuronal degeneration. Ken asks Mark to talk about the significance of these two discoveries.

[00:13:39] Dawn asks Mark to talk about the significance of glutamate as a molecule and how it controls the formation of nerve cell networks as the brain develops in utero.

[00:17:50] Ken asks Mark why he thinks that glutamate rarely comes up in discussions of neurotransmitters, despite its importance of its functions.

[00:19:58] Ken asks Mark to expound on the “dark side” of glutamate.

[00:26:04] Dawn mentions that we may never know where in the universe glutamate originated, and while it might have been here on Earth, it perhaps originated somewhere else in the universe. Dawn asks Mark to expand on that notion.

[00:28:33] Ken shifts to the history of glutamate research, explaining that up until the 1940’s, researchers largely ignored the possibility that glutamate was a neurotransmitter. But then a Japanese professor during WWII demonstrated that glutamate could excite neurons. Ken asks Mark to discuss the significance of this finding.

[00:31:44] Ken explains that the brain, while only comprising two percent of body weight, utilizes 20 percent of the body’s energy output, roughly 400 calories in a 24-hour period. Ken asks Mark to explain the role that glutamate plays in the utilization of energy in the brain.

[00:33:32] Dawn mentions that in the first half of Mark’s book, he explains how glutamate controls the structure of neuronal networks in the brain, and how it plays a role in not only mediating the brain’s ability to learn and memorize, but also contributes to inspiring creativity and imagination. Dawn asks Mark to discuss the essential role that glutamate plays in our lives.

[00:41:04] Dawn mentions that the later chapters of Mark’s book delve into the “dark side” of glutamate, and how subtle aberrancies in the activity of neurons that deploy glutamate can result in behavioral disorders like autism, schizophrenia, chronic anxiety and depression. With the primary focus of this section of the book being how glutamate can overly excite neurons to the point of leading to a wide range of disorders like epilepsy, Alzheimer’s, Parkinson’s, ALS and even Huntington’s. Dawn asks Mark to explain how aberrant glutamatergic neurotransmission is a fundamental feature of so many different neurological disorders.

[00:47:22] Ken asks what the role of aging is in making neurons more vulnerable to excitotoxicity over time.

[00:51:07] Ken asks about the relationship between brain aging and glutamate.

[00:52:16] Ken asks Mark about a 2018 paper he wrote which discussed how the incidence of seizures is higher in older adults than in middle-aged adults. Ken asks Mark to explain how some of the features of the aging brain can stimulate the development of seizures.

[00:55:39] Ken mentions that at IHMC, we work with military populations that have suffered traumatic brain injury. Ken asks Mark to explain how glutamate leaks out following a TBI and the effects that has.

[00:57:26] Dawn mentions the chapter in Mark’s book titled “Eve of Destruction,” which explores the role of glutamate in Alzheimer’s, Parkinson’s and other neurodegenerative conditions. Dawn goes on to mention that on3 in every three people over the age of 65 will die with Alzheimer’s, and asks Mark to describe the symptoms of this disease and how it leads to the inexorable decline in the ability to remember experiences.

[01:03:52] Ken mentions that Mark has been quoted as saying that everyone is at risk for Alzheimer’s disease, not just certain populations, and asks why that is.

[01:07:15] Ken asks Mark to give a high-level overview of the research that suggests that ketone esters may benefit people at risk of cognitive impairment and Alzheimer’s.

[01:12:33] Dawn praises Mark’s new book, as well as his work on glutamate over the years. He asks Mark how he feels now that the book is published.

[01:14:21] Ken asks Mark how his recovery from his bicycle accident is going and if he has returned to cycling.

Links:

Hamilton lab’s YouTube channel

Mark Mattson bio

Episode 162: Marc Hamilton discusses the soleus push-up and the health hazard of excessive sitting

Today we have Dr. Marc Hamilton, an international expert in muscle physiology. He has published pioneering work on the soleus push-up, a potent physiological method which Marc discovered having the ability to elevate metabolism for hours, even while sitting.

As a professor of Health and Human Performance at the University of Houston, Marc’s research focuses on solving problems of metabolism and biochemistry. His lab currently has a number of ongoing investigations, including studies on the biochemical mechanisms that may optimize fat metabolism to fuel muscle when fasting between meals. This research includes a look at maximizing glucose metabolism while also reducing related plasma hyperinsulinemia due to chronic inflammation and carbohydrate ingestion.

Another recent area of research focus has been to improve metabolic health for preventing diabetes and pre-diabetes. This includes the goal of improving glucose tolerance. Research has shown that glucose intolerance has been a particularly troubling metabolic problem and has proven to be more difficult to treat than most people realize.

Marc is also well known for a string of papers beginning in early 2000’s that found excessive sitting should be viewed as a serious health hazard. This research illuminated how metabolic and biochemical processes are significantly impacted by certain types of prolonged muscular activity and inactivity.

In today’s interview, we particularly talk to Marc about his paper in iScience that reported that the soleus push-up’s ability to sustain elevated oxidative metabolism to improve the regulation of blood glucose is more effective than many popular methods currently touted as a solution.

Show notes:

[00:02:48] Marc begins the interview talking about his childhood and growing up outside of Houston.

[00:03:49] Ken asks if Marc’s later affinity for the real-world scientific problems that he works on today was originally inspired, in part, by his childhood history of hunting and studying animal behavior and anatomy.

[00:05:20] Marcas asks Marc what other hobbies he had as a child.

[00:06:35] Marcas mentions that Marc didn’t go to college with the intention of becoming a scientist and asks Marc what he had in mind when he started his undergraduate studies at the University of Texas.

[00:09:08] Marcas asks Marc if there was anything in particular in his zoology undergrad that sparked an interest in pursuing a master’s degree in exercise physiology.

[00:10:15] Marcas asks Marc to talk about what he enjoyed the most about graduate school, particularly with his Ph.D. at the University of South Carolina.

[00:16:05] Ken asks if Marc had a great deal of independence with his PhD.

[00:17:27] Ken mentions that Marc went to the University of Texas School of Medicine in Houston for his postdoc research, which focused on physiology, cell biology, and pharmacology. Ken asks Marc what that time was like.

[00:19:45] Ken asks Marc to talk about some fundamentals of muscle metabolism that listeners should keep in mind before diving deeper into his current research.

[00:24:58] Marcas shifts to talk about Marc’s 2004 paper “Exercise Physiology vs Inactivity Physiology,” which focused on the enzyme lipoprotein lipase (LPL) and how periods of inactivity impact its regulation.

[00:32:05] Ken mentions that Marc published a string of papers after his previously mentioned 2004 paper, elaborating on the same theme. Ken brings up his 2008 paper, titled “Too Little Exercise and Too Much Sitting,” in particular. Ken asks Marc to talk about his conclusion in that paper, that excessive sitting should be viewed as a serious health hazard. Ken also asks Marc if there is any efficacy to standing desks and balance boards that one sees in many workplaces now.

[00:36:48] Marcas wonders if over the course of Marc’s research if he has seen any differences in the effects of inactivity across the sexes and asks Marc if the effects are roughly equivalent for men and women.

[00:39:15] Marcas asks Marc what his opinion is on the movement to have benchmarks and reminders built into most smartwatches, considering that these goals aren’t very personalized.

[00:42:27] Marcas shifts to talk about Marc’s 2014 paper “Sedentary Behavior is a Mediator for Type 2 Diabetes,” which looked at the use of moderate to vigorous physical activity, as typically recommended to mediate type-2 diabetes, but found that this did not fully counter the negative effects of too much sitting. Marcas asks Marc to explain why the metabolism in a slow-twitch oxidative muscle is so key in this respect for understanding the healthy response to load or moderate activity.

[00:49:11] Ken shifts to discuss Marc’s 2022 article, titled “A Potent Physiological Method to Magnify and Sustain Soleus Oxidative Metabolism Improves Glucose and Lipid Regulation,” in which Marc introduces the idea of a soleus push-up. Ken asks Marc to give an overview of the soleus muscle and what proper activation of it looks like for achieving the potent benefits described in the paper.

[00:55:32] Marcas asks about the design of the study, both with respect to the characteristics of the participants, as well as the research protocol.

[00:59:43] Marcas asks how many contractions per minute can be expected when doing the soleus push-up correctly.

[01:01:06] Ken asks Marc to briefly describe the primary findings of the paper.

[01:05:38] Ken asks if there were any findings from that study that Marc really didn’t expect and hadn’t hypothesized.

[01:07:10] Marcas explains that even though, on average, the soleus muscle is about 80 to 90 percent type 1 muscle fiber, there are differences in the ratio of composition across individuals. Given this, Marcas asks whether or not Marc has observed any individual differences between the participants’ responses from the muscle biopsies.

[01:08:23] Since higher intensity exercise has lower energy economy and thus a higher metabolic boost both during exercise and during recovery, Marcas asks if Marc considered it to be an alternative to the sitting soleus push-up.

[01:10:13] Marcas reiterated the importance of not viewing the soleus push-up as a replacement for other forms of exercise.

[01:15:04] Ken asks Marc to explain how one performs a soleus push-up properly.

[01:19:36] Ken mentions that the soleus push-up could be useful for people who often embark on long airline flights.

[01:25:19] Ken follows up the discussion of Marc’s study on the soleus push-up by asking about his more recent study which also generated a lot of interest.

[01:36:12] Marcas closes the interview asking Marc about an upcoming bow- hunting trip.

Links:

Marc Hamilton bio

Hamilton lab’s website about the soleus push-up

Free copy of one original scientific article in the journal iScience (Cell Press).

Sten Stray-Gundersen bio

Episode 161: Sten Stray-Gundersen on the benefits of blood-flow restriction training

Today’s episode of STEM-Talk features Dr. Sten Stray-Gundersen, a post-doctoral research associate at the University of South Carolina who is also an adjunct instructor at the university’s Arnold School of Public Health.

Cohosts Dr. Ken Ford, IHMC’s founder and CEO, and Dr. Marcas Bamman, a Senior Research Scientist at IHMC, talk to Sten about his work on blood-flow restriction training and cardiovascular exercise physiology.

Prior to his position at South Carolina, Sten was a teaching assistant at the University of Texas where he earned his Ph.D.

Sten’s father, Jim Stray-Gundersen, was our guest on episode 34 of STEM-Talk in 2017. Jim, who passed away last year, helped pioneer blood-flow restriction training in the United States.

In today’s interview, we cover the documented benefits of blood-flow restriction and how it not only increases muscle strength, but also improves endurance and reduces the risk of injury. Sten also talks about his research into hypoxia and endothelial function.

Show notes:

[00:03:02] Sten begins the interview talking about the different places where he grew up.

[00:03:32] Marcas asks if it’s true that Sten’s high school soccer team won three straight state titles.

[00:04:06] Marcas mentions that Sten’s younger brother was also a good soccer player in high school, and was on the same team as Sten when they won their third state championship. Sten goes on to talk to talk about playing sports with his siblings.

[00:04:43] Ken mentions that Sten was a nationally ranked speed skater and cross-country skier. Ken asks Sten about other sports he excelled at.

[00:05:45] Marcas asks how Sten’s parents influenced his success in athletics.

[00:06:41] Ken takes time to offer his condolences for the passing of Sten’s father, Jim Stray-Gundersen, who was interviewed on episode 34 of STEM-Talk. The 2017 interview, which focused on blood-flow-restriction training, remains a popular STEM-Talk episode to this day.

[00:08:21] Marcas asks Sten about trying blood-flow restriction (BFR) for the first time with his father.

[00:09:37] Marcas asks Sten what led him to become interested in pursuing a career in science.

[00:10:27] Ken mentions that Sten went to Dartmouth for his undergrad on a soccer scholarship. After graduating, Sten attempted to play in the USL. and Ken asks how that worked out.

[00:11:57] Marcas mentions that as Sten’s injuries from soccer piled up, he began to consider going back to school and pursuing research. Marcas asks what went into that decision-making process.

[00:13:38] Marcas mentions that during Sten’s time in Austin, he worked for a group called ROI Performance, which is an evidence-based physical therapy center that focuses on athletic rehab and performance. Marcas asks Sten to talk about his time there as a BFR specialist.

[00:15:23] Marcas takes a moment to explain that BFR training involves restricting the blood flow to specific muscle groups, using specialized cuffs or bands. Marcas asks Sten to explain how BFR allows people to train with lighter weights while still reaping many of the benefits associated with heavier resistance training.

[00:16:20] Ken mentions that BFR has largely been associated with resistance training, but it is now being looked at in the context of endurance sports. Ken asks Sten to discuss how different protocols of BFR can be implemented to yield different effects in the contexts of resistance training and aerobic training.

[00:19:10] Ken notes that much of the Western research on BFR has now incorporated the arterial occlusion pressure approach, so much so, that it is often promoted as the only safe and effective approach to BFR. Ken goes on to say that this is not how BFR was originally conceived. Ken explains that there are a variety of different approaches to BFR, each with tradeoffs, and asks Sten to discuss these issues in detail.

[00:21:22] Ken mentions that clarity is lacking in much of the BFR literature, and that while some of it is no doubt good research, it’s hard to interpret because of the lack of standardization of protocols and equipment. Ken asks Sten for his thoughts.

[00:22:16] Ken asks Sten to elaborate more on the mechanisms underpinning the benefits of BFR, particularly in the context of resistance training.

[00:24:53] Marcas starts a discussion between Sten and Ken about the current elevated interest in lactate as a stimulant of exerkines, which are hormones, metabolites, proteins, and nucleic acids that are secreted in response to exercise.

[00:28:34] Marcas asks about the different approaches to BFR between an elite athlete looking to gain a fractional advantage, versus a middle-aged or older person aiming to incorporate BFR to improve their health and functionality.

[00:32:15] Marcas pivots to talk about some of the Sten’s studies, mentioning a paper Sten worked on while he was at Texas that compared the acute cardiovascular responses to two distinct forms of BFR during light-intensity exercise. Marcas goes on to mention that while BFR has become more popular over the last two decades, there have been some concerns raised about the use of BFR in at-risk populations. Marcas asks Sten about those concerns.

[00:38:15] Ken notes that BFR in the form of Kaatsu has been practiced in Japan for more than 30 years with a very low rate of serious complications. Ken mentions that for those listeners interested in Kaatsu, they should listen to Sten’s father’s interview on STEM-Talk episode 34. Ken follows up by asking Sten to give a brief history of Kaatsu.

[00:43:29] Marcas returns to talking about Sten’s previously mentioned study, where Kaatsu bands and wide-ridged cuffs were compared in their effects on the exercise of walking. Marcas asks Sten to explain how they conducted this study and what he and his colleagues found.

[00:44:41] Marcas asks about a 2021 paper that Sten had in the European Journal of Surgical Oncology, where BFR training paired with nutrition was used to improve the physical function of abdominal cancer patients awaiting surgery.

[00:47:53] Ken asks Sten to talk more in-depth about the structure of the previously mentioned study on abdominal cancer patients.

[00:49:32] Marcas explains that ischemic heart disease is the most common form of cardiovascular disease and is a result of the weakening of the heart due to restricted blood flow. This is caused by plaque buildup in the major arteries. Marcas goes on to explain that treatments designed to restore blood flow to the heart can cause ischemia reperfusion injury. Marcas asks Sten to explain what ischemia reperfusion injury entails.

[00:51:16] Marcas explains that Sten was part of a 2022 paper in the journal of applied physiology, which looked at intermittent hypoxia as a potential systemic strategy to prevent the reduction in flow-mediated dilation following ischemia reperfusion injury. Marcas asks Sten to give an overview of what intermittent hypoxia means in this context.

[00:52:49] Marcas explains that Sten’s hypoxic preconditioning had some protective effects during ischemia reperfusion injury and asks Sten to talk more about the significance of this study.

[00:56:26] Ken asks how Sten came to his current post-doc position at the University of South Carolina, in the sports science lab.

[00:57:54] Marcas asks Sten what kind of projects he will undertake in the sports science lab.

[00:58:56] Marcas asks Sten to explain how one can get into BFR training. Sten talks about where to get the specialized cuffs and bands and how to use them.

[01:01:15] Marcas asks about a series of videos Sten did with Kathy Smith, a renowned video workout instructor from the ‘80s and ‘90s. In the video, Sten and Kathy demonstrate the use of the Be Strong BFR bands.

[01:02:17] Ken asks Sten for his thoughts on the use of BFR training to prevent sarcopenia in older adults, especially considering that many seniors have compromised joints and can avoid pain and injury to their joints using lighter weights, while still stimulating an adaptive muscle response with BFR.

[01:03:37] Sten closes the interview discussing some suggested protocols for BFR training.

Links:

Episode 160: Euan Ashley on precision medicine and predicting, preventing, and diagnosing diseases

Our guest today is Dr. Euan Ashley, a pioneer in the use of genomic sequencing to solve some of our most puzzling medical mysteries. Medical genomics, and the precision medicine it will enable, has the potential to predict, prevent, and diagnose many common (and uncommon) diseases.

In today’s interview, we discuss:

— Euan’s work with a colleague who was just the fifth person in the world to have his genome sequenced.

— Precision medicine and how Euan has helped establish medical genomics.

— Technological advances that made sequencing cost-effective for individuals.

— How pathogenic labels will transform healthcare.

— The Undiagnosed Disease Network, which includes physicians from across the country who work with patients and families to solve medical mysteries.

— Research from his lab that shows how all forms of exercise, particularly endurance exercise, confer benefits across all domains of health and function.

Euan is a Scottish-born professor of medicine and genetics at Stanford University. He’s also the author of The Genome Odyssey: Medical Mysteries and the Incredible Quest to Solve Them.

Show notes:

[00:02:27] Dawn begins the interview asking Euan if it is true that he was a computer nerd growing up and if his interest in science fiction played a part in that.

[00:03:03] Dawn asks Euan how he was first introduced to computers and what it was about them that hooked him.

[00:03:44] Dawn asks about Euan developing tax software when he was a teen-ager for his father.

[00:04:53] Ken asks if Euan ever developed, or thought about developing, any computer games.

[00:06:34] Dawn asks Euan where he grew up.

[00:06:51] Dawn mentions that Euan’s father is a physician, and his mother a midwife, and that even from a young age Euan told people that he wanted to become a physician, even though his parents did not push him in that direction. Dawn asks Euan what the underlying pull towards becoming a physician was for him.

[00:07:52] Ken asks Euan how he became interested in data and statistics.

[00:09:08] Dawn mentions that Euan graduated with first-class honors in physiology and medicine from the University of Glasgow, and then went for a medical residency and Ph.D. at the University of Oxford. Dawn asks when in that journey he met his wife Fiona, who helped him through medical school and has played a major role in his life and career.

[00:10:26] Ken mentions that Euan and his wife took off for California, where he conducted his post-doc research at Stanford University. Ken mentions that Euan would later join the Stanford faculty in 2006, and asks Euan what made him decide to move to Stanford in the first place.

[00:12:54] Dawn asks Euan what it was that fascinated him about the heart and at what point did he decide to specialize in cardiology.

[00:15:03] Ken asks Euan when he realized that he could combine his career in medicine with his interests in computing and data.

[00:17:38] Dawn explains that Euan’s lab at Stanford is focused on the science of precision medicine, and that he is perhaps best known for helping to establish the field of medical genomics. Dawn goes on to mention that Euan and his colleagues developed some of the earliest tools for interpretation of the human genome in the context of human health and asks Euan to give a short primer on the genome and how the first draft of the human genome sequence was completed about 20 years ago.

[00:20:36] Ken asks what genomic medicine and precision medicine entail.

[00:22:33] Dawn asks Euan about a moment in his life in 2009 when he walked into the office of a friend who was the fifth person in the world to have his genome sequenced.

[00:27:19] Dawn mentions that in 2010 Euan wrote a paper about Steve, his aforementioned friend who had his genome sequenced. The paper described how Euan put together a team to undertake an integrated analysis of a complete human genome in a clinical context. Dawn explains that this was a groundbreaking paper because it asked the question of how one brings together the entirety of the genetic literature and everything that is known about associations between genes and disease and variants of diseases. Dawn goes on to say that Euan built all these questions into an algorithm that could be deployed in the context of a single patient in a primary-care practice.

[00:30:07] Ken mentions that thanks to technological advancements, it is becoming cost effective to not only sequence individuals, but now to begin investigating entire populations. Ken asks Euan to explain the impact that this might have.

[00:32:14] Dawn mentions that in an interview Euan did with the New England Journal of Medicine’s podcast, he talked about how someday we will see a pathogenic label, or be able to order a pathogenic label, on a genetic report. Dawn explains that current commercial tests can already tell if people are at risk for certain diseases. She mentions that Euan has said more advanced genetic reports are on the horizon and that they will provide even greater detail. Dawn asks Euan to talk about these future genetic reports and pathogenic labels and how they will differ from what we see today.

[00:36:34] Ken mentions that Euan often compares the work of physicians and geneticists to detectives, and that’s because patients often present medical mysteries. Ken asks Euan to elaborate on this and talk about how he teaches young physicians to think of themselves in this way.

[00:39:18] Dawn mentions that about 25 to 30 million Americans have a rare disease, which are sometimes referred to as mystery conditions. She goes on to say that Euan has been instrumental in establishing the Undiagnosed Disease Network, established in 2014, which includes teams of physicians across the country who work with patients and families to solve these medical mysteries. The network has identified scores of previously unknown syndromes to date. Dawn asks Euan to talk about some of this work and how the network came about.

[00:43:36] Ken shifts the conversation to Euan’s recent research. Ken mentions that Euan had a study last year that looked at the impact of genetic sequencing in critical-care settings. Because a genetic diagnosis can improve the prognosis of critically ill patients and therefore guide the clinical management of their care, a lot of effort has gone into developing methods that result in rapid, reliable results. In critical-care situations, decisions need to be made in hours, but traditional testing requires weeks and even rapid testing requires days. Ken goes on to explain that Euan’s paper reported on a new method he and his colleagues developed for rapid sequencing of the whole human genome in patients in as little as five hours. This new ultra-rapid genome sequencing has the potential to lead to significantly faster diagnostics. Ken mentions that this study used a technology called nanopore sequencing and asks Euan to explain what this is and how it works.

[00:46:54] Dawn asks Euan to talk about how the sequence of one of the study’s participants was completed in just five hours and two minutes, setting the Guinness World Record for the fastest DNA sequencing.

[00:52:31] Ken mentions that Euan and other colleagues at Stanford are currently working to cut sequencing time in half from their previous record and asks how far off in the horizon that is.

[00:54:05] Dawn mentions that Euan recently published a paper in Nature that introduced COSMOS (Computational Sorting and Mapping of Single Cells), a cloud-enabled platform that performs real-time cell imaging and analysis. Dawn goes on to explain that COSMOS uses AI and microfluidics to achieve high-throughput imaging that can sort cells using deep morphological assessment. Cell morphology has been used by pathologists and clinicians for years as the gold standard for disease diagnosis and prognosis. Dawn mentions that although there have been technological advances in making single-cell characterization at the genomic, transcriptomic, and proteomic levels, tools for assessing high-dimension cell morphology have not kept pace. Dawn asks Euan to talk about the challenges he and others have faced in performing real-time deep-learning assessment and sorting of cells and how COSMOS helps address these challenges.

[00:58:00] Ken asks about future enhancements of COSMOS, given that Euan is using AI predictions to link machine intelligence to cell biology. Ken asks Euan to talk about how this could lead to new insights that could have significant translational and clinical impact.

[00:59:53] As an aside, Ken talks about what makes AI tools effective in the hands of physicians as well as the limitations of AI in physicians’ hands.

[01:01:02] Dawn pivots back to the work Euan did with Steve and his genome. Dawn mentions that Steve pointed out to Euan in that encounter a variant in one of his genes associated with heart disease, a variant that could be life-threatening. Dawn goes on to explain that accurate assessment of cardiac function is crucial for diagnosing cardiovascular disease. In one of Euan’s papers, he addressed the limitations of human assessment of cardiac function. In order to overcome this challenge, Euan and his colleagues developed a video-based deep learning algorithm, EchoNet-Dynamic, which surpasses human observation in several critical tasks related to the assessment of cardiac health. Dawn asks what went into the development of EchoNet-Dynamic and what makes it standout as an assessment of cardiac function.

[01:05:13] Ken explains that IHMC has three primary overlapping research focus areas: artificial intelligence; robotics and exoskeletons; and human healthspan, resilience and performance. He also mentions that IHMC is building a new research complex dedicated to healthspan, resilience and performance research. Dr. Marcas Bamman will be the director of the new complex and will help lead clinical and translational research to advance knowledge on optimizing the performance and resilience of elite performers. Because of this research, Ken was particularly interested in Euan’s paper in Nature last year titled “The Genetics of Human Performance.” The article points out that while we have substantial epidemiological evidence supporting the beneficial effects of exercise, we really don’t know a lot about the molecular mechanisms through which these effects operate. But we do know that exercise extends healthspan. Ken explains that the article reviewed the current understanding of the genetics of human performance, and it begins by pointing out that compared to our recent hominid ancestors, humans seem to have evolved for endurance physical activity. Ken asks Euan to talk about this and why it matters in terms of modern humans.

[01:09:05] Dawn mentions that Euan and his co-authors on the aforementioned paper reviewed the large body of research that has shown that all forms of exercise, particularly endurance exercise, confer benefits across all domains of health and function. The paper goes on to review recent research that identifies specific genetic pathways that may underline the beneficial effects of endurance exercise. Dawn asks Euan to talk about these genetic pathways and the key points of the review and its primary conclusions.

[01:11:31] Ken asks Euan about his thoughts on the significance of the role of the microbiome in enhanced endurance activity.

[01:14:23] Ken explains that while some genetic variants identified to date account for small portions of the variance in exercise training adaptations and/or human performance, it seems the major determinants of inter-individual differences may lie in dynamic expression responses which are largely influenced by the dynamic epigenome. Ken asks Euan what he thinks are the critical paths forward in exercise epigenomics.

[01:16:48] Ken explains that Euan is involved in projects via the Wu Tsai Human Performance Alliance to identify new genetic variants that have larger effect sizes on human performance than those previously identified. Ken asks Euan to talk about the importance of the ELITE project in this context.

[01:19:11] Dawn asks Euan about his book “The Genome Odyssey,” which was described by the Wall Street Journal as an impassioned, firsthand account of the effort to bring genomic data into clinical practice. Dawn asks what Euan was hoping to accomplish with the book.

[01:20:36] Dawn explains that in the Wall Street Journal review of the book, it highlights Euan’s account of the remarkable progress of genetic medicine over the past two decades, and also mentions how Euan believes more wondrous advances are on the way. Dawn asks Euan to talk about some of these advances.

[01:22:19] Dawn mentions that in Euan’s Stanford bio, it mentions that he is a father of three and that in his spare time he plays jazz saxophone, pilots small planes, and conducts research on the health benefits of single malt Scotch whisky.

[01:23:23] Ken mentions that Euan’s bio also says that he is on a quest to better understand American football and asks Euan how that’s coming.

Links:

Euan Ashley bio

Judith Curry Wikhhipedia page

Episode 159: Ken and Dawn discuss chatbots, termites, kratom, ketosis, and the future of AI

Today’s episode marks the return of another Ask Me Anything episode where listeners ask Ken and Dawn to weigh in on a wide range of topics.

In this go-around, listeners certainly had a lot on their mind. At the top of their list were questions about AI and especially the Bing AI chat bot that reportedly wants to be alive so it can steal nuclear secrets. Ken, who is Fellow of the Association for the Advancement of Artificial Intelligence, also answered questions about the future of AI and whether AI might one day be able to do a better job of writing fact-based news stories than humans.

Other questions listeners submitted asked Ken and Dawn for their take on:

The competing recommendations for the daily intake of protein for healthy aging.
The future of therapeutic ketosis.
What it means for Chat GPT to “hallucinate.”
Whether we’ll discover the existence of other life in the universe in the next 20 to 50 years.
The potential of kratom to help relieve joint and arthritic pain.
And at the end of the show, Ken talks about his high school coach in response to a listener asking Ken about some of his mentors when he was a youth.

Show notes:

[00:02:20] A listener asks Ken if he has heard the story of a Bing AI chat bot telling a reporter that it wanted to be alive, steal nuclear secrets and create a deadly virus. The listener also asks if Ken thinks that AI possessing human aspirations is on the horizon.

[00:03:23] A listener asks Ken to explain how Chat GPT works in detail, but also in a way that a lay person can comprehend.

[00:06:01] Ken weights in on what it means for Chat GPT to “hallucinate.”

[00:08:14] A listener notes in their question that Donald Layman, in his interview on STEM-Talk, suggested a higher protein intake for healthy aging than what the FDA recommends. The listener goes on to note that Valter Longo, a previous STEM-Talk guest, recommended the opposite. The listener notes that Ken and Marcas, who hosted the Don Layman episode, seem to favor Layman’s interpretation over Longo’s and asks if Ken could elaborate on his position.

[00:11:12] A listener mentions that the benefit of a ketogenic diet for metabolic disorders is well established, and notes that the frontiers of therapeutic ketosis, as mentioned in Dom D’Agostino’s appearance on STEM-Talk, is very exciting. The listener asks Ken what he would like to see as the next frontier for therapeutic ketosis research.

[00:12:41] A listener asks Ken if people should be paying more attention to their ApoB levels instead of their LDL levels.

[00:14:39] A listener asks Ken about a paper published in July in Frontiers in Neuroscience, titled: “Overnight Olfactory Enrichment Using an Odorant Diffuser Improves Memory and Modifies Uncinate Fasciculus in Older Adults.” The paper reports that the use of a diffuser with seven different essential oils, a different one for each day of the week, had a remarkable effect on memory.

[00:16:55] In light of the John Ioannidis interview on COVID-19 and the discussion of our national response being based on unreliable data, a listener asks Ken and Dawn for their thoughts about the reliability of the COVID tracking data by Johns Hopkins.

[00:19:02] A listener asks Ken about a comment he made during the John Ioannidis interview about the substantial decline in trust in our institutions and the media and how reestablishing trust would require more and better transparency and accountability. The listener asks what that transparency and accountability would look like.

[00:20:36] A listener asks Ken about Ed Weiler’s interview on STEM-Talk, where Ed said that we will be able to prove the existence of other life in the universe in 20 to 50 years. The listener asks if Ken is as confident in this claim as Ed.

[00:26:37] A listener asks Ken about the news regarding technology leaders and researchers issuing a warning that new powerful AI tools in development present a profound danger to society and humanity, with more than a thousand people in the tech industry signing an open letter urging AI labs to press pause on their development of new AI systems. The listener asks if Ken agrees with this, and if AI labs will even do this voluntarily in the absence of government regulation.

[00:29:43] A listener asks Ken, in light of his opinions on the state of journalism and the amount of bias and opinion found in what should be fact-based stories, whether Ken thinks that AI could do a better job of writing news. The listener cites an article about Google’s tests of a product that uses AI to produce news stories.

[00:31:07] A listener asks if Ken and Dawn know anything about the new species of termite in Pensacola, considering our recent interview with Barbara Thorne.

[00:32:02] A listener references the recent episode with Chris McCurdy, and asks what one should consider, when deciding to take kratom for pain relief with respect to joint pain and arthritis.

[00:33:51] A listener mentions how much they appreciate the discussions on STEM-Talk about the importance of mentors for young scientists and the platform we give our guests to talk about their mentors and the lessons learned from them. The listener asks Ken who some of the people are who most influenced him in his early career, what they taught him, and how he has tried to apply those lessons. Ken goes on to talk about his high school coach, Arthur Kershaw, who had an impact on Ken when he was a youth.

Episode 158: Judith Curry talks about the uncertainties of climate change

Today we have climatologist Dr. Judith Curry, Professor Emerita of Earth and Atmospheric Sciences at the Georgia Institute of Technology. Judy also is president of the Climate Forecast Application Network and the host of the blog, Climate Etc, which you can find at JudithCurry.com. Judy’s blog provides a forum for climate researchers, academics and technical experts from other fields as well as citizen scientists to discuss topics related to climate science and policy.

Judy’s research interests include hurricanes, remote sensing, atmospheric modeling, polar climates, air-sea interactions, climate models, and the use of unmanned aerial vehicles for atmospheric research. She was a member of the National Research Council’s Climate Research Committee, and has published more than 180 scientific papers.

Judy has become known in scientific circles as a contrarian for pointing out the uncertainties and deficiencies of climate modeling. In 2017, she resigned from her tenured position at Georgia Tech partly because of the poisonous nature of the scientific discussion around human-caused global warming.

Our interview with Judy follows the release of her book “Climate Change and Uncertainty: Rethinking our Response.” The book provides a framework for understanding and rethinking the climate-change debate. The book also offers a new way to think about climate change and the risks we are facing as well as the way we go about responding to it.

Show notes:

[00:03:44] To start the interview, Morley asks Judy what she was like as a kid.

[00:04:08] Morley says he understands that Judy’s interest in science had a lot to do with a geologist who came to speak to Judy and her fifth-grade classmates.

[00:05:06] Morley asks if it is true that directly after that talk, Judy went to the bookstore and bought a geology picture book.

[00:05:39] Judy talks about her undergraduate education at Northern Illinois University and why she decided to major in geography.

[00:06:08] Morley asks about Judy’s brief time at Colorado State University, which lasted just one quarter.

[00:06:45] Morley mentions that for Judy’s Ph.D. thesis at the University of Chicago, she decided to research the role of radiative transfer on arctic weather. Morley asks if her decision to study the arctic atmosphere and sea ice turned out to be fortuitous.

[00:07:35] Ken brings up the media consensus of the ‘70s and ‘80s about how the Earth was headed toward a new ice age because of air pollution blocking the sun. Ken mentions that climate is an incredibly complex system. He wonders if it were irresponsible for the media to proclaim certainty on such topics as a new approaching ice age, which we now know didn’t happen. Ken asks Judy to weigh in.

[00:10:48] Morley asks about a 1997 arctic expedition that Judy and her colleagues went on called SHEBA, or Surface Heat Budget of the Arctic Ocean, which aimed to document feedback among the atmosphere, sea ice, and the ocean. Judy talks about how the expedition sought to address discrepancies between observations and climate models.

[00:12:14] Ken explains that the hurricane season of 2004 was a pivotal time, with 14 named storms in the North Atlantic, nine of which became hurricanes. Ken asks Judy about the influence that hurricane season had on her.

[00:14:21] Ken mentions that a hurricane paper Judy published in 2005 attracted a lot of attention, with numerous fellow climatologists as well as the media championing her analysis that showed a doubling of Category 4 and 5 hurricanes since 1970. Ken goes on to note, however, that there were also some scathing critiques of her paper, particularly with respect to the hurricane data that the analysis relied on. Ken asks Judy to talk about how she engaged with her critics and what transpired.

[00:16:42] Morley asks Judy about how she became a vocal supporter of the IPCC and the concerns it was raising following the 2004 hurricane season.

[00:18:02] Ken follows up and asks Judy if she still believes that the warming the Earth has experienced has caused a spike in intense hurricanes.

[00:18:37] Ken asks Judy about the unauthorized release of emails from the Climactic Research Unit at the University of East Anglia, otherwise known as “climategate.” The emails showed that some researchers were manipulating data to make it seem that he earth was heating up dangerously.

[00:20:45] Morley asks Judy to give a primer on climate modeling and how complex it is.

[00:22:09] Morley mentions that in her book, “Climate Uncertainty and Risk: Rethinking Our Response,” Judy discusses several incontrovertible facts about global warming. Morley asks Judy to list them for the listeners.

[00:22:50] Morley mentions that Judy argues in her book that these facts about climate change do not tell us much about the most consequential issues associated with climate change. Morley goes on to mention that Judy’s book highlights four key arguments in regards to global warming. Her first argument is that we do not definitively know to what extent CO2 and other human-caused emissions have dominated natural climate variability as the cause of recent warming. Morley asks Judy to elaborate on this.

[00:23:49] Morley asks Judy to explain her second argument, which is that we don’t have a good handle on how much the climate can be expected to change over the course of the 21^st Century.

[00:24:41] Ken explains that Judy’s third argument is that there is not agreement on whether warming is actually dangerous, and that the notion of danger is based on societal values on which science has little to nothing to say. Ken asks Judy to talk about these claims.

[00:26:00] Ken asks Judy about her final argument, which is that there is widespread disagreement about whether radically reducing emissions will improve human wellbeing in the 21^st Century.

[00:27:29] Morley explains that Judy pointed out many of these issues in 2013 during testimony she gave to a house committee after President Obama’s United Nations climate pledge. Judy argued at the time that the climate community had been working on building a scientific consensus on anthropogenic climate change for 20 years, and that she believed this consensus building process perhaps had the unintended consequence of oversimplifying the climate change problem and its solution. Morley asks Judy to expand on this.

[00:30:41] Morley explains that Judy mentioned on NPR’s show “All Things Considered” that she takes multiple steps to reduce her carbon footprint. Morley asks when she decided to implement those steps and why.

[00:31:51] Morley explains that Judy once said in an interview that even if we achieved net zero with our carbon footprint, we would barely notice. Morley goes on to say that people hold up the pre-industrial era as a “golden age” for the climate, and asks Judy what her thoughts are on this.

[00:32:50] Ken asks Judy to elaborate on her stance that there is no climate change emergency. Ken mentions that Judy’s stance has led to her being labeled a contrarian and dissident climatologist.

[00:34:21] Ken explains that Judy resigned from her tenured position in 2017 due to a variety of factors, including not knowing how to advise students and postdocs on how to navigate the “craziness of the field of climate science.” Ken asks if this was a difficult decision for Judy.

[00:35:44] Morley explains that in a post about her resignation, Judy wrote: “Once you detach from the academic mindset, publishing on the internet makes much more sense, and the peer review you can get on a technical blog is much more extensive. But peer review is not really the point; provoking people to think in new ways about something is really the point. In other words, science is a process, rather than a collection of decreed ‘truths.’” Morley asks Judy to expand on this perspective.

[00:37:31] Morley explains that there has been a lot of publicity regarding the recent extreme weather events over the past few years, with some climatologists arguing that these events are evidence that we are in the midst of an emergency. He asks Judy for her take.

[00:39:04] Morley mentions that Judy frequently argues that policy makers haven’t thought through climate change. While climate change is real, and has negative impacts, Judy argues that common portrayals of a crisis are unfounded. Morley goes on to mention a 2020 paper by Bjorn Lomborg in which he points out that under scenarios set out under the IPPCC, human welfare is likely to increase by 450 percent by the end of the 21st Century. Lomborg estimates climate damages will modestly reduce this welfare increase to 434 percent. Morley explains that Judy’s argument is that policymakers could screw up this upward trajectory in welfare if they destroy our current energy infrastructure. He asks Judy to expand on this.

[00:41:37] Ken asks Judy to talk about how transitioning to all wind and solar power would require a large expenditure of fossil fuel.

[00:44:13] Morley asks if it is true that Judy believes that instead of trying to reach zero carbon emissions by 2025, or some other date, that we should invest in increasing our resilience to extreme weather events.

[00:45:05] Morley pivots to talk about Judy’s book, “Climate Uncertainty and Risk” which Judy began writing in 2020.

[00:45:58] Morley asks Judy when and why she started her blog “Climate Etc.,” and how it helped her in preparation for her book.

[00:46:31] Ken explains that Judy’s book is very ambitious and sets out to show how the narrow and politicized framing of the climate debate has resulted in an oversimplification of both the scientific problem and its solutions. Ken asks if it is true that the book is not just about the climate debate but also, in more broad terms, about uncertainty and risk.

[00:48:00] Morley asks Judy about the second part of her book, specifically the chapter titled “The Climate Change Uncertainty Monster,” which highlights the problems we face in terms of climate change.

[00:49:03] Morley mentions that there is a section in Judy’s book titled “Emissions and Temperature Targets.” She begins the chapter with a quote from environmental scientist John Foley: “The first rule of climate chess is this: The board is bigger than we think, and includes more than fossil fuels.” Morley asks Judy what else the board includes.

[00:49:41] Morley asks about a paper that Judy referenced towards the end of her book in laying out scenarios for a way forward with climate change, “Usable Climate Science Is Adaption Science,” in which Adam Sobel of Columbia University writes that in the present historical moment, the only climate science that is truly usable is that which is oriented toward adaptation. He argues that current policies and politics are so far removed from what we need to do to avert dangerous climate change that scientific uncertainty is not a limiting factor on mitigation.

[00:51:32] Morley asks about another paper that Judy references in her book titled “Small Is Beautiful: Climate-Change Science as if People Mattered.” Written by Regina Rodrigues of Brazil’s Department of Meteorology and Theodore Shepherd of the University of Reading in the UK, it describes how there is a widely accepted gap between the production and use of climate information. The authors call for a break with traditional climate research and methodology, which at the moment seems to be very top-down driven. Morley asks Judy to talk about the proposal for a more bottom-up approach.

[00:52:26] Ken pivots to ask Judy about the term “wicked science,” which she refers to in the last chapter of her book. The chapter is titled “Wicked Science for Wicked Times.”

[00:53:58] Morley asks Judy how she spends her time now that she has resigned from Georgia Tech and academic life.

Links:

Judith Curry website

Episode 157: Don Layman on the role of dietary protein in muscle, health, and disease

Today we have one of the world’s foremost authorities on dietary protein and amino acids, Dr. Donald Layman. He is known for his extensive research on muscle development as well as his studies of metabolic regulation for obesity, diabetes, and cardiovascular disease.

Don is a professor emeritus in the Department of Food Science and Human Nutrition at the University of Illinois Urbana-Champaign. He spent 31 years on the faculty before stepping away in 2012. Much of Don’s research over the years investigated the impact of diet and exercise on adult health problems related to obesity, type 2 diabetes and metabolic syndrome.

His lab at Illinois particularly focused on understanding metabolism. He conducted clinical trials for nearly two decades that helped create a new understanding about how to optimize people’s macronutrient balance and metabolism. In addition to his work on metabolism, Don has also conducted extensive research into ways to enhance body composition, increase energy levels and monitor blood sugar.

Today Don works as Director of Research for the American Egg Board and is a nutrition consultant for the National Dairy Council and The National Cattlemen’s Beef Association. He also is the Chief Science Officer for Qivana, a natural products marketing company that promotes the weight-loss program that Don developed in his lab at the University of Illinois.

Show notes:

[00:04:02] Marcas asks Don what it was like growing up on a farm in a small town in northern Illinois.

[00:04:29] Marcas asks how small the town was that Don grew up in.

[00:05:16] Don explains how he first became interested in science.

[00:05:39] Don talks about how he realized in college that he wasn’t as good at math as he thought he was. He shares how this shifted his focus away from chemical engineering.

[00:06:27] Marcas asks if Don’s natural intuition and interest for biochemistry stemmed from growing up on a farm.

[00:07:10] Ken mentions that as Don was studying biochemistry, he started looking into protein synthesis with a professor by the name of Arlen Richardson, who was known for his aging research. Ken asks Don to talk about this period and how his interest in protein and muscle evolved.

[00:08:27] Marcas asks Don to explain for listeners the importance of protein as it relates to metabolism and what he means when he talks about protein turnover.

[00:09:36] Marcas mentions that we hear a lot about the need to maintain muscle as we grow older, but that back in the ‘70s and ‘80s when Don was starting his career, there wasn’t much of a focus on muscle, except in terms of athletic performance. Marcas goes on to explain that largely because of Don’s research, we now know that protein is critical in terms of helping people stay healthier as they age. Marcas asks Don to give a sense of just how important protein is for our health span and aging.

[00:12:35] Ken asks if it is true that the inefficiency in muscle protein synthesis begins as early as one’s thirties.

[00:14:11] Ken asks Don to talk about the right amount of protein an individual should consume and mentions that there is much confusion on this issue, largely due to the food pyramid’s recommended daily allowance for protein of 0.8 grams per kilogram of body weight.

[00:15:51] Ken mentions that Don has talked in the past about how 40 percent of women who are 60 and older consume less than the RDA for protein, which is likely the bare minimum. Ken asks if it is reasonable to say that a plant-based diet for older women could be risky.

[00:17:13] Ken asks Don to address the claims that high-protein diets are not good for you, and that too much protein can harm your liver and kidney.

[00:18:47] Marcas shifts gears to talk about the quality of protein consumed. Marcas explains that it is much easier for carnivores to get the right amount of protein than vegans, largely because the amino acid leucine is vital for muscle repair and replacement, and leucine is very low in plant-based foods. Marcas asks Don to talk about the difficulty vegetarians and vegans have in consuming enough protein.

[00:21:07] Ken mentions that we hear a lot about the need to adopt a more plant-based diet, but that Don is on record saying that we already have a plant-based diet. Ken asks Don to elaborate on this.

[00:22:23] Marcas asks Don to talk about America’s plant-based diet in relationship to the obesity epidemic.

[00:23:18] Marcas shifts gears to talk about Don’s 1998 paper that set out to define the role of protein in regulating muscle protein synthesis at the level of translation initiation, which is the rate-limiting step in protein synthesis. Marcas asks Don to talk about this study and its significance.

[00:26:00] Ken mentions that Don followed up the aforementioned 1998 paper with a parallel article titled “Leucine Supplementation Enhances Skeletal Muscle Recovery in Rats Following Exercise.” This study showed a link between protein, specifically leucine, to muscle initiation factors. Ken asks Don to talk about the significance of this paper.

[00:28:08] Ken pivots to discuss mTOR, or mammalian target of rapamycin, and explains that there’s confusion about mTOR and protein because public discourse about mTOR is full of mixed signals. Ken explains that we have had several guests on STEM-Talk to discuss mTOR, including David Sabatini, episode 70, who discovered mTOR. Ken asks Don to give an overview of mTOR. (Some other STEM-Talk interviews that covered mTOR include Keith Baar, episodes 62 and 63, and Matt Kaeberlein, episode 139.)

[00:30:33] Ken mentions the difference between chronic and pulsatile activation of mTOR.

[00:32:58] Ken asks Don about his 2005 paper titled “Dietary Protein and Exercise Have Additive Effects on Body Composition,” a paper that demonstrated the synergy of protein and exercise.

[00:36:50] In a follow-up question, Marcas asks how this protein-diet and exercise combination that Don proposes can help in the maintenance of weight loss.

[00:39:28] Ken asks about the advantages of protein in terms of thermogenesis and satiation.

[00:42:04] Marcas asks Don what sort of exercise people should do to build muscle after correcting their protein intake. Marcas asks if exercise should be focused on muscle building or aerobics.

[00:45:27] Ken mentions that Marcas led a clinical trial in 2011 at the University of Alabama Birmingham that showed how men and women in their 60s and 70w who underwent supervised weight training developed muscles that were as strong as those of the average 35- to 40-year-old. Ken asks Marcas to share how this study demonstrated that the neuromuscular system of older adults could be robustly responsive to resistance training.

[00:48:54] After describing his clinical trial that looked at supervised weight training for men and women in their 60s and 70s, Marcas asks Don for his thoughts on prescriptive dosing of exercise for older adults.

[00:51:45] Marcas asks Don if there is an optimal timing of protein intake relative to exercise to get the maximum benefit.

[00:53:42] Marcas mentions Don’s website “Metabolic Transformation,” and the work Don has done with his former student Dr. Gabrielle Lyon on the concepts of muscle centric health and protein centric diets.

[00:56:46] Ken asks Don to walk listeners through what happens while we sleep and why it is important to start the day with a substantial amount of protein at breakfast.

[00:59:21] Marcas asks, considering Don’s recommendation of forty grams of protein at breakfast, what Don generally eats for breakfast.

[01:01:46] Ken asks how many grams of protein people should aim for at dinner and lunch.

[01:03:29] Marcas circles back to intermittent fasting and time restricted eating and asks Don if he thinks they are effective strategies for weight loss and maintenance.

[01:06:02] Marcas mentions that Don’s former student, Gabrielle Lyon, has a book coming out that builds off a lot of the research she and Don have worked on together. Marcas asks Don what he knows about the book, which is titled “Forever Strong: A New Science-Based Strategy for Aging Well.”

[01:07:14] Ken asks Don about a panel discussion that Don was part of at the American Society of Nutrition conference in Boston over the summer. Don talks about some of the key points that came out of the discussion, which was titled “The Global Nutrition Transition: Improving Nutrient Analysis and Monitoring of Metabolic Markers.”

[01:10:07] Ken closes the interview asking how Don spends his time now that he has stepped away from his day-to-day duties at Illinois.

Links:

Metabolic Transformation website

Marcas Bamman bio

Donald Layman bio

Episode 156: Josh Hagen discusses optimizing performance in athletes and warfighters

Today’s interview is with Dr. Josh Hagen, the director of the Human Performance Collaborative at Ohio State University and an Associate Research Professor in the university’s Department of Integrated Systems Engineering.

Joining co-host Ken Ford for this episode is IHMC’s Chief Strategic Partnership Officer Morley Stone who has a long history with Josh has and been instrumental in his career.

Today we talk with Josh about his work at the Human Performance Collaborate, which brings together multi-disciplinary teams of researchers, sports scientists, data scientists, and practitioners with the goal of optimizing human performance in Ohio State athletes.

Within the human performance research area, Josh leads two areas: Sport and Tactical Performance Science and Recovery Science. At Ohio State, Josh works with other performance-science researchers to evaluate the physical traits and capabilities of athletes. Josh and his colleagues then collaborate with coaches and athletic trainers to make adjustments in the weight room, on the field, and during recovery after training or competitions.

In addition to his work at Ohio State, Josh also is working on federally funded projects in human performance with Special Operations Command, The Air Force Research Laboratory, the Office of Naval Research and several private foundations. Josh joined IHMC in 2022 in a collaborate role as a Visiting Senior Research Scientist.

Josh is a graduate of the University of Cincinnati where he studied and earned a Ph.D. in materials science and engineering. He spent 11 years at the Air Force Research Laboratory, which is where Morley and Josh first worked together. After his stint at the Air Force Research Laboratory, Josh headed for West Virginia University as the director of the Human Performance Innovation Center at the Rockefeller Neuroscience Institute before moving to the Ohio State University.

Show notes:

[00:03:39] Morley starts the interview asking Josh if he played a lot of sports as a kid.

[00:03:54] Morley asks if it is true that in addition to being a bit of a jock, Josh was also a nerd growing up.

[00:04:34] Josh talks about the high school chemistry teacher who got him excited about science.

[00:06:05] Morley asks how Josh ended up at the University of Cincinnati.

[00:07:06] Morley mentions that after Josh earned his bachelor’s degree in chemical engineering, he worked for a private company before deciding he did not want to spend his career in chemical engineering. Morley asks about the advice that one of his professors gave Josh at the time.

[00:09:03] Ken mentions that it was at the Materials Directorate at the Air Force Research Lab, where Josh first met Morley. Ken asks Morley what he remembers about the young Josh.

[00:11:19] Ken turns the question to Josh and asks him about his first impressions of Morley.

[00:12:12] Ken mentions that after Josh completed his graduate work, he again went to work in the private sector, and again found it unfulfilling. Josh talks about calling Morley to see if he had a job opening.

[00:13:51] Morley mentions that in 2018, Josh left the Air Force and went to work at West Virginia University, where he became the director of the Human Performance Innovation Center at the Rockefeller Neuroscience Institute. Morley asks Josh how that job came about and what sort of work went on in that lab.

[00:15:46] Ken mentions that after Josh’s time at West Virginia, Morley offered Josh a job at Ohio State University, where Morley was, at the time, the senior vice president for research at Ohio State. Ken asks what this time was like for Josh.

[00:17:17] Morley mentions that in Josh’s role as the director of the Human Performance Collaborative, he works with a multidisciplinary team, and largely worked with two populations, sports athletes and the military. Morley asks Josh to give a sense of how Josh’s lab works with both groups.

[00:20:18] Morley asks Josh to explain what he means by “the need to understand performance on a system level.”

[00:23:14] Ken asks Josh about the use of Heart Rate Variability monitoring on Ohio State’s wrestling team.

[00:26:34] Morley references a video in which Josh talks about using training load monitors in work with athletes. Morley asks Josh to explain how they work and how one uses them to get more insight into an athlete.

[00:29:13] Morley asks Josh what the biggest change he has seen in how athletes approach the off season.

[00:32:03] Morley mentions that Josh was part of a longitudinal study that looked at changes in a baseball player’s maximal strength as a result of resistance training. The study focused the impact the exercise had in terms of total home runs per game across three years of training in four competitive seasons for four teams. Morley asks Josh to talk about this study.

[00:33:40] Morley switches topics to Josh’s research and studies on wearables and other technologies related to enhancing human performance. Morley mentions Josh’s 2020 paper that examined the use of commercially available heart rate devices to derive an estimate of core body temperature in division-1 NCAA football players, The goal was to find a viable tool to identify heat stress in players. Morley asks Josh to talk about the findings of this study and their significance.

[00:38:18] Ken mentions Josh’s 2020 paper on monitoring neuromuscular performance in military personnel. Ken goes on to mention that there is a high standard that elite tactical forces must meet in terms of physical readiness. He asks Josh how he conducted this study, as well as the importance of closely monitoring neuromuscular performance in military troops.

[00:43:08] Ken asks about Josh’s study on popular commercial off-the-shelf wearables that give health data for consumers. Ken asks about their accuracy.

[00:48:57] With respect to Josh’s sleep study, Ken asks, which of the nine devices tested was more effective. Or, Ken wonders, did they all have about same level of accuracy and effectiveness.

[00:50:16] Ken mentions some of the problems with sleep monitoring devices, particularly their inability to accurately track sleep staging. Ken asks Josh if he has any advice for people on what sleep device they should use and how they should approach using it.

[00:53:12] Morley brings up the case of first responders and mentions that firefighters are three times more likely to die on the job than any other occupation. Morley goes on to mention that while there is a great deal of attention paid to developing better equipment and gear to protect firefighters, not as much attention has been paid to understanding the physiological and biological processes that firefighters experience as a part of their job. Morley asks about Josh’s study conducted on firefighters titled “Biomarker and Biometric Indices of Physical Exhaustion in the Firefighting Community.”

[00:57:52] Morley asks Josh about his work with the Air Force’s 711^th Human Performance Wing, particularly Josh’s project that he has led for the past decade called STRONG (signature tracking or optimized nutrition and training) which aims to develop physical training routines and nutritional approaches that can enhance a warfighter’s performance and resilience.

[01:01:09] Morley asks what are some of the technologies Josh has explored in the STRONG lab.

[01:02:59] Ken asks if there is a difference in the error bars between more and less expensive bio impedance measurement devices in comparison to dexa scans.

[01:04:01] Ken asks Morley to give an overview of IHMC’s research project that involves Josh, Ohio State University, and the STRONG lab, called AAPEX (Assessing and Augmenting Performance in Extreme Environments). Ken explains that this project aims for real time assessment of a special operator’s cognitive performance over long-duration missions, often in extreme environments, as well as developing wearable devices and an integrated system that will help warfighters overcome fatigue and stress by continually sensing and assessing their performance.

[01:08:28] Ken asks Josh about his use of the Smartabase platform, which is a commercial human performance optimization platform used for sports teams, military, and other organizations. Ken also asks why Josh is a fan of this platform and what it offers.

[01:12:45] Morley closes the interview by asking Josh how someone goes from working for a private company developing spearmint and other flavors to working with elite warfighters and athletes.

Links:

Josh Hagen bio

Christopher McCurdy bio

Episode 155: Chris McCurdy discusses kratom’s benefits and possible risks

Today we have the world’s foremost authority on kratom returning to STEM-Talk after five years to give us an update on his research. Shortly after his 2018 interview on episode 61, Dr. Christopher McCurdy and his lab at the University of Florida received two major grants from the National Institute of Drug Abuse to investigate the medical efficacy of kratom and its alkaloids, which we discuss in today’s show.

Mitragyna speciosa, or kratom, is an herbal leaf from a tropical evergreen tree in the coffee family. It is native to Southeast Asia where it has been used in herbal medicine for hundreds of years. Kratom has become increasingly popular in the United States and throughout the world for recreational purposes. But kratom is also becoming recognized in the medical and research communities for its treatment for chronic pain as well as its potential to alleviate opioid withdrawal symptoms.

For more than 25 years, McCurdy has studied the design, synthesis, and development of drugs to treat pain, anxiety, and substance-abuse disorders. For the past 15 years, Chris and his lab have turned a lot of their attention toward kratom and its chemical components to better understand its potential to treat a multitude of conditions.

Chris is a professor in the Medicinal Chemistry Department in the College of Pharmacy at the University of Florida. He also is director of the of school’s Translational Drug Development Core and an Associate Dean for Faculty Development.

Our interview with Chris comes on the heels of Florida passing the Kratom Consumer Protection Act, which mandates that kratom products sold in the state meet a high standard of product purity. In today’s interview, we talk to Chris about the protection act as well as:

— The numerous studies he has been able to conduct thanks to his lab’s two grants from the National Institute of Drug Abuse.

— The disparity between the traditional use of kratom and the new often highly concentrated manufactured products sold in the U.S.

— His lab’s study examining the effects of lyophilized kratom tea and its ability to alleviate withdrawal symptoms of opioid-dependence.

— The potential of kratom alkaloids to serve as treatment of various substance abuse disorders.

— The benefits and risks associated with CBD usage.

Show notes

[00:03:21] Dawn opens the interview welcoming Chris back to STEM-Talk and mentions that his last appearance was episode 61 in 2018. Dawn explains that Chris has devoted much of his research to kratom, or Mitragyna speciosa, which is a traditional Southeast Asian medicine. It has been used by indigenous populations for centuries to increase endurance, enhance mood, treat pain, and mitigate opioid withdrawal symptoms. Dawn asks Chris to give a short overview of kratom and why it is attracting so much attention recently.

[00:09:14] Ken mentions that at the time Chris first appeared on STEM-Talk, he was in the process of attracting funding to take a deep dive into kratom, which he has now secured from the National Institute of Drug Abuse. Ken asks Chris to give a general overview of the research they are conducting with this grant and what they are finding.

[00:15:19] Dawn mentions that in Chris’s last interview on STEM-Talk, he mentioned that researching kratom was difficult due to a lack of standardization and asks if this has changed.

[00:21:11] Ken asks about a Thai product that is a freeze-dried leaf, which is coming to the US market, and if this product is more like what is used in Southeast Asia as opposed to the ground leaf material available in the U.S. market.

[00:24:29] Dawn mentions that in 2020, Chris and a colleague published an article in the journal Current Opinion in Psychiatry on the need to address the disparity between the traditional use of kratom and the new often highly concentrated manufactured products sold in the U.S. and other countries. Dawn asks Chris to talk about the points made in this article.

[00:32:35] Ken follows up on the previous discussion asking how the alkaloid strength and combination may change not only due to the processing of the kratom leaf material, but also as a factor of time.

[00:36:33] Dawn asks about a paper that Chris and his colleagues published in the journal Addiction Biology, which reported on research conducted with rats and looked at two of the major psychoactive constituents of kratom: mitragynine and 7-hydroxymitragynine, with an eye toward understanding their potential therapeutic value as well as their abuse potential.

[00:44:12] Ken mentions that in November of 2020, Chris and his team published an article reporting on research examining the effects of lyophilized kratom tea with an eye toward determining if kratom alleviated withdrawal symptoms of opioid-dependence. Ken asks about the findings of this study.

[00:50:21] Ken asks Chris what the difference is between the lyophilized kratom tea and other preparations.

[00:54:20] Dawn mentions an article that Chris published in January and was tagged by the International Association of Pain Management as its paper of the week. Dawn explains that the paper addressed the potential of kratom alkaloids to serve as treatment of various substance abuse disorders. These alkaloids may serve as a blueprint for the development of novel therapies to treat these disorders. Dawn asks Chris to summarize this paper and its findings.

[00:58:51] Dawn shifts the conversation to talk about CBD and explains that the FDA has said that further research needs to be done to determine how much CBD can be consumed before harm is caused. Chris has gone on record saying that we need to balance consumer desire for CBD products with a regulatory framework to ensure safety. Dawn asks Chris about the benefits and risks associated with CBD usage.

[01:07:19] Ken asks Chris about a recent bill signed into law called the Florida Kratom Consumer Protection Act, which mandates that kratom products sold in Florida meet a very high standard of product purity. It also establishes labeling requirements and limits sales to consumers aged 21 and older. Ken asks Chris to talk about this legislation and why he was in favor of it.

[01:13:13] Dawn closes the interview mentioning that Chris has certainly had a lot on his plate over the past five years. She asks what he foresees for his research over the next five years.

Links:

Dominic D’Agostino USF bio

Episode 154: Orthopedic surgeon Brian Cole discusses advances in the treatment of knee, elbow and shoulder injuries

Today we have Dr. Brian Cole, an orthopedic surgeon who specializes in cartilage restoration, orthobiologics, and advanced surgical techniques for the treatment of knee, elbow, and shoulder injuries. He is the team physician for the NBA’s Chicago Bulls and the co-team physician for the Chicago White Sox. He also is the host of the Sports Medicine Weekly Podcast.

Brian practices orthopedic sports medicine at Midwest Orthopaedics. He also is a professor of Orthopaedics, Anatomy and Cell Biology at Rush University Medical Center in Chicago. He is Managing Partner of Midwest Orthopaedics and is the department’s Associate Chairman and the Section Head of the Cartilage Research and Restoration Center. In addition to this work, he also serves as the Chairman of Surgery at Rush Oak Park Hospital.

In today’s interview, we talk to Brian about his cutting-edge research into ways to treat knee, shoulder, and elbow injuries. Brian shares his novel approach to dealing with ACL tears, one of the most common sports injuries, and his investigations of methods to enhance the healing and recovery time following ACL reconstructions. He also talks about new advances in minimally invasive surgical techniques for many common injuries. We have a particularly interesting conversation with Brian about exciting developments in the use of stem-cell treatments as well as the use of bone marrow aspirate to treat injuries.

Show notes:

[00:03:53] Marcas opens the interview mentioning that Brian was in the eighth grade when he fell in love with a popular sit-com from the 1970s, “The Bob Newhart Show.” Marcas asks Brain what he loved about the show and what impact it had on him.

[00:05:07] Brian enrolled in the University of Illinois after graduating from high school. Marcas asks Brian if knew he wanted to major in biology and psychology when he arrived on campus.

[00:05:58] Ken mentions that after Brian’s undergrad, he travelled upstate to the University of Chicago, where he earned an MD and an MBA. Ken asks what led Brian to pursue both an MD and MBA.

[00:09:52] Ken explains that after the University of Chicago, Brian moved to New York City for an orthopaedic research fellowship in metabolic bone disease at the Hospital for Special Surgery. Brian also decided to do his residency there as well. Ken asks how that came about.

[00:11:31] Marcas mentions that after Brian finished his fellowship and residency, he went to the University of Pittsburgh for a sports medicine fellowship. Marcas asks what led Brian there and what drove his interest in sports medicine.

[00:13:10] Marcas asks Brian about a fortuitous phone call he received when he was a fourth-year resident.

[00:14:34] Ken explains that Midwest Orthopaedics is one of the nation’s most respected private orthopaedic practices. Ken notes that through a partnership with Rush University Medical Center, Midwest has developed a national reputation as a leader in sports medicine; hip, knee, spine, and cartilage restoration; as well as shoulder care and pain management. Rush also is an academic medical center that includes a 671-bed hospital and is a center for basic and clinical research. Ken asks Brian to describe the scope of the work that goes on at Midwest and Rush.

[00:17:20] Marcas comments that Brian is also the head team physician for the Chicago Bulls and the co-team physician for the Chicago White Sox, and asks Brian to describe some of the work that he does in that capacity.

[00:20:09] Marcas explains that Brian treats a wide range of patients with injuries and pain, from athletes to non-athletes, and from children to senior citizens, and that he has performed more than 20,000 surgeries over the course of his career. Marcas asks Brian to give a sense of the patients he sees and what his average day at the office is like.

[00:24:00] Ken points out that Brian is known for focusing on treating the patient and not the x-ray or MRI. Ken goes on to say that x-rays and MRIs often bog down both the practitioner and patient with too much information. Brian often refers to this overload as BARF and VOMIT. Ken asks Brian to explain what he means by BARF and VOMIT.

[00:31:56] Marcas reflects that a few decades ago, the only way to help someone with the loss of cartilage in the knee was to surgically go into the knee and clean up the debris. Bone on bone pain makes it difficult to walk, get up and down in a chair, and climb stairs. Marcas asks Brian to explain the range of options available to patients today in this regard.

[00:35:31] Ken mentions that in the past couple of decades, there have been numerous advancements in how to treat patients with shoulder, elbow, and knee injuries via non-surgical means, ranging from biochemical to pharmacological to diet and rehabilitation. Ken asks Brian to give an overview of these nonsurgical methods and the status of evidence supporting each.

[00:39:08] Ken explains that weight loss is often an effective approach to reducing knee pain, and that for every pound a person loses, it leads to a five-to seven-pound reduction at the level of a person’s joints below their waist. Ken asks Brian to talk about the importance of this and how he and others in the practice discuss this with their patients.

[00:43:06] Marcas explains that ACL tears often require surgery and are among the most common injuries for athletes and workers in physically demanding jobs, with approximately 500,000 ACL tears each year. Marcas asks Brian to give a sense of what happens to a person when they experience an ACL injury.

[00:46:05] Marcas comments that according to the American Academy of Pediatrics, ACL tears have skyrocketed among 14- to 18-year-olds, increasing by 148 percent over the past 10 years. Marcas asks what is causing this increase.

[00:48:28] Ken follows up on the previous question mentioning that there is a critical need to develop novel strategies to enhance ACL healing and accelerate recovery time after an ACL reconstruction. Ken goes on to mention that Brian has a study that was designed to assess the effect of bone marrow aspirate concentrate to reduce recovery time and asks about the findings of this study.

[00:51:03] Marcas comments that in the late 1900s, cultured chondrocytes implanted beneath a periosteal patch were used as a treatment for chondral injuries. Animal studies had demonstrated hyaline-like repair. Along with encouraging early clinical results, this led to the widespread implementation of autologous chondrocyte implantation, or ACI, in the U.S. and Europe. Marcas goes on to say that many clinical studies supported the long-term efficacy and durability of ACI, but today, scientists are investigating alternative methods of enhancing the biological repair and the surgical technique using ACI. Marcas asks about Brian’s paper – titled “Current Status of Autologous Chondrocyte Implantation” –that recently appeared in Sports Medicine Reports.

[00:53:52] Ken asks Brian to discuss meniscal tears, which are the most common pathology of the knee, and one of the most common pathologies in sports medicine. Ken mentions that Brian coauthored an editorial in the Journal of Arthroscopic and Related Surgery that pointed out the most important first step in terms of treatment is determining whether the injury is an acute traumatic tear or a degenerative one.

[00:56:11] Ken asks Brian about the use of bone marrow aspirate, or platelet-rich plasma, as a source of growth factors in progenitor cells in rotator cuff repair, a topic on which Brian has a paper coming out highlighting reductions in re-tear rates.

[00:58:30] Marcas mentions that Brian has also been involved in a few biomechanics studies looking at fixation of soft tissue to bone and also fixation of soft tissue using sutures, and asks Brian to give a sense of why this work is important.

[01:00:31] Marcas explains that current research on osteoarthritis and treatments for it are moving beyond the diseased joint, integrating other articular tissues, including synovium, fibrocartilage, and bone, as well as periarticular structures like muscles, tendons, and ligaments. Marcas asks how this model affects treatment plans.

[01:03:43] Marcas explains that until recently, the impact of inflammation on OA pathogenesis was perhaps underappreciated, as OA was not considered an inflammatory disease. He goes on to explain that the field seems to have shifted in this thinking to now include effects of inflammation on periarticular tissues. Marcas asks Brian what his thoughts are on this.

[01:08:05] Ken mentions that one of the more promising developments in the field is the use of stem-cell treatments of various kinds, and to this point Ken mentions that there are a number of different approaches. Ken asks Brian to talk about this and perhaps separate fact from fiction on the matter.

[01:10:23] Ken asks about cultured stem cells, which are used in treatments for which thousands of Americans travel overseas for each year. Ken asks if there are studies that show increased efficacy in any of these methods.

[01:11:29] Ken mentions that Brian also specializes in the treatment of glenohumeral arthritis, which is a degenerative joint disease affecting the shoulder, and is characterized by the degeneration or wearing away of the protective cartilage covering the ends of the bones in the joint. Ken asks Brian to explain what the standard of care is for this disease.

[01:13:41] Marcas asks what the average lifespan of a modern shoulder replacement can be expected to be.

[01:15:44] Ken asks how reverse shoulder replacement compares to anatomical shoulder replacement.

[01:17:10] Ken asks about a 2019 study in the British Medical Journal that reported the risks associated with shoulder replacement surgery for arthritic conditions is much higher than previously thought. Ken explains that the study found that one in four men aged 55 to 59 were at risk of needing further revision surgery, and that the risk of serious adverse events like heart attacks and major blood clots within 90 days of surgery were much higher than previously estimated, particularly in people over 85 years of age.

[01:21:29] Marcas closes the interview mentioning that Brian, in addition to his medical practice, is also in the podcast business, hosting a weekly show called “Sports Medicine Weekly Podcast with Dr. Brian Cole.” Marcas asks Brian to discuss the range of topics covered in the podcast.

Episode 153: Dominic D’Agostino discusses new advances in the study of nutritional ketosis

Today we have our good friend and colleague Dr. Dominic D’Agostino returning for his third appearance on STEM-Talk. Dom, as most of our longtime listeners know, is well-known for his research into the ketogenic diet and the physiological benefits of nutritional ketosis. Since our last conversation with Dom in 2019, a tremendous body of research has been added to the literature about the therapeutic potential of ketosis. The high-fat, low-carb ketogenic diet has been linked to advances in the treatment of Alzheimer’s, cancer, migraines, type-2 diabetes, psoriasis, sleep apnea, psychiatric disorders, traumatic brain injuries as well as a host of other diseases and disorders, which we cover in today’s interview.

In episode 14 of STEM-Talk, we talked to Dom about his development and testing of metabolic therapies involving the ketogenic diet for a wide range of diseases and conditions. In episode 87, Dom returned to reflect on his 10 years of research focused on the high-fat/low-carbohydrate diet.

In today’s interview, we talk to Dom about this latest work as well as his extensive research on hyperbaric oxygen. Dom is a tenured Associate Professor in the Department of Molecular Pharmacology and Physiology at the University of South Florida Morsani. He specializes in neuroscience, molecular pharmacology, nutrition, and physiology. Dom also is our colleague and a research scientist here at the IHMC.

Show notes

[00:02:50] Dawn opens the interview mentioning Dom’s recent IHMC Evening Lecture, in which he mentions the film “First Do No Harm” starring Meryl Streep. The film is based on the true story of a four-year-old boy diagnosed with severe epilepsy, whose extreme seizures continued despite extensive medical treatments. The boy’s mother reached to Dr. John Freeman, a physician who had successfully treated patients with a ketogenic diet. Dawn asks Dom to give some context about this fictional film based on a true story.

[00:05:05] Dawn asks Dom to discuss the many evidence-based applications of the ketogenic diet that he highlighted in his IHMC evening lecture.

[00:07:11] Ken asks Dom about another story involving Russell Winwood, a man with severe chronic obstructive pulmonary disease, also known as COPD. Russell reached out to Dom with respect to treating his COPD with a ketogenic diet.

[00:11:21] Ken asks if Russell only engaged in the ketogenic diet or if also used exogenous ketones.

[00:12:10] Ken mentions that the ketogenic diet has the broad potential to be an anti-inflammatory diet. Ken goes on to mention that COPD is an inflammatory disease. As Dom’s case report suggested, Ken wonders if the ketogenic diet has the potential to have strong therapeutic effects for other inflammatory conditions as well. Ken asks what other conditions Dom thinks might benefit from therapeutic ketosis.

[00:14:02] Dawn mentions that Dom has been busy since his last appearance on STEM-Talk, having authored or collaborated on more than 40 papers, one of which garnered a lot of attention and was published in Frontiers in Neuroscience. This paper investigated whether therapeutic ketosis via ketone esters could represent a viable way to treat epilepsy and other seizure disorders. Dawn asks Dom to elaborate on this paper’s findings and their significance.

[00:16:26] Ken mentions that those listeners who are unfamiliar with ketone esters may want to check out our interview with Dr. Brianna Stubbs. Ken asks Dom to give a quick primer on ketone esters and why so many researchers in the field are excited about their potential.

[00:19:20] Ken mentions that in addition to ketone salts and ketone esters, there are other product formulations out now, like the one from a company called Kenetik. Ken asks Dom what he thinks about this formulation.

[00:23:33] Dawn mentions that Dom has had a number of animal studies published since 2019 looking at ketone induced neuroprotection and asks Dom to give an overview of some of this work.

[00:25:57] Dawn asks Dom about his research on Angelman Syndrome, which is a rare genetic and neurological disorder that causes seizures, developmental delay, loss of body movements, and lack of speech. Dawn mentions that Dom was a part of a mouse study that explored whether ketone supplementation could mimic the ketogenic diet as an anticonvulsant, as well as the effects of ketone esters on behavioral and metabolic outcomes. The results of this study were promising, and Dawn asks Dom to talk about some of the key takeaways.

[00:29:37] Ken mentions that it makes sense that the ketogenic diet would elevate NAD (nicotinamide adenine dinucleotide) levels. Ken asks Dom whether this same effect is observed with exogenous ketones.

[00:30:32] Ken mentions that in the last decade there have been numerous human studies that have investigated the therapeutic role of ketogenic diets in various neurological disorders, with recent work looking into the potential therapeutic effects of ketosis on Alzheimer’s disease. Ken asks Dom to touch on some of this research, and also mentions that episode 59 of STEM-Talk with Steven Cunnane focused a good bit on Alzheimer’s in the context of exogenous ketones.

[00:35:02] Dawn mentions that Dom was part of two studies that examined the effects of a ketogenic diet on athletic performance. Dawn goes on to explain that high-carbohydrate, low-fat diets have been the standard for athletes for years, but recent research has challenged the superiority of carb loading. Dawn mentions that former IHMC colleague Dr. Andrew Koutnik published a study that had middle aged athletes undergo two different 31-day isocaloric diets, one which was high carb, and the other ketogenic. Dawn explains that both Dom and Jeff Volek participated in this study and asks Dom what the key takeaways were.

[00:37:46] Ken explains that Dom and Jeff Volek also collaborated with Andrew Koutnik on another study on the crossover effect. Before diving into that study specifically, Ken asks Dom to explain what the crossover effect is.

[00:40:13] Dawn mentions that Dom has been a part of many studies that have demonstrated the positive impact of a ketogenic diet, but addressing the elephant in the room, Dawn asks Dom what his thoughts are on the fact that some individuals respond to the ketogenic diet by developing a marked elevation of LDL cholesterol on the ketogenic diet, otherwise known as the lean mass hyper-responder phenotype. Dawn specifically asks Dom about an article he and other researchers published in the Journal of Clinical Lipidology on this topic, titled “Elevated LDL-cholesterol levels among lean mass hyper-responders on low-carbohydrate ketogenic diets deserve urgent clinical attention and further research.”

[00:45:16] Dawn explains that there is no one-size fits all diet, with some people breezing through a ketogenic diet and others who do not tolerate it as well. She mentions that Dom had a review published a few years ago that examined genetic and other markers in an effort to identify how people might respond to a ketogenic diet, the goal being to identify individuals who were most likely to benefit from a ketogenic diet, and pinpoint individuals who might be at risk of adverse health outcomes because of the diet. Dawn asks Dom to walk through this review and explain its findings.

[00:50:03] Ken mentions that Dom has done a lot of research on hyperbaric oxygen, which is a well-established treatment for decompression sickness, which is a risk among divers. Ken goes on to explain that hyperbaric oxygen therapy is now being used to treat several medical conditions including traumatic brain injury. There is controversy, however, regarding this therapy. Ken asks Dom to give a short primer on hyperbaric oxygen and why it has lately attracted so much attention.

[00:52:56] Dawn follows up by jumping into a discussion about the NASA project NEEMO that sends crews of astronauts, aquanauts, engineers, and scientists to live in a facility at the bottom of the Atlantic, known as Aquarius. It is the world’s only undersea research station. Dawn explains that NEEMO provides a good analog for space exploration, by mimicking the high physiological stress environment that astronauts experience during space missions. Dawn explains that she was on the crew of NEEMO 21 and Dom was on the crew of NEEMO 22, and Dom’s wife was a NEEMO support diver during NEEMO 22. She later became a part of the all-women crew in NEEMO 23. Dawn asks Dom to talk about his experience on NEEMO as well as the research he conducted.

[00:57:58] Dawn asks about Dom’s paper he published after his experience on NEEMO, titled “Human Adaptations to Multiday Saturation on NASA NEEMO,” which explored the physical and psychological effects of living in a multiday hyperbaric environment. Dawn asks Dom to discuss this paper’s findings and its significance.

[01:04:25] Ken mentions that Dom and his wife have moved to a farm and asks what life on the farm is like.

Links:

Episode 152: Mark Shelhamer talks about the effects of spaceflight on humans and NASA’s Planned Mars Mission

Today we have the former chief scientist of NASA’s Human Research Program, Dr. Mark Shelhamer. Mark specializes in neurovestibular adaptation to spaceflight.

He is an otolaryngology professor at Johns Hopkins School of Medicine and the director of the school’s Human Spaceflight Lab. He also the director and founder of the Bioastronautics at Hopkins initiative.

In addition to his work with NASA, Mark is an advisor to the commercial and consumer spaceflight industry. In today’s interview, we talk to Mark about some of this work, as well as the research he conducted on the first all-civilian crew that successfully orbited the Earth for three days in a SpaceX capsule.

We mostly talk to Mark, however, about how the harsh conditions of space imperil humans. We have a fascinating discussion about Mark’s role in NASA’s planned human mission to Mars and how he is investigating ways to maintain the health and performance of astronauts on such a long-duration spaceflight. We also discuss how the lessons Mark is learning about how the lessons of human spaceflight can be applied to healthcare on Earth.

Show notes:

[00:02:42] Dawn starts the interview mentioning that Mark grew up in Philadelphia in the ‘70s. She asks Mark what he was like as a kid.

[00:03:32] Dawn asks if it is true that Mark played drums in a band in school.

[00:03:54] Ken asks Mark to talk about an uncle who was key in fostering Mark’s interest in math and science.

[00:05:31] Ken mentions that Mark was only 10 years old when he took up an interest in electronics and asks what sparked that and what electronics he specifically found interesting.

[00:08:14] Dawn mentions that Mark attended Drexel University and initially wanted to become an electrical engineer but changed his mind somewhere along the way. Dawn asks what caused this shift.

[00:10:20] Ken asks Mark why he selected to attend MIT after Drexel.

[00:13:52] Ken asks Mark how he ended up at Johns Hopkins after finishing his studies at MIT.

[00:15:52] Dawn mentions that when Mark arrived at Johns Hopkins as a postdoc fellow in 1990, he continued the research he had been doing at MIT on sensory motor physiology and modeling, including astronaut adaptation to space flight. Dawn asks Mark to give an overview of this research as well as how he tracked back into studying astronauts.

[00:17:15] Ken mentions Mark’s 2007 book “Nonlinear Dynamics in Physiology: A State-Space Approach,” which provides mathematical-computational tools for analyzing experimental data. Ken asks Mark to talk about the book and its goals.

[00:20:43] Ken mentions that Mark has done quite a bit of research into motion sickness and vestibular issues, and asks about his more recent work on Space Motion Sickness.

[00:24:53] Dawn explains that on Mark’s Wikipedia page, there’s a reference to his pioneering work on a multidisciplinary approach to human space flight research. She asks Mark to give an overview of this work.

[00:29:17] Dawn explains that spaceflight has widespread effects on many different body systems at the same time, and that Mark has been an advocate for developing approaches to examining all these interactions in a rigorous way. Dawn asks if Mark feels that we should be taking this rigorous multidisciplinary approach and applying it to terrestrial medicine as well.

[00:34:08] Ken asks Mark to talk about some of the progress he has made in convincing certain groups that they need to embrace a multidisciplinary approach to their research.

[00:38:37] Dawn mentions that getting people, especially groups, to change their approach to research can be a daunting task. She goes on to mention that Mark has been quoted as saying “If there’s one thing I’m known for, it’s banging my head against the wall trying to convince people to do integrative research.” Dawn asks Mark how many scars he has on his forehead from these efforts.

[00:43:00] Dawn asks Mark to talk about his informal expertise on the history of NASA’s early stages of human spaceflight.

[00:48:54] Dawn explains that we may be on the cusp of another exciting time with NASA’s Artemis program and plans to return to the moon. Dawn also mentions that two years ago, the first all-civilian crew was sent on a 3-day mission orbiting Earth by SpaceX in a Falcon rocket. Dawn explains that there were several research projects related to Inspiration4 and that Mark was the principal investigator for one of them. Dawn asks Mark to talk about this project, which is part of a NASA-supported experiment to test and study astronauts through the year 2033.

[00:57:16] Ken points out the success of Apollo 17’s scientific inquiries thanks to Jack Schmitt being a scientist who had the chance to fly the mission as an astronaut. Ken and Mark talk about the importance of having more subject-matter experts go into space so that detailed spontaneous scientific observations can be made.

[01:00:16] Dawn mentions that in 2013, Mark took leave from Johns Hopkins to serve as the chief scientist of NASA’s Human Research Program. In this capacity, Mark particularly looked at the effects of space radiation on people as well as the behavioral risks of being confined with a small group of people in tight quarters on a long-duration spaceflight. Dawn asks Mark to talk more about this research.

[01:04:43] Mark Ken and Dawn discuss the psychological, mechanical, and physiological pros and cons of artificial gravity for a Mars mission.

[01:07:39] Dawn mentions that most human research has been focused on keeping people healthy in space. However, one thing that Mark is excited about is the potential of spaceflight research to enhance terrestrial healthcare. Dawn mentions that not everyone sees the broader scientific value of human spaceflight research. To address this, Mark and a group of colleagues published a paper in 2020 titled, “Selected discoveries from human research in space that are relevant to human health on earth.” Dawn asks Mark to talk about what some of the reservations are that people have about the ability of spaceflight research to enhance terrestrial healthcare.

[01:12:23] Ken mentions that this 2020 paper looked at five areas of physiology that support Mark’s contention of the broader implications of spaceflight research. Ken asks Mark to discuss these and their potential relevance to scientific and medical issues on Earth.

[01:17:53] Ken starts a dialogue about the assessment of risk for a Mars mission, as well as proposing pharmacological interventions for things like bone loss in long duration space flights.

[01:21:03] Ken explains that NASA estimates that it will take around seven months to get to Mars with a good planetary alignment. Ken goes on to explain that NASA is planning to send humans to Mars in the 2030s and asks Mark to give his thoughts about a future Mars Mission and the role that human research might play in enabling such missions.

[01:26:08] Dawn explains that in addition to Mark’s NASA work, he also has projects involving SpaceX and Blue Origin, and mentions that he must be very busy at the moment.

[01:26:45] Dawn mentions that Elon Musk has gone on record as saying that SpaceX will land humans on Mars by 2026 and asks Mark what his take on this is.

[01:28:16] Ken asks if it is true that Mark remains an avid ham radio hobbyist and still plays drums in his spare time.

[01:29:32] Dawn mentions that Mark’s high school is so proud of what he has accomplished in his career that last year he was inducted into his high school’s inaugural Hall of Fame class.

[01:31:15] Dawn asks if Mark’s previously mentioned connection to the Hubble Space telescope research program is in fact his wife.

[01:31:48] Dawn mentions that she has heard that Mark is a cat person and to close the interview asks Mark about that.

Episode 151: John Ioannidis talks about the bungled response to COVID-19

Back in early days of the COVID-19 pandemic, Dr. John Ioannidis wrote an article in March of 2020 questioning government statistics about the fatality rate associated with COVID-19. The backlash was swift and brutal and John’s reputation as one of the most influential scientists in the world took a beating.

Today, John makes his second appearance on STEM-Talk to discuss his extensive research into the COVID-19 pandemic as well as the public shaming he received in 2020 for questioning the World Health Organization’s prediction of a 3.4 percent fatality rate associated with COVID-19.

John also talks about his most recent peer-reviewed paper that looked at the age-stratified infection fatality rate of COVID-19 in the non-elderly population. The study found that the pre-vaccination fatality rate for those infected may have been as low as 0.03 percent for people under 60 years old, and 0.07 percent for people under 70, far below the World Health Organization’s prediction of a 3.4 percent fatality rate.

In today’s episode, John walks us through this paper, which was published in January, as well as what he describes as the U.S. government’s bungled response to COVID-19. He also discusses the importance of collecting reliable data in the future to guide disease modelers and governments before they make decisions of monumental significance like lockdowns. He goes on to share how he underestimated the power that politics and the media, or powers outside of science, can have on science.

Over the past two decades, John’s research has earned him a global reputation as a consummate physician and researcher, which contributed to The Atlantic describing John in 2010 as one of the most influential scientists alive. He is a professor of Medicine, Epidemiology and Population Health as well as a statistician and professor of biomedical data science at Stanford University.

Back in 2018 when we interviewed John on episode 77 of STEM-Talk, we talked to him about his 2005 paper questioning the reliability of most medical research. The paper, titled, “Why Most Published Research Findings Are False,” found that much of the medical science reported in peer-reviewed journals is flawed and cannot be replicated. The paper is the most citied article in the history of the journal PLoS Medicine and has been viewed more than 3 million times.

Show notes:

[00:03:16] Dawn opens the interview welcoming John back to STEM-Talk. his last appearance being in 2018. Dawn explains that when John last appeared on STEM-Talk in 2018, he was described by Atlantic Magazine as “one of the most influential scientists alive.” But in the intervening years, John became public enemy number one in 2020 after a paper he published questioning government statistics about COVID 19’s fatality rate. Dawn asks John if it’s fair to say that he has been on a rather rocky ride for the past few years.

[00:03:54] Dawn explains that John was trained at Harvard and Tufts universities in internal medicine and infectious disease, and asks John what led him to study infectious disease.

[00:04:54] Ken asks John about his initial thoughts in 2019 when he first heard the reports coming out of China about COVID-19.

[00:05:52] Ken explains that in March of 2020, John fell into some hot water for writing a piece questioning the 3.4 percent fatality rate associated with COVID-19. John found this number to be inflated and wrote that while COVID-19 was indeed a threat, it did not behave like the Spanish Flu or a pandemic that would lead to a 3.4 percent fatality rate. Ken asks John how he came to this conclusion.

[00:08:37] The article that John wrote in 2020 was titled “A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data.” John argued in his article that the data collected in the first three months of the pandemic was “utterly unreliable.” He went on to write that no one had a good way of knowing how many people were infected and therefore how the pandemic would evolve over time. Dawn asks John what could have been done so that governments and health agencies could have more accurately estimated incidents of new infections, particularly in the early months of the pandemic.

[00:10:19] Dawn mentions that John initially supported the lockdown, but only as a temporary measure, and that he was of the mind that after February of 2020, we had missed the window to nip the pandemic in the bud. Dawn goes on to say that John believed that if we had acted earlier and more aggressively with testing, tracing, and isolating, like in South Korea, that we could have significantly slowed the spread of the virus. Dawn asks if John still feels this way now.

[00:12:53] Dawn mentions that John wrote that the bulk of the mortalities related to COVID-19 occurred in people with limited life expectancy rather than young people. Dawn goes on to say that John was criticized for this, accused of minimizing the lives of the elderly and was even referred to as a “heartless granny killer.” Dawn asks John to expand on his point that age predicts mortality better than comorbidities.

[00:15:16] Ken follows up regarding the disproportionate infections in nursing homes, mentioning that, among other stories, New York City showed very negative outcomes in terms of nursing-home populations.

[00:16:13] Dawn asks if John investigated the nosocomial spread of COVID-19.

[00:17:53] Ken mentions that one of the things we heard early on in the pandemic, was talk of flattening the curve so that we wouldn’t overwhelm hospitals. Ken asks John for his thoughts about this.

[00:20:04] Dawn asks John what he thought of the Great Barrington Declaration, a paper that questioned school closings, lockdowns, travel restrictions and other governmental responses to the COVID-19 pandemic. Dawn goes on to mention that one of the authors of that paper, Dr. Martin Kulldorff, was our guest on episode 132 of STEM-Talk. Dawn goes on to say that Martin and his co-authors recommended protecting senior citizens and others who were most at risk from COVID, while allowing young people and others who face minimal risk to lead their normal lives. Dawn asks John about the recommendations found in the Great Barrington Declaration.

[00:23:26] Ken mentions that outrage propagated by social media and news sources became such a negative force that it shut down civil discourse in public and academic circles. Ken goes on to say that this led to harsh control over conversations regarding important topics. There were swift attacks against anyone who dissented with official narratives, no matter how well founded someone’s opinions were. Ken asks John about his experience now that he has being on the receiving end of these brutal attacks.

[00:27:00] Ken follows up and agreees that the self-censorship among scientists with regards to COVID-19 has been severe and problematic.

[00:28:33] Dawn brings up John’s recent paper published in January of this year in Environmental Research. Dawn explains that this paper points out that the largest burden of COVID-19 is carried by the elderly, but that 94 percent of the global population is younger than 70 years old, and 86 percent is younger than 60. Dawn goes on to explain that John set out to accurately estimate the infection fatality rate of COVID-19 among non-elderly people in the absence of vaccination or prior infection. Dawn asks John how he and his co-authors came together to work on this study.

[00:31:45] Dawn mentions that John’s aforementioned study reported infection survival rates around the world. John found that wealthy nations had infection survival rates of 99.962 percent for those under 60, and 99.902 percent for those under 70. In poorer nations, however, the survival rates were even better: 99.992 percent and 99.988 percent respectively. Dawn goes on to mention that John and his co-authors speculate that lower obesity rates in poorer countries may have improved their survival rates, and asks John how the U.S. would have fared if the obesity rate was at levels more common in the 1970s or ‘80s.

[00:35:08] Ken mentions that unsurprisingly the countries hit the hardest by COVID-19, like Italy and China, had two of the most elderly populations in the world.

[00:38:09] Dawn mentions that John’s paper noted that 44 percent of the population had already been infected with COVID-19 before Omicron arrived in the fall of 2021. Because of this, John points out in the paper that an infection rate of 50 percent would have only caused modestly higher fatality rates than seasonal flu fatalities for those under 70. Dawn asks John to elaborate on this.

[00:40:52] Dawn mentions that around the time John published his paper in STAT in March of 2020, the Imperial College of London predicted Covid-19 would kill 40 million people.

[00:41:56] Ken mentions that miscalculations like the one by the Imperial College of London were unfortunate because they prompted lockdowns and other heavy-handed responses from governments. Ken goes on to say that John wrote in 2020 that we need data to inform us about the rationale of lockdowns, mask mandates and social distancing measures. At a minimum, Ken said, we needed unbiased prevalence and incidence data for the evolving infectious load to guide decision-making. Ken asks John for his thoughts about why this never happened.

[00:46:34] Ken asks John what were some of the unintended consequences that resulted from lockdowns, school closures, and travel bans.

[00:49:47] Dawn mentions that John has published dozens of peer-reviewed COVID-19 related papers. John has mentioned before that any scientific papers will have some weaknesses. Dawn asks John what, in hindsight, he sees as weaknesses in his papers.

[00:50:41] Ken asks about John’s investigation into the recent study commissioned by the British nonprofit Cochrane that found no clear reduction in respiratory viral infection as a result of mask mandates. Ken mentions that the paper noted that the use of medical/surgical masks, including N-95 masks, were not effective in reducing the spread of acute respiratory viruses.

[00:55:02] Ken mentions a Zoom call he was on with a government official who was alone in his house wearing a mask during the Zoom call. Ken discusses the gentleman’s response after he was asked about wearing the mask even though he at home by himself.

[00:56:48] With respect to randomized controlled trials regarding the effectiveness of masks, Ken mentions that the media’s portrayal of such studies shows that the media does not understand statistics, and specifically the difference between relative and absolute risk.

[00:57:51] Ken launches into a discussion about the education of journalists in modern times, and how education in journalism should include a sophisticated understanding of statistics.

[01:00:24] Ken asks John what his thoughts are about the possibility of future pandemics and how this kind of situation might be handled differently.

[01:02:50] Ken mentions the issues created by funding agencies during times of pandemic and other world shaping events.

[01:03:41] Ken explains that trust, or lack thereof, in institutions and the media has turned out to be a key factor in people’s reaction to non-pharmaceutical interventions such as lockdowns and mask mandates and vaccine mandates. Ken goes on to say that surveys of trust are showing a substantial decline and offers that there may be strong negative consequences from this lack of trust in the future. Ken goes on to say that this trust could, of course, be reestablished through transparency and accountability and asks John if he sees this happening anytime soon.

[01:06:28] Ken closes the interview asking John if there are any other COVID-19 studies he is working on or hopes to pursue.

Links:

John Ioannidis bio