Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / What's the deal with methylene blue?

Transcript

What's the deal with methylene blue? · Wellness, Actually with Emily Oster & Perry Wilson, MD

0:01
Speaker 1: If you haven't heard of methylene blue yet, you have
0:03
Speaker 1: to listen to Joe Rogan and Chase He's discussing on
0:05
Speaker 1: his podcast.
0:05
Speaker 2: Mel Gibson was on here talking about it.
0:07
Speaker 1: RFK Junior tory about you had a brain disease.
0:10
Speaker 2: What did you do to fix it? I started him
0:12
Speaker 2: a seizures like a few years ago. And everybody in
0:14
Speaker 2: my family knows I'm a neuroscientist, so I kind of
0:17
Speaker 2: looked around and I found this guy's a functional medicine guy,
0:20
Speaker 2: and he got me on methylene blue. And I know
0:23
Speaker 2: mel Gibson was on here talking about it. That instantly
0:26
Speaker 2: stopped everything. Tastes like chewing an ass. I take it, okay, Yeah,
0:29
Speaker 2: I take it every day as well.
0:30
Speaker 1: And RFK Junior toy about it.
0:32
Speaker 2: Man, It's fantastic. It helps with depression and anxiety and
0:35
Speaker 2: all kinds of life stress and stuff. It is a
0:38
Speaker 2: miracle and it's been proven for one hundred years. That's
0:41
Speaker 2: one of the most well proven drugs out there.
0:43
Speaker 1: Emily, I am stressing out a little bit about this episode,
0:48
Speaker 1: are you? I am so? Methylene blue is probably the
0:54
Speaker 1: first topic we've covered that, like most people may not
0:58
Speaker 1: have heard of yet. Like this is I mean, it's
1:01
Speaker 1: definitely in the wellness space, but you know, it's not microplastics,
1:05
Speaker 1: it's not glp ones, and they're certainly as we'll get to,
1:10
Speaker 1: you know, this stuff is not totally benign. And I
1:14
Speaker 1: was thinking, like, wait, should we even be talking about
1:16
Speaker 1: this or like we platform? Can you platform a wellness product?
1:21
Speaker 3: And should you do your platform a synthetic dye?
1:24
Speaker 1: Yeah? Yeah, yeah yeah. Are we to methylene blue what
1:28
Speaker 1: Tucker Carlson is to Nick Fuent's That is what is
1:30
Speaker 1: keeping me up at night right now?
1:32
Speaker 3: That would keep me up? But I think the answer
1:35
Speaker 3: is no, partly because Joe Rogan has already talked about this.
1:39
Speaker 3: People have speculated that the Health Secretary is drinking and
1:42
Speaker 3: although he is not confirmed. And I also think one
1:47
Speaker 3: of the things that happens with a lot of these
1:49
Speaker 3: wellness trends is they pop up when you're not expecting them.
1:52
Speaker 3: And this is like a pre preparation. So in your analogy,
1:58
Speaker 3: it's like, we are going to pair you for what
2:00
Speaker 3: Nick Foundays is like and then whin Tacker Carlson has
2:04
Speaker 3: him on, you'll be ready. I'm Emily Aster. I'm an
2:09
Speaker 3: economist and a data expert.
2:11
Speaker 1: And I'm Perry Wilson. I'm a medical doctor.
2:14
Speaker 3: It's Thursday, May twenty first, twenty twenty six, and this
2:17
Speaker 3: is wellness actually.
2:19
Speaker 1: Because you're getting a staggering amount of health and wellness
2:22
Speaker 1: information nowadays from every source imaginable, and some of it
2:26
Speaker 1: is awesome and some.
2:27
Speaker 3: Of it is well actually bullshit. Fortunately, we are both
2:33
Speaker 3: people who know how to read studies, how to parse
2:35
Speaker 3: the data, and can tell you what's worth thinking about
2:38
Speaker 3: and what you can safely ignore.
2:40
Speaker 1: But before we dig in, a note that this podcast
2:42
Speaker 1: is for educational purposes and should not be construed as
2:45
Speaker 1: medical advice. We don't know your unique situation, so talk
2:48
Speaker 1: to your doctor for personal health decisions.
2:51
Speaker 3: This week we're asking what's the deal with methylene blue?
2:55
Speaker 3: Perry and I will give the official smasher pass, and
2:57
Speaker 3: then we'll get to your question of the week. But
3:00
Speaker 3: first let's do the health news. After the break.
3:14
Speaker 1: And we're back with your health news of the week, Emily,
3:18
Speaker 1: I'm going to start with something that is like really
3:22
Speaker 1: caught fire on social media, and that is Driscolls strawberries,
3:26
Speaker 1: a product that because my youngest absolutely loves strawberries, I'm
3:30
Speaker 1: buying quite frequently. There was a report released that there
3:36
Speaker 1: were multiple pesticides and including some so called forever chemicals
3:42
Speaker 1: found on these strawberries, and it's leading to people getting
3:47
Speaker 1: very afraid to purchase them. So what do you think?
3:50
Speaker 1: Is this a disaster for the strawberry industry?
3:53
Speaker 3: So I think it's worth saying what people are seeing online,
3:57
Speaker 3: which is posts that say there's a thirty eight percent
3:59
Speaker 3: increased risk of cancer consume from Driscoll strawberries. That's the headline,
4:03
Speaker 3: panic headline that people are hearing, and I want to
4:06
Speaker 3: start with what that is. So what's going on there
4:09
Speaker 3: is some people have looked at childhood cancer rates by
4:15
Speaker 3: county in California and one of the things they've noted
4:19
Speaker 3: is that the counties that grow strawberries have, relative to
4:25
Speaker 3: the average in California, elevated cancer rates. Now, there are
4:28
Speaker 3: a lot of reasons that could be true. They may
4:32
Speaker 3: have a different demographic population, they may have actually sometimes
4:36
Speaker 3: this is because they have a hospital and so you're
4:38
Speaker 3: counting things in a different way because of where the
4:41
Speaker 3: diagnosis is. These aren't the places with the highest cancer
4:44
Speaker 3: rates in California, but they are higher than the average.
4:47
Speaker 3: And the link that is then made is Okay, this
4:51
Speaker 3: is because of pesticide exposure from the strawberries. There's really
4:55
Speaker 3: no direct evidence that that is true. And even and
5:00
Speaker 3: if that were true, it doesn't mean that eating the
5:03
Speaker 3: strawberries gives you the kind of exposure that would have
5:06
Speaker 3: any risk for cancer. So this is like we're sort
5:08
Speaker 3: of seven steps down on the causal chain. It is
5:13
Speaker 3: true that most fruits are treated with pesticides, but then
5:15
Speaker 3: they are washed, and we do have some exposure to
5:18
Speaker 3: chemicals as people, but that is part of our life
5:21
Speaker 3: in the modern world. So this has struck me as
5:25
Speaker 3: an overstated panic headline that should not really be keeping
5:30
Speaker 3: people up the way that it is.
5:32
Speaker 1: But I should keep washing my strawberries.
5:34
Speaker 3: You should wash your strawberries because they've been at the
5:37
Speaker 3: store and they might have poop on them and stuff
5:39
Speaker 3: like that. But yes, you should wash your fruit, but
5:42
Speaker 3: it's not a you should always be washing your fruit.
5:44
Speaker 1: Don't underestimate how lazy I am.
5:47
Speaker 3: Wash your fruit berry?
5:48
Speaker 1: Okay, good lord, what if I'm really hungry?
5:51
Speaker 3: Okay? On another topic, we have been seeing a lot
5:54
Speaker 3: about ebola. Yeah, say more. Can we be worried about ebola?
6:01
Speaker 3: Have moved, We've moved on from hauntavirus seems to have
6:04
Speaker 3: died down, and when now we're on a Bola. What's
6:05
Speaker 3: going on with Abola?
6:06
Speaker 1: I know this is our third week in a row
6:09
Speaker 1: talking about a epidemic slash potential pandemic, which is very
6:14
Speaker 1: upciting and giving me some COVID PTSD. But let's level
6:19
Speaker 1: set here. So first of all, remember hauntavirus like the
6:21
Speaker 1: hottest thing a week ago, and now it's like, oh no,
6:24
Speaker 1: that's that's old news. We're onto ebol. Everybody, haunt of
6:27
Speaker 1: virus is gone, haunt virus is still out there. I
6:30
Speaker 1: will just point out that there are no positive cases
6:32
Speaker 1: in the US and that particular outbreak on the cruise
6:35
Speaker 1: ship does seem to have been effectively contained. Knock on woods,
6:39
Speaker 1: so we'll see. Ebola is a virus that causes a
6:43
Speaker 1: hemorrhagic gastron tritis. You know, you're essentially bleeding from multiple orifices.
6:49
Speaker 1: This particular outbreak is a version of the virus called
6:52
Speaker 1: Ebola Bundy bugio, which is actually relatively rare. They are
6:56
Speaker 1: about four different Ebola viruses. You may have heard of
6:59
Speaker 1: Ebola year, which is the one that they talked about
7:02
Speaker 1: in the hot zone. This outbreak is primarily in the
7:07
Speaker 1: Democratic Republic of Congo. There are three hundred and thirty
7:10
Speaker 1: cases with eighty to ninety fatalities so far, almost all
7:14
Speaker 1: entirely in that country, although there has been some spread
7:17
Speaker 1: into Uganda. Just yesterday, the US instituted a thirty day
7:21
Speaker 1: travel restriction from the DRC Uganda and Southern Sudan, And
7:28
Speaker 1: so you know, they're treating this as and the who
7:31
Speaker 1: is treating this as a public health emergency. Ebola is
7:35
Speaker 1: transmitted through bodily fluids, through the blood and excrement and
7:40
Speaker 1: stuff like that that an infected person is putting out,
7:44
Speaker 1: and so the primary risk here is to healthcare professionals
7:48
Speaker 1: and family members potentially in under resourced areas, who are
7:51
Speaker 1: trying to treat and care for these people. Transmission can
7:55
Speaker 1: be very effectively prevented through the use of personal protective
7:59
Speaker 1: equipment gowns, loves masks, biohazard suits, et cetera. But this
8:03
Speaker 1: does spread person to person. It has. We've talked before,
8:08
Speaker 1: Emily about the basic reproduction number, the average number of
8:11
Speaker 1: people that one person spreads the virus two and a
8:15
Speaker 1: bowl is sitting around two. It's not crazy high. But
8:19
Speaker 1: it's a little bit. That number is an average and
8:21
Speaker 1: it belies one of the weirdnesses of ebola transmission, which
8:26
Speaker 1: is that it's it's very super spreader dominant, So most
8:31
Speaker 1: people with ebola may not transmit it at all, and
8:34
Speaker 1: then you have these individual people who will transmit it
8:37
Speaker 1: to you know, ten twenty thirty people, so you get
8:39
Speaker 1: an average of two, and that just means you have
8:42
Speaker 1: to be super careful again with containment, you know, we
8:45
Speaker 1: have to follow this. This is something particularly in areas
8:48
Speaker 1: that don't have access to good quality healthcare and the
8:52
Speaker 1: biohazard containment that's necessary for very infectious and obviously very
8:57
Speaker 1: deadly virus like this, like this could lead to a
8:59
Speaker 1: large outbreak, particularly you know in sub Saharan Africa where
9:03
Speaker 1: those resources just aren't available.
9:05
Speaker 3: Yeah, and we've seen that kind of size outbreak before
9:08
Speaker 3: in these areas. The last few years, there have been
9:12
Speaker 3: some smaller outbreaks which have been contained. So this is
9:15
Speaker 3: something where I think we do know how to contain it,
9:19
Speaker 3: or at least have some tools to do that. The
9:21
Speaker 3: question is just sort of implementing them.
9:24
Speaker 1: I should say, there is an FDA proved e bowl
9:27
Speaker 1: of vaccine, but it is targeted against the zyre strain,
9:31
Speaker 1: and there's a lot of consternation actually about whether this
9:35
Speaker 1: vaccine would be affected for this Bungi bunyo strain. They're
9:39
Speaker 1: genetically not very similar. I mean, they're both the BOWLA viruses,
9:42
Speaker 1: but they're not like brother and sister, and so there's
9:46
Speaker 1: some debate about whether it's ethical to, you know, ship
9:49
Speaker 1: vaccine over there. You want my cards on the table,
9:52
Speaker 1: I'm like, why don't you give it a tribe because
9:55
Speaker 1: that's what we have, and you know, the vaccine is
9:58
Speaker 1: relatively safe. But people above my pay grade will be deciding.
10:02
Speaker 3: Those sorts of things, that's for sure.
10:05
Speaker 1: All right, Let's move on to something a little less scary,
10:10
Speaker 1: and that's tanning beds. So the FDA is now withdrawing
10:18
Speaker 1: a proposed rule that would limit tanning bed exposure for miners.
10:23
Speaker 1: Several states across the country do prohibit miners from using
10:28
Speaker 1: tanning beds, and the FDA was potentially going to make
10:31
Speaker 1: that a national rule. And the reporting here is that
10:37
Speaker 1: this comes from the La Times, is that this was
10:39
Speaker 1: driven by RFK Jr, a man who may or may
10:45
Speaker 1: not own eight tanning beds and rotate through them every
10:49
Speaker 1: single day. RFK has said stuff about like the importance
10:53
Speaker 1: of some light that I've always kind of wondered what
10:54
Speaker 1: he's talking about, Emily, like what's going on? What's going
10:57
Speaker 1: on with tanning beds?
10:58
Speaker 3: And RFK no, he So you know, first of all,
11:02
Speaker 3: we have a fair amount of evidence that exposure to
11:05
Speaker 3: a lot of a UV light increases your risk of
11:08
Speaker 3: skin cancer. So tanning beds are not a good idea
11:11
Speaker 3: for people, and they're actually particularly not a good idea
11:15
Speaker 3: for young people who have many, many years in which
11:18
Speaker 3: to develop skin cancer. And so it is this is
11:22
Speaker 3: why we tell people that they should wear sunscreen, and
11:25
Speaker 3: why we tell kids that they should wear sunscreen, and
11:26
Speaker 3: why you shouldn't purposely go inside a place with no
11:30
Speaker 3: sunscreen that's going.
11:31
Speaker 1: To irradiate you.
11:33
Speaker 3: But what I think is interesting here is like what's
11:37
Speaker 3: behind this? Because often with these things you sort of
11:40
Speaker 3: back into like, well, why would you think this is
11:43
Speaker 3: a good idea? And I think the answer is that
11:45
Speaker 3: there is this feeling in some of these wellness spaces
11:48
Speaker 3: that we need more sun exposure because of vitamin D,
11:51
Speaker 3: that like we need more natural vitamin D sun exposure,
11:54
Speaker 3: and people have gotten it's gotten too much with the sunscreen,
11:56
Speaker 3: and you should be going outside some of the time
11:59
Speaker 3: to be exposed to some vitamin D. I don't think
12:02
Speaker 3: we have a lot of evidence for that, But even
12:04
Speaker 3: if we did, what you'd be talking about, if you said, like, look,
12:06
Speaker 3: you need a little more vitamin D, we'd be talking
12:08
Speaker 3: about like fifteen minutes in the early morning when the
12:12
Speaker 3: UV light is not as extreme. This is very different
12:15
Speaker 3: than you know, lay inside an ultra radiated UV experience
12:20
Speaker 3: as a teenager. So I'm just I am a no
12:23
Speaker 3: on tanning bits. Yeah, I'm a past I'm not smashing
12:27
Speaker 3: Teenso tanning beds pairy.
12:29
Speaker 1: Oh, their carcinogenic. And also they give you wrinkles.
12:32
Speaker 3: They do give you wrinkles. I wore so much sunscreen
12:36
Speaker 3: and look at where we are now. You know people
12:38
Speaker 3: can't see. But it's just beauty, porcelain, porcelain.
12:42
Speaker 1: It's so small porcelain skin.
12:44
Speaker 3: Well, that's not just the filter. That's also.
12:48
Speaker 1: All right, that's the health news of the week after
12:51
Speaker 1: the break, what's the deal with methylene blue?
13:00
Speaker 4: First, fighting for my life, I learned something most people
13:02
Speaker 4: never hear from their doctor. Your mitochondria decide whether your
13:05
Speaker 4: body heals or breaks down. And one of the simplest
13:08
Speaker 4: tools I still used to energize mysels is methylene blue.
13:11
Speaker 5: What makes methylene blue such an amazing chemical? Methylin blue
13:14
Speaker 5: does a bunch of things to the body. Can help
13:16
Speaker 5: improve your energy, and it can help improve your mood.
13:18
Speaker 5: It can help improve your brain function, can help improve
13:20
Speaker 5: your focus. It's a bit of an anti microbial and
13:22
Speaker 5: also an anti viral.
13:23
Speaker 1: Hand it can improve your skin.
13:25
Speaker 4: Trust me, a blue tongue is worth it if your
13:27
Speaker 4: mitochondria are tired.
13:28
Speaker 3: Okay, Perry, So before we even get into methylene blue,
13:32
Speaker 3: I actually want to talk about mitochondria.
13:36
Speaker 1: Oh good, there is.
13:38
Speaker 3: There are two reasons. One is I feel very prepared
13:40
Speaker 3: because my ninth grader has been doing biology and so
13:43
Speaker 3: all year I've been learning about this. So I feel
13:46
Speaker 3: like I'm this is the first time in like, you know,
13:48
Speaker 3: twenty seven years, that I'm prepared to discuss the details
13:51
Speaker 3: of mitochondria.
13:52
Speaker 1: I'm so excited. Maybe we should just do a whole
13:54
Speaker 1: episode on mitochondria, bring your ninth grader on board.
13:57
Speaker 3: But I also but I think the thing that struck
14:02
Speaker 3: me here is the phrase my mitochondria are tired, And
14:06
Speaker 3: like I think we should help people. We should start
14:08
Speaker 3: by helping people understand why are your mitochondria and what
14:11
Speaker 3: would it mean to say that they are tired of
14:14
Speaker 3: doing things?
14:15
Speaker 1: Yeah? I mean people, stop anthropomorphizing your mitochondria. Do we
14:21
Speaker 1: name our mitochondria? Jason?
14:23
Speaker 3: We have so many it would be hard.
14:25
Speaker 1: It is hard.
14:26
Speaker 3: Jason one and Jason two, Jason three.
14:28
Speaker 1: Okay, So the ninth grade version, of course, is that
14:33
Speaker 1: the mitochondria are the powerhouse of the cell, right, They're
14:37
Speaker 1: the things that make energy. But you know, I think
14:40
Speaker 1: we have to now we've got to like go up
14:42
Speaker 1: to ap bio level maybe here, and talk to people
14:46
Speaker 1: in a little more detail about what the mitochondria are
14:49
Speaker 1: actually doing. So do you want me to talk about
14:52
Speaker 1: the electronic transport chain or do you want to jump in?
14:55
Speaker 3: First of all, I just want to be clear. I
14:57
Speaker 3: did learn about the electronic transfer again earlier this year,
15:00
Speaker 3: so I'm prepared. But why don't you start?
15:03
Speaker 1: And then okay you jump there? All right, So we've
15:08
Speaker 1: talked before that your cells use ATP as their energy currency.
15:13
Speaker 1: So all the proteins that need energy bind ATP. They
15:17
Speaker 1: use the energy of ATP kick off a phosphate and
15:19
Speaker 1: they can do their stuff that requires energy, and it's
15:22
Speaker 1: the mitochondria that make that atp. They do that by
15:28
Speaker 1: getting electrons in a very high energy state from a
15:32
Speaker 1: variety of digestive processes that occur in your cell, like
15:35
Speaker 1: the CREB cycle, which is something else that I really
15:39
Speaker 1: don't want to go through right now. We're staying away
15:43
Speaker 1: from the Cb cycle. But what you get out of
15:45
Speaker 1: the Creb cycle takes glucose and things like that down
15:48
Speaker 1: to a very highly energetic molecule called NADH, which has
15:54
Speaker 1: an electron in it that's at a very high energy state,
15:57
Speaker 1: and that electron is donated to the electron transport chain
16:01
Speaker 1: in the mitochondria. And the best way I can explain
16:03
Speaker 1: the electron transport chain is like, imagine you have a reservoir, okay,
16:09
Speaker 1: and you know a dam that's holding back water, and
16:12
Speaker 1: then you can open you know, a valve on that
16:16
Speaker 1: dam and water flows to a lower level and generates electricity.
16:21
Speaker 1: And then imagine below that level you have a lower
16:24
Speaker 1: level that you can open a valve and the water
16:26
Speaker 1: drains down and generates more electricity, and so on and
16:28
Speaker 1: so forth. That's the electron transport chain. There are four
16:30
Speaker 1: complexes in it, and it takes that high energy electron
16:34
Speaker 1: and every time that electron gets passed from one complex
16:37
Speaker 1: to another, it gets to a lower and lower energy state,
16:41
Speaker 1: and that energy is used to pump protons into the mitochondria.
16:47
Speaker 1: And at the very end, all those protons are stuck
16:50
Speaker 1: in the mitochondria, they're really eager to get out. They
16:52
Speaker 1: flow through this protein which is like a turbine, which
16:57
Speaker 1: is called the proton ATP synthase, and that protein makes ATP.
17:01
Speaker 1: So you've got this really complicated process to take energy
17:04
Speaker 1: from electrons and step wise get it into something that
17:09
Speaker 1: can make ATP. That's a mitochondria, and the ATP can
17:13
Speaker 1: do it's thing. If one of those proteins doesn't work, okay,
17:18
Speaker 1: like the valve in the dam is stuck. You can't
17:22
Speaker 1: open the valve, okay. Those are typically genetic conditions that
17:26
Speaker 1: we call the mitochondrial diseases. So these are typically inherited
17:31
Speaker 1: from the mother, because you get virtually all your mitochondrial
17:34
Speaker 1: DNA from your mom, because the egg has all the
17:37
Speaker 1: mitochondrias your mitochondrial DNA is maternal and kids who have
17:41
Speaker 1: these these particular mutations in the electron transport chain are
17:45
Speaker 1: severely disabled. I mean sometimes fatally so because they can't
17:50
Speaker 1: generate ATP in adequate amounts. But of course that's not
17:54
Speaker 1: what people are using methylene blue form.
17:57
Speaker 3: Okay, so let's like, okay, so we're in a bag
18:00
Speaker 3: no methylene blue yet, Perry, we're not ready for it.
18:01
Speaker 1: Yeah.
18:02
Speaker 3: So the electron transport chain inside the mitochondria, it takes
18:06
Speaker 3: the electrons and their high energy state, it turns them
18:08
Speaker 3: into a TP.
18:10
Speaker 1: Yeah.
18:11
Speaker 3: In a person without where that process is generally working. Fine.
18:17
Speaker 3: There is no meaning to the phrase my mitochondria are tired.
18:21
Speaker 3: They aren't tired. You could be tired, and that is
18:26
Speaker 3: the thing. People get tired, people get fatigued. It's a
18:29
Speaker 3: experience people have. It's not because your mitochondria are like
18:32
Speaker 3: only sort of slowly. They're not like, ah, too many
18:36
Speaker 3: electrons today, Like I just I want to take a
18:38
Speaker 3: nap and not move so many. Like that's not how
18:41
Speaker 3: this works. They're not tired. That's it's not a person.
18:45
Speaker 3: It's it's not chemical reaction cell.
18:48
Speaker 1: But when you hear people talk about mitochondria in the
18:51
Speaker 1: wellness space, that's often what it is. It's like it's
18:54
Speaker 1: like we're going to unleash your mitochondria. We're gonna you know,
18:57
Speaker 1: we're we're It's as if you've got like a G
19:00
Speaker 1: on the motor and you were gonna, you know, whatever
19:01
Speaker 1: the supplement is. People are hawking, it's gonna nice, you know,
19:05
Speaker 1: turn off that that governor and things are going to
19:07
Speaker 1: go rippering and you'll feel like you're nineteen again.
19:09
Speaker 3: And you know, and I think the idea, I see
19:13
Speaker 3: the idea. The link there, which is like the mitochondria
19:15
Speaker 3: is making the ATPD. ATP is what's providing you energy.
19:17
Speaker 3: And it is true that there are things you can
19:20
Speaker 3: do that would lower your ability to do that. For example,
19:22
Speaker 3: if you don't have enough glucose these like you know,
19:25
Speaker 3: you don't have enough clycogen like, it can't this can't
19:28
Speaker 3: work because you need that to stick in to get
19:30
Speaker 3: the thing with the high energy to make the ATP
19:33
Speaker 3: on the other end. So it is true if you
19:35
Speaker 3: didn't have enough glucose, yeah, your mitochondria wouldn't be doing
19:38
Speaker 3: enough and then you'll be tired.
19:39
Speaker 1: Do you know what else you need to make that
19:42
Speaker 1: electron transport chain work is you need something to accept
19:45
Speaker 1: the low energy electron at the end to like get
19:47
Speaker 1: it out of the mitochondria.
19:48
Speaker 3: It's called oxygen.
19:50
Speaker 1: That's oxygen. It It turns out if you do not breathe,
19:54
Speaker 1: your mitochondria suffer quite dramatically and.
19:58
Speaker 3: You'll feel tired and also dead. But the mitochondria are
20:02
Speaker 3: so they're not tired, They're just okay.
20:04
Speaker 1: So I have to say, as I was doing the
20:07
Speaker 1: like reading again into the etc. And stuff and now
20:11
Speaker 1: that I'm paying more attention to the wellness space, I
20:14
Speaker 1: was making a list of the number of supplements that
20:18
Speaker 1: like appear somewhere in the electron transport chain. So here's
20:22
Speaker 1: my here's my list of things that are actually in
20:24
Speaker 1: the electron transport chain. Not saying that supplements make any
20:28
Speaker 1: difference here, by the way, I'm just saying, like, here
20:30
Speaker 1: they are coenz im q, ten nadh riboflavi and vitamin
20:35
Speaker 1: B two sucks and eight vitamin K two magnesium. These
20:39
Speaker 1: are all things that like biologically speaking, facilitate the work
20:44
Speaker 1: of the electron transport chain. And all of those things
20:47
Speaker 1: will get marketed to you using the same exact logic
20:50
Speaker 1: as bethlene blue, which we'll get to, which is like,
20:52
Speaker 1: don't you want your mitochondria to work better? And I
20:56
Speaker 1: think if there's one thing that people need to sort
20:58
Speaker 1: of understand this a lot, like maybe there's biological plausibility here,
21:03
Speaker 1: But just because something is necessary in some amount to
21:09
Speaker 1: make a biological process work doesn't mean that getting more
21:13
Speaker 1: of that makes it work better. Like that's just not
21:16
Speaker 1: typically how the body works.
21:19
Speaker 3: It is not okay. So with that background, I hope
21:23
Speaker 3: people enjoyed this ape bio lesson. Let's talk about methylene blue. So,
21:29
Speaker 3: methylene blue is a die. It was first prepared in
21:33
Speaker 3: the late eighteen hundreds by a guy named Henrik Heinrich
21:37
Speaker 3: presumably Caro as a dye for fabrics. It makes things
21:40
Speaker 3: blue like fabric or your poop or pee. And it
21:45
Speaker 3: has the property that it can stain cells and bacteria
21:52
Speaker 3: without necessarily killing them. That turns out to be a
21:56
Speaker 3: very valuable property because it generates some uses where you
22:02
Speaker 3: can basically color cells in bacteria, yeah, which is helpful
22:07
Speaker 3: for various diagnostic things we can talk about. And it
22:11
Speaker 3: was originally used in a variety of medical settings like
22:14
Speaker 3: for UTIs. It may have some efficacy as an anti
22:17
Speaker 3: malarial although we have much better versions of that now.
22:21
Speaker 3: But I will say the thing I did not dig up,
22:24
Speaker 3: although perhaps you know is like how on Earth did
22:27
Speaker 3: people have this fabric dye? And then they were like,
22:30
Speaker 3: let's try drinking it. There's the link there.
22:34
Speaker 1: It's it is really hard. I mean, I don't have
22:38
Speaker 1: a one to one link, but I think I can
22:40
Speaker 1: tell a story here, which is that you get this
22:42
Speaker 1: fabric dye in the late eighteen hundreds. This is the
22:45
Speaker 1: heyday of you know, microscopy and germ theory, like we're
22:50
Speaker 1: starting to categorize bacterias and amibas, and so people are
22:53
Speaker 1: really excited about what are called vital dyes, dyes that
22:56
Speaker 1: don't kill the thing you're trying to study under the microscope.
22:59
Speaker 1: They're just like, dies, kill the thing and then they
23:02
Speaker 1: don't move anymore. And so this was really cool. And
23:05
Speaker 1: they also saw that it had some anti malarial effects,
23:07
Speaker 1: so people started taking it for things like malaria. So
23:10
Speaker 1: at least then you've got, okay, there's human data that
23:14
Speaker 1: it doesn't kill humans when you take it, and then
23:19
Speaker 1: it's really not until I think the year here is
23:24
Speaker 1: almost like two thousand and eight, like the early two thousands,
23:28
Speaker 1: when people started experimenting with methylene blue in cell culture
23:35
Speaker 1: to see what its effects would be specifically on oxidative
23:41
Speaker 1: stress in cells. So one of the things that makes
23:44
Speaker 1: methylene blue sort of special is that it can accept
23:48
Speaker 1: electrons and give electrons two things we've talked about electrons
23:52
Speaker 1: and electron transport chain. This is going to be why
23:53
Speaker 1: it's important. And chemists knew that property of it. They
23:57
Speaker 1: were actually using methylene blue as an indicator die in
24:00
Speaker 1: chemical reactions. So you could if you remember like in chemistry,
24:03
Speaker 1: where you would you know, you'd titrate things and like
24:05
Speaker 1: it would turn like red, and then you'd add acid
24:08
Speaker 1: and it would turn blue. Like those were so fun.
24:10
Speaker 1: So methylene blue does that too, because it's an electron
24:13
Speaker 1: acceptor and an electron donor depending on the conditions. And
24:17
Speaker 1: so it made sense that like, oh, if it can
24:20
Speaker 1: do that, maybe it will do something with mitochondria. And
24:23
Speaker 1: so people started experimenting with that in you know, in
24:29
Speaker 1: vitro in cell culture with some promising results and we
24:32
Speaker 1: can talk about those. And I think, like all wellness things,
24:35
Speaker 1: you get like one tiny study in a petri dish
24:38
Speaker 1: full of cells, and then especially if that thing is
24:42
Speaker 1: cheap and already available, and you can just like market
24:45
Speaker 1: it without needing approval from the FDA, Like you are
24:47
Speaker 1: off to the races man.
24:49
Speaker 3: And I think here it is like worth stepping one
24:53
Speaker 3: step back into the discussion of the electron transport chain
24:56
Speaker 3: and thinking about why this might matter. So if you
25:00
Speaker 3: think about methylene blue as like a bus that can
25:04
Speaker 3: pick up some electrons and drop them somewhere else, it
25:08
Speaker 3: is possible if there's like a like a problem in
25:12
Speaker 3: the electron transport chain where one of those you know,
25:15
Speaker 3: pieces of the dam doesn't open, like in principle, yeah,
25:18
Speaker 3: this mall. This could take some of those electrons and
25:21
Speaker 3: deliver them to a later part of the transport chain
25:24
Speaker 3: and kind of bypass something that is that is.
25:26
Speaker 1: Exactly like if that valve is stuck between complex one
25:30
Speaker 1: and complex two, methylene blue can take an electron from
25:33
Speaker 1: complex one and give it straight to complex three. Right,
25:36
Speaker 1: And I should say, medically speaking, this has been used
25:40
Speaker 1: for cyanide poisoning, so second time cyanide has come up
25:45
Speaker 1: on this podcast for longtime listeners. Cyanide blocks the very
25:50
Speaker 1: end of the electron transport chain, that step where oxygen
25:55
Speaker 1: is there to pick up the low powered electron and
25:58
Speaker 1: get rid of it so that things can keep moving
26:00
Speaker 1: so it blocks that very end point, and because of
26:03
Speaker 1: that ATP synthesis stops and you die. Cyanide is quite poisonous,
26:08
Speaker 1: and so again this might be a recurring theme. We
26:11
Speaker 1: have better treatments for cyanide toxicity now, but before we did,
26:15
Speaker 1: methylene blue was used for this basically to like pick
26:18
Speaker 1: up that last electron to kind of keep things moving
26:20
Speaker 1: a little bit, even in the presence of cyanide while
26:23
Speaker 1: you try to work. It does work. I mean it
26:25
Speaker 1: doesn't work. I mean still people died a lot, but
26:27
Speaker 1: like it does work. Better than nothing, and not as
26:30
Speaker 1: good as you know, the current treatments for cyanide toxicity.
26:34
Speaker 3: Okay, I think that's a good that's a good segue
26:37
Speaker 3: into the fact that this actually is something with some
26:42
Speaker 3: small number of real medical uses, and so one obviously
26:45
Speaker 3: is cyanide poisoning in the past. The other usage that
26:51
Speaker 3: is still the one FDA approved indication for use of
26:56
Speaker 3: methylene blue is for something called acquired methane moglob I
27:04
Speaker 3: could say it metemoglobinemia, which is a hemoglobin disorder effectively,
27:15
Speaker 3: uh yeah, but can be acquired and is really bad.
27:18
Speaker 1: Uh. So this is the FDA approved indication metemoglobinemia is
27:22
Speaker 1: like your your hemoglobin has an iron atom in the
27:25
Speaker 1: middle to pick up oxygen, and that under certain states,
27:30
Speaker 1: and like certain drugs do this, like benzocaine toxicity can
27:34
Speaker 1: do this. But I guess maybe more more relevant is
27:38
Speaker 1: uh IS poppers like those are the recreational drugs, like
27:41
Speaker 1: the inhalance alkyl nitrates, so that can reduce the iron
27:47
Speaker 1: in hemoglobin to a state that cannot bind oxygen. It
27:53
Speaker 1: kind of imagine it like rusts the iron in the hemoglobin,
27:56
Speaker 1: so like the iron doesn't work anymore, and this is
27:59
Speaker 1: really bad, and like the blood turns this chocolate brown color.
28:03
Speaker 1: If you've seen me hemoglobinemia, it is very strange and disturbing.
28:07
Speaker 1: It's like it's not dark blue like venus blood. It's
28:09
Speaker 1: not bright red. It's brown like hot chocolate. Very weird.
28:13
Speaker 1: And you need to give an electron back to that
28:16
Speaker 1: iron to get it back into its ordinary hemoglobin state.
28:19
Speaker 1: And methylene blue, as we've said, can like donate electrons
28:22
Speaker 1: under the proper circumstances, can receive electrons under other circumstances.
28:26
Speaker 1: That's its main indication. I actually see it as a nephrologist.
28:31
Speaker 1: Not infrequently. When I'm rounding in the cardiothoracic intensive care unit,
28:35
Speaker 1: you see the folly bag, that's the urine bag, you know,
28:37
Speaker 1: next to the bed, and every once in a while
28:39
Speaker 1: one is blue, sometimes green if the person is a
28:42
Speaker 1: little bit more dehydrated, because yellow and blue makes green.
28:45
Speaker 1: And these are people who get methylene blue after heart surgery.
28:49
Speaker 1: So if you're on cardiopulmonary bypass, when you put the
28:53
Speaker 1: patient back, when you switch their heart back on and
28:56
Speaker 1: now they're supporting themselves, they often will have this phenomenon
29:00
Speaker 1: called vasoplesia where just like their blood vessels don't they
29:03
Speaker 1: kind of like are like floppy and their blood pressure
29:07
Speaker 1: just drops extremely and methylene blue. The data is not
29:10
Speaker 1: great for this, but it is common practice to use
29:13
Speaker 1: methylene blue to sort of reverse that. Post cardiac surgery.
29:17
Speaker 1: Vasoplegia probably reduces nitric oxide synthase for the biologists who
29:22
Speaker 1: are listening. And the up practical upshot is that I
29:25
Speaker 1: see a lot of blue urine when I walk through
29:27
Speaker 1: the cardiothoracic I see you, so obviously you should take
29:29
Speaker 1: this to make yourself like have more energy from daily life.
29:34
Speaker 3: Right, But here is where I think I can see
29:38
Speaker 3: why this compound is so like compelling in the wellness space,
29:45
Speaker 3: because there are a lot of processes in our body
29:48
Speaker 3: for which electrons need to be moved around, not just
29:53
Speaker 3: the yes, including the mitochondria function, but also all these
29:56
Speaker 3: other things. And now you're sort of listing like, oh, well,
29:59
Speaker 3: here's some that you know, someone who has had a
30:01
Speaker 3: serious surgery or has like overdosed on poppers or in
30:05
Speaker 3: some other way has some kind of diffuse problem that
30:10
Speaker 3: involves electrons, and this is the thing that fixes it.
30:14
Speaker 3: You can see why you would get to like, well,
30:17
Speaker 3: I'm feeling tired, and like I'm you know, maybe I
30:20
Speaker 3: need more electrons moving around Like that sounds fun and
30:23
Speaker 3: maybe it is going to fix my problem because we
30:25
Speaker 3: don't really understand that much about exactly how this is working,
30:30
Speaker 3: so it seems plausible. I mean, I think that's the
30:33
Speaker 3: that's the kind of interesting thing about all these spaces,
30:35
Speaker 3: but this one in particular for me.
30:37
Speaker 1: Yeah, one of the things I liked about this particular
30:41
Speaker 1: topic is because it's not just nonsense. It's not total
30:44
Speaker 1: snake oil. It's not you know, it's something that someone
30:47
Speaker 1: made up or like homeopathic remedies that have nothing actually
30:50
Speaker 1: in them, like it does do things. But let me
30:52
Speaker 1: give you a counterpoint for someone who's worried about their
30:55
Speaker 1: sleepy mitochondria, which is based on what I just told you.
30:59
Speaker 1: Let's say you're mitochondria are working okay, like there isn't
31:01
Speaker 1: a blockage. And by the way, I don't know why
31:03
Speaker 1: they're why people are like, oh, your mitochondria blocked up,
31:06
Speaker 1: Like I don't know why we think that's happening. But
31:09
Speaker 1: let's say you have normally functioning mitochondria. You know, so
31:12
Speaker 1: you take high energy electrons and they goin jin jing
31:14
Speaker 1: down the chain and drive a gradient to make atp
31:19
Speaker 1: if I skip a step in that chain artificially, like
31:22
Speaker 1: that gives me less energy per unit, right, Like like
31:27
Speaker 1: why would if I need to skip a step because
31:30
Speaker 1: something's blocked up, that's one thing, but if not, like,
31:33
Speaker 1: why would you think this is better? This is, you know,
31:35
Speaker 1: short circuiting a system that is supposed to work the
31:39
Speaker 1: way it's supposed to work.
31:40
Speaker 3: Yeah. I was explaining this to my husband the other night,
31:42
Speaker 3: for event, and he was like, you know, I just
31:45
Speaker 3: don't think you should be messing with your mitochondria. I
31:47
Speaker 3: just feel like they're just I feel that they're they
31:50
Speaker 3: should just do their thing. And I was like, I
31:53
Speaker 3: could I can see that perspective.
31:55
Speaker 1: Let the mitochondria be the mitochondria. I'm a big proponent
31:57
Speaker 1: of the mitochondria rights movement.
32:00
Speaker 3: All right, So let's talk about what the data, what
32:03
Speaker 3: some of the data says, because this has this is
32:06
Speaker 3: a place where we've had a little bit of you know,
32:09
Speaker 3: people trying treatment with this for various things and mostly
32:16
Speaker 3: with pretty limited success.
32:18
Speaker 1: I would say, yeah, it's again one of those things
32:21
Speaker 1: where if you do it in a small test tube
32:24
Speaker 1: with like cells and everything's very carefully done, you can
32:26
Speaker 1: generate some interesting results. And then if we scale up
32:29
Speaker 1: to full sized humans or even to mice, even to mice,
32:33
Speaker 1: we can go through the mice. But let me maybe
32:36
Speaker 1: can I I want to touch on one of the
32:39
Speaker 1: studies that really got this going, which was a study
32:45
Speaker 1: of lung fibroblasts among some other types of cells. So
32:48
Speaker 1: these are just these are lung cells in a petri dish,
32:52
Speaker 1: and they were looking at the rate at which the
32:55
Speaker 1: cells would double, which is like a measure of lifespan,
32:58
Speaker 1: like how many times can they before they like give
33:01
Speaker 1: up and die, right, Like how many kids going to
33:02
Speaker 1: have I guess is one way to think about it.
33:04
Speaker 1: And the study shows that cells exposed to methylene blue
33:08
Speaker 1: compared to you know, treated with a vehicle that doesn't
33:11
Speaker 1: contain methylene blue, had a significantly longer lifespan. So okay,
33:15
Speaker 1: long fiberbraasts in a petri dish, Okay, but they live longer.
33:20
Speaker 1: That's cool. But if you read the study and sorry
33:23
Speaker 1: this is in the FACEB Journal, two thousand and eight,
33:26
Speaker 1: if you read the study, the cells were all treated
33:30
Speaker 1: with either hydrogen peroxide or cadmium, so they were given
33:35
Speaker 1: a poison, and particularly poisons that are redox agents, so
33:41
Speaker 1: poisons that like messing with electrons would be the appropriate
33:44
Speaker 1: treatment for And then they showed that, okay, treatment with
33:48
Speaker 1: methylene blue like makes the cells live longer. And I
33:52
Speaker 1: just want to point that out that like the devil's
33:54
Speaker 1: in the details here. It's not like, oh, these were healthy,
33:56
Speaker 1: happy cells that they showed live longer. These were cells
33:58
Speaker 1: that were actively being killed by hydrogen peroxide and then
34:01
Speaker 1: you add some mathlene blue and they don't get killed
34:03
Speaker 1: as much. So I'm level setting again that like there's
34:06
Speaker 1: a difference between you just had cardiac surgery and are
34:09
Speaker 1: in cardiogenic shock versus like you feel well, sleepy.
34:13
Speaker 3: Yeah, And then you know, we when they've sort of
34:17
Speaker 3: moved this into say mice, they've tried to evaluate like
34:25
Speaker 3: lifespan effects in mice, and they do not find life
34:31
Speaker 3: span effects in mice. Maybe, so this is a study
34:35
Speaker 3: in with an incredibly difficult to pronounce title called arkobose
34:41
Speaker 3: seven alpha estradol and nordy hydro guanouretic acid extends lifestan
34:48
Speaker 3: preferentially in males. But what they find here.
34:52
Speaker 1: A classic No, no, no, it's great. I just think
34:55
Speaker 1: it's hilarious, Like this is. I can guarantee this is
34:58
Speaker 1: the only time this study has ever been mentioned by
35:01
Speaker 1: full title anywhere in the universe. I think that's very
35:04
Speaker 1: special for us.
35:05
Speaker 3: Yeah, congratulations to the twenty three authors of this study.
35:09
Speaker 3: I have successfully said the title of your paper. But
35:12
Speaker 3: unfortunately they do not find treatment with methylene blue improved
35:16
Speaker 3: lifespan in even in mice. And this is you know, again,
35:19
Speaker 3: when we think about some of these biological some of
35:22
Speaker 3: these sort of like there's a biologically plausible argument, then
35:26
Speaker 3: maybe you go into cells, maybe you see something then
35:28
Speaker 3: maybe you go into mice. And there's often times even
35:32
Speaker 3: if we see something in mice, then we don't see
35:33
Speaker 3: it in people. And here we kind of couldn't quite
35:36
Speaker 3: get to mice. And again that may be a result
35:39
Speaker 3: of you know, maybe the mice were fine. I don't
35:41
Speaker 3: think these were unhealthy mice. There's like regular mice and
35:44
Speaker 3: the mice maybe it didn't neither electrons to be moved
35:46
Speaker 3: around right quite so much.
35:49
Speaker 1: Yeah, I did Google earlier just to see, like, is
35:53
Speaker 1: Brian Johnson taking methylene lean blue? That is influencer that
35:58
Speaker 1: you know, is like experiment on himself.
36:02
Speaker 3: Yes, of course he takes everything.
36:04
Speaker 1: Of course he is. He has some posts with like
36:06
Speaker 1: you know, the blue tongue. That's the influencers will like
36:09
Speaker 1: post their blue tongue because it, you know, stains, It
36:12
Speaker 1: stains living tissue.
36:13
Speaker 3: And you can also get af from cupcakes. Actually, as
36:16
Speaker 3: most parents will know, you can get a blue tongue
36:18
Speaker 3: from eating too many frosted cup.
36:20
Speaker 1: I mean equally disturbing to me in some sense.
36:22
Speaker 3: Also that also will make your poop blue.
36:24
Speaker 1: By the way, how did the wellness there is something
36:27
Speaker 1: about like okay, wait, we like dies now, like what
36:29
Speaker 1: about like we put don't we hate only some of
36:32
Speaker 1: the like some dies. My friend is yeah anyway, Brian
36:37
Speaker 1: Johnson is yes. And I was reading an article about
36:41
Speaker 1: like some of the changes in biomarkers from before and
36:43
Speaker 1: after he took methleene blue and had the greatest caveat ever,
36:46
Speaker 1: which was that unfortunately, during this period of treatment he
36:51
Speaker 1: was also taking one hundred other vitamins and supplements.
36:55
Speaker 3: So it's like like the worst study design ever. I
36:59
Speaker 3: change literally everything.
37:04
Speaker 1: So great. Anyway, all right, moving on from trying to
37:09
Speaker 1: extend your life, let's I think you know, people do
37:14
Speaker 1: tend to focus a little bit more on like the
37:16
Speaker 1: energy cognition stuff. And I will mention a paper just
37:21
Speaker 1: because it comes out in a lot of influencers suggesting
37:25
Speaker 1: that the use of methylene blue can maybe improve memory
37:28
Speaker 1: a little bit. This is a paper in Radiology twenty sixteen,
37:32
Speaker 1: twenty six healthy adults. This is from ut Health, San Antonio.
37:36
Speaker 1: And they got just a single dose of methylene blue
37:41
Speaker 1: versus placebo, and it was randomized and double blind everything
37:43
Speaker 1: you would want. And then an hour later they got
37:46
Speaker 1: an fMRI and did some like short term memory tasks
37:50
Speaker 1: and after the methylene blue. They had like a seven
37:54
Speaker 1: percent increased correct response on the short term memory tag,
38:00
Speaker 1: and that's what people will lean on when they're like
38:04
Speaker 1: the data that randomized clinical trial data shows that methylene
38:07
Speaker 1: blue improves your memory.
38:09
Speaker 3: What do you think, m what's the placebo?
38:14
Speaker 1: Some pill that did not contain methylene blues?
38:17
Speaker 3: Yeah, so it was I think my first question would
38:20
Speaker 3: be here is like did you know, like, did you
38:23
Speaker 3: know that you were getting the methylene blue? Was the
38:25
Speaker 3: other pill blue?
38:26
Speaker 1: I think the other pill was blue, and I think
38:28
Speaker 1: it was encapsulated so it wouldn't turn your tongue blue. Yeah, okay,
38:31
Speaker 1: so seven percent.
38:33
Speaker 3: An hour later, my read of this is like, first
38:36
Speaker 3: of all, seven percent is a very small effect. The
38:39
Speaker 3: P value on this is not aggressive. It's point oh one,
38:42
Speaker 3: which is a fine P value. But you know, given
38:45
Speaker 3: the number of things that we test and my general
38:49
Speaker 3: feeling about fMRI machines, I'm not wildly impressed. And also,
38:55
Speaker 3: like with many things here, you do a study on
38:58
Speaker 3: twenty six people, you need to do another study, Like
39:03
Speaker 3: maybe there are fifty studies of this and this is
39:05
Speaker 3: the only one that found this, and it's the only
39:07
Speaker 3: one that got published. There's like a publication bias issue.
39:10
Speaker 3: There are just a lot of reasons why pulling out
39:13
Speaker 3: a single study of a small number of people and saying, ah,
39:17
Speaker 3: there's a statistically significant result at a conventional level is
39:20
Speaker 3: actually different than saying, you know, we have hard quality
39:23
Speaker 3: evidence of this being true.
39:25
Speaker 1: And whenever you're talking about wellness stuff and you want
39:28
Speaker 1: to look at studies, you know studies appropriately so are
39:31
Speaker 1: often controlled with placebo. But that's not really the question
39:35
Speaker 1: that you, as like an individual, need to ask. Let's
39:37
Speaker 1: say I want to improve my memory. The question isn't
39:39
Speaker 1: should I take methylene blue or should I take a
39:42
Speaker 1: blue colored sugar pill? That's not what my actual question is,
39:45
Speaker 1: Like should I take methlene blue? Or should I do
39:48
Speaker 1: the New York Times crossword every day? Or should I
39:51
Speaker 1: just like practice memory drills on flash cards?
39:54
Speaker 3: Or or should I sleep more?
39:55
Speaker 1: Or should I sleep more or keep more? Should Yeah?
39:58
Speaker 1: Like so, I think people are so quick to lean
40:03
Speaker 1: on placebo controlled studies that they forget that the problem
40:07
Speaker 1: in this space is that there are almost too many choices.
40:11
Speaker 1: Brian Johnson's hundred supplements is a problem, Like, that's not
40:15
Speaker 1: the right strategy. I'm sure at the very least it's
40:19
Speaker 1: incredibly expensive and none of us can afford it.
40:21
Speaker 3: He's not dead yet. And I think consistent with consistent
40:25
Speaker 3: with this view, there are some follow up papers, or
40:29
Speaker 3: at least later papers that have looked at this question
40:32
Speaker 3: of cerebral blood flow and oxygen consumption other things which
40:36
Speaker 3: could be correlates of this, which haven't found that same
40:39
Speaker 3: kind of impact. So it isn't the case that there's
40:42
Speaker 3: this study and then there's a million follow up studies
40:44
Speaker 3: with the same kind of kind of thing. We see
40:46
Speaker 3: some but I would say mixed evidence on mixed evidence
40:50
Speaker 3: on the brain. Yeah, and none of it is very big.
40:53
Speaker 1: Right, And I mean there's even some evidence to the contrary.
40:58
Speaker 1: Did you see the study that actually maybe look like
41:02
Speaker 1: the use of methylene blue decreases blood flow to the brain.
41:06
Speaker 3: But again it's like, yeah, so there's a study that
41:07
Speaker 3: says it decreases blood flow. Is a study that says
41:09
Speaker 3: it increases blood flow? Again, maybe the studies that say
41:12
Speaker 3: nothing are just sitting in someone's drawer not published because
41:16
Speaker 3: it's not very interesting to publish a paper that says
41:19
Speaker 3: I did this with these people and nothing happened. Fair enough,
41:23
Speaker 3: very hard to publish a null finding. That's something we
41:25
Speaker 3: can talk about.
41:27
Speaker 1: Oh, I've been there.
41:30
Speaker 3: Yeah, let's actually pause on that, because I think this
41:32
Speaker 3: is something we can talk about more in other contexts.
41:35
Speaker 3: But when you are reading papers that are published, you
41:38
Speaker 3: want to remember that there are many studies that happen
41:42
Speaker 3: that do not get published, and we are more likely
41:46
Speaker 3: to see things published if the result is significant in
41:48
Speaker 3: one way or the other. Right, if you think about, like,
41:51
Speaker 3: what is the journal looking for? Usually looking for something
41:53
Speaker 3: that's significant or surprising.
41:54
Speaker 1: Or you know, yeah, impactful.
41:57
Speaker 3: Yeah, and so there is a thing called publication bias,
42:01
Speaker 3: which is why we less frequently see null results, which
42:05
Speaker 3: means results where the effect was zero. Then we might
42:09
Speaker 3: expect to because many of those things get run and
42:11
Speaker 3: then just no one ever reports out on them.
42:14
Speaker 1: Yeah, sadly, there is maybe one area and I'm actually
42:18
Speaker 1: curious if you're going to agree with me on this,
42:20
Speaker 1: but there is one area that I think methylene blue
42:25
Speaker 1: might actually work. And that's for mood. All right, you're
42:32
Speaker 1: making skeptical face.
42:34
Speaker 3: Uh, give a pitch.
42:36
Speaker 1: Let's let's test this out. Okay. One of the things
42:42
Speaker 1: that methylene blue does is inhibits something called monoamine. Oxidase.
42:50
Speaker 1: It is an MAO inhibitor, And does that ring a
42:55
Speaker 1: bell to anyone? Does I ever remember what the MAO
42:57
Speaker 1: inhibitors were. Maybe not, because these are pretty old drugs.
43:02
Speaker 1: MAO inhibitors were the first antidepressants. They were invented, like
43:07
Speaker 1: in the nineteen fifties nineteen sixties. Monomineoxidase in the brain
43:10
Speaker 1: breaks down serotonin, dopamine and stuff like that. So if
43:13
Speaker 1: you inhibit that, the levels of serotonin and dopamine in
43:16
Speaker 1: your brain go up, and it has an antidepressant effect,
43:19
Speaker 1: and they do work. They're actually still used today for
43:23
Speaker 1: refractory depression. But there's a reason that we don't use
43:28
Speaker 1: MAO inhibitors anymore, and that's because the side effects are
43:31
Speaker 1: quite brutal. It has this effect where if you're on
43:35
Speaker 1: MAO inhibitors, you can't eat like certain aged cheeses or
43:39
Speaker 1: other things that contain tyramine because you can get dramatic
43:44
Speaker 1: spikes in blood pressure due to a difficulty to metabolize
43:47
Speaker 1: tyramine that can be life threatening. And so MAO inhibitors.
43:53
Speaker 1: Once SSRIs came out and tricyclic antidepressants came out, MAO
43:56
Speaker 1: inhibitors just kind of like because of that side effect,
43:59
Speaker 1: profile went to the wayside. But methylene blue is an
44:03
Speaker 1: MAO inhibitor. We have good in vitro documentation that it
44:07
Speaker 1: is an MAO inhibitor at doses that people take, and
44:10
Speaker 1: with a potency that is similar to some of the
44:12
Speaker 1: pharmacologic MAO inhibitors. I've got a human study from nineteen
44:17
Speaker 1: eighty seven.
44:18
Speaker 3: Yeah, I do, Okay, okay, fifteen people, what how many people?
44:23
Speaker 3: There is number of.
44:24
Speaker 1: People thirty patients with severe depression who got daily methylene
44:30
Speaker 1: blue for three weeks in addition to their existing treatment
44:32
Speaker 1: versus match placebo, and they had a significant reduction in
44:37
Speaker 1: depression scores. That's back in nineteen eighty seven, before the SSRIs.
44:41
Speaker 1: We're really up and going. But there's even a study
44:44
Speaker 1: in twenty seventeen which took thirty seven patients with bipolar
44:49
Speaker 1: disorder and randomized them to methylene blue for three months
44:54
Speaker 1: and then cross them over in a random order to
44:58
Speaker 1: a placebo for three months, and they had significant improvement
45:01
Speaker 1: in depression scores. And so I'm going to argue Emily
45:05
Speaker 1: that it's an MAO inhibitor. It's not a regulated MAO inhibitor.
45:10
Speaker 1: You're not getting it prescribed by a doctor. We have
45:12
Speaker 1: some randomized trial data that suggests it improves depression scores.
45:16
Speaker 1: People say it gives them some energy. Maybe they're just
45:20
Speaker 1: taking an MAO inhibitor.
45:23
Speaker 3: Okay, I will say I I'm going to say a
45:28
Speaker 3: few things. So First, I am generally skeptical of a
45:32
Speaker 3: literature that has thirty years between papers studies, and each
45:38
Speaker 3: of which have like thirty people in them. You know,
45:41
Speaker 3: it's just like if this were a very effective version
45:45
Speaker 3: of this, I think we would have seen more of it.
45:49
Speaker 3: The second thing I will say is, even if this
45:53
Speaker 3: is true, I don't think it's very important because if
45:57
Speaker 3: someone is struggling with depression, we have much better treatments
46:01
Speaker 3: than this. Now.
46:02
Speaker 1: We have treatments that are stigmatized.
46:04
Speaker 3: We have treatments that are are are the I mean,
46:07
Speaker 3: I feel like we've made progress on that. I think.
46:09
Speaker 1: I think in particular, there's like in the wellness space,
46:13
Speaker 1: there's this like very there's this undercurrent that's highly skeptical
46:16
Speaker 1: of things like SSRIs, I mean, even skeptical of psychiatry.
46:21
Speaker 3: I guess. But I think to say like we should
46:23
Speaker 3: have it people, like we should encourage people to take
46:25
Speaker 3: this because their skepticis there no, no, no, And obviously
46:28
Speaker 3: you're not saying, but I think what I would say
46:30
Speaker 3: is like if you just sort of look at from
46:32
Speaker 3: a science if somebody came to me and they said,
46:34
Speaker 3: I'm struggling with depression, should I take methylene blue, my
46:37
Speaker 3: answer would be no, you should go talk to a
46:40
Speaker 3: doctor and see if you can get on one of
46:41
Speaker 3: the many effective treatments for depression, or think about non
46:45
Speaker 3: pharmacological remedies like exercise, and so, depending on kind of
46:48
Speaker 3: where you are in this in this space, I think
46:51
Speaker 3: the other the third thing I will say is that
46:55
Speaker 3: one of the risks associated with methylene blue is it
46:58
Speaker 3: interacts in a dangerous way with serotonin inhibitors. So the
47:02
Speaker 3: thing I would really worry about is people who are
47:04
Speaker 3: on an SSRI who decide to take this as like
47:07
Speaker 3: a like a boost up in their antidipression. That is
47:10
Speaker 3: actually incredibly risky.
47:12
Speaker 1: Super risky black box warning on the FDA label for
47:15
Speaker 1: methylene blue because of this. Because you can't mix MAO
47:18
Speaker 1: inhibitors and selective serotonin reuptake inhibitors together, you get something
47:23
Speaker 1: called serotonin syndrome, which is terrible super high blood pressures,
47:27
Speaker 1: fevers out of control, like muscle problems can be life
47:31
Speaker 1: threatening and fatal, so you definitely can't mix those two things.
47:35
Speaker 1: I think I'm more sort of bringing this issue up
47:37
Speaker 1: as like maybe people aren't like I'm clinically depressed, but
47:43
Speaker 1: I have a feeling that there are more people walking
47:45
Speaker 1: around with some depression than are diagnosed with depression, and
47:51
Speaker 1: maybe they don't recognize it themselves, and maybe it's not pure.
47:55
Speaker 1: Maybe it's not full blown like major depressive disorder. Maybe
47:58
Speaker 1: it's dysthymia, which is kind of it's like the medical
48:00
Speaker 1: term for like you're just not great. And if a
48:03
Speaker 1: person who's in that state decides to take some methylene blue,
48:07
Speaker 1: maybe just for energy, and it kind of bumps their
48:10
Speaker 1: moon up a little bit, does that like reinforce the
48:13
Speaker 1: idea like, Wow, this thing works. I feel different because
48:17
Speaker 1: I think I think it can make you feel different.
48:19
Speaker 1: I'm not saying you should take it, but it has
48:22
Speaker 1: potential neurologic effects.
48:24
Speaker 3: I feel like you're just making an argument for the
48:26
Speaker 3: placebo effect. I feel like you're just saying, like, if
48:28
Speaker 3: you you know there's a lot of people walk around
48:30
Speaker 3: with able depressions, benefit from thinking that you're taking something
48:33
Speaker 3: that helps them, and like, yeah, sure, the placebo effect is,
48:36
Speaker 3: as I've said many times, it's one of our best effects. Yeah,
48:39
Speaker 3: and so I can see it working for that reason.
48:41
Speaker 3: But at the same time, it seems like there are
48:45
Speaker 3: many other things without any risks that don't turn your
48:48
Speaker 3: pee blue that also work as a placebo. And then
48:51
Speaker 3: some things like exercise which aren't even like have treatment
48:54
Speaker 3: effects on this, that aren't a placebo.
48:57
Speaker 1: Yeah, couldn't agree more. Let's mention risks, because now I
49:01
Speaker 1: feel bad that I've been like, hey, everybody, it's a free,
49:03
Speaker 1: cheap antidepressant.
49:05
Speaker 3: It's like and later we'll be get we'll be put it.
49:09
Speaker 3: See the link in the show notes for Perry.
49:12
Speaker 1: It's actually rand doctor Wilson's special methylene blue preparation turns
49:17
Speaker 1: your pee glow in the dark. You know what there
49:22
Speaker 1: is glowing the dark?
49:22
Speaker 2: Pea.
49:23
Speaker 3: Oh, why does that happen?
49:25
Speaker 1: Okay, it's it's it's it's actually a little sad. But
49:29
Speaker 1: people who drink ethylene gly call, which is anti freeze.
49:33
Speaker 1: Uh it, I don't even know if I should say this.
49:36
Speaker 1: It's sweet tasting and it does make you feel drunk.
49:39
Speaker 1: It's also highly highly toxic. Some people drink it as
49:42
Speaker 1: a suicide attempt. Some people drink it because it makes
49:44
Speaker 1: you feel drunk. But anti freeze has a chemical in
49:48
Speaker 1: it that glows in the dark, so you can see
49:50
Speaker 1: spills with a UV light. So when we are suspicious
49:55
Speaker 1: that someone has consumed ethylene GLYCLL, we can go to
49:58
Speaker 1: the ED and we can put a little YOU light
50:00
Speaker 1: on their urine and if it glows, that is a
50:02
Speaker 1: quick way to make the diagnosis.
50:05
Speaker 3: Wow. Cool, right, your job is unusual. Okay, let's talk
50:12
Speaker 3: about the risks. So we talked about the serotonin risks.
50:15
Speaker 3: So if you're on an SSRI absolutely counter indicated, do
50:19
Speaker 3: not take this. It is very dangerous.
50:21
Speaker 1: You could die good. Another big risk is that it's
50:27
Speaker 1: un like so many things, unregulated, not tested by the FDA.
50:32
Speaker 1: If you google methylene blue, you'll find that methylene blue
50:35
Speaker 1: is in aquarium tank treatments. It can, you know, help
50:41
Speaker 1: some parasites on your fish or something like that. Don't
50:44
Speaker 1: take that kind of methylene blue. Like that's even less
50:46
Speaker 1: tested than the stuff that you can buy that are
50:49
Speaker 1: actually marketed to humans. But just to say it out
50:52
Speaker 1: loud and then the other thing is if you have
50:55
Speaker 1: G six pd deficiency, methylene blue can cause homolysis and
50:59
Speaker 1: you don't know if you have G six pd deficiency.
51:02
Speaker 1: About two percent of the population does, and there's no
51:06
Speaker 1: reason you would particularly be aware of it unless you
51:08
Speaker 1: are about to be treated with a medication that interacts
51:11
Speaker 1: with G sixpd, in which case we test you first
51:14
Speaker 1: before we give you that medication. Methylene blue is one
51:16
Speaker 1: of those medications. So yeah, unless you've already been ruled
51:21
Speaker 1: out for G six pd deficiency, something to think about.
51:24
Speaker 3: All right, Perry, are you a smash or pass? I'm
51:28
Speaker 3: methylene I'm a pass on. Methylene blue is not going
51:31
Speaker 3: to shock polymarket. Sorry everyone, I'm a pass.
51:35
Speaker 1: This at best is an MAO inhibitor, which is a
51:39
Speaker 1: pretty bad anti depressant that we gave up on long ago.
51:44
Speaker 1: And at worst, it's something that you're going to waste
51:47
Speaker 1: your money on and it's going to turn your p
51:50
Speaker 1: fun colors. I mean, reasonable party trick, but not worth
51:54
Speaker 1: your wellness dollar. Emily smash pass.
51:58
Speaker 3: I'm a pass. I think to say that this is
52:01
Speaker 3: something that is dangerous for two percent of the population
52:04
Speaker 3: plus anyone on an SSRI feels like already significant downsides
52:09
Speaker 3: on top of there being no real upsides so that
52:13
Speaker 3: we are aware of for healthy people. So I'm I'm
52:16
Speaker 3: a past but I did enjoy learning more about the
52:18
Speaker 3: electron transport chain.
52:19
Speaker 1: So yeah, this's a good biology episode.
52:21
Speaker 3: Good biology episode, good bio. I'm gonna have my kids
52:23
Speaker 3: listen to it, you know.
52:25
Speaker 1: Perfect. That's it for Bethlene Blue your male back question
52:28
Speaker 1: the week after the break. Hey, emilyam Perry, here's one
52:38
Speaker 1: for you. I am a knuckle cracker. Am I going
52:42
Speaker 1: to give myself athritis? Do you crack your knuckles?
52:46
Speaker 3: No? I don't. I think I used to, but I don't,
52:50
Speaker 3: and I don't think I could do it anymore. Maybe
52:53
Speaker 3: I'm just old.
52:55
Speaker 1: Do you try? I don't, but I think I could.
52:58
Speaker 1: Should We let's see if you can. Oh, our producer
53:00
Speaker 1: is like freaking out right now.
53:02
Speaker 3: Oh yeah, my thumb. I can crack one of them, one.
53:05
Speaker 1: Of my hands. That's good audio. Emily's cracking knuckles bad
53:09
Speaker 1: for you?
53:10
Speaker 3: Get Cracking knuckles is not bad. It doesn't give you arthritis.
53:13
Speaker 3: And I want to read you. This is a great
53:16
Speaker 3: opportunity for me because my favorite paper in the whole
53:21
Speaker 3: wide world of academic papers is about this topic, okay.
53:26
Speaker 3: It is a nineteen ninety eight letter to the editor
53:28
Speaker 3: in a journal called Arthritis and Rheumatism. Here's how it starts.
53:32
Speaker 3: During the author's childhood, various renowned authorities, his mother, several aunts,
53:37
Speaker 3: and later his mother in law informed him that cracking
53:40
Speaker 3: his knuckles would lead to arthritis of the fingers. And
53:43
Speaker 3: then the author explains the study he performed. For fifty years,
53:46
Speaker 3: the author cracked the knuckles of his left hand at
53:48
Speaker 3: least twice a day, leaving those of the on the
53:51
Speaker 3: right as a control. Thus, the knuckles on the left
53:53
Speaker 3: were cracked at least thirty six five hundred times, while
53:56
Speaker 3: those on the right were cracked barely. At the end
53:58
Speaker 3: of the fifty years, the hands were compared for the
53:59
Speaker 3: present barthritis, and he concludes he has no northritis in
54:02
Speaker 3: either hand and as a result, knuckle cracking doesn't matter.
54:05
Speaker 3: And I just love so very much this paper by
54:10
Speaker 3: Donald Hunger m d Oh.
54:12
Speaker 1: My gosh, doctor, I salute you.
54:14
Speaker 3: That is yes, but we actually have some larger scale evidence.
54:19
Speaker 3: It also shows that there's there's no data we do.
54:23
Speaker 1: Do you know what the sound comes from?
54:24
Speaker 5: You?
54:25
Speaker 3: I don't.
54:26
Speaker 1: So it was always like people were like, oh, is
54:28
Speaker 1: that the bones kind of moving against each other. It's not.
54:32
Speaker 1: There was an MRI study that actually like captured what
54:35
Speaker 1: was happening in the joint at the time the knuckles
54:38
Speaker 1: were cracked, and apparently it's what's called cavity formation, which
54:46
Speaker 1: happens when I guess, when certain fluids are moved very rapidly,
54:50
Speaker 1: so like if you've seen a propeller underwater of a boat,
54:55
Speaker 1: like how bubbles will form behind it, even though like
54:58
Speaker 1: it's not like sucking bubbles. I'm from the surface right
55:01
Speaker 1: like like a submarine. You know, it's like that. That's
55:03
Speaker 1: cavitary bubble formation, and a tiny little version of that
55:06
Speaker 1: happens in your joint when you crack your knuckles, and
55:10
Speaker 1: that makes the sound that.
55:11
Speaker 3: Is very interesting. People will sometimes also ask like, once
55:15
Speaker 3: you do it, you have to keep doing it, because
55:17
Speaker 3: one people do it, then they keep then they do
55:18
Speaker 3: keep doing it. But that's called habit formation. That's not
55:21
Speaker 3: a medical thing. So anyway, if you want to crack
55:24
Speaker 3: your knuckles, it's fine.
55:25
Speaker 1: But uh, from tomorrow, our producer.
55:28
Speaker 3: People, our producer doesn't like it. So if you're spending
55:30
Speaker 3: time with our producer tomorrow Please do not crack.
55:32
Speaker 1: Your knuckles about to crawl under the table.
55:39
Speaker 3: All right, that's it for us today. Stick with us
55:42
Speaker 3: next week when we'll ask what's the deal with red
55:45
Speaker 3: meat and the carnivore diet. Wellness Actually is produced in
55:50
Speaker 3: association with iHeartMedia. Our senior producer is Tamar Avishaik. Our
55:55
Speaker 3: executive producer at iHeart is Jennifer Bassett. Our theme music
55:59
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56:02
Speaker 3: purposes only.
56:03
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56:06
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56:09
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56:12
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56:18
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56:21
Speaker 1: a question for our mailbag or suggest a topic for
56:23
Speaker 1: a future show.
56:25
Speaker 3: We'll let the influencers have the last word. The reason
56:27
Speaker 3: I argue so effectively so I'm absolutely out of my mind.
56:31
Speaker 3: On Methyline Blue, you can get it.
56:33
Speaker 1: Go try reborn dot com and get it in pill
56:34
Speaker 1: form if you don't like the avatar tongue, or you
56:38
Speaker 1: can get it this one. Do it properly if you're
56:40
Speaker 1: gonna do it dear right.
56:40
Speaker 3: And I still regret to this day not being an
56:43
Speaker 3: intravenious heroin addict.
56:44
Speaker 1: So there's no way I'm going to get by with
56:46
Speaker 1: just shoving Methlin Blue peels up my ass when I
56:49
Speaker 1: could be taking it straight down the garland like a man.
57:00
Speaker 1: That's