Are You Okay?

Disclaimer: The views expressed here are my own and are not a substitute for advice from your personal physician.

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My book, Beyond the Prescription, is out now! I wrote it with you in mind. The book is a roadmap for navigating your health in real life without perfectionism, pseudoscience, or shame.

You can order your copy at Amazon, Bookshop.org, or Barnes & Noble.

Friday Q&A: new study on hormone therapy and Alzheimer’s; blood pressure variability; Galleri cancer testing, & are GLP1s forever?

Dr. Lucy McBride — Fri, 28 Aug 2026 12:22:14 GMT

BEYOND THE PRESCRIPTION is a USA Today bestseller!! Thank you to everyone who ordered a copy and made this possible!

If you haven’t yet, you can purchase or gift the book here:

Photo by Aakash Dhage on Unsplash

The following questions have been lightly edited for length and clarity.

QUESTION #1: MENOPAUSE HORMONE THERAPY & ALZHEIMER’S

Dr. McBride, I just saw this piece from the New York Times on the new studies showing a reduced risk for Alzheimer’s for women taking HRT, and I’ve been hearing online about the potential benefits of HRT for women’s brain health too. But then the article ends saying that even with all the evidence so far, it’s not enough to change how individuals use HRT? I’m confused. Is it helpful or not? I’m 51, and I need to know if this something I should keep in mind when making decisions around HRT.
—Angela

Hi Angela,

I understand your confusion. Here’s the short story: mounting evidence suggests that starting hormone therapy at or around menopause offers some protection against Alzheimer’s. The recent study cited in the NYT looked at over 180,000 post-menopausal women, approximately 4,000 of whom went on to develop dementia. Taking hormone therapy reduced the risk of Alzheimer’s by 11 percent in women who went through menopause naturally (i.e., not through surgical removal of the ovaries). Interestingly, the benefit of hormone therapy fell to six percent when assessing for all types of dementia (i.e., vascular, Lewy body, etc).

So this provides more compelling evidence for the potentially protective effect of estrogen and progesterone on the brain. Based on the totality of evidence we have to date, and based on the research showing that estrogen has a protective effect in the brain (see the work of Dr. Lisa Mosconi), it is hard for me not to be enthusiastic about hormone therapy for brain health.

But there are major caveats here: this wasn’t a randomized controlled trial, so it’s difficult to prove a causal relationship between hormone therapy and the absence of dementia. In other words, the jury is still out, and I wouldn’t recommend using this data alone to inform your decision about hormone therapy. Lest I get ahead of the data on cognitive benefits, we already have plenty of evidence-based reasons to recommend hormone therapy—specifically its benefits on bone, heart, and genitourinary, and sexual health. The data are clear that for the vast majority of women, the benefits of hormone therapy tends to outweigh the risks, especially when hormones are started within the last 10 years of her last menstrual period.

In practice, the decision to take hormone therapy is highly nuanced and should be tailored to the individual—her age, symptoms, risk factors, family history, personal preferences, and risk tolerance. Hormone therapy for postmenopausal women has withstood more scrutiny than any other medication in the pharmacopeia, and it’s time women are given fact-based information about their own bodies—we just have more to learn about the connection between estrogen and the brain before we recommend it solely for that purpose.

What if blood pressure readings fluctuate between, say, 120/80 and 135/85 or 140/70 or whatever over a day or so when there are no unusual factors of stress, diet or exercise? I have asked several of my very well-respected physicians over time and they nearly all wave it off as of no concern.
Even when there are no extenuating circumstances, my BP still varies from day to day and is nearly always different on different visits to physicians. To be honest, I’ve given up trying to get an explanation. Can you help?
-Stuart

Hi Stuart,

I hear your frustration, and I get this question a lot. This is why I sometimes order a 24-hour blood pressure monitor for patients: to get a sense of the range of reading, to learn what the average is, and then treat that average if it’s high.

Big picture: blood pressure (BP) readings can vary widely, even within the course of the day. Readings can vary due to factors such as stress; salt and alcohol intake; exercise versus inactivity; and certain medications. They also can vary due to the size of the cuff, the tightness of the cuff on your arm, and the machine itself. Also, note that blood pressure variability tends to increase with age. Think about blood pressure this way: it reflects the “elasticity” of the large blood vessels in your body. Blood vessels become less elastic (more “stiff”) over time. As an analogy, imagine the intrinsic tension of your blood vessels as the bed of a trampoline. Now imagine throwing a beach ball onto the trampoline bed. The beach ball represents external factors like stress, pain, sleep apnea, or a high salt diet. When you bounce the beach ball onto a trampoline bed that is taut, the beach ball bounces up high. But if the trampoline bed is looser (more elastic), that same beach ball doesn’t bounce as high.

The upshot: Blood pressures vary similarly to how our heart rate, temperature, and respiratory rates do. There are intrinsic and extrinsic factors, all of which change during the day. Doctors want to know what your average blood pressure readings are—and not to treat just the lows or highs.

Does that help?

I have a lot of cancer in my family. What do you think about the Galleri panel of tests that people are talking about - to detect cancer early?
-Gabrielle

Dear Gabrielle,

I hope that someday we have the technology to reliably detect the presence of various cancers in people before they develop symptoms, but, at this moment, tests like Galleri can only offer imperfect and incomplete reassurance to people who can afford it.

The Galleri test is a non-FDA-approved blood test that claims to detect more than 50 kinds of cancer in people who do not have symptoms. While this sounds terrific in theory, the sensitivity and specificity of the test are low. In other words, there are too many false negatives and false positives to consider it a useful screening test—and for me to recommend this test to my patients.

Is it possible that a hidden cancer could be detected by the Galleri test? Sure! It’s also possible to scare the pants off people—or, perhaps worse, to send them for unnecessary testing and procedures after a false alarm.

The better way to screen for cancer? To follow evidence-based recommendations such as screening mammography for breast cancer, colonoscopy for colon cancer, thin-slice chest CT scanning in active and former smokers for lung cancer, Pap testing for cervical cancer, and specific genetic testing for people are particularly high risk for certain cancers (e.g. BRCA testing for Ashkenazi Jewish women with a family history of breast or ovarian cancer).

In addition to keeping up with your cancer screening tests, my best advice for anyone worried about cancer is to work on the things we already know reduce cancer risk, for example limiting your intake of alcohol and processed foods, quitting tobacco products and cigarette smoking, eating a high-fiber diet, and getting routine exercise.

It’s natural to worry about your risk of cancer. Who doesn’t? But cancer is not a black box. It’s also not one disease. It’s important to recognize how much we do know about cancer prevention and screening. So, I suggest talking with your doctor about what tests you need based on your age, family history, lifestyle and medical history. Cancer screening isn’t a “one-size-fits-all” prescription, and it definitely doesn’t come in a single blood test! (At least not yet.)

If you start a GLP1, do you have to be on it forever? I’m interested- but don’t like the idea of being dependent on any medicine- I hardly take an aspirin if I’m sick.
—Lillian

Hi Lillian,

GLP1s are marketed as long-term drugs. Indeed they work best when taken regularly, for many months, and under close supervision of a physician. And yes, many patients will need to take these medications in perpetuity for metabolic disorders beyond their control. However, they are not always forever. Patients can experience lasting benefits from GLP1 (on metabolism, weight, and the relationship with food) even after it is discontinued.

Do most people tend to gain some weight back when the drug is stopped? Absolutely. But what is often lasting is the insight people gain from the experience of taking a GLP1—specifically insight into their natural hunger and satiety cues, their behaviors around eating, and their relationship with alcohol and carbohydrates. To the extent that the experience of taking a GLP1 promotes behavioral changes (such as eating more deliberately or starting an exercise program), and to the extent people are motivated to continue those habits even after the GLP1 is discontinued, the benefits on metabolism and health can last beyond the duration of the drug itself.

In my experience, GLP1s can offer patients a sense of control of their body that they never had before. This is particularly true for my patients who have long suffered from weight problems and metabolic sluggishness despite their best efforts—made worse by the toxic internal narrative that they weren’t doing enough. For these patients, GLP1s might need to be long-term, but the sense of agency over their body and mind is powerful on its own.

Needing a GLP1 long-term is not a failure—it’s also not an inevitability. Does that answer your question?

My book, Beyond the Prescription, is out now! I wrote it with you in mind. The book is a roadmap for navigating your health in real life without perfectionism, pseudoscience, or shame.

You can order your copy at Amazon, Bookshop.org, or Barnes & Noble.

What I Tell Patients About Alcohol

Dr. Lucy McBride — Tue, 25 Aug 2026 09:15:45 GMT

BEYOND THE PRESCRIPTION is a USA Today bestseller!! Thank you to everyone who ordered a copy and made this possible!

If you haven’t yet, you can purchase or gift the book here:

If you’re anything like me, summer has a different energy—fewer rules, more levity, less fussing about things like putting away clean laundry or taming unruly hair. I’m also more liberal about alcohol in the summer. To me, a glass of wine or my favorite cocktail signals relaxation: a reward after a long day or an opportunity to celebrate with friends. And last month has been particularly boozy for me.

I know what alcohol does to me. I drank it anyway. After one of my recent book events, I slept terribly! At first, I assumed it was because my cat started meowing two inches from my head around 4 am. More likely, though, it was the two glasses of wine that flung my eyelids open in the wee hours of the night. And over the last few weeks it became clear that alcohol was an uninvited houseguest in my subconscious.

So when patients ask me, “How much alcohol is okay?” I answer them as a doctor and a real person: there is no simple answer.

The Risk … and the Nuance

It has been well established—at least as far as the evidence now shows—that there is essentially no amount of alcohol that is good for your health. The potential harms of alcohol are vast and include mental health disorders, heart disease, diabetes, cognitive impairment, and cancer. On a more immediate level, alcohol impacts sleep, mood, anxiety, focus, and attention. It can affect behavior and relationships with other people. It can lead to dangerous dependence and abuse.

At the same time, not everyone will benefit from full abstinence. And not everyone who abstains will benefit in the same way or to the same extent. Roughly speaking, the degree of benefit you gain from quitting alcohol intake is directly proportional to the degree of actual and potential harm it poses to your health. So the real question isn’t “Is alcohol potentially harmful?” It’s “To what degree is alcohol harming your health now and/or posing risk down the road?”

After all, risk is not monolithic. For someone with a history of alcohol overuse or dependence, one drink is probably one drink too many. For someone with atrial fibrillation or cognitive impairment, alcohol is worth avoiding altogether. For someone with a strong family history of cancer, limiting alcohol may reap more rewards than it would for someone without that genetic profile. But for someone who is generally healthy, notices no immediate downsides of consuming alcohol, and has no particular risk factors for chronic disease (including depression and addiction), a few drinks a week is probably causing little-to-no harm. (For me, it’s alcohol’s immediate effects on sleep, mood, cognition, and energy that periodically remind me why I usually skip it.)

A Better Way to Think About Alcohol

Which is why simply asking someone “How much do you drink?” isn’t terribly helpful. It also frames the question as if there’s a right or wrong number—a line in the sand separating problem drinkers from non-problem-drinkers. (The question is also commonly framed as a moral test—which, among other reasons, is why people often underreport their drinking to doctors.) In reality, the line between casual drinking and problematic alcohol use isn’t always clear. But many people who wouldn’t identify as having a drinking problem still experience negative health effects from alcohol. The space between social drinking and dependency is a gray area. It’s one that is often overlooked.

So, before you go in for your next checkup, and before you get asked the off-the-shelf question, “How many drinks per week?” I’d ask yourself a more nuanced set of questions:

First, your behaviors around alcohol. What is the quantity and frequency of alcohol you consume? If it’s 7 drinks a week, for example, is it one drink every night with dinner, or is it abstinence during the week and a 7-drink binge on a Friday night? If it’s two drinks per week, is it two drinks before work? Or is it two drinks in the evenings as you cook dinner?

Second, your relationship with alcohol. Do you consume alcohol to avoid uncomfortable feelings like worry, loneliness, or boredom? Or are you drinking to enjoy nights out with friends? Are you drinking to fit in with a new friend group? Or to ease the blind-date jitters? Is your first drink mostly about hunger because you didn’t eat enough during the day—and then one drink becomes two or three simply because you ate too late and because alcohol (especially on an empty stomach) impairs our ability to stop?

The Non-Prescription Prescription

From there, figure out the quantity of alcohol that is appropriate given your underlying health conditions and risks for disease. That’s where your doctor can help. As examples, conditions like hypertension, sleep apnea, and diabetes tend to worsen with alcohol and improve with alcohol cessation. Symptoms like insomnia, menopausal hot flashes, and fatigue also tend to improve with less alcohol consumption—each for different reasons. A patient who’s having trouble with attention and focus or emotional regulation might benefit from reducing her alcohol intake even if she isn’t drinking “too much” in the scheme of her whole health.

Side note: my job would be a lot simpler if I preached 📣 Abstinence For All 📣 and shamed anyone who deviated from my advice. The problem? This advice isn’t realistic or necessary for everyone. Plus, no one would be honest with me, and many would decide (rightly so) never to come back.

Finally, ask yourself what your goals are—in health and as it pertains to alcohol. Be honest. Get curious about what alcohol is doing or not doing for you. For me, what I need most right now is myself, unadulterated. But giving something up is hard when you don’t get something in return. So, I will remind myself that saying no to alcohol is saying yes to the inevitable improvement in my sleep, mood, and sense of agency. Until I have this same conversation with myself, again.

The upshot: there’s no one-size-fits-all prescription for alcohol use. Self-awareness, honesty, and frank discourse with your doctor pave the way toward a healthier relationship with it, whatever you decide to do next.

What is your plan with alcohol this fall? I am all ears!

My book, Beyond the Prescription, is out now! I wrote it with you in mind. The book is a roadmap for navigating your health in real life without perfectionism, pseudoscience, or shame.

You can order your copy at Amazon, Bookshop.org, or Barnes & Noble.

Please hit the ❤️ or 🔄 button so more people can discover this post! Even better, please share it with friends and loved ones! 🙏

Friday Q&A: brain-eating amoeba; coronary calcium scoring; berberine for weight loss, & CBD gummies for sleep

Dr. Lucy McBride — Fri, 21 Aug 2026 09:15:35 GMT

BEYOND THE PRESCRIPTION is a USA Today bestseller!! Thank you to everyone who ordered a copy and made this possible!

If you haven’t yet, you can purchase or gift the book here:

📣 TODAY! Join me and Dr. Ezekiel Emanuel, bioethicist and oncologist, at 1:45 pm ET right here to discuss The Future of AI in Medicine: Will Doctors Be a Thing of the Past?

The following questions have been lightly edited for length and clarity.

QUESTION #1: BRAIN-EATING AMOEBA

Dr. McBride, I have been reading more reports every summer about the brain-eating amoeba from swimming… and that infections are almost always deadly! That sounds terrifying! How worried should I be about this??
—Jamie

Hi Jamie,

As if we need more than diarrhea-inducing lettuce to worry about this summer!! Now the news is reporting cases of Naegleria fowleri, a free-living amoeba, a kind of one-celled organism, that lives in warm freshwater lakes, rivers, and hot springs. If water that contains the amoeba goes up your nose and travels to your brain, it can cause an infection called primary amoebic meningoencephalitis (i.e, an infection of the brain and surrounding tissues). Less than 10 people per year in the US get this, but nearly everyone who gets it dies from it.

Sounds terrifying indeed. But let me provide some context. While this critter has been found in poorly maintained swimming pools, splash pads, and other recreational venues, it is rare to become infected by it. Between 1962 and 2024, there were 167 reported cases of brain infections from this ameba in the US.

How to protect yourself from it? The CDC recommends the following:

Hold your nose or wear a nose clip if you are jumping or diving into freshwater lakes, rivers, etc.
Always keep your head above water in hot springs.
Don’t dig in shallow water because the ameba is more likely to live there.
Use distilled or boiled tap water to rinsing your sinuses or cleansing your nasal passages after exposure to water in lakes, ponds, etc.

Does that help?

I’ve seen more and more people talking about getting calcium scores (CAC) lately. When do you typically recommend those? I’ve seen doctors say everyone should “know their baseline” and get one regardless of risk factors but is that true?
-Mia

Hi Mia,

A coronary calcium score (or “CAC”) is obtained through an imaging study (basically a fancy X-ray) and can help determine the presence or absence of cholesterol plaque in the coronary arteries, the blood vessels that supply blood to the heart muscle. The presence of cholesterol plaque in these arteries is called coronary artery disease (aka CAD). Risk factors for the development of CAD include age, genetic factors, high blood pressure, high cholesterol levels, an elevated lipoprotein (a) level, cigarette smoking, diabetes, obesity, physical inactivity, and a high-stress lifestyle.

The accumulation of cholesterol plaque can, over time, impair blood flow to the heart muscle. This can result in a heart attack, where part of the heart muscle sustains permanent damage from the absence of adequate blood flow. It can also cause chest pain or “angina,” which is pain as a result of transiently insufficient blood flow to the heart muscle. CAD is a leading cause of death globally.

A CAC can help identify who is at increased risk for heart attack, stroke, and cardiovascular disease in general—in order to help direct treatment. Patients who are at low risk for CAD—that is, patients without hypertension, diabetes, cigarette smoking or other cardiac risk factors—usually don’t need a CAC test and rather should focus on preventing disease by maintaining a healthy lifestyle and having regular checkups of their cholesterol, blood pressure, etc. People at high risk for CAD should already be treated aggressively for presumed or existing heart disease with, for example, lifestyle changes and medications. In short, it’s patients at “intermediate risk”—for example, patients for whom we’re on the fence about starting a statin medication—who should be screened with a CAC.

Cheers to your heart!

Is the Berberine as a supplement any good? People say it is “nature’s Ozempic”?
-JP

Dear JP,

In a nutshell, the buzz around berberine being nature’s Ozempic is intriguing, but it’s a bit more nuanced than that. Berberine, found in plants like goldenseal and barberry, has caught attention for its potential in managing blood sugar levels, akin to the effects of Ozempic in treating type 2 diabetes.

However, it’s not a straightforward comparison, and the science is still unfolding. Some studies suggest that berberine could enhance insulin sensitivity and lower blood sugar. This can lead to better glucose control, which may indirectly support weight loss by reducing cravings and promoting better energy utilization. Other studies suggest that berberine may help lower levels of cholesterol and triglycerides, which are important markers of cardiovascular health. By improving lipid metabolism, berberine may indirectly support weight loss and overall metabolic health.

While these findings are promising, it’s important to note that research on berberine’s effectiveness for weight loss is still ongoing, and results from studies can be mixed. Additionally, berberine is not a magic solution for weight loss and should be used as part of a comprehensive approach that includes a balanced diet, regular exercise, and other healthy lifestyle habits.

As with any supplement, it’s essential to consult with your doctor before starting berberine, especially if you have any underlying health conditions or are taking medications, as berberine (like any supplement) may interact with other things you are taking.

So, while the idea of berberine for weight loss is intriguing, caution is key. Here’s to making informed choices about your health!

Over the past few years I've had trouble falling asleep. My husband wants me to try CBD gummies. I was never a big marijuana fan. Should I try them?
—Joan

Hi Joan,

In general, CBD (cannabidiol) is very safe. It is a compound found in cannabis plants, and it is often promoted as a safe and natural remedy for various conditions, including sleep disorders. So far the research on CBD seems to back this up.

The good news about CBD is that it is not psychoactive, meaning it doesn’t produce the “high” associated with THC, another compound found in cannabis. It is also generally well-tolerated, however some people may experience side effects, such as fatigue, changes in appetite, or diarrhea.

Some other things to consider:

The safety of CBD products depends on their quality and purity, so it’s essential to choose reputable brands that provide third-party testing for their products to ensure they meet safety and potency standards.
People may react differently to CBD. What works for one person may not work the same way for another. It’s advisable to start with a low dose and gradually increase if needed.

Regulatory issues: The regulation of CBD products varies, and the quality of products on the market may differ. It’s crucial to choose products from reputable manufacturers that adhere to good manufacturing practices.

Of course it’s wise to consult with your doctor before you start any CBD product, especially if you have any pre-existing health conditions or are taking medications, in order to get more nuanced advice. But given that Sleep is the glue that holds our body and mind together, I am a big believer in working on getting healthy zzzz’s!

🙏 Lucy

My book, Beyond the Prescription, is out now! I wrote it with you in mind. The book is a roadmap for navigating your health in real life without perfectionism, pseudoscience, or shame.

You can order your copy at Amazon, Bookshop.org, or Barnes & Noble.

The Post-Vacation Reset

Dr. Lucy McBride — Tue, 18 Aug 2026 09:15:10 GMT

BEYOND THE PRESCRIPTION is on sale now!

Purchase or gift the book here:

What a week!! Beyond the Prescription is out in the world—and it’s got LEGS. I’ve appeared on CNN and Morning Joe, was published in TIME, and I stood in Times Square watching my own face on the Nasdaq Tower, which is a sentence I never expected to type. None of this would have happened without you. And to the nearly 2,000 of you who’ve joined this community in the past month: welcome. I’m so glad you’re here.

Now let’s talk about what happens after the party.

Because the last three weeks have been PARTY TIME for me. Lots of Aperol spritzes, gourmet dinners, late nights, and not nearly enough sleep. Not much exercise either between jet lag and book launch chaos. Basically my routines went out the window.

Taking a pit stop in NYC last week

So here I am, under-slept, craving a routine, longing for home-cooked meals instead of restaurant food. And it’s funny how it works with sweets—the more you eat them, the more you crave them. It’s time to rein in that sweet tooth! But let me be clear: I have NO REGRETS about falling off the healthy wagon temporarily. Health is about enjoying yourself, too.

So, today I want to tell you what the reset looks like for me—mentally, physically, and logistically—and what I recommend to my patients this time of year, when so many of us are staring down the end of summer and feeling the pull back toward routine.

The short story: it’s not about self-flagellation. It’s not about strict, punitive measures. Getting back into healthy habits shouldn’t be looked at as a punishment but as a reward for your body and mind (albeit a different kind of reward than tucking into cookies at midnight with your best friend from high school).

Step one is self-compassion.

Practice forgiveness for having fun, which, let's remember, is GOOD for you. Yesterday I told a patient who stopped going to the gym all summer not to spend so much time criticizing herself in front of the mirror and to channel that energy into lifting heavy weights—tomorrow. For me, what this looks like in practice is that last night, as I sat down to write this, I had a bowl of ice cream despite having told myself this last weekend was the end of sweets for a bit. I didn't beat myself up. I soaked in the pleasure of Chunky Monkey and told myself: let's start again tomorrow.

Step two is setting yourself up for success.

This means not planning anything rigid or extreme, because rigidity is a setup for failure. Don’t plan to exercise EVERY day when you resume. Don’t commit to NEVER having sweets after a vacation full of desserts. Remember that you have a real life with real limitations on your time and energy—then figure out what’s realistic. For me, that means committing to one yoga class this week and a walk after work three times. It means skipping dessert until the weekend—but not refusing it when I’m out with friends Saturday night. Moderation, not restriction.

(And for what it’s worth: I never get on a scale. That’s not a tool that helps me. This isn’t about my weight—it’s about feeling good, which I do when I’m not overloaded on sugar, alcohol, and late nights.)

Step three is meeting your basic biological needs before anything else.

Sleep. Movement. Nutritious eating. Limiting alcohol. Taking care of your mind—resting your brain, practicing calm. These are the non-negotiables, and they come before everything else. For example, if I’m not getting enough rest at night, I won’t watch a show on Netflix before bed—even if it’s restful and fun—because sleep comes first.

Step four is engaging a friend or partner to join you.

Accountability is key when you’re resetting habits. I’ll resume my regular Tuesday evening walks with Jen when she’s back from her trip—because I might cancel on myself, but I definitely won’t cancel on her. For my patients who have a hard time motivating to exercise any time of the year, I always suggest pairing exercise with something they love—music, another person, a supportive community like at a local yoga studio. The best exercise for you is the one you will actually do.

Step five is don’t beat yourself up when the reset isn’t a straight line.

It won’t be. Give yourself permission to slip up, to revert to vacation brain every now and then. It’s okay. I told a patient recently, who came back from vacation remorseful over the weight she’d gained, to just do the best she can on reentry. Habits are more likely to stick when you’re kind to yourself and simply start over the next day.

Oh, and the very last step? Pat yourself on the back when you’ve stuck with it.

I will be VERY pleased with myself if I actually make it to yoga, take my walks, and go back to eating vegetables instead of dips and cheese and sweet things. I’ll also feel so much better—which is, after all, the whole point.

So that’s my reset. Not a punishment but rather a reward of a different kind. Whether you’re just coming back from a trip, a college drop-off, or a summer staycation, it’s always a good time to press control-alt-delete on your health habits. Just don’t delete your whole mindset that gave you a good break in the first place.

What does your post-vacation reset look like? I’m all ears!

I wrote Beyond the Prescription with you in mind. It is a roadmap for navigating your health in real life without perfectionism, pseudoscience, or shame.

You can order your copy at Amazon, Bookshop.org, or Barnes & Noble.

Please hit the ❤️ or 🔄 button so more people can discover this post! Even better, please share it with friends and loved ones! 🙏

Friday Q&A: dietary protein; holistic primary care; anxiety about medications; & knee arthritis

Dr. Lucy McBride — Fri, 14 Aug 2026 09:15:35 GMT

BEYOND THE PRESCRIPTION is on sale now!

And it’s the #1 BESTSELLER in “Healing” on Amazon! 🎉

Purchase or gift the book here:

Your Local Epidemiologist

MY BOOK TALK - STANDING ROOM ONLY! - AT POLITICS & PROSE IN DC (my parents in the front row ❤️)

📣 Click here to send me your questions for future Q&As! ✍️

The following questions have been lightly edited for length and clarity.

QUESTION #1: DIETARY PROTEIN REQUIREMENTS

Dr. McBride, I read a lot of books and listen to wellness-related podcasts. What do you think about the amount of daily protein intake as we age? I am almost 68 and want to stave off sarcopenia. Some professionals advise a lot of protein, preferably animal-based. Others say you can be healthy and Vegan. While others are somewhere in between. Are there really Vegans that are truly healthy in the long run?
—Joan

Hi Joan,

Protein is like premium gasoline. It is crucial for energy, weight management, lean muscle mass, post-exercise recovery, immune function, focus, concentration, and cognitive and mental health. Dietary protein need not come from animal products. It’s very possible to get adequate protein (and to be healthy) with a vegan diet.

How much daily protein does a body need? Ideally 0.32 to 0.45 grams of protein per pound of body weight. Some evidence suggests that people over age 65 should get at least 0.45 to 0.54 grams per pound. To determine your daily protein needs, use this online protein calculator.

Here are some excellent sources of lean dietary protein along with their approximate grams of protein per serving (this is pulled from my book!):

Chicken breast (skinless, boneless): 3 oz contains around 26 grams of protein.
Turkey breast (skinless, boneless): 3 oz provides approximately 26 g.
Fish (e.g., salmon, tuna, cod): 3 oz generally contains 20-25 g.
Lean beef (e.g., sirloin or tenderloin): 3 oz typically provides around 22-26 g.
Pork tenderloin: 3 oz contains approximately 22 g.
Eggs: One large egg contains about 6 g.
Greek yogurt (plain, non-fat): 1 cup generally provides around 20 g.
Cottage cheese (low-fat): 1⁄2 cup contains approximately 14 g.
Tofu: 1⁄2 cup of firm tofu typically contains around 10 g.
Lentils: 1 cup of cooked lentils provides approximately 18 g.
Quinoa: 1 cup of cooked quinoa contains about 8 g.
Edamame: 1 cup of cooked edamame typically provides around 17 g.
Chickpeas: 1 cup of cooked chickpeas contains approximately 15 g.
Almonds: 1⁄4 cup of almonds generally provides around 6 g.
Peanut butter (natural): 2 tablespoons contains approximately 8 g.

There’s also a lot of hype around protein these days (protein water? no thanks!) So, in real life, I advise my patients to simply try to get protein with every meal—and not to organize their day around it. I hope this helps!

Because of a diversity of health problems (everything seems to be falling apart at one time), where do we find someone who can take the diagnoses from all these specialists, plus a therapist who might not be in that network, and synthesis it into a treatment plan for the whole person: mind, body, and soul? My primary care physician doesn't have time to do that. Where does that leave us as patients?
—Diane

Dear Diane,

Great question—this is exactly why I wrote my book. Medicine has become so transactional and impersonal. Yet we know patients do better when they have a primary care medical “home.” I wrote a guest essay about the state of primary care in the U.S. for this week:

Why you can’t find a primary care doctor

While public health systems have plenty of room to become more trustworthy, I am increasingly convinced that much mistrust stems also from health systems. In a recent YLE survey, for example, more than 1 in 2 participants had difficulty finding a primary care provider…

21 days ago · 687 likes · 104 comments · Dr. Lucy McBride

Everyone deserves a more integrated, evidence-based strategy to address our whole health. The American healthcare system is so broken that it’s nearly impossible for more primary care doctors to spend the time needed to synthesize patients’ medical issues, map out a strategic plan, and coordinate care. Just like patients, primary care doctors are increasingly frustrated with the system, and many are moving to direct primary care (DPC) like I did, taking matters in our own hands to care for patients in the way that allows for patient-centered, whole-person care.

This kind of care needs to be accessible for all. It shouldn’t be luxury to have a doctor who knows your name, not just your diagnosis codes—someone who treats YOU, not just your body parts. In the meantime, patients need to be strong self-advocates and to develop a vocabulary about their health and an arsenal of questions to ask themselves and to bring to their doctors. I hope my book helps you become your best self-advocate, well before you even step into the next doctor’s appointment.

With SO much information out there on medications, and with medications being marketed on TV (yikes!), coupled with the ability of consumers to research side effects, black box warnings, etc., I (and my other friends around my age - 50ish+) am becoming at times unbearably anxious about taking medications! Does/can health anxiety extend to anxiety about taking medications, do you see this in your practice, and how can we manage this form of health anxiety in addition to talking to our doctors?
—Lindsey

Dear Lindsey,

Yes! I have written a bunch about health anxiety. It’s real and can also pertain to worrying about medications. I see this a lot in my own patients. It’s normal to feel uneasy when you need medical help, are overwhelmed with information, and lack appropriate context to make an informed decision. It’s hard to know what to believe and who to trust!

As you know, doctors take an oath to first “do no harm“—which includes not prescribing medications whose known and potential harms outweigh the known and potential benefits. So, it’s important that a prescription is coupled with fact-based, nuanced advice from a physician who knows your clinical situation well. It’s also important to realize that those lengthy package inserts with warnings do more to provide legal “cover” for the drug manufacturer than deliver helpful guidance for the consumer. Does the fine print represent actual risks of the drug at hand? Sure, but how much you need to worry completely depends on the context and your medical issue. Remember that possible does not mean probable.

I wouldn’t want my patient *not* to take a drug I recommended simply because they freaked themselves out looking on the internet; I’d rather have a conversation about their particular concern and the fear itself. This is why you should have a doctor who knows you and who can explain the relevance of any potential side effect or drug interaction to your unique medical situation.

The upshot? Don’t believe everything you read, do your best to avoid Dr. Google, and ask an expert!

What is best advice regarding arthritic knees? There are so many claims & products advertised. I am 71 & working to avoid knee replacement if possible, however, there is a lot of confusing information. I am very interested in “natural” alternatives but would appreciate actual medical guidance. Thank you!
—Maryann

Hi Maryann,

I hear you! The public square is filled with gizmos and gurus, and it’s hard to know who to trust. The first person I recommend talking to is your own primary care doctor or orthopedic (knee) specialist. However, there are several non-surgical options to help manage knee arthritis symptoms. Here are some of the best:

Physical Therapy: I am a huge fan of PT. It is a woefully underutilized modality, and it is often covered by insurance. Exercises focused on strengthening the muscles around the knee can help stabilize the joint and reduce pain.
Weight Management: Maintaining a healthy weight can alleviate stress on the knee joints, reducing pain and slowing down the progression of arthritis. Of course it’s common to have difficulty managing weight when mobility is impaired!
Low-Impact Exercise: Activities such as swimming, cycling, and walking are easier on the knees compared to high-impact exercises like running. Movement is always a good thing for our skeletal health.
Medications: Over-the-counter pain relievers like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. Prescription medications like corticosteroids or hyaluronic acid injections may also be recommended by your doc.
Cold Therapy: Applying cold packs can help alleviate pain and reduce inflammation. Grab that bag of frozen peas and park it on your knee while you watch the evening news!
Injections: Besides corticosteroids and hyaluronic acid injections, newer options like platelet-rich plasma (PRP) injections or stem cell therapy may be considered to promote healing and reduce inflammation.
Acupuncture: Some people find relief from knee arthritis symptoms through acupuncture, though scientific evidence supporting its effectiveness is mixed.

At the end of the day, arthritis is about “wear and tear” on the joints, so the mainstays of treatment involve reducing stress and inflammation until you need a new knee. Hopefully you can avoid surgery, however there’s no amount of ice or Advil to repair a “bone-on-bone” knee joint. So be sure to get personalized advice from a trusted medical source. I hope that helps!

🙏 Lucy

*BEYOND THE PRESCRIPTION* UPCOMING EVENTS 👉

August 15 @ 1-2 pm | Mitchell’s Book Corner | Nantucket, MA | book signing

My book, Beyond the Prescription, is out now! I wrote it with you in mind. The book is a roadmap for navigating your health in real life without perfectionism, pseudoscience, or shame.

You can order your copy at Amazon, Bookshop.org, or Barnes & Noble.

Today is the day!

Dr. Lucy McBride — Tue, 11 Aug 2026 09:15:28 GMT

Dear friends,

The day I’ve been working toward for 3 years is finally here!

It takes an *army* of supporters to launch a book. The video above is to say HUGE THANKS to everyone who has purchased books and supported this process.

I wrote Beyond the Prescription to help you, your friends, and loved ones become empowered patients, armed with tools and actionable information to get what you need from our medical system.

If you haven’t yet purchased your copy of Beyond the Prescription, today is the day! 🥳 🙏 📣 🎁 🎉 🥰

You can purchase and gift a copy here:

With love and gratitude,

Lucy

P.S. If you purchased the book through my website, it will arrive within a week. And to anyone in DC, come celebrate with me at Politics & Prose (Conn Ave location) tomorrow night 8/12 at 7 pm ET. 🥳 🎉

Friday Q&A: non-GLP1 peptides for weight loss; aging and acceptance; alcohol and social anxiety; & APOE4 gene testing for Alzheimer's

Dr. Lucy McBride — Fri, 07 Aug 2026 09:15:33 GMT

BEYOND THE PRESCRIPTION is on sale now!

Get your copy here:

You can purchase and gift a copy here:

Photo from last night’s book talk at Zibby’s bookshop in Santa Monica, CA

📣 Click here to send me your questions for future Q&As! ✍️

The following questions have been lightly edited for length and clarity.

QUESTION #1: NON-GLP1 PEPTIDES FOR WEIGHT LOSS

Dr. McBride, my partner wants to lose weight and is suspicious about GLP1s like Ozempic and Zepbound. So instead, he’s taking 8 other peptides from a naturopathic doctor. Is this something you think is okay? What are the risks and benefits?
—Leah

Hi Leah,

This is fascinating, and I’ll be blunt: I wonder why he would trust an unproven set of peptides and not a rigorously studied and FDA-approved peptide like Zepbound that has been shown in robust clinical trials to help patients lose weight and improve metabolic health? Because not all peptides are the same.

Most of these substances (for example BPC-157 and TB-500) operate in a regulatory gray zone, with limited human evidence and significant safety concerns. Sure, some animal studies do show compelling things like faster healing times, reduced inflammation, and faster fat loss. But human are not rodents!

Ever since the blockbuster drug Ozempic hit the market, the peptide economy has been booming. Unregulated peptides are touted by wellness influencers and biohackers and are increasingly being taken up by people searching for healing and an edge against aging.

But here’s the truth: If you have diabetes or obesity, GLP-1s have been shown to be safe and effective when paired with lifestyle modifications and careful medical supervision. But for other peptides that claim to do the same thing, we just don’t have the data to say they’re safe or effective in humans. That doesn’t mean they don’t work, it just means we don’t know. The absence of evidence is not evidence of absence, but know that using under-studied peptides means you’re essentially experimenting on yourself.

Does that help?

Hi Dr. McBride, for seniors, losing vision, hearing and other abilities can be distressing. But I know some parts of aging are inevitable and can’t be “fixed.” How do I tell my terrific internist that I’m not necessarily looking for solutions for every problem I have (although I welcome her advice) and that what I need most is her support and understanding plus reassurance when there’s no real cause for alarm?
—Linda

Dear Linda,

I hear you loud and clear. A doctor’s impulse is to make a diagnosis and fix problems, but what patients often need most is to be seen and heard and reassured when reassurance is appropriate. Not everyone wants a pill for every symptom or a prescription for every body part, But if you don’t make your needs known, you may become like so many older patients—medicalized and at risk for what we call “polypharmacy.”

Of course reassurance from a doctor must be rooted in facts and paired with the patient’s personal risk tolerance. For example, I wouldn’t reassure a patient with heart failure that their chest pain was “nothing to worry about” without ordering an EKG and lab work first! But empathy and intellectual rigor aren’t mutually exclusive. Caring for patients is not only about prolonging life; it’s about enhancing it.

Take, for example, two patients with foot pain. Patient A might want every available X-ray, MRI, lab test, and specialty assessment. They might desire a definitive diagnosis and/or expect full resolution of symptoms. Patient B with the same problem might be satisfied with adjusting their footwear and getting (appropriate) reassurance from their doctor.

Getting what you want out of your medical care begins with communicating to your doctor and taking time for her to understand your goals and needs. It also should include the doctor setting realistic expectations and clearly understanding the patient’s tolerance for risk, discomfort, and medical interventions.

So whether it’s with a “full-court-press” or a “less-is-more” style, your doctor should understand that you already accept the natural course of aging. I think that’s a very healthy approach!

I’m 44 and have really bad social anxiety, and alcohol helps take the edge off social situations. How can I manage my social anxiety and still be social? I want to be more comfortable around other people, but alcohol is everywhere, so it makes it doubly hard to say no. I feel like I would lose friends if I abstained. Anything you advise your patients like me?
—Anonymous

Dear Anonymous,

You are in good company when you say you use alcohol to quiet social anxiety. The disinhibition from alcohol can temporarily get us “out of our head,” but alcohol can also negatively affect every organ system. Depending on the person, it can put us at higher risk for things like heart disease, cancer, depression, and anxiety. Because alcohol is legal and socially acceptable, I think this is easy to forget!

Bravo for being self-aware enough to understand your relationship with alcohol. My first piece of advice is ask yourself these questions: Are you certain that your social life hinges on alcohol? What evidence do you have that friendships would change without it? Be honest. For example, when you’re in a social situation and feel anxious, you may have negative thoughts such as “I’m going to embarrass myself” or “People are judging me.” Challenge these thoughts by asking yourself if they’re really true and coming up with more realistic, positive thoughts instead.

Here are some tips that I recommend to my patients like you who want to socialize without alcohol:

Tell your friends that you aren’t drinking that night. It’s much easier to stick to your goals when you make your plan public.

Try not to confuse well-intended questions from friends like, Why aren’t you drinking? with disapproval of your choices. They may simply be curious—or even envious of your fortitude!

Find a good substitute for alcohol, and bring it with you. There are so many non-alcoholic options out there! (Personally I love Athletic NA beer.) Having a fun alternative puts an unprepared host at ease.

Remind yourself the next morning that you did it. Keep practicing. You are strengthening a new muscle one day at a time.

PS. You might like an article I wrote last year that expands on this idea “How’s Your Relationship with Alcohol?”

When, if ever, do you recommend a patient find out their APOE status? I am prone to health anxiety, but I also hear there are lifestyle interventions you should take if you carry an APOE4 gene. Thanks!
—Amanda

Hi Amanda,

Great question. As you know, the APOE4 gene mutation is primarily associated with Alzheimer’s disease risk assessment. The mutation in the APOE gene is considered a risk factor for late-onset Alzheimer’s disease.

What does it mean if you have the gene variant? It’s important to note that having the APOE4 mutation does not guarantee the development of Alzheimer’s. Conversely, many people with Alzheimer’s do not have the APOE4 mutation. In other words, screening for Alzheimer’s is much more complicated than a single test.

Why wouldn’t you want to know your APO4 status? There are ethical considerations and potential psychological harms associated with APOE4 testing. The knowledge of the presence of the APOE4 variant can be emotionally difficult. Because APOE4 status doesn’t necessarily change the management of a symptom-free patient at risk for dementia, this test is typically best suited for clinical trials focused on Alzheimer’s treatments—or for people with objective evidence of cognitive problems where this test would lead them to get an early treatment.

What can you do to prevent Alzheimer’s, regardless of APOE4 status? A lot. We know that lifestyle modifications such as engaging in regular physical exercise, maintaining a healthy diet rich in antioxidants and omega-3 fatty acids, and staying mentally and socially active can reduce your risk for dementia. We also know that screening for cardiovascular risk factors, such as high cholesterol, hypertension, and diabetes can protect your cognitive health, regardless of APOE4 status.

The upshot? It’s crucial to understand the limitation of APOE4 testing. Like many other diseases, the development of Alzheimer’s reflects a complex interplay of genetic, environmental, and lifestyle factors—some of which we cannot control, and some of which we can.

PS. You might like my recent article “There’s Now a Blood Test for Alzheimer’s. Should You Get It?”

🙏 Lucy

*BEYOND THE PRESCRIPTION* UPCOMING EVENTS 👉

August 12 @ 7-8 pm | Politics & Prose | Washington, DC | in conversation with Franklin Foer
August 15 @ 1-2 pm | Mitchell’s Book Corner | Nantucket, MA | book signing

My book, Beyond the Prescription, comes out on August 11. I wrote it with you in mind. The book is a roadmap for navigating your health in real life without perfectionism, pseudoscience, or shame.

PRE-ORDER HERE

You can order your copy at Amazon, Bookshop.org, or Barnes & Noble.

The Box on the Front Stoop 📚

Dr. Lucy McBride — Tue, 04 Aug 2026 09:15:10 GMT

BEYOND THE PRESCRIPTION officially goes on sale next week.

Get your advance copy here:

Last week, I spotted a large box on my front stoop as I pulled in from work. It was either the dog food I‘d ordered from Amazon or fresh-printed copies of my debut book. When the return address read “Simon & Schuster, New York City,” I thought to myself: the dog is going to be hungry and THIS IS IT!

I called out to my husband and asked him to film this moment. He shot it in one take, no prep. As you can hear, I have lots of instructions for him 😆

Let me know what you think! (Besides needing a box-cutter ✂️)

Last, a huge THANK YOU to this readership. Without you, I wouldn’t have gotten the book deal, I wouldn’t be reaching people far and wide, and I wouldn’t have built a community of supportive, curious, thoughtful people who want to be more okay tomorrow than you are today.

See you next week!

🙏 Lucy

*BEYOND THE PRESCRIPTION* BOOK UPDATE: UPCOMING EVENTS 👉

August 6 @ 6-7 pm PT | Zibby’s Bookshop | Santa Monica, CA | in conversation with Elise Loehnen | RSVP here!
August 12 @ 7-8 pm | Politics & Prose | Washington, DC | in conversation with Franklin Foer
August 15 @ 1-2 pm | Mitchell’s Book Corner | Nantucket, MA | book signing

PRE-ORDER HERE

You can order your copy at Amazon, Bookshop.org, or Barnes & Noble.

Friday Q&A: full body MRIs; insomnia; GLP1s & hair loss; & the snoring bed partner

Dr. Lucy McBride — Fri, 31 Jul 2026 09:15:12 GMT

BOOK UPDATE: UPCOMING EVENTS 👉

August 6 @ 6-7 pm PT | Zibby’s Bookshop | Santa Monica, CA | in conversation with Elise Loehnen | RSVP here!
August 12 @ 7-8 pm | Politics & Prose | Washington, DC | in conversation with Franklin Foer
August 15 @ 1-2 pm | Mitchell’s Book Corner | Nantucket, MA | book signing

Photo by Accuray on Unsplash

📣 Click here to send me your questions for future Q&As! ✍️

The following questions have been lightly edited for length and clarity.

QUESTION #1: FULL-BODY MRIS

Is there any utility to full-body MRIs as a health screening tool? I have seen a lot of health and wellness influencers promote this but haven’t seen any evidence.
—Angelica

Dear Angelica,

Great question. MRIs are wonderful for detecting a wide range of structural problems in the body—for example a herniated disc or an abdominal mass that an X-ray can’t capture. But using them as “kitchen-sink” screening tool for the whole body is not evidence-based, nor is it generally a good idea.

Here’s why:

Full body MRIs detect many abnormalities that are not clinically significant, leading to unnecessary anxiety, testing, and medical interventions. Just recently a patient of mine underwent a Prenuvo full body MRI that revealed benign findings that (understandably) sent her anxiety into overdrive.
Insurance doesn’t cover full body MRIs. They are expensive and time-consuming.
Having a normal full body MRI is not the same thing as being healthy. Full body MRI look at structure, not function. So it cannot detect some of the most common and important medical issues we see—for example diabetes, hypertension, metabolic dysfunction, non-specific inflammation, certain infections, fatigue, insomnia, depression, chronic pain, and cognitive impairment.
These scans can give people a false sense of security. MRIs provide a snaphot—a point in time—without context—in the same way a photograph of your family can’t possibly characterize the relationships between members or their individual personalities.

The American College of Radiology and other medical organizations do not recommend routine full body MRI for asymptomatic individuals, as the risks tend to outweigh the benefits. Better than any snapshot to assess your health is getting regular check-ups and targeted screening tests based on your age, family history, unique risk factors and symptoms. So, I suggest saving your money!

Hi, I struggle with insomnia sometimes due to anxiety and my mind whirring too much. So, I use Xanax for nights that I just cannot relax. But my doc wanted me to switch to Trazodone. Neither medication is great. This is not an everyday problem but it feels harrowing when I get into a weird insomnia phase. Do you have any thoughts on what to do? Thank you for considering my question. You are a blessing and great resource!
—Kathy

Dear Kathy,

As you know, sleep is the glue for our whole health, but getting adequate rest is easier said than done. I commonly hear from patients that they turn to sleep aids like Nyquil, Unisom, or even alcohol to quiet a noisy brain at bedtime. The problem with these stop-gap measures is that they produce a state that is closer to sedation and not actually restorative sleep. They can also be addictive and can cause unpleasant side effects like nighttime eating and fuzzy-headedness upon awakening. The same can be true for prescription sleep aids like Xanax and Ambien. Ambien can also negatively affect cognition over time. I generally prefer Trazodone because it is safer for long-term use compared to Xanax (or its cousins, Clonazepam or Lorazepam) which can be particularly habit-forming. While prescription medications can certainly be appropriate for some patients, it’s important to remember that everything we put in our bodies—prescription or not—carries risk and reward.

The best medicine is optimizing the environmental, behavioral, and psychological “ingredients” for sleep. People tend to sleep best when:

their bedroom is dark, quiet and cool—and when it’s free of pets or pesky bed partners (i.e. try using earplugs, eyeshades, or noise machines as needed).
they develop a bedtime routine in order to naturally wind down. Try ditching screens an hour before bedtime and instead writing in a journal, using a meditation app like Calm, Headspace, or Insight Timer; or taking a warm bath and listening to calming music.
they are managing their stress and anxiety. Sleep comes a lot easier to people who exercise regularly, actively process their worries (i.e., with a therapist, friend, or coach), and ask for support for emotional distress.

Some of these items—like ear plugs—are quick and easy. Others—like setting an electronic curfew—are easier said than done. And others—like reforming a snoring bed partner—may be close to impossible.

So just do the best you can. And remember that this is a process. For example, even if you can only manage a 15-minute window of screen-free time before bed, it’s well worth trying. If you notice it helping just a wee bit, you might try experimenting with it further. You might even delete an over-stimulating app or two and find yourself more refreshed upon awakening.

I am a Diabetes Nurse Practitioner and have been prescribing GLP1 such as Ozempic, Wegovy, and Zepbound. I have found they cause mild hair loss. What are your thoughts regarding these medications that are now consuming our time with Prior Authorizations and have become almost a request with every patient with or without DM for weight loss.
—Terri

Hello Terri,

I’ll answer this question in two parts. First, yes, these medications can cause hair loss—as can any intervention that causes significant weight loss or shift in metabolism. This is one of the many reasons gradual weight loss is better than sudden weight loss.

The best way to prevent hair loss from rapid weight loss is so go slow with GLP-1s. Be closely monitored by a board-certified physician, not someone you met online one time. Make sure you are getting your labs checked, including vitamin levels and blood counts. And remember you still have to eat while taking a GLP-1. Relative malnutrition causes a stress response that can cause hair loss—among other things—and is not the goal of GLP-1s in the first place.

As for my general thoughts on GLP-1 agonists, they are wonderful tools in the toolkit for patients with obesity, diabetes, metabolic problems, and the downstream effects on the heart, brain, and blood vessels. The applications for these drugs keeps growing. Thankfully the medical establishment is waking up to the fact that obesity is not an intellectual or willpower problem, but rather a chronic disease, and these medicines are terrific when used in conjunction with lifestyle modifications.

That said, they are not a panacea. They can have side effects. They are expensive if not covered by insurance. They require close medical monitoring. As for the prior authorization dance (read: nightmare) with insurance companies, it is extremely burdensome for patients, providers and staff. I could hire an army of assistants to help process these meds alone. As frustrating as it can be to get the drugs in hand, for the right person, and with appropriate medical guidance, they can be a wonderful way to help patients medically and psychologically in tandem.

My husband snores but denies it. It is negatively affecting our relationship (at least on my end!) How does one stop/prevent snoring that is negatively impacting a relationship?
—DL

Hi DL,

It sounds like there are two problems: your husband’s snoring and his denial about it. Let’s start with the first. Snoring by a bed partner is one of the more common complaints I hear about in my office. The best way to treat snoring is to address the underlying cause, which can include the following:

Obesity: Excess body weight, especially around the neck, can put pressure on the airways and lead to snoring.
Nasal congestion: If the nasal passages are blocked due to a cold, sinus infection, or other nasal issues, airflow can be restricted, contributing to snoring.
Sleeping position: Sleeping on your back may cause the tongue and soft palate to collapse to the back of the throat, narrowing the airway and causing snoring.
Alcohol and sedatives: Consuming these before bedtime can relax the muscles in the throat, increasing the likelihood of snoring.
Smoking: Smoking irritates the membranes of the throat and nose, leading to inflammation and increased snoring.
Age: As people age, the throat muscles may become weaker, increasing the likelihood of snoring.
Anatomical factors: Some people may have anatomical features that contribute to snoring, such as a low, thick soft palate, enlarged tonsils or adenoids, or a long uvula.
Sleep deprivation: Lack of proper sleep can relax throat muscles and contribute to snoring.
Sleep position and sleep hygiene: Poor sleep hygiene, irregular sleep patterns, or insufficient sleep can contribute to snoring.
Sleep apnea: In some cases, snoring may be a symptom of obstructive sleep apnea, a serious sleep disorder where breathing repeatedly stops and starts during sleep.

The second issue is more persnickety. Denial is a common response to being told you snore, but that doesn’t mean you aren’t making your bed partner crazy! My best advice is to lead the conversation about your husband’s snoring with empathy and curiosity about his health (this will land better than an accusation). Remind him that sleep disturbances can lead to heart disease, metabolic problems, and even memory issues. Then encourage him to seek medical attention. It’s also important to name how you feel, saying, for example, “I’m worried about you.” Or “I need more rest than I’m getting and I want to help you figure out your snoring issues.” You could always sleep in separate bedrooms (what people call a “sleep divorce”), however, addressing the problem head-on means you’re less likely to miss a significant health issue—and that might help you sleep at night. I hope that helps!

If it wasn’t SUPER OBVIOUS already, my book, Beyond the Prescription, comes out on August 11!

What is Your Patient Personality?

Dr. Lucy McBride — Tue, 28 Jul 2026 09:15:08 GMT

BOOKSTORE EVENTS 👉

August 6 @ 6-7 pm PT | | Santa Monica, CA | in conversation with | RSVP here!
August 12 @ 7-8 pm | Politics & Prose | Washington, DC | in conversation with Franklin Foer
August 15 @ 1-2 pm | Mitchell’s Book Corner | Nantucket, MA | book signing

Get your free Patient Personality Quiz here!

POP QUIZ ✏️

What would you do if you woke up with out-of-the-blue chest pain?

Would you ignore it? Would you calmly take some deep breaths and think, I can handle this? Would you race toward the internet to Google heart attack symptoms? Or would you call your doctor immediately and do whatever they told you to do?

Over 25 years of patient care, I’ve witnessed a wide array of reactions to the same set of symptoms. Some people call me for every symptom, while others forget to mention the chest pain that signals serious heart disease.

I don’t judge patients for how they react—I have my own sometimes-helpful-and-sometimes-nonsensical response to vulnerability—but I do think it’s useful to reckon with something I call your patient personality.

We all have one. Your patient personality is the version of yourself that shows up in the doctor’s office or when you’re sick or faced with medical unknowns. It’s the set of beliefs and mental shortcuts we bring into the exam room. It is a product of your medical history, your threshold for asking for help, your relationship with certainty, your past experiences with doctors, and many other factors. In my experience, knowing your patient personality—and naming it out loud—can help you get what you need. It can also help you get out of your own way.

What is YOUR patient personality?

The Optimizer is someone who believes that willpower guarantees outcomes. They have great habits and are disciplined, but they can have a hard time accepting things out of their control. (This was me before I realized health is about much more than being fit. In fact, you can be fit and quite miserable at the same time.)
The Pleaser is the person we discussed last month, the one who thinks, If I can just get the doctor to like me everything will be fine! This is the person who only comes in for their checkup once they’ve lost weight so as not to disappoint the doctor. It’s also the person who minimizes their symptoms or tells their doctor things they want to hear in order to get the proverbial gold star. (This is me, too, when I recently told my doctor I exercise most days of the week. I don’t. I mean sure, I MOVE MY LIMBS daily, but let’s be honest.)
The Internet warrior is the patient who loves data and information, who spends hours on the internet researching symptoms and diseases, and who comes in with scientific studies—and often a lot of anxiety about their health. (This WOULD be me if I didn’t have a medical degree.)
The Outsourcer is someone who respects expertise and defers to medical advice. They are low on the anxiety scale and they often aren’t interested in the “why”—they just want the prescription or pills. They don’t want to think too hard; they’d rather just trust the experts and do what they’re told. (This is not me; sometimes I wish I didn’t need to understand the why and just DID THE THING without questioning it.)

None of these is good or bad. Each is a natural response to being in the patient role. Most people are some kind of Venn diagram of two, like I do. (Remember my neck pain problem? When the Denial Plan wasn’t working, I combed the internet for quick fixes, only to learn from an MRI that my spinal cord was compressed by a bulging disc. It took me a minute to notice my left arm wasn’t working, and only then did I call for help and get the medical care I needed.)

Why does this matter?

Not to shame and blame ourselves but rather to know yourself well enough to identify strengths to play up (e.g., understanding your body and respectfulness toward other people); identify weaknesses to work on (ruminating on symptoms without asking for help); and to communicate these things to your doctor so they can help you best.

For example, if you tend to be a Pleaser, you might say to your doctor, “Hey doc, I tend to minimize symptoms” or “Hey doc, I get worried about being judged by doctors.” Acknowledging your tendencies helps build a rapport and signals to your doctor that you know your biases and you’re working on them. That humility builds trust. It also might generate a reply from your doctor like, “No need to perform for me. I’m here to help the real you.”

Take my patient, a man in his mid 50s, who comes in to see me every year with spreadsheets and data from his various trackers and apps. When we discovered he had heart disease he was distraught, not just because of the test results showing coronary disease, but because he felt like a failure. I explained that his heart was better off because of his diligent exercise routine and careful attention to his diet and reminded him that we cannot control our genetics. And that this wasn’t his fault. For years he still refused to take cholesterol medication—not because he didn’t trust me but because it didn’t fit his self-concept. It was only when I was able to get at his internal narrative of guilt and shame that he agreed to take the medication his heart needs.

Chapter 15 of my book is all about the patient personality. (It’s the most asked-about chapter so far.)

For your pop-quiz pleasure, pasted below is a one-page self-assessment tool to help you identify your patient personality. It’s page 6 of my 11-page Patient Self-Advocacy Starter Pack (which comes free when you pre-order my book here!)

So I’ll ask you, what is YOUR patient personality? What are your strengths as a patient? And what are your blind spots? Tell me—I am all ears!

PRE-ORDER BEYOND THE PRESCRIPTION!

Beyond the Prescription comes out on August 11! I wrote it with you in mind.

Please hit the ❤️ or 🔄 button so more people can discover this post! Even better, please share it with friends and loved ones! 🙏

Friday Q&A: Diet Coke; weight worries with adult children; gas and bloating; & duration of antidepressant use

Dr. Lucy McBride — Fri, 24 Jul 2026 09:15:16 GMT

BOOK UPDATE: UPCOMING EVENTS 👉

Join me at Zibby’s Bookshop in LA on August 6 at 6 pm PT 🥂🎉
Join me in Times Square in NYC on August 11 at 4:15 pm ET 🥂🎉
Join me at Politics & Prose in DC on August 12 at 7 pm ET 🥂🎉
Beyond the Prescription releases on August 11. Pre-order on my website and claim your bonus!

Photo by Aron L on Unsplash

📣 Click here to send me your questions for future Q&As! ✍️

The following questions have been lightly edited for length and clarity.

QUESTION #1: DIET COKE

This maybe is a silly question, but am I negating all my efforts to eat clean and avoid processed food by having a daily Diet Coke? I feel so guilty. I try to focus on organic fruits, veggies and meats/fish. I only drink wine on the weekends and I exercise regularly. But I can’t seem to give up my daily diet Coke. I would love your thoughts!
-Julie

Dear Julie,

No, your healthy habits aren’t negated by soda. Would swapping your can of Diet Coke for a glass of water be healthier? Probably yes. The caffeine in Diet Coke can increase stomach acid, interfere with sleep, increase urinary frequency, and dehydrate you. The artificial sweeteners and chemicals in Diet Coke probably aren’t great for you, but there’s also no credible evidence that they cause cancer. It also sounds like Diet Coke provides you great pleasure!

One suggestion is to try a month without it. If your sleep, mood, and sense of calm improved, you might decide to limit it. But if you decide that the benefit of a midday energy boost outweighs the frequent trips to the bathroom, then keep it!

Everything we put into our body has pros and cons. Everything we do carries risk and reward. Health is about mitigating risks while optimizing rewards. Sometimes that means enjoying Diet Coke and tolerating the downsides. Sometimes it means quitting a joyful habit because we took stock of the harms. Meanwhile, nice work with your generally healthy lifestyle, Julie! Nothing—not even Diet Coke—can undo that.

How do you approach talking to adult children about weight gain? My daughter is smart, a parent of two young children and a busy professional. I understand all this and remember how hard it is to eat healthy when you are so busy. I don't care if my daughter gets thin. I just want her to be healthy. Her weight gain over the past few years really worries me. How can I talk to her, an adult in her late thirties, whom I love but whom I worry is harming herself by not attending to this problem or getting the help she needs? Should I suggest a GLP1?
—Grace

Hello Grace,

It’s normal to worry about our children’s health, even when they are adults. That said, it’s safe to assume your daughter is well aware of the potential harms of obesity and the health benefits of maintaining a healthy weight. She knows. I’m also guessing she’d like to lose weight but has a hard time doing it—like so many people do—and is already feeling the pressure herself. And I promise you she’s well aware of GLP-1s!

My advice? Acknowledge your worry. While it’s well-intended and coming from the right place, your worry is not going to help your daughter get what she needs. She needs to get there herself. Then do your best to soothe your own anxiety. Journal, talk with friends, even see a therapist to work on accepting that you cannot change or “fix” your daughter’s health issues, habits, or personal decisions—and that trying to do so runs the risk of harming your relationship. Let her figure out her health issues on her own timeline and with her own doctor. Instead, focus on loving and supporting her for everything that she is. That is the medicine you can give her.

I hope this helps.

What is the best way to deal with gas, bloating, and irregular poops? Is a probiotic any help? Everyone I ask has a different suggestion.
—Lois

Hello Lois,

My patients commonly report exactly the kind of bowel irregularity that you describe. In the US, irritable bowel symptoms account for 25 to 50 percent of all referrals to gastroenterologists. The root cause will be different for each person, so it’s important to talk to your doctor to get to the bottom of the issue (no pun intended.)

I wrote an article about what your gut might be trying to tell you here. In the meantime, here are a few things you might do to help alleviate the symptoms.

Identify and avoid trigger foods: Certain foods such as beans, onions, broccoli, cabbage, and carbonated drinks can produce more gas in the digestive tract. Many of my patients like using the list of FODMAPs as a guide. (These are foods that commonly irritate the gut.) The gut also tends not to like alcohol, caffeine, and heavy meals. Try keeping a food diary to identify which foods may be causing your symptoms and do your best to avoid them.
Eat slowly and chew food thoroughly: When you eat too quickly, you swallow air that can lead to gas and bloating. Chewing your food properly can also help break down food more effectively, which can reduce the amount of gas produced.
Take a walk after meals: Going for a short walk after meals can help stimulate digestion and move gas through the digestive tract.
Try over-the-counter medications and supplements: Over-the-counter medications such as simethicone (GasX) can help break up gas bubbles and relieve symptoms of bloating and discomfort. Peppermint is lovely for calming the gut.
Work on stress management: Stress lives in our bodies, and it commonly finds a home in the GI tract. You might consider relaxation techniques (i.e., deep breathing, yoga, or meditation), talking to a friend or loved one, or asking for professional help to help reduce stress and its effect on your whole health.

I don’t put too much stock in probiotics unless I have a particular reason—for example, in a patient who is taking antibiotics for Strep throat. As with anything in medicine, there is no one-size-fits all prescription here. Wishing you luck!

I have used antidepressants for many years to treat my anxiety and mild depression. I asked my psychiatrist recently if this is safe to do over decades (thanks RFK), and her answer was that I can take a smaller dose “if I want to.” Later I was frustrated by the complete lack of answers. Months, years and decades go by and nobody ever seems to question if the antidepressants are still needed. What do you tell your patients?
—Laurel

Hi Laurel,

This is a great question. The short answer: there is no rule here. Anxiety and moods are informed by genetics, brain chemistry, behaviors, relationships, and the robustness of our coping tools. Medications for anxiety and depression are tools in the toolbox, just like exercise or sleep are tools. Some people need lifelong meds, some need meds as a bridge to making a needed habit change.

When prescribed appropriately, medications like Prozac, Lexapro, and Zoloft can help reduce suffering and improve patients’ quality of life. But they are not a panacea. They are not a substitute for appropriate behavioral, chemical, and/or environmental changes that drive or trigger psychological distress.

For example, a patient with depression and alcohol overuse might find their depression lifts with sustained sobriety, and they never need an antidepressant medication. Or they might need an antidepressant to lift mood into order to get sober in the first place. Or they might remain depressed even without alcohol, thus requiring an antidepressant long term.

The question isn’t “How long should this patient be on an antidepressant?” It is, “To what extent are the patient’s symptoms fixed versus dynamic?” (and then how readily is the patient able to make needed lifestyle or habit changes).

Does that help?

If it wasn’t SUPER OBVIOUS already, my book, Beyond the Prescription, comes out on August 11!

There's Now a Blood Test for Alzheimer's. Should You Get It?

Dr. Lucy McBride — Tue, 21 Jul 2026 09:16:17 GMT

BOOK UPDATE: UPCOMING EVENTS 👉

Join me at Zibby’s Bookshop in LA on August 6 at 6 pm PT 🥂🎉
Join me at Politics & Prose in DC on August 12 at 7 pm ET 🥂🎉
Beyond the Prescription releases on August 11. Pre-order on my website and claim your bonus!

This story is told with permission from my patient.

A patient messaged me last week from an airport gate. She’d just seen a story on CNN about a new blood test for Alzheimer’s—one that can now, apparently, flag the disease years before it starts. She was flying to visit her mother, who has Alzheimer’s, and the timing had rattled her.

“Should I just bite the bullet and get the test?” she asked me.

She’s in her 60s and has no particular memory issues beyond the usual fog of a woman juggling a job, a family, and her mother’s care at once. But the question underneath her question wasn’t really about a lab value. It was: Am I next?

Photo by Google DeepMind on Unsplash

Her question is a good one, and it’s newly urgent. On July 14, a study published in JAMA revealed that a blood marker called p-tau217 can estimate a healthy person’s risk of cognitive decline up to a decade before any symptoms appear. The study showed that in people without cognitive complaints, higher levels of p-tau217 tracked with a significantly higher chance of developing Alzheimer’s down the road. For a disease we’ve long been able to confirm only after it announces itself, this is a giant leap for science. Not long ago, spotting the earliest signs of Alzheimer’s required an expensive brain scan or a spinal tap. Now it can start with a blood draw.

A quick word on basic brain science: Alzheimer’s stems from the abnormal accumulation of two proteins: amyloid and tau. Amyloid lives outside brain cells and builds up silently for decades. Tau lives inside brain cells, and its buildup tracks with the severity of memory loss. Think of amyloid as the match, tau as the bonfire. Strike the match, and the bonfire spreads through the brain, kills cells, and tracks the damage that eventually surfaces as memory loss. P-tau217 is a fragment of tau that starts slipping into the bloodstream early in that process. Which is why a blood draw can now catch (proverbial) smoke before you feel any heat.

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So here’s where I slowed my patient down. Smoke is a warning, not a verdict. A high p-tau217 raises your odds; it doesn’t seal your fate. Plenty of people with elevated levels never develop dementia in their lifetimes, and the test can’t tell you when—if at all—symptoms will come. It’s also only about 85% accurate in everyday practice, which means real people can get frightening results that turn out to be wrong.

And then there’s the even bigger question to ponder: if you got the answer, what would you actually do with it? The unpleasant reality is that that the drugs we have for Alzheimer’s (and we do finally have a couple that modestly slow the disease) are FDA approved only for people who already have symptoms. These drugs also carry real risks, including brain swelling and bleeding, and they require a lot of monitoring. In other words, for someone with no symptoms and a worrying p-tau blood test, there is no approved pharmacologic treatment to alter the course of one’s cognitive health. Whether these drugs help before symptoms begin is still being studied. So a scary number, today, mostly buys you anxiety, not a plan.

Which is why no serious guideline recommends the p-tau test for healthy people yet. Screening for a disease makes sense only when the test is accurate enough and a positive result would change what you’d do. For Alzheimer’s, in someone without symptoms, knowing a p-tau level wouldn’t change what your doctor recommends—at least not yet.

If that sounds discouraging, stay with me, because this is the part I most wanted my patient to hear. You don’t need a p-tau test to alter the course of your brain health. Regardless of your p-tau score, the non-pharmacologic interventions known to protect cognitive health are still in play.

Roughly 45% of dementia risk is tied to factors within your reach. (See my conversation with Harvard neurologist Dr. Jonathan Rosand here.) What’s good for your heart is good for your brain, so the unglamorous work of managing blood pressure, blood sugar, and cholesterol matters more than any lab you could order. Move your body, because exercise has actually been shown to lower p-tau217, the very marker in question. Protect your sleep, which is when the brain clears its own waste. Get your hearing and vision checked, because straining to hear and see hastens decline. Stay socially connected and mentally engaged. Go easy on alcohol. And keep up with your vaccines; the shingles and flu shots are both associated with lower dementia risk, for reasons we’re still untangling.

A word of caution about what a discovery like this tends to summon. Very soon, someone will be selling you a pricey “brain panel” or a supplement that promises to lower your number. Be skeptical. The drug the internet was certain would also rescue our brains—semaglutide, the molecule behind Ozempic—just failed its large Alzheimer’s trial. The real levers are the boring ones, and they’ve been available to you all along.

So what did I tell my patient as she boarded her plane? I told her the truth: the test can’t yet give her what she’s really after, which is reassurance, or a plan she doesn’t already have. What it might hand her instead is a number she can’t unknow, about a future none of us can fully see. I also told her that her fear was pointing her in the right direction—toward her health, toward her mother, toward paying closer attention—even if this blood test wasn’t the tool for the moment.

Knowing your data can be powerful. But your data is only ever half the story, and worshipping a number you can’t yet act on is its own kind of trap.

So here’s the question I’d leave you with, the one I asked her: if a test could tell you your risk years early, would you want to know? And what, if anything, would you do differently if it did?

Have a parent, or a fear, like hers? Tell me in the comments. I’m all ears.

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Beyond the Prescription comes out on August 11! I wrote it with you in mind.

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Friday Q&A: new cholesterol pill; poor air quality; sleep trackers; mouth taping and nasal strips

Dr. Lucy McBride — Fri, 17 Jul 2026 09:15:37 GMT

FUN BOOK UPDATE 👉

I spent all day in NYC yesterday doing book-related media events. Stay tuned for fun podcast episodes, to be released during publication week (8/11)!

📣 Click here to send me your questions for future Q&As! ✍️

The following questions have been lightly edited for length and clarity.

QUESTION #1: NEW CHOLESTEROL PILL

Dr. McBride, I just read about the new cholesterol medication Lipfendra. Is it better than statins? Should I switch from Crestor?
—Dan

Hi Dan,

I’ve been getting a lot of questions like this since Lipfendra hit the headlines this week. Here’s the short answer: Lipfendra isn’t a replacement for statins—yet. Right now it’s designed to work alongside them.

Lipfendra (generic = enlicitide) is the first pill in a class of drugs called PCSK9 inhibitors. Until this week, these drugs required self-administered injections. PCSK9 drugs are impressive at lowering LDL (”bad”) cholesterol—often by 50% or more on top of a statin. But here’s what this week’s headlines miss: lowering a number on a lab report isn’t the same as preventing a heart attack. Statins have decades of data showing they reduce heart attacks, strokes, and deaths. Lipfendra doesn’t have that evidence yet. Those studies are still underway.

That said, the data on its cousins, the injectable PCSK9 inhibitors (called Repatha and Praluent) are impressive: they have been shown in large trials to reduce heart attacks and strokes, not just cholesterol numbers. Early data on Leqvio, which is a twice-yearly injection targeting the same pathway, also hint at fewer cardiovascular events, though its definitive trials haven’t finished. So the pathway Lipfendra targets is a proven one; the pill itself just hasn’t earned its stripes yet.

If your cholesterol is well controlled on a statin, there’s no reason to switch. If it’s not, Lipfendra may be worth a conversation with your doctor—as an addition, not a substitute.

Dr. McBride, I keep reading reports about wildfires creating hazardous air quality all over this summer, and I'm wondering what I should actually be doing to protect my health on bad air days. Right now, my weather app says the air outside is "unhealthy." I have mild asthma, and I'm trying to figure out what I'm supposed to do when the air we are supposed to breathe is unhealthy?
—Michelle

Hello Michelle,

Yes, it’s bad out there in various parts of the country right now. The sad truth is that staying indoors is your best bet on days when Air Quality Index, or AQI, is in the “very unhealthy” or “hazardous” range. I suggest checking AirNow.gov for real-time conditions in your area. (It’s more reliable than most weather apps for this specific purpose.)

“Unhealthy” air typically means AQI in the 151–200 range, at which point everyone can start to feel effects, and people with respiratory conditions like asthma are at higher risk. On days like that, the general guidance is to limit outdoor exertion (not necessarily to stay completely indoors) but to avoid anything that has you breathing hard outside, like running, cycling, or yard work.

When indoors, try to keep windows and doors closed and run your air conditioning if you have it, since AC filters and recirculates indoor air rather than pulling smoky air in. An air purifier with a HEPA filter can be well worth the investment (it’s not just a wellness gimmick), particularly for anyone with asthma living in a location where wildfires have (tragically) become part of summer.

For your asthma specifically, make sure your rescue inhaler is accessible and not expired, and if you notice your symptoms worsening on bad air days, e.g., more wheezing, tightness, or you’re reaching for your inhaler more than usual, call your doctor rather than pushing through. Wildfire smoke contains particulate matter that is particularly irritating to airways, and it can trigger flares even in people whose asthma is otherwise well controlled.

Here’s hoping the air clears soon.

I’ve been using a sleep app from my smart watch that says I’m only getting 20 minutes of deep sleep per night. I wake up tired most mornings even though I’m in bed for 8 hours. I’m 49 and wondering if I should do a sleep study, or if these apps are just making me anxious about normal sleep.
—Jennifer

Hello Jennifer,

You’re asking exactly the right questions. Consumer sleep apps and wearables are notoriously inaccurate when it comes to measuring sleep stages, especially deep sleep. These devices use movement and sometimes heart rate to estimate sleep phases, but they can’t actually measure the brain waves that define true deep sleep. That requires specialized equipment used in sleep labs. I’ve had patients develop real insomnia from obsessing over their sleep scores!

The more important question is why you’re waking up tired despite eight hours in bed. At 49, hormonal changes from perimenopause could absolutely be disrupting your sleep quality. Other common culprits include sleep apnea, medication side effects, caffeine later in the day, or even stress that doesn’t let your mind truly settle.

A sleep study might be worth considering if you have signs of sleep apnea—like loud snoring, gasping during sleep, or morning headaches. It’s also reasonable if you’ve addressed other factors like cutting caffeine after 2 PM, creating a cooler bedroom environment, and managing evening screen time without improvement.

In general I suggest focusing less on what the app says and more on how your body feels, then discussing this with your doctor. Sometimes the most helpful thing is to step back from the technology and tune into what your body is actually telling you.

I hope that helps!

I keep seeing mouth tape and nasal strips being promoted for better sleep, more energy, and improved athletic performance. I'm a decent sleeper and not an elite athlete, but maybe I’ve been breathing wrong for awhile. What do you think about trying these out?
-Donna

Dear Donna,

The short answer is that there's real science here, even if the marketing has gotten ahead of it. The nose filters, humidifies, and warms air before it reaches the lungs, and nasal breathing produces nitric oxide, which has real cardiovascular and pulmonary benefits. Chronic mouth breathing—especially during sleep—is associated with worse sleep quality, dry mouth, and dental problems. Athletes who’ve focused on nasal breathing during training report improvements in endurance and recovery, and there’s emerging research supporting this.

Nasal strips work by physically widening the nasal passages, which can reduce resistance and make nasal breathing easier, particularly useful if you tend toward congestion at night. They’re low-risk and a reasonable place to start. Mouth tape is a more significant intervention with an earlier-stage evidence base, but for people who are confirmed mouth breathers during sleep, the logic is sound, and some people find it genuinely helpful.

One thing worth knowing before trying either: mouth tape isn’t appropriate for anyone with undiagnosed sleep apnea. If you wake unrefreshed, snore significantly, or feel fatigued during the day, a conversation with your doctor is the right starting point before experimenting on your own. (I cover more on sleep apnea in this episode of my podcast here.)

For a decent sleeper who’s simply curious, nasal strips are an inexpensive place to start.

My book, Beyond the Prescription, comes out on August 11! I wrote it with you in mind.

Is Chronic Lyme Real?

Tue, 14 Jul 2026 09:15:32 GMT

BOOK UPDATE: UPCOMING EVENTS 👉

Join me at Zibby’s Bookshop in LA on August 6 at 6 pm PT 🥂🎉
Join me at Politics & Prose in DC on August 12 at 7 pm ET 🥂🎉
Beyond the Prescription releases on August 11. Pre-order on my website and claim your bonus!

This story is told with permission from my patient.

She came in convinced she had Lyme disease. A woman in her mid-60s, she’d spent a few weeks hiking in Maine this spring. She never saw a tick. But in June she started feeling achy in her hips and exhausted for no clear reason. She also had a dull headache that wouldn’t quit. She did what most of us would do: she went online and read up on Lyme disease.

Then she took herself to an urgent care clinic in Maine where they ran basic labs including a Lyme test. Everything came back normal. “Good news,” she was told by a cheerful young doctor. Except it didn’t feel like good news when she felt draggy and not herself.

So she kept looking. A friend recommended a clinic that claimed to specialize in chronic Lyme. There, she got something urgent care hadn’t offered: someone who took her symptoms seriously. She also got a treatment plan—IV antibiotics and oral supplements for $5,000 without good evidence behind any of it. By the time she sat down in my office this month, she wasn’t sure who to believe: the provider who told her nothing was wrong? Or the one who told her he knew exactly what was wrong?

I could tell you the same story about a patient recovering from COVID, or mono, or influenza. (Or any patient with non-specific symptoms and normal labs.) The details change; the limbo doesn’t.

Photo by Simone Secci on Unsplash

To be clear, the urgent care doctor wasn’t a bad doctor. She just didn’t have time to surface my patient’s whole story. My patient asked, “Do I have Lyme disease?” The labs said no. Visit over. Because answering the question a patient brings in is faster than discovering the question underneath it. Her real question wasn’t “Do I have Lyme?” It was “What could cause fatigue, joint pain, and headaches in a woman my age?” Those are two very different medical encounters.

And the Lyme clinic? It offered the most precious commodity for anyone feeling lost and unwell: someone who listened. That’s why these clinics thrive. Validation is the product; the treatments are the price.

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Here’s what both clinics had in common: they took her question at face value. One answered “no” and stopped looking. The other answered “yes” and stopped looking. A dismissal and a diagnosis-for-sale are twin mistakes, each one ending the search.

Because here’s the ugly truth about lingering post-infectious syndromes: they are usually not one thing. In my experience, what gets labeled “chronic Lyme” or lumped under “long COVID” is often several different problems wearing the same costume—de-conditioning after weeks of illness, insomnia triggered by coughing jags or fitful sleep, depression or anxiety showing up in physical form, an underlying condition such as diabetes or COPD that the infection unmasked. Each of those has a different treatment. None of them is discoverable if curiosity ends at “Your labs are fine” or “It’s chronic Lyme.”

So what happened in my office? I took a detailed history: her migraines, her pre-diabetes, her family history of rheumatoid arthritis, her medications and supplements, her sleep, her stress. I examined her head to toe. And I re-ran her labs, this time casting a wider net, including markers of inflammation and a more detailed Lyme panel.

When she left, I told her the truth: I didn’t know yet what was going on, but I was optimistic we’d figure it out.

Her results came back a few days later. Lyme: negative, again. Everything else normal—except a sky-high sedimentation rate, a nonspecific marker of inflammation. A sedimentation rate that high isn’t a diagnosis; it’s a flare sent up by the body. Finding the source meant going back to her story. So, I called her on the phone and asked more about the headaches. They had started localizing to her right temple. That detail—along with her age, her fatigue, and that inflammatory marker—pointed to temporal arteritis (also called giant cell arteritis or “GCA”), an autoimmune inflammation of the arteries in the head that, left untreated, can threaten vision. I started her on steroids that day, arranged a biopsy to confirm the diagnosis (which it ultimately did), and looped in my rheumatology colleague.

The hip pain turned out to be a separate story: wear and tear from a car accident years ago, unmasked when fatigue knocked her off her regular stretching routine. An X-ray proved it. The pain was related to her new diagnosis, just indirectly—which meant the treatment for hip pain wasn’t treating the GCA; it addressing an old injury that was flaring alongside it.

It’s funny—even after she got fully better on steroids, she still didn’t quite believe me that a tick bite wasn’t behind the whole shebang. And I told her: maybe it was. Maybe a tick bite she never saw set the cascade in motion. Medicine is an art as much as a science. Labs are only half the story. The other half—the timeline, the fears, the life surrounding the symptoms—is data too.

If you’re living in this limbo—if your tests are normal and you still feel terrible—the question isn’t “Who will finally believe me?” It’s: “Who will keep looking alongside me?” That’s a different kind of help, and you’re allowed to ask for it by name.

Have you lived in this limbo—after Lyme, COVID, or anything else? What did it take to be taken seriously? I’m all ears.

Beyond the Prescription comes out on August 11! I wrote it with you in mind.

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Friday Q&A: Cyclospora outbreak; too much dietary protein; urinary urgency; & top exercise hacks

Dr. Lucy McBride — Fri, 10 Jul 2026 09:15:16 GMT

BOOK UPDATE 👉

Join me at Zibby’s Bookshop in LA on August 6 at 6 pm PT 🥂🎉
Join me at Politics & Prose in DC on August 12 at 7 pm ET 🥂🎉
PRE-ORDER BEYOND THE PRESCRIPTION!

📣 Click here to send me your questions for future Q&As! . ✍️

Photo by Bozhin Karaivanov on Unsplash

The following questions have been lightly edited for length and clarity.

QUESTION #1: CYCLOSPORA OUTBREAK

Dr. McBride, I just read about a Cyclospora outbreak and I had never heard of it before. How does it spread? Should we stop eating certain kinds of food?! How can we avoid this? (The symptoms sound so unpleasant!)
—Amber

Hello Amber,

I’m getting this question a lot lately! Cyclospora isn’t a household name, but right now case counts are higher than usual and fresh summer produce is at the center of it.

Here’s the deal: Cyclospora is a parasite that gets into the food supply through fecal contamination (I know, yuck), typically on fresh produce. Bagged salad mixes, fresh herbs, raspberries, and snow peas are the usual suspects. You eat it, it sets up shop in your small intestine, and roughly a week later, you feel it. The symptoms are miserable: watery, persistent diarrhea, cramping, fatigue, nausea. What makes Cyclospora particularly annoying is that it tends to seem like it’s getting better before it comes back. That relapsing pattern is actually one of the things that tips clinicians off.

The reassuring part: it’s very treatable once identified, and it’s not the kind of thing that typically lands healthy adults in serious trouble. The catch: Cyclospora requires specific testing to diagnose (it won’t show up on a standard stool culture), so if you’ve had persistent GI symptoms that aren’t resolving, be sure to mention the possibility to your doctor by name rather than assuming they’ll think to test for it.

For now, you don’t need to stop eating produce. Just wash everything thoroughly under running water. (Cooking eliminates the parasite entirely.) And stay alert to GI symptoms that don't resolve.

I have a question - Is it possible to eat too much protein? I’ve started adding peanut butter to my high protein shakes, and I also eat a lot of protein bars but now I’m wondering if you can you overdo it?
—Jake

Hello Jake,

Great question. I get this a lot as people pay more attention to the role of protein in energy, muscle maintenance, metabolism, and overall well-being. The short answer: yes, it is technically possible to eat too much protein. But for most people, the concern isn’t “too much” protein. It’s not enough, especially as we age.

Here’s some context. Most healthy adults need about 0.7 to 1.0 grams of protein per kilogram of body weight per day (that’s about 0.36 to 0.45 grams per pound). For a 150-pound person, that’s somewhere in the range of 55 to 70 grams of protein daily—more if you’re physically active, recovering from illness or surgery, or trying to maintain or build muscle in midlife and beyond.

If you’re adding a shake or a protein bar or two to your day, you’re probably not overdoing it. In fact, you might be landing closer to where your body wants to be—especially if your previous intake was light on protein (which is very common, especially among women).

That said, excessive protein can, over time, stress the kidneys in people with preexisting kidney disease and may crowd out other important nutrients like fiber. So it’s less about the total grams and more about balance—and listening to your body. If you’re suddenly relying on bars and shakes for most meals or feeling bloated, constipated, or sluggish, it might be worth dialing it back and focusing on whole food sources of protein (like fish, eggs, beans, tofu, or lean meat) and pairing them with fiber and healthy fats.

Protein is essential, not just for muscles but for mood, metabolism, immune health, and more. You don’t need to fear it. Just aim for a steady, balanced intake throughout the day and check in with how you feel. That’s usually the best data of all.

Hi Dr McBride, I am in my late 60’s and when I get the urge to urinate I have to get to the bathroom very quickly or I am unable to hold back very well. Are there exercises that I can do to strengthen my muscles and keep this from happening? Thank you!
-Theresa

Dear Theresa,

Urinary urgency—i.e., the sudden need to get to the bathroom—is one of the most common complaints I hear from women after menopause. And it’s not something you have to accept as part of aging.

In postmenopausal women, urinary urgency typically results from some combination of weak pelvic floor muscles and the absence of estrogen affecting the bladder and surrounding tissues. It can also be from a UTI, so it’s worth ruling that out first with a simple urine test, since infection can mimic urgency without the typical burning symptoms that most people expect.

Pelvic floor physical therapy can make a real difference here, and it goes beyond Kegel exercises (many people don’t perform Kegels correctly or consistently.) A PT who specializes in pelvic floor rehabilitation can give you a targeted program. There are also bladder training techniques that a pelvic floor PT can walk you through, which help retrain the bladder to tolerate longer intervals between bathroom trips.

Vaginal estrogen is also critical. Discuss it with your doctor. It’s delivered locally and is considered safe for most women. It helps restore tissue integrity in the bladder and pelvic floor in ways that can meaningfully reduce urgency over time. (You can listen to my conversation with Dr. Lauren Streicher where we discuss the vaginal estrogen here.) I hope this helps point you in the right direction toward finding relief soon!

I know I’m supposed to do some form of aerobic exercise every week … my doctor tells me all the time but I don’t feel like I have the time or motivation to do so. What are some easy & accessible ways to exercise? I need a jump start or a miracle maybe .. thanks in advance.
-Adriana

Hello Adriana,

Patients often ask me, What’s the best kind of exercise to do? The answer: it’s the one you will do. Usually that means you enjoy it, it fits your budget and schedule, and it’s social. In an ideal world, people would get 150 minutes of exercise per week, with a combination of strength training, cardiovascular exercise and stretching. However this can be difficult for mere mortals. I get it.

For busy people, it can feel overwhelming to get started when you aren’t in a regular habit of exercising. However, I will remind you that even a 5-minute walk around the block is better than nothing. Just taking the stairs instead of the elevator counts as valuable movement in your day.

Also, know that changing habits takes about three weeks to take hold. So, if you decide to start exercising, I wouldn’t give up if you hit the snooze button two mornings in a row. Try again, and give yourself a break if you don’t follow through on every promise to yourself.

If you’re in a rut of non-activity and you want to get started on exercise, my best advice is to start by tricking yourself into exercising. Take the stairs, shimmy while you vacuum, walk whenever you can. And if you already enjoy walking, try wearing a weighted vest in order to “supercharge” your cardio and add upper body strength. Voila!

Does anyone have other exercise hacks to share with Adriana? Fire away!

My book, Beyond the Prescription, comes out on August 11! I wrote it with you in mind.

What I Wish Every Woman Knew About Breast Cancer

Dr. Lucy McBride — Tue, 07 Jul 2026 09:15:11 GMT

Episode Summary

Dr. Lucy McBride sits down with Dr. Amy Comander, Harvard breast oncologist and author of Paving Your Path Through Breast Cancer and Beyond, to cut through the fear and misinformation around breast cancer. They cover who is at risk, what the screening guidelines mean in practice, what lifestyle factors move the needle, and how to make sense of the HRT and breast cancer conversation.

Risk: Genetics, Bad Luck, and Everything In Between

Only 5–10% of breast cancers in the U.S. are due to identifiable inherited gene mutations—BRCA1 and BRCA2 account for roughly half of those
Another 10–15% involve familial patterns without a single identifiable gene; the remaining majority are sporadic, meaning they occur without an inherited cause we can currently explain
Having breast cancer in your family doesn’t mean you have a genetic mutation—given that one in eight women will develop breast cancer in her lifetime, sometimes it just means you have women in your family
A strong pattern—grandmother, mother, and sister all with breast cancer—is a signal worth discussing with a doctor; a single relative is not necessarily a reason for genetic testing

Screening: Mammograms, Dense Breasts, and MRI

Annual screening with mammography starting at 40 is recommended for average-risk women, with the end point determined by a shared conversation with a doctor
Dense breast tissue makes mammograms harder to read—finding a tumor in extremely dense tissue is like finding a snowman in a snowstorm; about 10% of women have extremely dense tissue and most should add an annual breast MRI staggered six months from their mammogram
Heterogeneously dense tissue is common—up to 40% of women under 50—but not everyone with it needs an MRI; the decision depends on other risk factors and should incorporate a validated risk model like the Tyrer-Cuzick calculator
Breast MRI catches more cancers but also generates more false positives; the downstream anxiety and biopsies are costs that belong in the conversation about pros and cons of MRI as a screening modality

Lifestyle and Prevention

Alcohol is the most consistent and modifiable lifestyle risk factor for breast cancer—even one drink per day carries a small but real increased risk, and the relationship is dose-dependent
Maintaining a healthy weight and engaging in regular physical activity reduce risk, partly by reducing circulating estrogen in post-menopausal women and by improving metabolic health overall
Soy is not a risk factor for breast cancer—this is a persistent myth; soy foods are a good source of plant-based protein and the evidence is clear that they are safe
Risk factors divide into fixed (age, sex, genetics) and modifiable (alcohol, weight, exercise, metabolic health); the goal is to lean into what can be changed without catastrophizing what cannot

The fear around HRT and breast cancer stems largely from the 2002 Women’s Health Initiative study, which used synthetic progestins—not the bioidentical hormones most commonly prescribed today
In the WHI, women who took estrogen alone—those who had undergone hysterectomy—actually had a reduced risk of breast cancer, a finding that was not widely reported
The overall increased risk from combined hormone therapy is small, and causation has not been established; a family history of breast cancer is not an automatic disqualification from HRT
HRT is a tool in the toolkit, not a solution for everyone—the right answer depends on individual risk factors, symptom burden, and what risks a woman is willing to tolerate on both sides of the decision

Vaginal Estrogen and Breast Cancer Survivors

Vaginal estrogen is considered safe for virtually all women, including most breast cancer survivors, because systemic absorption is minimal
It is distinct from systemic HRT and should not be lumped in with it—women who have had breast cancer and are suffering from genitourinary symptoms should know this option exists
For women on systemic HRT who also use vaginal estrogen, the two can be used together; the patch is not a substitute for vaginal estrogen because the tissue itself needs local treatment
Oncologists are increasingly getting educated on menopause management—the divide between oncology and women’s health is closing, and patients benefit when their cancer doctor and primary care doctor are working from the same playbook

Survivorship: Thriving Beyond a Diagnosis

Too many women feel defined by their diagnosis, or guilty that they somehow caused it—neither is warranted, and neither serves the goal of getting better
Breast cancer is not one disease; genomic tools like the Oncotype DX and ProSigna help determine whether chemotherapy is even necessary, sparing many women from treatment that won’t help them
The pillars of thriving after breast cancer mirror the pillars of health generally—sleep, movement, stress management, social connection, and a sense of purpose
Patients have more agency than they often believe: where genetics and diagnosis are fixed, how a woman shows up for her body, her relationships, and her care is not

Upshot

One in eight women will develop breast cancer in their lifetime. Most cases are not due to an inherited genetic mutation. Screening saves lives. HRT is not the villain it was made out to be. And breast cancer patients have more agency than they often think.

If you enjoyed this episode, check out my other conversations on women’s health:

My book, Beyond the Prescription, comes out on August 11! I wrote it with you in mind.

Friday Q&A: mosquitos and West Nile virus; fatigue with normal labs; GLP-1s and alcohol cravings; & elevated liver tests

Dr. Lucy McBride — Fri, 03 Jul 2026 09:15:50 GMT

BOOK UPDATE 👉

Join me at Zibby’s Bookshop in LA on August 6 at 6 pm PT 🥂🎉
Join me at Politics & Prose in DC on August 12 at 7 pm ET 🥂🎉
PRE-ORDER BEYOND THE PRESCRIPTION!

📣 Send me your questions for future Q&As! Click here to write me. ✍️

My favorite summer table accessory

The following questions have been lightly edited for length and clarity.

QUESTION #1: MOSQUITOS & WEST NILE VIRUS

With summer, I'm seeing more mosquitoes than ever and starting to worry about mosquito-borne illnesses. I know West Nile virus gets mentioned every year, but I don't really understand how serious the risk actually is or who is most vulnerable. What should I be doing to protect myself?
—Aubrey

Hello Aubrey,

I’m glad you asked. West Nile season is off to one of its worst starts in years, and it’s good to think about prevention rather than just swatting and hoping for the best.

The good news is that most cases of West Nile are asymptomatic or mild. Serious illness is less common, nonetheless it’s important to know what to look for. Symptoms like fever, headache, body aches, weakness or numbness in an extremity, or rash—particularly when occurring days after a known bite—warrant a call to your doctor. Note that serious illness tends to occur in adults over 60 or those with underlying health conditions but can affect anyone.

Since there’s no vaccine for West Nile, prevention is key. On mosquito repellents: EPA-registered options containing DEET, picaridin, or oil of lemon eucalyptus are the most effective and are safe for adults and children. Apply to exposed skin and clothing before heading out, and reapply if you’re outside for extended periods.

Because mosquitoes are most active at dawn and dusk, shift outdoor activities to midday if possible to reduce exposure. Lightweight long sleeves and pants during those peak hours help more than most people realize. And around your home, eliminating standing water is one of the most impactful things you can do. Birdbaths, clogged gutters, planters, buckets, even bottle caps collect enough water to become breeding grounds.

I hope you can enjoy being outside this summer—just bring the bug spray!

Hello, Dr. McBride. I recently went through a series of blood work to help determine what’s causing my fatigue, the muscle cramping in my legs and feet, and how I’m doing in general. Everything was “normal”. But then I started to wonder, whose “normal”? Men’s “normal” or women’s “normal”? I’m happy things look good, but I was also hoping for more insight into what might be causing these symptoms in an active, healthy-eating, good-sleeping GenX woman. And I refuse to continue hearing this is “normal” and “part of aging” for “women.” We can do better than that. Thanks!
—Chris

Hello Chris,

Your frustration is completely valid, and the question you’re asking—whose normal? —is legit. The short answer: most reference ranges used in standard lab work were historically derived from studies that skewed heavily male. Women’s hormonal fluctuations, body composition, and physiology differ enough from men’s that a number landing “within range” doesn’t always mean it’s optimal for you specifically.

On your symptoms: fatigue and muscle cramping in an otherwise healthy, active woman have a differential diagnosis worth working through rather than dismissing. A few things that frequently get missed (or at least underweighted) include magnesium deficiency, which rarely shows up on standard panels because serum magnesium doesn’t reflect intracellular stores well; iron deficiency without anemia, where ferritin can be low enough to cause symptoms even when hemoglobin is normal; vitamin D insufficiency; thyroid function at the lower end of “normal” that still affects how you feel; and perimenopause or early menopause-related hormonal shifts that don’t always trigger obvious symptoms but can drive exactly what you’re describing.

The “ask” worth making at your next appointment: don’t just request labs, request context. What is my ferritin, not just whether I’m anemic. What is my free T3, not just my TSH. What is my vitamin D level in actual numbers. And if your symptoms persist despite normal results, a referral to a specialist who works with women’s health and hormonal issues is entirely reasonable to push for.

You’re right that we can do better. And asking these questions is exactly how that happens.

PS. Asking better questions and gaining confidence to advocate for yourself is something I cover in-depth in my forthcoming book, Beyond the Prescription! You can pre-order it here.

I am hearing that people lose their taste for alcohol on Ozempic (and similar medications for weight loss). I would be interested in it for that reason but I don’t know if the side effects are worth it- plus the cost.
-Monica

Dear Monica,

Yes, people who take Ozempic and other GLP-1 medications commonly report reduced cravings for alcohol. Interestingly, they also may find themselves less inclined to engage in other compulsive behaviors (e.g., skin picking, compulsive shopping, etc).

Why is that? These drugs not only reduce appetite and tell the pancreas to produce more insulin, they also act on the brain’s pleasure center, such that people who typically over-indulge in food get less of a dopamine rush in response to eating. They are less interested in food because the reward circuitry in the brain has changed. It makes intuitive sense, then, that the compulsion to drink alcohol is dampened when less dopamine is released when consuming it (or even when thinking about it!) (You can read more about how Ozempic works in my article here.)

You might ask: Could Ozempic be a solution for addiction? It’s too early to tell. The early observational data on Ozempic’s ability to reduce impulsivity and cravings around various habits is promising. Eli Lilly will study the use of GLP-1s to treat alcohol, nicotine and drug abuse.

What do I think? Given that addiction is a complex bio-psycho-social phenomenon, it’s unlikely that medication alone will be universally helpful. In other words, the brain’s dopamine and pleasure circuitry is only one piece of a more complex problem. That said, if addressing the neurobiology of addiction with a drug helps millions of people who suffer from substance use disorders (without doing more harm than good), I welcome it.

I am closely following the Ozempic data and will keep you posted. Now I will ask you—what are your thoughts about this drug and the fanfare around it? Drop me a note in the comments below!

QUESTION #4: ELEVATED LIVER ENZYMES

Dr. McBride, Three of my last four blood labs in the past three years have come back with mildly elevated ALT (in the 40s-50s). I’m a 39-year-old woman in good health, have never abused alcohol, and all other labs are normal. We’ve ruled out hepatitis and now my doctor is recommending a liver ultrasound, but I’m also wondering—are there any lifestyle changes (other than reducing alcohol) that can help reduce stress on the liver? Thanks!
-Elise

Hello Elise,

Your doctor is right to recommend a liver ultrasound for a persistently elevated ALT. It’s the next step to rule out metabolic-associated steatohepatitis (aka “fatty liver” disease), which is now the most common cause of mildly elevated liver enzymes in otherwise healthy adults. You don’t have to drink heavily, or at all, to develop it.

Assuming that’s what you are dealing with, there’s a lot you can do on the lifestyle front. The liver is super sensitive to metabolic health and dietary inputs. Think of your liver as the garbage disposal for almost everything you consume, so the most impactful changes center on reducing what the liver has to process—like fructose and added sugars. Reducing these are a good place to start because the liver metabolizes fructose directly; excess intake drives fat accumulation in the liver even in lean, active people. Ultra-processed foods have a similar effect. A diet that emphasizes whole foods, fiber, lean protein, and healthy fats supports liver health more reliably than any supplement can.

Exercise matters, too, independent of body weight. Regular aerobic activity and strength training reduce liver fat even when the scale doesn’t move, which is an under-appreciated finding. If you’re already active, you’re already on the right track.

One more thing to review with your doctor: certain medications and supplements, including acetaminophen used regularly, some herbal supplements, and even high-dose vitamins, can quietly elevate ALT over time. A full inventory of everything you’re taking is critical.

That imaging will give you and your doctor a clearer picture of what’s actually going on. In the meantime, the lifestyle factors above support liver health across the board, whatever the result turns out to be. I hope that helps!

My book, Beyond the Prescription, comes out on August 11! I wrote it with you in mind.

Are You Getting What You Need from Your Doctor’s Appointments?

Dr. Lucy McBride — Tue, 30 Jun 2026 09:15:29 GMT

BOOK UPDATE: UPCOMING EVENTS 👉

Join me at in LA on August 6 at 6 pm PT 🥂🎉
Join me at Politics & Prose in DC on August 12 at 7 pm ET 🥂🎉

A reader wrote me last week. She hit the nail on the head.

I find the U.S. healthcare system frustrating. When I see my “primary care” doctor—for a problem, or an annual physical—it feels like we’re just going through the motions. My few chronic conditions never get better; if anything, they get worse as I age. What’s worse, with a science background, is that I never understand whether we’re ruling anything out, or what’s cause and effect. Is the diagnosis simply that my condition can’t be cured, so I take medication forever? If so, what are the side effects—and if we’re only managing symptoms, what are the other options?
I’ve started having new symptoms: joint stiffness, aches and pains. I’d like to understand what’s wrong—and understand it in the context of the other conditions I’ve been carrying. I feel like I need a new approach, or a new doctor. I wonder if any of the longevity practitioners offer a more holistic approach. Am I crazy, or does this not exist—is it only for billionaires? Can you recommend a way to start?

I’ll be honest: when I read this message, my first thought was that you’ll all think I made her up! Because she’s put her finger on exactly the problem so many people are facing: medicine that’s become transactional and impersonal. Studies have found that doctors tend to interrupt patients in the first 11 seconds. This is not the fault of doctors; there just isn’t time.

There’s no time to ask the questions you deserve to ask. Is this test meant to rule something out, or are you ordering it because you’re worried? Is this medication something I need long term, or is it short-term only? And to weave in your lifestyle, your medications, your goals, your lab work—who you are as a person. That kind of care shouldn’t be a luxury.

So, dear reader, THANK YOU for the layup, because you’ve captured what so many people are experiencing (and the reason I wrote my book).

Here’s what I wrote back to her

You probably don’t need a longevity expert. (The word “longevity” gets thrown around a lot these days.) And you may not even need a new doctor. What you need is someone board-certified in internal medicine or primary care who has enough time to consider your health as an ecosystem.

You are more than a set of body parts. You are more than a set of lab tests. You’re a living, breathing, whole human being. Yes you have lab data; you also have biographic data that needs to be surfaced. You have nutritional inputs. You have a skeleton that carries you through life. You have mental health, emotional health, biases, and personal goals. Healthcare shouldn’t treat you like a transaction; it should help you connect the dots between your habits and your lab results, your genetics and your risk for disease, your life stressors and your everyday experience of being alive. It should arm you with the tools, the information, and the guidance to live the way you want to live.

Healthcare should be a series of conversations, not a stack of prescriptions.

So yes, you may need a new doctor. But what you’re really after is to understand where you have control and where you have to cede it. You want to know what’s fixed, what’s dynamic, and where you have agency over your health.

Take your new aches and pains. I can’t diagnose you from here (that’s a conversation for you and your doctor), but it might be arthritis: something you could manage for a while with an anti-inflammatory or physical therapy, and that might one day mean a joint replacement. It might be muscle imbalances, certain groups that need strengthening, others that need loosening, again with physical therapy. You might decide a joint replacement isn’t something you want at any cost, which points toward more conservative, ongoing management.

The point isn’t which of those is right for you. It’s knowing what levers you have. Maybe you want less stiffness. Maybe you want more mobility. Maybe you want to be as aggressive as possible and have surgery, if it’s on the menu. Maybe you’d rather avoid surgery at all costs and accept that you’ll need medication long term.

Those are your questions to bring into the room. And the ones you’re already asking are exactly right.

So maybe the real question isn’t whether you need a new doctor. It’s whether anyone has ever helped you ask the right questions.

If this reader’s letter sounds familiar, here’s something to take with you. I’ve pulled one page from my Four-Quadrant guide—a set of questions to bring to any appointment, whether it’s primary care, a specialist, or the ER—grouped by the four parts of your health that usually get treated in isolation. Print it, screenshot it, keep it in your bag. Because health isn’t about having all the answers. It’s about asking better questions—to yourself, and to the people responsible for your care.

That’s two pages. (You can download them here.) The full Four-Quadrant Self-Reflection & Action Guide is my gift to everyone who pre-orders the book. →

Beyond the Prescription comes out on August 11! I wrote it with you in mind.

Please hit the ❤️ or 🔄 button so more people can discover this post! Even better, please share it with friends and loved ones! 🙏

Friday Q&A: insulin levels in non-diabetics; vaginal estrogen; dietary calcium and oxalate; & brain fog vs dementia

Dr. Lucy McBride — Fri, 26 Jun 2026 09:15:10 GMT

BREAST CANCER CONVO 👉

Today at 10 am ET: Join me & Dr. Amy Comander, Harvard breast cancer specialist, live for a conversation about breast cancer prevention, treatment & survivorship. Click HERE to join us!

BOOK UPDATE 👉

Barnes & Noble has 25% off all pre-orders through June 26, including Beyond the Prescription! Grab your copy here.
I’m building a Launch Team Team for Beyond the Prescription! And I’d love you to join it! 👯👯👯

Join the Launch Team!

📣 Send me your questions for future Q&As! Click here to write me. ✍️

Photo by D koi on Unsplash

The following questions have been lightly edited for length and clarity.

QUESTION #1: INSULIN LEVELS IN NON-DIABETICS

Dr McBride, I’m having some anxiety around all the info (from doctors on-line) that people should have their insulin levels checked, not just A1c and glucose. (For example, may cause heart related diseases). I’d love to see a future post on this. Both of these and my weight are “normal” for me and my PCP isn’t interested.
—Laurie

Hello Laurie,

It’s normal to think, What am I missing? when an online doctor says that a normal A1c and glucose—the traditional measures for diabetes and pre-diabetes—can mask a problem that only your insulin level would reveal.

The fear-mongering is so unhelpful!

Here’s what gets lost: Sure, fasting insulin often can can flag insulin resistance earlier than glucose or A1c. But insulin levels aren’t well standardized, “normal” ranges vary from lab to lab, and in someone like you—normal weight, normal glucose, normal A1c, no symptoms—an elevated number rarely changes the plan. Regardless of your insulin level, when you have a normal A1C and glucose, the plan is to move your body, build muscle, protect your sleep, manage stress, eat mostly whole foods. A spot insulin level doesn’t get you anything you can’t already act on.

So, rather than asking your PCP to order this test, you might try a different question: “Given my whole picture, what would actually move the needle on my metabolic health?” That is more likely to result in a conversation about what to do, not just what not to do.

Does that help?

I am not happy. I'm 72 and my primary care clinic won't prescribe HRT to women over 65 or more than 10 years past menopause. Full stop. I’ve listened to you and Rachel Rubin talk about the safety and benefits of vaginal estrogen so I asked the nurse - she hinted that a compounding pharmacy might be an option. Why is this so hard for women?
—Barb

Hello Barb,

This burns me up!! Your frustration is completely justified and all too common. A blanket “no HRT after 65” policy is not evidence-based. It’s liability management dressed up as clinical guidance, and it is failing women like you every day.

Here’s what the evidence actually says: vaginal or topical estrogen, which acts locally with minimal systemic absorption, carries near-zero risk and has myriad benefits for postmenopausal benefits (specifically it reduces the risk for urinary tract infections, vaginal dryness, painful intercourse, urinary symptoms like frequency and burning, and pelvic floor dysfunction).

The risk of estrogen (topical and systemic) has been overblown, ever since the misreading of the 2002 Women’s Health Initiative study. This was a very well done study that enrolled women who were, in many cases, years out from menopause and had pre-existing cardiovascular risk. The problem is that the study’s conclusions about breast cancer and cardiovascular risk were wildly overstated. They have since been substantially revised. The Menopause Society now states clearly that there is no fixed age cutoff for hormone therapy. Vaginal estrogen is safe for everyone. Decisions about whether or not to take systemic hormone therapy should be individualized based on symptoms, medical history, and risk profile.

(You can read my full thoughts on the ten year window and age restrictions for HRT here. And here’s a recent conversation with menopause expert Lauren Streicher MD related to this topic as well.)

Vaginal estrogen is widely available at traditional pharmacies with a prescription. I prefer the vaginal estrogen cream over the suppository. The key is to apply it using your finger, not the applicator (toss it out!), to make sure the estrogen is absorbed into your tissue (around the labia, urethra, and in the vagina) to protect what can become very fragile tissue without hormonal support.

More importantly, none of this should happen without a physician who specializes in menopause medicine in your corner, ideally someone who can prescribe appropriately and monitor your progress over time. The providers exist and increasingly, they may be accessible via telehealth if your local options are limited.

You deserve better!! I hope you find it.

Can you discuss how oxalates and phytates interfere with calcium absorption, how much is problematic, and tips to improve calcium absorption?

I’ve been taking 500 mg. of calcium per day (thinking I was getting the rest from my diet). My last two lab reports came back low in Calcium. I was following (too closely, I think) my endocrinologist’s advice to eat Calcium rich foods like almonds and kale. I have only recently discovered these bind to calcium. Because I take Levothyroxine, I avoided Calcium intake in the morning and took my Calcium supplement with dinner. Thinking I was upping my Calcium intake, I was eating lots of almonds, uncooked kale in salads, chia seeds in yogurt and soups, etc.
-CD

Dear CD,

Great questions. Let’s break them down.

First about oxalates: Oxalates (in spinach, almonds, chia, beet greens) and phytates (in nuts, seeds, whole grains, legumes) bind calcium in your gut and form compounds you can’t absorb, so some of the calcium in “calcium-rich” foods is effectively locked up. There’s no clean cutoff for “how much oxalate is too much.” For most people eating a varied diet, the effect is modest; it matters most when a high-oxalate food is your main calcium source. And here’s a fun fact: kale is actually LOW in oxalates, and calcium from kale is very well absorbed, often better than dairy products. Spinach is the oxalate offender, not kale.

But here’s the bigger point: a low calcium level on blood work usually isn’t a story about dietary calcium intake. Your body holds blood calcium in a tight range, borrowing from bone if it has to. When that number runs low, the usual culprits are vitamin D, magnesium, your parathyroid, or your albumin level (which changes how calcium reads on the test). In other words, almonds and kale rarely bump blood calcium levels.

So, the better questions for your next doc visit: Has my vitamin D been checked? My magnesium? Is this a corrected or ionized calcium? (And separating your calcium from your Levothyroxine, by the way, is exactly right—calcium blocks its absorption.)

That’s the heart of Beyond the Prescription, learning what to ask, and whom. I hope this helps!

Hi Dr. M. I feel like I’m forgetting things all the time. I’m not that old, just 51, but I forget names more, lose my train of thought mid-sentence, and walk into rooms not remembering why. I’m worried about early dementia. Also I have not had a menstrual period in 8 months and have hot flashes at night, and sweats. How do you know if memory problems are normal aging or something more serious? (I know I need to see my doc!) -Stephanie
-Stephanie

Hello Stephanie,

At 51, the symptoms you’re describing, while frustrating, are incredibly common and probably not early dementia. What you’re experiencing sounds much more like menopause or perimenopause brain fog, which is real, frustrating, and usually temporary.

Here’s what’s likely happening: fluctuating estrogen levels during perimenopause directly affect brain function, particularly areas involved in memory, attention, and verbal fluency. Estrogen helps with neurotransmitter production and supports neural connections, so when levels drop and surge unpredictably, your brain doesn’t function as smoothly. Add in disrupted sleep from night sweats or insomnia (also common in menopause and perimenopause), chronic stress, managing multiple responsibilities, and possibly some underlying anxiety about these symptoms, and you’ve got a perfect storm for feeling mentally “foggy.”

True dementia looks different. It’s progressive—meaning it steadily worsens over time rather than fluctuating day to day. It interferes with your ability to function independently—forgetting how to do familiar tasks, getting lost in familiar places, struggling to follow conversations or manage finances. It often involves personality changes or poor judgment that others notice before you do. The fact that you’re aware of and worried about your forgetfulness is actually reassuring—people with true dementia often don’t recognize their cognitive decline.

Independent of hormonal fluctuations, consider other treatable causes of inattention and forgetfulness: Sleep deprivation (regardless of its cause) can wreak havoc on memory and concentration. Are you taking any medications that affect cognition, like antihistamines, sleep aids, or certain antidepressants? Is your thyroid function normal? Are you dealing with significant stress or anxiety? All of these can mimic or worsen cognitive symptoms.

As you say, it’s important to talk with your doctor about your symptoms and get a basic workup—thyroid, B12, vitamin D, iron levels, a metabolic panel. If menopause or perimenopause seems likely, hormone therapy might help—and you would probably know it was helping over the course of a few weeks.

Cheers to a healthy brain!

My book, Beyond the Prescription, comes out on August 11! I wrote it with you in mind.