Intelligent Medicine

Integrative rheumatologist Dr. Aly Cohen combines conventional rheumatology medications with lifestyle and environmental health approaches to manage autoimmune disease, emphasizing nutrition, sleep, exercise, the gut microbiome, and reducing exposure to synthetic chemicals, pesticides, and contaminated water. They discuss how immunosuppressive drugs can be lifesaving but carry infection risks, and how “risk mitigation” and anti-inflammatory dietary patterns can support resilience. Cohen highlights vitamin D's importance in autoimmunity and COVID outcomes and lists four foundational supplements: a clean multivitamin (including iodine), vitamin D3 guided by blood levels, a quality probiotic, and omega-3 fish oil with adequate EPA+DHA; they also cover cautious use of curcumin, limited enthusiasm for glucosamine/chondroitin, and a measured view of collagen. Cohen promotes her hybrid Smart Human Health Summit on women's health (Saturday, April 25), featuring clinicians speaking on menopause/HRT, dementia, cardiology, endocrinology, GLP-1s, and toxins, with in-person, virtual, and recorded access.

Dr. Hoffman continues his conversation with Integrative rheumatologist Dr. Aly Cohen. 

Bioethicist and psychiatrist Dr. Aaron Kheriaty, author of “Making the Cut: How to Heal Modern Medicine,” discusses declining public trust in healthcare. Kheriaty describes his medical training and argues medicine has become an industrial, bureaucratic “turnstile” system that dehumanizes care, turns physicians into data-entry clerks, and relies on reimbursement-driven “guidelines” and narrow evidence-based medicine that favors costly pharmaceuticals. He proposes creating “parallel” grassroots medical institutions—such as direct primary care—analogous to homeschooling and Eastern European dissidents' “parallel polis,” since systemic reform from within is difficult. Kheriaty recounts opposing COVID vaccine mandates at UC Irvine, being fired after suing, and participating in Missouri v. Biden and Ho v. Newsom, which challenged government-influenced social-media censorship and California's physician “misinformation” law. He also discusses informed consent, assisted suicide opposition, and advocating opt-in organ donation.

Dr. Hoffman continues his conversation with bioethicist and psychiatrist Dr. Aaron Kheriaty, author of “Making the Cut: How to Heal Modern Medicine.” 

Expect a renewed push to take a statin at your next doctor's visit; PREVENT online calculator skews decisions to prescribe cholesterol reduction as early as 30; American Heart Association discourages at-risk patients from taking fish oil and garlic supplements—REALLY? Renewed interest in muscle as promoter of overall health and metabolism; The key role of urolithin A (Mitopure®️) for supporting muscle function. Is DHEA a reasonable supplement for post-menopausal women?

CEO of large hospital system makes controversial call to replace radiologists with AI; Inclusion Body Myositis—is it curable? New worries over flame retardants in recycled black plastic utensils; Scientists discover link to toxic microbiome byproducts in causation of ALS, frontotemporal dementia; When depression-sufferers lose all interest in food; Eating plenty of fresh fruits and vegetables incurs risk of bio-accumulation of pesticide residues; Tattoos carry long-term health risks.

Nutritionist Leyla Muedin discusses news from Secretary Robert F. Kennedy Jr.'s “Take Back Your Health” tour, highlighting hospital commitments to nutrition-driven care, including connecting Florida farms directly to hospital food systems. She reports that CMS issued a quality and safety special alert directing hospitals to align meals with the 2025–2030 Dietary Guidelines for Americans, emphasizing whole nutrient-dense foods and adequate protein while reducing ultra-processed foods, sugar-sweetened beverages, refined carbohydrates, and added sugars, and reinforcing Medicare participation requirements such as meeting individual nutrition needs, dietitian oversight, current therapeutic diet manuals, and integrating nutrition into quality improvement. At Nicklaus Children's Hospital, Kennedy and CMS Administrator Dr. Mehmet Oz met with healthcare leaders; the hospital signed a pledge to partner with Florida producers to improve food quality, remove procurement barriers, and expand medically tailored meals and training. Muedin praises regenerative agriculture and local supply chains and contrasts these efforts with past high-carbohydrate hospital diets.

The benefits of saunaThe Take Back Your Health TourA follow-up on milk thistle interactions with drugsWhat are your thoughts on low-dose saw palmetto for hair growth?Is monk fruit a safe sweetener to use?

Would strontium help in the healing of lumbar fractures?  How about as a preventive?How valuable is the hs-CRP test?  Are there any drawbacks to eating canned fish?What are your thoughts on Arterosil for cardiovascular health?

Dr. Jeffrey Bland, Founder and President of the Personalized Lifestyle Medicine Institute and President of Big Bold Health, is described as the “godfather of functional medicine.” He details the origins of functional medicine as a systems-biology, root-cause approach emphasizing diet, lifestyle, and supplements alongside conventional allopathic care, especially for chronic disease. Bland contrasts medication “number needed to treat” examples (statins and TNF-alpha blockers) with personalized lifestyle interventions, noting adherence challenges. He discusses GLP-1 weight-loss drugs as a major pharmacologic advance but raises concerns about long-term effects, discontinuation rates, side effects, and inadequate nutrition if food intake drops. Bland describes research on bitter compounds and gut “taste” receptors influencing GLP-1 and related hormones, links to Blue Zone diets, and introduces Big Bold Health's Himalayan Tartary Buckwheat and minimally processed, sustainably sourced fish oil products, the Omega-3 index, and targeted formulations with lutein/astaxanthin, plus ongoing clinical trials on immune aging and gene expression.

Dr. Hoffman continues his conversation with Dr. Jeffrey Bland, Founder and President of the Personalized Lifestyle Medicine Institute and President of Big Bold Health.

Dr. Sina McCullough, author of “Hands Off My Food! How to Defend Your Food, Health, and Freedom,” argues that bureaucrats, multinational biotech corporations, and regulatory loopholes have helped adulterate the U.S. food supply. McCullough describes nearly dying from rheumatoid arthritis after years of worsening symptoms despite a “clean” organic, paleo-style diet, then recovering through functional testing that revealed 15 nutrient deficiencies, food sensitivities, and arsenic poisoning; she says she healed without pharmaceuticals. She explains that nutrition training often ignores food adulterants and claims the FDA facilitates markets rather than ensures safety, highlighting the GRAS loophole, voluntary notification, lack of long-term and cumulative testing, and industry influence via the revolving door. Examples include trans fats, glyphosate formulation issues, gene-edited crops, and recombinant bovine growth hormone approvals and labeling. She discusses organic loopholes and emphasizes solutions: read labels, “feed the good and starve the bad,” vote with purchasing, seek third-party certifications, and know your farmer; she also promotes her Beyond Labels podcast with farmer Joel Salatin.

Dr. Hoffman continues his conversation with Dr. Sina McCullough, author of “Hands Off My Food! How to Defend Your Food, Health, and Freedom.”

Social media and AI—the digital equivalents of ultra-processed junk food--are undermining our brain power; Are natural non-caloric sweeteners—erythritol, xylitol and stevia—safe? A pig's brain has been flash frozen, and reanimated, signaling new prospects for cryopreservation after death; Dr. Jeffrey Bland weighs in on a new, enhanced form of fish oil from Big Bold Health.

Heart Association clashes with RFK, Jr., doubles down on recommendation for low-fat diets; Why the evidence for meat and full-fat dairy avoidance is weak; What are the health benefits of circumcision? The ultimate weight loss plan—the Boring Diet; Substituting famotidine for PPIs for reflux; Midlife vitamin D curbs Alzheimer's risk; Natural support for polymyalgia rheumatica; What teens eat could be affecting their mental health.

Leyla Muedin, a registered dietitian nutritionist, discusses a UK Biobank analysis published in the Journal of Cachexia, “Sarcopenia and Muscle” (Nov 2025) linking continuous long-term statin use (e.g., Lipitor, Zocor, Crestor) to accelerated declines in grip strength and appendicular lean mass compared with never-users. Among 35,557 with follow-up data, grip strength declined by a mean 0.315 kg/year and appendicular lean mass by 0.057 kg/year in statin users; findings persisted after adjustment for age, sex, BMI, comorbidities, and a pharmacogenomic statin-response score. Leyla notes possible mechanisms (CoQ10/mevalonate pathway effects, mitochondrial dysfunction, apoptosis, calcium disruption, insulin resistance) and advises monitoring musculoskeletal health, supporting diet and regular physical activity, while not interpreting results as a reason to stop prescribing statins.

Highlights from Dr. Hoffman's New Zealand bike tripDo you prefer whey protein isolate or concentrate?My liver enzymes went up taking a statin drug. My doctor recommends I take milk thistle. What are your thoughts?If any supplement protocols are out of stock, should we make substitutions?

What are your thoughts on peptides?So it's not possible to get enough protein from plants only?What about the downsides to animal protein?Are there any negative reports on the usage of extra virgin olive oil?Is it true that the nutritional value of farmed seafood is the same as wild caught?

Dr. David Clarke, president of the Psychophysiologic Disorders Association, details the link between stress and chronic pain and the scope of brain-generated symptoms. Clarke says many patients have symptoms not explained by disease or injury, estimating about 20% of U.S. adults (about 50 million) live with chronic pain, with costs estimated at $650 billion, and notes clinicians are often not trained to evaluate psychosocial stressors. He describes clues that pain is brain-generated (e.g., multiple long-lasting or shifting symptoms, lack of objective nerve damage) and a broad symptom spectrum from migraines and IBS to pelvic pain and rashes. Clarke discusses adverse childhood experiences, triggers, personality traits, and repressed emotions, cites randomized trials showing “pain relief psychology” can reduce pain and change MRI findings, and shares resources including a clinician directory, self-assessment quiz, and the Curable app. 

Dr. Hoffman continues his conversation with Dr. David Clarke, president of the Psychophysiologic Disorders Association.

How Continuous Glucose Monitors Can Optimize Metabolic Health—and Where GLP-1 Drugs Fit: Emergency physician-turned-preventive/metabolic medicine specialist Dr. Paul Kolodzik of Metabolic MD reveals how continuous glucose monitors (CGMs) are a tool not only for diabetics but also for non-diabetics and pre-diabetics to personalize diet, sleep, and exercise by seeing real-time glucose patterns instead of relying on fingersticks or A1c averages. Kolodzik describes CGM use in his clinic (two-week diagnostic wear, then therapeutic guidance), highlights insulin resistance, fasting insulin testing, glucose variability, and the role of low-carb eating, intermittent fasting, and strength training to improve metabolic syndrome, triglycerides, and fatty liver. They discuss CGM sourcing/cost, device mechanics and accuracy, possible future noninvasive wearables, and GLP-1/GIP weight-loss drugs, emphasizing supervised, limited-dose use with protein and lifestyle changes to avoid muscle loss and weight regain. A free PDF of Kolodzik's book is offered HERE.  

Dr. Hoffman continues his conversation with Dr. Paul Kolodzik of Metabolic MD.

Nutritionist Leyla Muedin discusses nutrition and menopause, defining menopause as 12 months without a period and noting it can occur naturally or due to surgery/medical procedures. She links declining estrogen to increased cardiometabolic risk, endothelial dysfunction, vascular aging, musculoskeletal pain, and higher risks with early menopause (including cardiovascular disease, chronic kidney disease, and dementia), and notes many estrogen-modulated conditions are associated with gut dysbiosis. She emphasizes lifestyle—especially nutrition—as key, highlighting anti-inflammatory, minimally processed eating and warning against ultra-processed foods, refined carbs, and excess omega-6. She cites research that high adherence to a Mediterranean diet improves markers like heart rate, lipids, triglycerides, CRP, and overall cardiometabolic risk, and mentions omega-3s lowering triglycerides while modestly raising HDL and LDL. She reviews diet approaches for hot flashes, suggests reducing caffeine, alcohol, sugar, and carbs, notes some women require (bioidentical) HRT, and describes clients improving symptoms with dietary change.

Half of US adults are interested in GLP-1 agonists for weight lossIs spelt matzoh better than traditional wheat matzoh for Passover?Is a dry red wine preferable to sweet wine or grape juice?Is Einkorn flour a better alternative to modern wheat?Which liver support supplements are best for alcoholic issues?

I was diagnosed with Exocrine Pancreatic Insufficiency. Which digestive enzymes are best to take?I still have pain and tingling after a shingles outbreak. What can I take for it?So many protein shakes contain carrageenan, but isn't it a carcinogen?My 5-year-old grandson has pancolitis.  Do you have any recommendations?What do you think of an organic acids test for chronic fatigue?How can I find the cause of my atopic dermatitis?  

Oral Health, Inflammation, and Periodontal Disease: Dr. William Levine, a board-certified periodontist and chief scientist at Peri Active Oral Rinse, offers a deep-dive on periodontal disease as an infectious inflammatory condition with autoimmune-like tissue destruction. It affects over 50% of U.S. adults over 35 and rises with age. He details bidirectional links between gum disease and systemic conditions, including cardiovascular disease, stroke, diabetes, and some dementias, and notes signs such as bleeding, pain, swelling, loose or shifting teeth, and gum recession. Levine explains plaque, dysbiosis, and biofilms, emphasizing mechanical plaque removal to preserve a healthy oral microbiome. Standard care includes scaling and root planing, possible surgery, and lasers; antiseptic rinses like chlorhexidine can be harsh and limited against biofilms. Levine describes a plant-bioactive rinse (gotu kola, echinacea, elderberry) designed to reduce harmful bacteria, penetrate gums, lower inflammation, and promote repair; xylitol may help via saliva stimulation. He also addresses smoking, dry mouth, fluoride toothpaste, interdental cleaning, and osteoporotic drugs' dental risks.

Dr. Hoffman continues his conversation with Dr. William Levine, a board-certified periodontist and chief scientist at Peri Active Oral Rinse.

Herbal Medicine, Quality Control, and Adulteration Prevention: Mark Blumenthal, founder and executive director of the American Botanical Council (ABC), recounts his entry into herbalism via vegetarianism in 1968, off-grid living, and starting a wholesale herb business in 1974 before shifting to nonprofit education, research, advocacy, and quality control. The discussion covers the evolution from teas and tinctures to standardized extracts, the complexity and synergy of multiple constituents, and how standardization supports quality control and therapeutic consistency. Blumenthal explains ABC's Botanical Adulterants Prevention Program and its free, peer-reviewed resources addressing global fraud, plus GMP requirements and laboratory methods for identity, contamination, and potency testing. He discusses herbs including ashwagandha, turmeric/curcumin and adulteration risks, maca, nigella, and milk thistle, and outlines ABC resources, HerbClip, and membership options at herbalgram.org.

Dr. Hoffman continues his conversation with Mark Blumenthal, founder and executive director of the American Botanical Council (ABC).

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

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

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

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

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

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

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

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

Robotic pets make life easier for patients with dementia; Risks, benefits of “natural” ED formulas; Sorting out those pricey new injectable osteoporosis drugs; Daily multivitamin delays biological aging; Study challenges notion that aging means inevitable decline; Breastfeeding confers weight loss benefits—to moms; Can you avoid a colonoscopy with a new colon cancer blood test? Color blindness may hide warning signs of cancer.