The People's Pharmacy

Birth rates have been dropping for years. This is happening in many parts of the world, not just the US. Demographers estimate that women need to have 2.1 children, on average, to replace the population. (The US is currently at about 1.7 or 1.8 children per woman.) Where the average number of babies falls below replacement, the country may end up with more elderly people than children. Eventually, this can have economic and social consequences. In this episode, we explore the baby bust. Why is fertility falling?

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

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, October 3, 2026, through your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Oct. 5, 2026.

Why Is Fertility Falling?

Fertility in the US is at a historical low, according to our guest, Dr. Linnea Zimmerman. Whether or not this baby bust constitutes a crisis depends upon your perspective, however. Those who see young people primarily as eager working hands could perceive the economic effects of falling fertility as a future crisis. Others who worry that we are straining the ecological limits of the planet might view a decline in fertility more positively.

We asked Dr. Zimmerman about the sources of this baby bust, and she explained that the factors are complex. Although there will almost certainly be some economic consequences of a steep drop in fertility, economic considerations are also important for people considering parenthood. Housing is expensive, and so is childcare. Do they feel confident about their healthcare coverage?

It is not clear that the lifetime fertility rate of American women has declined as steeply as the statistics suggest. One good aspect of the current situation is fewer teenage pregnancies. In addition, many women in their 20s, when past generations would have been bearing babies, may be waiting until they feel more settled in their lives, or until they find a suitable partner to raise children with. This can take time.

Has Environmental Contamination Affected Fertility?

We asked Dr. Zimmerman if we could attribute fertility falling to exposure to environmental factors such as forever chemicals. While PFAS compounds are certainly not good for humans and should be avoided as much as possible, we don’t yet have evidence that they are contributing to a baby bust.

What Can You Do About Fertility Challenges?

We turned to Dr. Genevieve Neal-Perry to learn about what options people might have if they discover they need help conceiving. According to Dr. Neal-Perry, the available technology has improved greatly over the years, and fertility specialists are frequently able to help a woman conceive and carry the pregnancy to term. Moreover, many more people now have fertility benefits as part of their health insurance. In past years, this was much less common.

The source of a fertility challenge is not always obvious. Dr. Neal-Perry suggests that a third of the time, the difficulty lies with the female, a third of the time with the male and a third of the time with the combination. If a woman has endometriosis and is not ovulating, that would need to be addressed first. Men’s fertility begins to drop when they are in their 40s or 50s. Men who take testosterone may have lower sperm counts. In addition, people with very high BMI (40 or above) often have reduced fertility.

How Long Should You Wait for Nature to Take its Course?

Dr. Neal-Perry suggests that healthy women 35 and under could try for a year before seeking out assistance. Beyond that age, six months is a more realistic time frame. Women who plan to freeze their eggs for future pregnancy should also consider doing this while they are in their mid30s, as they have the best chance of retrieving viable eggs for future use at that age.

How Do Medications Affect Conception and Pregnancy?

Obstetricians do not recommend that people undertake major weight loss while they are trying to become pregnant. Although there has been some media attention to the phenomenon of “Ozempic babies,” we do not have safety data for GLP-1 agonists such as semaglutide or tirzepatide during pregnancy. In fact, a preconception review of medications a few months before beginning the attempt for a pregnancy is highly advised.

Interventions to Promote Conception

If the woman has intact fallopian tubes, intrauterine insemination may be helpful. It overcomes barriers that may exist at the cervix and helps the sperm unite successfully with the egg. If the fallopian tubes are not open or not present, the best option may be in vitro fertilization. The eggs are removed and inseminated in the laboratory (“in vitro” implies in glass). The embryos are incubated for the first few days of development. The doctor may then take tiny samples of the embryo to do genetic testing before introducing it into the uterus. As Dr. Neal-Perry put it, the implantation is “out of our hands.”

Throughout the fertility journey, from before conception to after birth, people are encouraged to continue their best health practices: following a well-balanced diet without junk food, getting regular physical activity and sleep, avoiding chemicals that may be harmful.

This Week’s Guests

Linnea Zimmerman, PhD, MPH, is an associate professor of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. Dr. Zimmerman studies family planning and women’s reproductive health, evaluates use and barriers to critical maternal and newborn health interventions. Her website is https://publichealth.jhu.edu/faculty/3046/linnea-a-zimmerman

Linnea Zimmerman, PhD, MPH, Johns Hopkins University

Genevieve Neal-Perry, MD, PhD, is Department Chair of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill. She is the Robert A. Ross Distinguished Professor of Reproductive Endocrinology and Infertility.

Genevieve Neal-Perry, MD, PhD, UNC Chair of OB-GYN

Listen to the Podcast

The podcast of this program will be available Monday, October 5, 2026, after broadcast on Oct. 3. You can stream the show from this site and download the podcast for free. This week’s episode contains additional discussion on over-the-counter drugs to avoid during pregnancy and some possible treatments for the future.

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

After years of dementia, many people have reduced their communication to minimal levels. Sometimes, they don’t say anything at all, and family members may be tempted to assume that memories have disappeared along with cognitive function. Occasionally, such a person will become surprisingly coherent and able to discuss aspects of their lives for a few minutes or even hours. Because they often die within days of such an episode, researchers have termed the phenomenon “terminal lucidity.” Our guest, Dr. Marjorie Woollacott, suggests that the more inclusive term “paradoxical lucidity” might be more appropriate. What do these unexpected events have in common with near-death experiences? Can they teach us about consciousness?

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

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, September 26, 2026, through your computer or smart phone (wunc.org).  Here is a link [] so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Sept. 28, 2026.

What Is Terminal Lucidity?

An article by Billy Brennan in the New York Times Magazine (July 15, 2026) was titled, “Why Do Some Dementia Patients ‘Return’ Just Before They Die?” The subtitle explained, “As they near death, some dementia patients recover mental faculties assumed to be long lost. Researchers want to know why.” Coincidentally, the Washington Post also ran a story recently on terminal lucidity: “Some dementia patients grow lucid near the end. Scientists hope it’s a clue.”

We were fascinated by the story Mr. Brennan shares about a conversation with a grandmother a few days before her death. It reminded us of an experience a friend of ours had shared about his own mother. She had dementia and had not communicated much with anyone for a long time. When the nursing home called him and told him she had broken her hip, he expected she would be even more incoherent because of the opioids she would be administered for the pain. So when he arrived at the hospital to find her oriented to time and place and aware of the situation, he was astonished. In this instance, her unexplained clarity continued for a few weeks. We can’t call it “terminal” lucidity, though, as she survived several more years.

Such tales suggest that even a disordered brain is not completely lacking in consciousness. But what do we mean by consciousness?

A Stroke of Insight to Teach Us About Consciousness

Neuroscientists usually assume that the brain creates consciousness, although they haven’t explained exactly how it does so. Some philosophers postulate that consciousness is a fundamental property of the universe. In this view, our brains act as filters so that we don’t become entirely overwhelmed and unable to function. Many years ago, we interviewed Dr. Jill Bolte Taylor, a neuroanatomist, about her brilliant book, My Stroke of Insight. In it, she recounts her own experience and perceptions as she suffered a massive hemorrhagic stroke that affected the left side of her brain. She observed as her brain circuits went offline, one by one. In particular, she was struck by a sense of joy and unity with the entire universe. Our guest for this episode, Dr. Marjorie Woollacott, suggests that during this time, Dr. Bolte Taylor’s stroke removed the usual filters that our brain puts on our consciousness.

How Else Might People Have a Different Access to Consciousness?

Dr. Woollacott is a meditator as well as a neuroscientist, and she describes her initiation into meditation. To her, it felt as though she were participating in a larger consciousness. Meditation might facilitate a lowering of the filters that usually limit our awareness of a broader consciousness. Dr. Woollacott describes this as a spiritual awakening. Sometimes people describe an experience under the influence of psilocybin in similar terms.

Many people who have died and then been revived have described their feelings about such a near-death experience. Dr. Sam Parnia and Dr. Bruce Greyson have both discussed these phenomena for People’s Pharmacy listeners. In such situations, people often accurately depict events that occurred while they were unconscious or technically dead. Most people who have survived a near-death experience consider it a spiritual awakening. They may change their lives from there on.

Near Death in a Healthcare Setting

Not everyone who undergoes a near-death experience is in a healthcare setting where heart rate (or lack of heart beat), brain activity, respiration and so forth can be observed and recorded. In one instance, a woman named Pamela Reynolds required surgery on a brain aneurysm. It was a very delicate operation, and to conduct it properly, the surgical team chilled her body and drained the blood from her brain. She told us about leaving her body and observing the operation from above. The descriptions she gave of the surgical drill and the music the team was playing have been corroborated by the people involved, although Ms. Reynolds had no visual or auditory input and should have had absolutely no consciousness whatsoever.

Dr. Bettina Peyton Comes Back

Dr. Woollacott described another, more recent incident in which a patient who should have had no awareness described watching her own resuscitation. Bettina Peyton, a physician, needed a C-section to deliver her third baby, but the operation went badly and she started to hemorrhage. She described accessing a much broader consciousness and then being commanded to live. When she revived, she was able to relate the events that had occurred in the delivery room although she had not been able to see or hear them. Could we use such case histories to teach us about consciousness?

Do Nonverbal Children Participate in Nonlocal Consciousness?

Dr. Woollacott has been interacting with parents and family members of certain children with autism who do not speak. They do communicate through other means. Some of these youngsters describe meeting and communing with other autistic kids on The Hill. They describe it in remarkably similar terms, even though they have not met face to face. Dr. Woollacott believes that these young people may have reduced neural filters. Perhaps that explains why they seem to be more skilled at telepathy than the rest of us. Although it is foreign to our materialist world view, we may need to take the idea of nonlocal consciousness seriously.

This Week’s Guest

Marjorie Woollacott, PhD, is an Emeritus Professor of Human Physiology and member of the Institute of Neuroscience at the University of Oregon. She is Research Director for the International Association of Near-Death Studies and President of the Academy for the Advancement of Postmaterialist Sciences. Dr. Woollacott has published more than 200 scientific articles and written or co-edited eight books, including Infinite Awareness: The Awakening of a Scientific Mind.

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

Marjorie Woollacott, PhD, author of Infinite Awareness

Listen to the Podcast

The podcast of this program will be available Monday, September 28, 2026, after broadcast on Sept. 26. You can stream the show from this site and download the podcast for free. This week’s episode contains additional discussion on Dr. Ian Stevenson’s research on cases suggestive of reincarnation. What can that teach us about consciousness?

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

Do you worry that your hair is thinning? You may wonder what treatments could make a real difference. After all, you wouldn’t want to spend money on something that has no chance of helping. Many people also have concerns about their nails. Perhaps they are ridged, or loose, or too thick. Could that be due to nail fungus, or might it have another cause? Most importantly, what could you do about it? In this episode, you’ll get a dermatologist’s guide to what actually works.

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

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, September 19, 2026, through your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Sept. 21, 2026.

What Actually Works for Hair and Nail Problems

Dr. Chris Adigun practices both general and cosmetic dermatology. We wanted to ask her about nail problems in particular because they are very common and she maintains a specialty in treating them.

We asked her about the most common nail problems she sees, and she named simple onycholysis (pronounced Oh-nick-oh-LYE-sis). In this condition, the nail begins to lift away from the nail bed. You can identify it because the white area at the fingertip becomes much more extensive than usual. Usually, this is due to exposure to acids such as citrus juices or cleaning solutions. Having your hands in and out of irritants or even water (with or without soap) could lead to onycholysis. An overactive thyroid gland could also lead to onycholysis. To prevent it, try to avoid putting your hands into that sort of liquid. If you must do so, use gloves. And of course, a good hand cream to bolster the skin barrier is a very good idea. If these approaches don’t do the trick, especially if there are other symptoms, the doctor may want to test for thyroid function.

Another common problem is allergic contact dermatitis. This could be caused by some of the same irritating substances responsible for onycholysis, but cosmetics are common culprits here. Nail polish and remover, especially nail polish remover, can cause nail problems for some people. If you are one of them, what actually works best might mean finding a less irritating product or, even better, leaving the nails unadorned.

White Spots on Nails

Many people have noticed white spots on their nails. We asked Dr. Adigun what causes these, and she replied that usually they are not worrisome. If you bang your fingertip, as you might if you slammed it in a door or a drawer, the trauma may show up several weeks later as a white spot. (More serious trauma could show up as a dark spot due to blood pooling under the nail; we discussed that with podiatrist Jane Anderson here,  but not with Dr. Adigun.)

What About Ridges on the Nails?

Nail ridges are very common, and the ones that run lengthwise along the same axis as the finger are due to aging. Just as our skin develops wrinkles, so do our nails. Consequently, there are no effective treatments.

Nail ridges in children are a different story. They might show up as nails having the texture of sandpaper, or they could be horizontal ridges. Such nails should be seen by a physician, as they could signal an inflammatory condition called lichen planus or even an early sign of psoriasis. While we don’t have cures for these conditions, there are effective medications to manage them.

Hangnails and Cuticle Problems

Are you surprised that dermatologists have a fancy term to describe cuticle problems and other trouble affecting the skin around the nail? They call it paronychia (PEAR-oh-nick-ee-ya). If it is caused by an infection, it might be treated with an antimicrobial compound. The best preventative is not to pull, bite or clip off hangnails or rough spots in the cuticles, the skin near the nails. Instead, moisturize and possibly cover the spot with a bandage to remove the temptation while it softens and heals. Instant glue is another simple remedy that really works for hangnails.

Treating Nail Fungus

When the nails are thick, ugly and hard to trim, often people blame nail fungus. But surprisingly, it isn’t always the culprit. Mechanical trauma can also create thick nails that are hard to cut. If the nail is thick because it is on a hammer toe so it bumps against the insole of the shoe, antifungal treatment won’t help. If a healthcare professional addresses it when it first appears, it may be treatable, but once the body has grown accustomed to producing that thick nail, there may be no effective treatment.

Some nail infections are bacterial as well as fungal. Both may show up together, or the infection may be one or the other. A dermatologist has techniques for diagnosing whether the problem is due to a fungus or to bacteria such as Corynebacterium. Different types of antimicrobial medicines are effective for these infections. Athlete’s foot also needs a real diagnosis, since it too might be bacterial rather than fungal in nature. OTC athlete’s foot medicines target fungal infections.

Handling Hair Loss

Both men and women experience hair thinning, and no one is pleased about it. The patterns differ, with men noticing a receding hairline and less hair on their temples. Women’s hair loss tends to form a Christmas-tree pattern, with the tip of the tree right behind the hairline and the base spreading out over the crown of the head. Women are also prone to hair loss after giving birth to a baby. However, while that may be alarming in the moment, it often corrects itself without treatment over the following months.

Hormonal Treatments for Hair Loss

With men, scientists have identified testosterone metabolites as contributing factors. Drugs such as finasteride (Propecia) or dutasteride block those metabolites and help men regrow hair. Dr. Adigun has begun using these compounds in women who are beyond childbearing. (They are off limits for a person who might become pregnant because they could interfere with the normal development of genitals in a fetus.)

A different hormonal treatment for hair loss is spironolactone. Dermatologists have long used it to treat female pattern hair loss. A review found that spironolactone is an effective and safe treatment option for hair loss” (Cureus, Aug. 16, 2023). Besides boosting scalp hair growth, however, it can also cause itchy scalp, facial hair growth and menstrual problems.

Another approach that actually works for hair loss is minoxidil (Rogaine). Most people are familiar with this as a topical product to be applied twice daily. That might get old after a while. Also, some people react to the product with contact dermatitis, irritation or itching. Low-dose oral minoxidil seems to work as well as topical minoxidil without the irritation. Another possible option which is better than placebo but not as potent as full strength topical minoxidil is rosemary oil. It is less likely to cause itching, however.

This Week’s Guest

Chris G. Adigun, MD, FAAD, is a board-certified dermatologist and the President and Medical Director of the Dermatology & Laser Center of Chapel Hill, which she founded in 2016. Dr. Adigun practices both general and cosmetic dermatology, with a strong emphasis on minimally invasive treatments that deliver natural, impactful results. She has devoted much of her career to increasing public awareness of skin cancer and the harmful effects of UV exposure—both medical and cosmetic—and maintains an academic specialty in nail disorders.

Chris G. Adigun, MD, FAAD, Dermatology & Laser Center of Chapel Hill

Listen to the Podcast

The podcast of this program will be available Monday, September 21, 2026, after broadcast on Sept. 19. You can stream the show from this site and download the podcast for free. This week’s episode contains additional information on hair loss due to chemotherapy and why it may grow back with a different color or texture. We also discuss red light therapy for hair growth, along with biotin supplements. Those call for caution, as they can interfere with the results on tests for thyroid function.

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

For years, anyone who sprained an ankle or twisted a knee got some standard advice: ice it, rest it, wrap it with compression tape and keep it elevated. The acronym for Rest, Ice, Compress and Elevate is RICE. New research shows that following this advice alleviates the pain from the injury in the short term, but it may actually slow healing. What can help you in healing faster from this type of problem? You can hear it directly from a scientist applying cutting-edge research with tendons and rats to getting NBA players back on the court sooner.

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

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, September 12, 2026, through your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the audio stream on this post starting on Sept. 14, 2026. We will also be putting up a YouTube video podcast so you can watch our guest do some demonstrating.

Healing Faster from Injuries

Sports medicine expert Dr. Gabe Mirkin coined the acronym RICE in the 1970s. At the time, many physicians and physical therapists embraced this approach to treating injuries. It helped reduce the pain in the immediate term, and it doesn’t seem to do any harm over the longer term. It can take quite a while to heal damaged tendons and ligaments, however. Sometimes, that takes even longer than for broken bones to knit.

Eventually, Dr. Mirkin reversed his RICE recommendation. But very few professionals took note. Is there a happy medium between applying RICE and toughing it out by trying to walk a sprained ankle off? Our guest on this episode has been studying the topic of healing faster from injuries and has some concrete advice to offer.

Trying to Fool Mother Nature

Many of the precautions that amateur athletes take are designed to undermine the body’s inflammatory response. Yet acute inflammation is exactly how the body tries to heal itself from injury. Ice and ibuprofen are anti-inflammatory, so taking ibuprofen before exercise or icing a sore knee afterwards might be counterproductive.

What Is a Better Approach to Healing Faster?

According to Dr. Keith Baar, immobilizing a joint (“rest”) leads quickly to loss of muscle and force. When he put rats on bed rest (listen to learn how), they lost strength rapidly. On the other hand, moving a joint gently helps to reduce swelling by pumping fluid out. This, in turn, is an early step in healing faster. How do you move a joint gently? Dr. Baar has developed his own acronym: 3LD isometrics.

How Do You Practice 3LD Isometrics?

First of all, what does 3LD even mean? It stands for low-load, long-duration isometrics. During isometric exercise, instead of moving a muscle quickly, you hold it in position until it fatigues. Physical therapists recommend isometrics, such as planks or wall squats, to strengthen the muscles around joints.

In low-load long-duration exercises, you provide some support so you are not putting your entire body weight on the joint. In other words, you lessen the load. Rather than moving quickly through the motion, you find the point at which you can feel the tension in the muscle but it doesn’t actually hurt. Dr. Baar describes this as ooh instead of ouch. Then you hold that position (with the support, remember) for 30 seconds or so. This is a relatively long duration.

Healing Faster from Sports Injuries

Dr. Baar describes how he helped his nephew, a college-team football linebacker, heal an injured shoulder. Sports injuries are not the only joint problems that could benefit from healing faster with 3LD isometrics. Other common complaints are carpal tunnel syndrome in the wrist or plantar fasciitis in the foot.

Changing the Culture of Treating Injury

Dr. Baar describes his work with a rugby player who injured his hamstring tendon and was able to resume playing much earlier than the surgeon initially anticipated. Baar’s team has also worked with a basketball player who ruptured an Achilles tendon last year. Healing faster with 3LD isometric work got him back on the court last year–the only NBA player with such an injury to manage that. As elite athletes learn the advantages of 3LD isometrics, physical therapists will begin offering it to ordinary people who simply want to resume their usual activities sooner.

This Week’s Guest

Keith Baar, PhD, is a professor of molecular exercise physiology at the University of California, Davis who leads the Functional Molecular Biology Laboratory. Dr. Baar is a leading expert in musculoskeletal health, studying how muscles, tendons, and ligaments respond to mechanical loading and nutrition. His websites are https://biology.ucdavis.edu/people/keith-baar and https://health.ucdavis.edu/basic-sciences/physiology/team/faculty/baar

Keith Baar Headshot

Listen to the Podcast

The podcast of this program will be available Monday, September 14, 2026, after broadcast on Sept. 12. You can stream the show from this site and download the podcast for free. And we are hoping to get the video podcast up on YouTube. Just search for People’s Pharmacy next time you go to YouTube.

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

This week, we get in-depth information on Lp(a), the heart risk no one talks about. You have heard of cholesterol, and you may even know what your cholesterol level is. The compound lipoprotein a may be equally dangerous when it is elevated, but you have probably heard very little about it.

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

How You Can Listen

You could listen through your local public radio station on Sept. 5, 2026, or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Sept. 7, 2026.

What Is Lp(a)?

Lipoprotein a, or L-P-little a for short, circulates in the bloodstream, where it picks up and carries cholesterol and oxidized phospholipids. Scientists believe that blood levels are determined mostly by genetics and change very little over the course of our lives. Roughly 20 percent of people have high levels of Lp(a), above 30 ng/dL or 75 nmol/L. The two different figures are because tests use different units to measure the blood concentration, either nanograms per deciliter or nanomols per liter.

While we don’t know if Lp(a) has or perhaps once had some important functions, we do know that elevated levels of this chemical is associated with heart disease. People with higher levels are more likely to suffer blood clots and inflammation. That puts them at risk for heart attacks or even strokes. So why hasn’t your doctor ordered a blood test to learn your level?

Is Lp(a) the Heart Risk Doctors Can’t Treat?

Perhaps doctors have been reluctant to measure or discuss lipoprotein a because they don’t have good interventions. That is beginning to change with the development of antisense oligonucleotides, a new category of prescription drugs that can cut levels sharply. The FDA has not yet approved any of these new medications, though. The first of these, pelacarsen, is still in Phase 3 trials needed before the agency can consider the evidence. However, it can bring down lipoprotein a by an estimated 80 percent.

Cardiologists’ favorite drugs, statins, do not help Lp(a) levels. In fact, Lp(a) the heart risk rises when people are taking statins to lower their cholesterol. Other cholesterol-lowering drugs such as evolocumab (Repatha) and alirocumab (Praluent) can bring Lp(a) levels down modestly. One really old cholesterol-lowering drug, high-dose niacin, also helps moderate Lp(a). Some people do not tolerate it, however, as it can cause very uncomfortable flushing. So far as we know, no scientists have run studies to see whether niacin reduces the risk of heart attacks and other complications because of its effects on Lp(a).

Other Complications of Lp(a):

Our guest, Dr. Sam Tsimikas, is among the country’s leading experts on lipoprotein a. We asked him whether Lp(a) the heart risk factor causes other problems as well. Dr. Tsimikas described heart failure, potentially resulting from a heart attack, as well as peripheral artery disease (PAD), which can make it painful to walk. Lp(a) seems to cause plaque in arteries throughout the body. As a result, it can increase the chance of a stroke. In addition, it contributes to calcification of the heart valves. This condition interferes with their ability to function properly.

What Can We Do If Lp(a) Is Too High?

Dr. Tsimikas runs a unique clinic for cardiology patients with high levels of Lp(a). We asked him how he helps them. One approach is to collect additional information about their level of risk. A coronary calcium score can be a useful indicator. If it is high, he and his patients work to control all the potential risk factors that they can. He discusses the potential benefit of aspirin with them. Because Lp(a) the heart risk factor increases the chance of dangerous blood clots, the anti-clotting activity of aspirin can sometimes be helpful.

Offering dietary advice can be tricky if a patient has high cholesterol as well as elevated Lp(a), since the ideal diets for each are nearly opposite each other. A ketogenic diet tends to raise LDL cholesterol, for example, while it may modestly lower Lp(a). We think by the end of this episode, you’ll join us in hoping that scientists can learn a lot more about Lp(a) in the next few years.

This Week’s Guest:

Sotirios (Sam) Tsimikas, MD, FACC, FAHA, FSCAI, is Professor of Medicine/Cardiology and Director of Vascular Medicine at the Sulpizio Cardiovascular Center. That is part of the Division of Cardiovascular Medicine at the University of California, San Diego. His website is https://profiles.ucsd.edu/sotirios.tsimikas

Sotirios (Sam) Tsimikas, MD, FACC, FAHA, FSCAI, UCSD

Listen to the Podcast:

The podcast of this program will be available Monday, Sept. 7, 2026, after rebroadcast on Sept. 5. You can stream the show from this site and download the podcast for free. In addition to what you heard in the broadcast, the podcast includes additional information on calcium scores and the benefits and risks of statins to lower cholesterol.

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