Explore the Mediterranean Diet benefits that support heart health and long-term wellness. The Mediterranean diet is one of the most researched eating patterns in the world, with evidence showing benefits for heart health, diabetes prevention, chronic disease management, and healthy aging. Culinary Medicine Nutrition / Bariatric Medicine by Anu Saraf, MD, and Jay Zaslow, MD What Is the Mediterranean Diet? The Mediterranean diet involves eating patterns typical of countries bordering the Mediterranean Sea. It emphasizes a mostly plant-based diet that includes fruits, vegetables, legumes, whole grains, nuts, seeds, and monounsaturated fats (eg, olive oil). The diet generally allows the consumption of small amounts of meat and dairy products. In addition, added salt may be replaced with herbs and spices, and a limited amounts of sweets are allowed. Key Foods and Lifestyle Principles of the Mediterranean Diet The Mediterranean diet lifestyle also recommends that people eat slowly, enjoy their food, and eat in the company of friends and family. Further, they should drink lots of water, exercise, try to eat seasonal plant-based foods, and consume fish and seafood at least twice weekly. Health outcomes related to the Mediterranean diet has been widely studied. This lifestyle has been compared with other popular dietary modification techniques, including the low-carbohydrate diet, the low-dietary fat diet, the Dietary Approaches to Stop Hypertension (DASH) diet, the vegetarian/vegan diets, and the ketogenic diet. Generally, experts recommend that the best diet is one that can be followed consistently. Possible Benefits Multiple studies (including large, prospective cohort trials) have shown people with chronic diseases to benefit from following the Mediterranean diet. However, results have been mixed, depending on whether or not the study was conducted in a Mediterranean country. The diet has been associated with reductions in overall mortality (10%), cardiovascular events and mortality (9%), reduction in overall cancer incidence and mortality (6%), reduction in colorectal, prostate, and breast cancer (14%), Alzheimer’s and Parkinson’s diseases (13%), and diabetes (52%). Mediterranean Diet Benefits for Heart Health Lower Risk of Cardiovascular Disease The Prevención con Dieta Mediterránea, or Primary Prevention of Cardiovascular Disease with a Mediterranean Diet (PREDIMED), trial was a randomized, controlled study published in the New England Journal of Medicine in 2013. Estruch et al studied 7,887 persons (age: 55-80 years old; gender: 57% female) at high cardiovascular risk but who did not have cardiovascular disease to find out how diet affected the primary outcome of major cardiovascular events (MCE). These individuals randomly were assigned to one group that consumed a Mediterranean diet supplemented with extra-virgin olive oil, another group that followed a Mediterranean diet supplemented with nuts, or a control group advised to reduce dietary fat. Over a median follow-up of 4.8 years, those who consumed the Mediterranean diet supplemented with olive oil had fewer MCEs than did the control group (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.54- 0.92), and those who followed the Mediterranean diet with nuts also had fewer MCEs than did the control group (HR 0.72, 95% CI 0.55-0.96). This corresponded to an absolute reduction in three cardiovascular events per 1,000 patient-years, or a 30% relative risk reduction. However, in the subgroup analysis, only death resulting from cardiovascular accident was significantly lowered; reductions in myocardial infarction and cardiovascular death were not statistically significant between groups. A later publication found that the study had inconsistent randomization and inadequate concealment; secondary analyses have found that the primary result holds the same, but the initial findings still are being examined. Mediterranean Diet Benefits for Diabetes and Metabolic Health Favorable results have been reported in studies of the Mediterranean diet and associated risk reduction of type-2 diabetes mellitus. When compared with a low-fat diet, the low-carbohydrate, high-protein Mediterranean diet was associated with less need for, and a delayed time to, antihyperglycemic medication. Does the Mediterranean Diet Support Weight Loss? The Mediterranean diet has been associated with weight loss. Most studies having a follow-up of 5 years have shown a 2- to 3-kg (5- to 7-lb) weight decrease during the first 2 years that did not persist to the fourth year. Persistence of weight loss has not been consistent; the few large, prospective, randomized controlled trials with intention-to-treat analyses (including participants who did not report consistent use of diet) have reported a return to regular weight by the end of follow-up, whereas several large observational studies have reported persistent weight loss. The Mediterranean diet is not associated with greater weight loss than seen with other diets in head-to-head comparison trials. Other Health Benefits of the Mediterranean Diet Use of the Mediterranean diet has reduced the risk of stroke but not the incidence of cardiovascular disease or overall mortality in a meta-analysis. Smaller observational studies showed that following the Mediterranean diet was associated with a decreased incidence in neurologic disease (including Alzheimer’s disease) and cancer (eg, of the prostate, breast, gastrointestinal system, and oropharynx). Sources Barak Y, Fridman D. Impact of Mediterranean diet on cancer: focused literature review. Cancer Genom Proteom. 2017;14:403-408. Dinu M, Pagliai G, Sofi F. A heart-healthy diet: recent insights and practical recommendations. Curr Cardiol Rep. 2017;19:95. Donovan MG, Selmin OI, Doetschman TC, Romagnolo DF. Mediterranean diet: prevention of colorectal cancer. Front Nutr. 2017;4:59. Esposito K, Maiorino MI, Ciotola M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med. 2009; 151:306-314. Esposito K, Maiorino MI, Petrizzo M, Bellastella G, Giugliano D. The effects of a Mediterranean diet on the need for diabetes drugs and remission of newly diagnosed type 2 diabetes: follow-up of a randomized trial. Diabetes Care. 2014;37:1824-1830. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013; 368:1279-1290. Estruch R, Ros E, Salas-Salvadó J, et al. Retraction and republication: primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2018;378:2441-2442. Lourida I, Soni M, Thompson-Coon J, et al. Mediterranean diet, cognitive function, and dementia: a systematic review of the evidence. Adv Nutr. 2016;7:889-904. Sofi F, Dinu M, Pagliai G, et al. Low-calorie vegetarian versus Mediterranean diets for reducing body weight and improving cardiovascular risk profile: CARDIVEG study (Cardiovascular Prevention With Vegetarian Diet). Circulation. 2018;137:1103-1113.

Learn the differences between omega-3 vs. omega-6 fatty acids, their health benefits, food sources, fish oil supplements, and the ideal dietary balance. Omega: Too Much or Not Enough? by Madeleine Beckman The 2012 National Health Interview Survey, to date, provides the most comprehensive information on complementary health approaches in the U.S. According to the survey, fish oil is one of the most commonly used nonvitamin/nonmineral dietary supplements among adults and children in the U.S. Reasons for fish oil supplementation range from improved heart health to reduced symptoms of ulcerative colitis. However, definitive evidence is lacking to support its use, and the words “may” and “promising” frequently appear in journal articles when discussing omega-3 and -6 supplementation. Omega-3 fatty acids (generally considered the healthier fatty acids) are essential polyunsaturated fats usually obtained from the human diet. There are three types of omega-3 fatty acids (also called n-3 fatty acids): eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and a-linolenic acid (ALA). EPA and DHA are found in fatty fish such as wild salmon, lake trout, sardines, anchovies, striped bass, and Arctic char. ALA is the plant form of omega-3 fatty acids found in flax meal, chia seeds, walnuts, and flax seed oil. The conversion of ALA to EPA/DHA is limited. A multitude of presumed health benefits of omega-3 fatty acids have been shown in research studies. Particularly impressive have been the findings for preventing heart disease. Many studies report some effectiveness of n-3 fatty acids (especially from diet) for reducing triglycerides and metabolic syndrome; decreasing risk of stroke and heart disease; and reducing plaque and arteriosclerosis. Other benefits, according to previous studies, include reducing inflammation, reducing symptoms in rheumatoid arthritis, improving blood vessel elasticity, decreasing clotting, improving cognitive decline and depression, and reducing the risk of macular degeneration. It’s been reported that omega-3 fatty acids might even help regulate heart rhythm and decrease heart rate and blood pressure. However, in a recent meta-analysis of omega-3 studies (Cochran Database, April 2017, a review of 79 trials involving 112,000 participants and mostly involving supplementation with fish oil capsules), the authors found no “high quality evidence that omega-3 fatty acids supplementation is effective for improving core and associated symptoms of arteriosclerotic heart disease (ASHD).” Furthermore, “given the paucity of rigorous studies in this area, there isa need for large well-conducted randomized controlled trials...” Although EPA and DHA (the omega-3 fatty acids), especially in the diet reduces serum triglycerides and slightly raises HDL(high-quality evidence), only increasing plant-based ALA may be slightly protective for someheart and circulatory diseases especially anti-arrhythmic effects. Significant research has also been conducted with omega-3 fatty acids and childhood-associated diseases such as asthma, cognitive learning disabilities, and autism. In an article in the European Journal of Clinical Nutrition, the authors report on a study amongst children with a history of asthma. In the study, 239 children were randomized to receive tuna fish oil (high in omega-3s with 135 mg DHA, 32 mg EPA, and low in omega-6 fatty acids) or Sunola oil (low in omega-3s, but contains omega-6s) daily from age 6 months to 5 years. The National Assessment Program Literacy and Numeracy (NAPLAN) test was administered in school every 2 years. The authors concluded that their findings didn't support administering fatty acids to children in infancy and childhood to improve academic performance. Despite experts advocating for large-scale studies to gain “evidence”, omega-3 and omega-6 supplementation remains widely seen as beneficial for a panacea of diseases and diagnoses including: ADD, psychiatric disorders, cystic fibrosis, macular degeneration, and cancer. On the other hand, quoting an academic- “I don’t recommend supplementation to my patients,” says Van-Hong Nguyen, MD, FACC, a cardiologist and Assistant Professor, Mt. Sinai Medical Center, in New York. Nguyen is skeptical of anything that’s a “panacea”. “I recommend that my patients get their omegas through diet.” So, until further research is conducted and more definitive evidence is in, it’s best to get omega-3 and omega-6 through food. Additionally, there’s also research that supports the dangers of too much of these essential fatty acids: “...There is also evidence that a high omega-6 fatty acid diet inhibits the anti-inflammatory and inflammation-resolving effect of the omega-3 fatty acids. The interaction of omega-3 and omega-6 fatty acids and their lipid mediators in the context of inflammation is complex and still not properly understood. (Prostaglandins Leukot Essential Fatty Acids, 2018 May) The FDA currently recommends that adults get 250-500 mg combined EPA and DHA daily. For children, the Institute of Medicine recommends a daily intake of between 700 mg to 1200 mg, dependent on age. Best Food Sources of Omega-3 and Omega-6. Good sources of omega-3 include: Fish and other seafood (ie, salmon, mackerel, tuna, herring, sardines) Soybeans and edamame Kidney beans Nuts and seeds (ie, flaxseed, chia seeds, walnuts) Seaweed and algae Fortified foods (ie, eggs, yogurt, juices, milk, soy beverages) Good sources of omega-6 include: eggs whole grain breads cereals Oils, such as flaxseed, hempseed, grapeseed Seeds, such as: pumpkin, sunflower, flaxseed, hempseed Nuts, including pignolia (pine) and pistachios Key Takeaways In conclusion, the omega-3 and omega-6 (essential polyunsaturated) fatty acids both show health benefits. However, when intake of omega-6’s far outweigh the omega-3’s, this may reverse some of the benefits of the omega-3’s, especially their anti-inflammatory effects. Until we have better studies, this author recommends: Obtaining your fish oil from whole foods rather than from supplementation, as much as possible Replacing your saturated fats with omega-3 and omega-6 fatty oils Trying to maintain a more favorable ratio of omega-3 to omega-6 (1: 4 or better) Expanded article now available on "The Omega-3, Omega-6 Fatty Acid Controversy: Do They Work" References Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007; 369:1090-98. Leitzmann MF, Stampfer MJ, Michaud DS, et al. Dietary intake of n-3 and n-6 fatty acids and the risk of prostate cancer. Am J Clin Nutr. 2004; 80:204-16. Koralek DO, Peters U, Andriole G, et al. A prospective study of dietary alpha-linolenic acid and the risk of prostate cancer (United States). Cancer Causes Control. 2006; 17:783-91. Willett WC. The role of dietary n-6 fatty acids in the prevention of cardiovascular disease. J Cardiovasc Med. (Hagerstown). 2007; 8 Suppl 1:S42-5. Mozaffarian D, Ascherio A, Hu FB, et al. Interplay between different polyunsaturated fatty acids and risk of coronary heart disease in men. Circulation. 2005; 111:157-64. https://www.ncbi.nlm.nih.gov/pubmed/29610056 https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/ https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007992.pub2/full?highlightAbstract=acid%7C3%7Cacids%7Comeg%7Cfatty%7Cfatti%7Cwithdrawn%7Comega https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002201.pub5/information https://www.nature.com/articles/ejcn2014155 https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/ AHRQ, Agency for Healthcare Research and Quality www.ahrq.gov https://www.ahrq.gov/research/findings/evidence-based-reports/er223-abstract.html https://www.cochrane.org/CD003177/VASC_omega-3-intake-cardiovascular-disease Brew BK, Toelle BG, Webb KL, et al. Omega-3 supplementation during the first 5 years of life and later academic performance: a randomised controlled trial. European Journal of Clinical Nutrition. 2015; 69: 419–424.

Anthocyanins, Antioxidants and Heart Healthy Phytonutrients Anthocyanins are naturally occurring antioxidant phytonutrients found in colorful fruits and vegetables. These flavonoid compounds create the vibrant red, purple, and blue pigments in many foods and continue to be studied in Culinary Medicine and nutrition research. Culinary Medicine by Stefanie Schwartz, MS, RD, CDN and Rich Strongwater, MD Anthocyanins comprise a group of compounds in the flavonoid class. Flavinoids are low-molecular-weight phenolic compounds that are found widely throughout the plant kingdom. Anthocyanins are water-soluble, pigments found in plant vacuoles that give fruits and vegetables their red, purple, and blue colors. Vacuoles are water-filled cytoplasmic plant organelles that help maintain water balance. Anthocyanidins are the sugar free form of anthocyanins. Foods High in Anthocyanins Some foods high in anthocyanin content are black currants, acai, black raspberries, blueberries, purple corn, Concord grapes, red apples, eggplant, cranberries, cherries, black plums and red cabbage. Cyanidin-3-glucoside is the main anthocyanin found in many of these foods. Commercially, anthocyanin pigments are used as “natural food” additives to give food products more attractive color. Commercial food products that may use these natural colorants include yogurt drinks, desserts and mixed fruit juices. Potential Health Benefits of Anthocyanins Anthocyanin intake may reduce blood pressure and arterial stiffness, enhance memory, and slow age-related cognitive decline. Laboratory studies have shown anticarcinogenic activity. Anthocyanins have many potential benefits including: antioxidant properties, activating detoxifying enzymes, decreasing cancer cell proliferation, and inducing apoptosis (the orderly death of cells as a normal part of an organism’s repair processes, growth or embryonic development). They also have anti-inflammatory and anti-angiogenic effects. Health experts recommend at least three servings of anthocyanin-rich fruits and vegetables per week. An excellent review article published in the 2017 issue of Food and Nutrition Research stated the following: “Scientific studies, such as cell culture studies, animal models, and human clinical trials, show that anthocyanidins and anthocyanins possess antioxidative and antimicrobial activities, improve visual and neurological health, and protect against various non-communicable diseases.” The authors felt these studies indicated that the health effects of anthocyanidins and anthocyanins, are due to their potent antioxidant properties and cytoprotective effects. Pearl to Know There seems to be an association between anthocyanin-rich foods and prevention of cardiovascular disease. The Iowa Women's Health Study of postmenopausal women without cardiovascular disease (CVD) followed participants for 16 years and those who ate more anthocyanidin containing food showed a significant reduction in death from coronary heart disease. Conclusion To date, there have only been a few human clinical trials that validate the health benefits of anthocyanins or their ability to reduce disease. Their bioactivity, uptake, absorption, bioavailability, and tissue distribution are not well understood and require further study. However, based on some animal and human studies, it seems that consumption of anthocyanin-rich foods may reduce the risk of cardiovascular disease, cancer (via antiangiogenesis effect as well as other mechanisms), diabetes and cognitive decline. More research is needed to conclusively prove these benefits and investigate further if there are any adverse effects of high dose consumption of anthocyanins. Key Takeaway: Anthocyanins are antioxidant phytonutrients found in many colorful fruits and vegetables. While additional clinical research is needed, current evidence suggests that regularly eating anthocyanin-rich foods as part of a balanced diet may support cardiovascular, cognitive, and overall health. Continue Exploring Culinary Medicine Food plays an important role in preventing disease and supporting long-term health. Browse our growing collection of Culinary Medicine articles for physician- and dietitian-reviewed insights, nutrition science, and practical strategies to help you make informed food choices every day. Browse more Culinary Medicine articles and recipes → More topics and recipes on food with high Anthocyanins Blueberries: Colorful and Mighty Our Cabbage Soup Recipe can be made with red cabbage Integrative medicine information about Cherry Juice in the Compendium section of our APP. Our FibonacciRECIPES section for Blueberry French Toast recipe Sources Mink PJ, Scafford CG, Barrag LM, et al. Flavonoid intake and cardiovascular disease mortality: a prospective study in post menopausal women. Am J Clin Nutr, 2007;85:895-909. Cassidy A, Mukamal KJ, Liu L, Franz M, Eliassen AH, Rimm EB. High anthocyanin intake is associated with a reduced risk of myocardial infarction in young middle age women. Circulation. 2013;127:188-196. Wang LS, Stoner GD. Anthocyanins and their role in cancer prevention. Cancer Lett. 2008;269:281-290. Khoo HE, Azlan A, Tang ST, Lim SM. Anthocyanidins and anthocyanins: colored pigments as food, pharmaceutical ingredients, and the potential health benefits. Food Nutr Res. 2017; 61(1): 1361779. Published online 2017 Aug 13. doi: 10.1080/16546628.2017.1361779

Latent Tuberculosis Risk Stratification, Diagnostic Testing Pearls, and Evidence-Based Treatment Regimens Fibonacci Infectious Disease by Richard Strongwater, MD and Jay A. Zazlow, MD MPH Reviewed by Harish Moorjani, MD Latent tuberculosis is an asymptomatic, nontransmissable infection with Mycobacterium tuberculosis, carrying a 5 to 10% lifetime risk of progressing to active disease. One half of this risk of progression to active disease occurs within the first two years after infection. Risk factors for progression to active disease- immunodeficiency, recent exposure to tuberculosis, and chronic kidney disease requiring dialysis, children younger than five years. High-risk groups in the United States for contracting latent TB- recent immigrants from high-incidence countries (Africa, Asia, eastern Europe, Central America, and South America), health care professionals, persons living or working in institutional settings, and homeless persons. Also extended travel in high-incidence countries and illicit drug use. Additional risk factors for progression to active disease- patients with silicosis or cancer of head, neck, or lung, and presence of abnormalities on CXR consistent with healed fibrotic changes from past M. tuberculosis infection. Asians and Native Hawaiians and other Pacific Islanders living in U.S. have highest rates of active disease. Symptoms of Active infection- 3 weeks or more cough, hemoptysis, weight loss, fever, night sweats Diagnostic Evaluation Blood test vs skin test Interferon-gamma release blood assays (IGRAs) and tuberculin skin tests (TSTs) can identify M. tuberculosis infection but cannot differentiate between active and latent forms. Active TB should be diagnosed by the presence of symptoms or signs on radiography, AFB smears or by culture. IGRA versus TST: IGRA is recommended over a TST in individuals who are at least five years of age and in patients who are likely to have M. tuberculosis infection. If active pulmonary TB infection is suspected: AFB smear can be performed. Typically, three specimens are tested. Note that a negative result does not exclude active pulmonary TB. If extrapulmonary TB is suspected: Collect specimens from those sites for mycobacterial culture. The QuantiFERON-TB gold assay is a blood test used to detect latent tuberculosis (TB) infection (LTBI). It is the most commonly used interferon-gamma release assay (IGRA) used to diagnose infection with Mycobacterium tuberculosis. In patients infected with M tuberculosis, white blood cells release interferon-gamma when exposed to M tuberculosis antigens. The QuantiFERON-TB gold blood test has a sensitivity of 70%-90% and a specificity of 95% for LTBI. It is not designed to diagnose active tuberculosis, which requires microbiologic testing (i.e., sputum acid-fast bacilli and culture). One practical advantage of IGRAs over the TB skin test (TST) is that the patient does not need to return for a second visit for test interpretation. Unlike the TST, the IGRA is not affected by Bacillus Calmette-Guerin (BCG) vaccination status. The PPD has a specificity as low as 60% in individuals from countries where BCG vaccination is used. Algorithms are available to confirm a positive PPD using the QuantiFERON-TB gold test in low-risk individuals suspected of having a false-positive PPD (e.g., those having BCG vaccination, serial testing, or cross-reactivity from other nontuberculous mycobacterium strains). IGRA confirmation of positive TST results may persuade reluctant patients with latent TB to consider treatment. Diagnostic Evaluation – Pearls to Know [1] Tuberculin skin test (TST)- 80 -95% sensitive, 60 - 80% specific (based on delayed hypersensitivity to TB antigens) is more sensitive, less specific- positive if induration of 15 mm or more, especially in persons without risk factors. Positive if 10 mm or more in patients with higher risk. Positive if 5 mm or more in immunocompromised patients and those exposed to active TB. Interferon-gamma release assay (IGRA) AKA Quantiferon-TB Gold In-Tube test or T-Spot TB test-enzyme-linked immunosorbent assays- more specific (greater than 95%) and less sensitive (70-91%) than the TST IGRA preferred, TST acceptable- in groups with historically low rates of returning for TST result interpretation (homeless, drug users). Persons who have received BCG vaccination. False-positive results are more likely if the interval between BCG vaccination and use of the TST is less than 10 years.* TST preferred, IGRA acceptable- children younger than five years Either test acceptable- persons who have occupational exposure to Mycobacterium tuberculosis and who are undergoing periodic screening. And recent contacts with known or suspected active tuberculosis. Screening after exposure to active TB- Use either the TST or IGRA, but either test may not show conversion for eight to 12 weeks in infected individuals. "Window prophylaxis" should be initiated in exposed high-risk patients. If repeat testing at 12 weeks is negative, consider stopping medications (except further clinical evaluation is indicated for immunocompromised patients). *Despite previous recommendations that tuberculin skin test (TST) results be interpreted without regard for BCG vaccination status, about 20% of positive TST results in this population may represent false positives rather than latent or active TB infection. Other Pearls [1] Two-step TST- Repeat skin test in one to three weeks after initial negative test (this stimulates a reaction or booster effect in persons infected with M. Tuberculosis in the distant past. IGRA test antigens (blood test) are not shared by BCG or environmental mycobacteria (except Mycobacterium marinum, M. szulgai, and M. kaansaii) TST contains ESAT-6 and CFP-10 antigens, which may boost IGRA results Treatment and Recommended Follow-Up [3] Neither the TST or the IGRA can distinguish between latent and active disease. At risk patients with positive TB results should be offered treatment after active disease is ruled out. Any Xray abnormalities should be followed with three sputum AFB smears to exclude active TB. Five approved treatment regimens for latent TB infection Standard nine-month INH regimen- reduces TB activation risk by 90% Six-month INH regimen- reduces risk by 60-80% Four-month daily rifampin regimen- reduces risk by 60% but has less liver toxicity Three-month, 12-dose regimen of INH and rifapentine (Priftin), given once weekly under direct observation- as effective as nine months of INH in persons 12 years and older Three-month, daily isoniazid plus rifampin. This regimen is recommended for: Children and adults of all ages who are HIV-negative Patients with HIV taking some combinations of antiretroviral therapy (ART) For further information on indications and dosing see Treatment for Latent Tuberculosis. CDC Tuberculosis. April 17, 2025 Sources Adapted from American Family Physician- June 1, 2014. Holly Hartman-Adams et al. CDC: MMWR 12/16/05 54(RR15) 49-55. Treatment for Latent Tuberculosis. CDC Tuberculosis. April 17, 2025. Paul E. Sax. One-Month Treatment for Latent Tuberculosis. NEJM Voices. April 2, 2026.

Sunlight therapy for TB patients in Colorado By Stuart M. Caplen, MD Tuberculosis (TB) is an airborne infectious disease that primarily affects the lungs but can spread to almost any part of the body. It is thought that about 25% of the world’s population has been infected with TB, with an estimated 10.7 million people developing active TB and 1.2 million dying from it each year. In most individuals, the immune system contains the infection, typically walling off the bacteria within granulomas so it does not spread. However, approximately 5 to 10% of those infected will go on to have active TB disease. History of Tuberculosis TB is caused by Mycobacterium tuberculosis and is thought to have infected humans for more than 70,000 years. About 15,000 to 20,000 years ago, the modern strain of TB is believed to have first appeared. The illness was described in Indian texts dating to approximately 3300 BC. Some Egyptian mummies dating back to 2400 BC have shown evidence of the disease. TB may have been described in the Bible using the ancient Hebrew word schachepheth. In Ancient Greece, where it was common and documented by Hippocrates, it was known as phthisis. After the Roman era, TB was widespread in Europe and Asia. Evidence of TB has been found in Peruvian mummies, dating to before the arrival of the first European explorers in South America. During the Middle Ages, physicians first described scrofula, a form of TB affecting the cervical lymph nodes. In England and France, it was known as the “king’s evil,” and it was commonly believed that it could be cured by the “royal touch.” People lined up in large numbers to receive this “touch” from the king or queen. The “royal touch” was practiced in England until 1714 and in France until 1825. In 1720, the English physician Benjamin Marten first proposed that TB was an infectious disease in his book, A New Theory of Consumptions. TB was known as consumption or phthisis during the 17th and 18th centuries. In 1735, the Italian Health Board of the Republic of Lucca ordered the isolation of TB patients, or “consumptives,” as they were known. They were denied admission to public hospitals and had to be cared for in specialized treatment centers. By the 18th century, TB had become epidemic in Europe and was known as the “robber of youth” due to the number of young people who died from it. It was also known as the “white plague” due to the severe anemia and paleness of its victims. In the mid-1800s, up to a third of English tradesmen and laborers and up to one-sixth of the British upper class were dying from TB. In the late 1700s and early 1800s, TB was increasingly being recognized as a systemic disease that could affect multiple organs, not just the lungs. In 1839, German physician Johann Lukas Schönlein coined the term “tuberculosis.” This came from the tubercles (granulomas), or small, hardened nodules that form in the body as an immune system response to contain the infection. In the early 1800s, considerable debate surrounded the cause of TB, with infection being the predominant theory in Southern Europe and heredity in Northern Europe. Some physicians even thought it was a form of cancer. In 1865, Jean-Antoine Villemin, a French military surgeon, noted that TB was more common in soldiers living in barracks than among those stationed in the field. He inoculated rabbits with liquid from a TB cavity and produced TB in the animals, demonstrating the infectious nature of the disease. Koch Identifies TB and Develops Tuberculin In 1882, Robert Koch, a German physician and microbiologist, isolated the TB bacillus and demonstrated that it caused TB by infecting laboratory animals. It was a scientific breakthrough that earned him the 1905 Nobel Prize in Physiology or Medicine. His experiments on TB became one of the classic demonstrations of what later became known as Koch's postulates, a set of principles used to establish that a specific microorganism causes a particular disease. In 1890, he claimed to have isolated a substance from heated, dead “tubercle bacilli” that could cure patients with TB, which he named tuberculin. While it failed as a treatment, Koch noticed that injecting small amounts of tuberculin produced a much stronger reaction in patients with TB and very little reaction in healthy individuals. He concluded that tuberculin could potentially be used as a diagnostic tool. Further Advances in TB Testing In 1907, Viennese pediatrician Clemens von Pirquet developed a cutaneous tuberculin test by applying tuberculin to superficial skin scratches, allowing him to identify latent or asymptomatic TB infection. In 1908, Charles Mantoux, a French physician, developed an intradermal method of tuberculin testing using a syringe. In 1934, biochemist Florence Seibert demonstrated that the active component of tuberculin was a protein that caused the reaction when a person had previously been infected with TB. She isolated the protein and called it purified protein derivative (PPD), which ultimately became the standard in TB skin testing. Although imperfect, the PPD skin test allowed clinicians to identify individuals with prior exposure and immune sensitization to TB, including those with latent infection. Once effective antibiotics became available, individuals with latent infection could be treated to reduce their risk of developing active disease. By 2001, a blood test called the interferon-gamma release assay (IGRA) was developed to detect TB. Today there are two of these IGRA blood tests, the QuantiFERON-TB Gold Plus and the T-SPOT.TB. They have higher specificity than skin testing and are not affected by the bacille Calmette-Guérin (BCG) vaccine. Colorado, the “World’s Sanitarium” In the 1800s, TB was the leading cause of death in the United States. Physicians of that era believed that sunshine, high altitude, and dry climates could improve TB symptoms. As a result, Denver, Colorado, became one of the nation's most popular destinations for people with consumption and helped drive Colorado's population growth. Before becoming a haven for TB patients, Denver was known as a rough frontier town filled with outlaws and miners. Many TB sufferers arrived in Denver after spending much of their savings on a one-way ticket, contributing to rising homelessness in the city. There were also some East Coast charitable groups that would give TB sufferers a fruit basket and a one-way ticket to Denver. At its peak, an estimated one in three Denver residents was infected with TB. Modern Woodmen of America TB Sanatorium- Colorado Springs early 1900s Denver’s first facility for TB patients was opened in 1860, two years after the city was founded. TB facilities soon followed in Colorado Springs and Boulder and cities began to develop around the TB treatment centers. TB treatment became Colorado Springs’ first major industry. Colorado became known as the “World’s Sanitarium.” There were luxurious resort-like facilities, such as the Hygiene House for the wealthy, while for those less well-off, the sanatoriums sometimes consisted of little more than tent colonies. Frances Wisebart Jacobs, a wealthy Denver philanthropist, was instrumental in the founding of the National Jewish Hospital for Consumptives, which opened in 1899. Its motto was “None may enter who can pay—none can pay who enter.” It still operates today as National Jewish Health. TB Treatment In the 1940s, the first treatments for TB were introduced: streptomycin and para-aminosalicylic acid. This was followed by isoniazid (INH) in 1952. INH was first studied to treat latent (asymptomatic) TB in 1956 and is still used today for that purpose. Active TB is generally treated with multidrug regimens to prevent treatment failure and the development of drug resistance. Standard first-line medications used in various treatment regimens include ethambutol, isoniazid, rifampin, rifapentine, pyrazinamide, and selected fluoroquinolones such as moxifloxacin. Drug-resistant TB remains a major global challenge that requires specialized, long-term treatment regimens. Latent TB infection is commonly treated with isoniazid, rifampin, or rifapentine, or combination regimens. The bacille Calmette-Guérin (BCG) vaccine is frequently administered to people living in countries where TB is endemic. It uses a live attenuated strain of Mycobacterium bovis that provides partial protection against Mycobacterium tuberculosis. The vaccine provides 70%-80% protection against children developing severe forms of TB, including TB meningitis and disseminated TB. It provides substantially less protection against pulmonary TB. Because prior BCG vaccination may cause a false-positive TB skin test, interferon-gamma release assay blood testing is generally preferred when screening vaccinated individuals. Summary For much of human history, an active TB diagnosis was often considered a death sentence, and the only "cures" available were largely limited to measures such as sunshine, fresh air, and the belief in a king's touch. Despite major advances in diagnosis, prevention, and treatment, TB remains the world's leading cause of death from a single infectious agent and continues to pose a significant global health challenge. If you liked this article, you may also enjoy reading The History of Malaria. You may also find these other FibonacciMedicine history of medicine articles interesting: The Discovery of Radium and the Start of the “Radium Cure Craze” Era The History of Mercury as Medicine How Gila Monsters and Gut Hormones Changed Modern Medicine - The History of GLP-1 Drugs The History of Insulin and Type 1 Diabetes The History of “Snake Oil” and “Snake Oil Salesmen” The History of Nitroglycerin, an Explosive with Medical Benefits The History of Heroin, the “Non-addictive” Substitute for Morphine The Story of the Most “Kissed” Face in the World “Gentlemen this is no humbug” - The First Use of General Anesthesia in Surgery and the Battle for Recognition that Ensued The History of the Coney Island Incubator Babies The Tobacco Smoke Enema, One of the First CPR Techniques? The Dancing Plague of 1518 Benjamin Franklin, Mesmerism, and the First Use of Placebos in Science Penicillin, the Accidental Antibiotic The History of Leeches in Medicine and the Era of the “Leech Mania” The History of the “Whale Cure” for Rheumatism The History of Antiseptic Surgery The History of the Electrocardiogram (EKG/ECG) The History of Phrenology; Just Another Bump in the Road? The Creation of the Gin and Tonic; a Medical Odyssey The History of Cocaine The History of the Iron Lung The First Medical Text - The Edwin Smith Surgical Papyrus References Barberis I, Bragazzi NL, Galluzzo L, Martini M. The history of tuberculosis: from the first historical records to the isolation of Koch's bacillus. J Prev Med Hyg. 2017;58(1):E9-E12. Retrieved from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5432783/#R02 Kestler B, Tyler SK. Latent tuberculosis testing through the ages: the search for a sleeping killer. Am J Physiol Lung Cell Mol Physiol. 2022;322(3):L412-L419. Retrieved from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8934672/ When 'Consumption' Came to the West. National Jewish Health. 2026. Retrieved from: https://www.nationaljewish.org/about-us/our-history/when-consumption-came-to-the-west Blakemore E. When Tuberculosis Helped Put Colorado on the Map. The History Channel. Last Updated: June 30, 2025, Retrieved from: https://www.history.com/articles/the-disease-that-helped-put-colorado-on-the-map Lewis S. How tuberculosis fueled Colorado’s growth. Colorado Public Radio. February 10, 2015. Retrieved from: https://www.cpr.org/show-segment/how-tuberculosis-fueled-colorados-growth/ Harris M. The Tiny Tuberculosis Huts of Colorado Springs. Mental Floss. May 5, 2020. Retrieved from: https://www.mentalfloss.com/article/623965/history-tuberculosis-huts-colorado-springs Treating Tuberculosis. CDC. April 17, 2025. Retrieved from: https://www.cdc.gov/tb/treatment/index.html Cai H, Luo Q, Zhou G et al. Effect of Bacillus Calmette-Guérin vaccination against Mycobacterium tuberculosis infection in children: an updated systematic review and meta-analysis. International Journal of Infectious Diseases. Volume 156, 2025. Retrieved from: https://www.sciencedirect.com/science/article/pii/S1201971225001328 BCG Vaccine (TB vaccine). University of Oxford. last updated January 19, 2022. Retrieved from: https://vaccineknowledge.ox.ac.uk/bcg-vaccine Tuberculosis. WHO. 24 March 2026 Retrieved from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis TB Overview Fact Sheet. CDC Last updated: March 17, 2025. Retrieved from: https://www.cdc.gov/global-hiv-tb/php/resources/tb-overview-fact-sheet.html

By Stuart M. Caplen, MD Few diseases have shaped human history as profoundly as malaria, which still remains one of the world’s most deadly diseases. In 2024, the World Health Organization (WHO) estimated that malaria infected 282 million people and caused 610,000 deaths, with 95% of these infections occurring in Africa. Malaria is a life-threatening illness caused by a protozoan parasite and transmitted to humans through the bites of infected female Anopheles mosquitoes. There are five distinct species of Plasmodium that can cause malaria, with Plasmodium falciparum and Plasmodium vivax posing the greatest threats. Symptoms typically begin 10-15 days after a bite, commonly beginning with fever, headache, and chills. The parasite initially travels to the liver where it reproduces. It then leaves the liver to infect red blood cells, which is where more parasites are released. In some people, the infection is partially controlled, and symptoms improve until more parasites are released from infected red blood cells, restarting the cycle. If an Anopheles mosquito feeds on a person with circulating parasites, it may pass the infection on to the next person they bite. In severe cases, the parasites can cause convulsions, respiratory distress, bleeding, as well as other significant health issues. Some people can develop partial immunity to the parasite, and in others the parasite may reside dormant in the liver and reactivate at a later date. Historical Timeline and Impact Ancient writings attest to the length of time malaria has infected humans. Mesopotamian clay tablets contain writings of a febrile disease suggestive of malaria. Malaria antigens have been discovered in ancient Egyptian remains. In ancient Indian texts, malaria is called the “king of diseases.” The ancient Greeks also wrote about the disease. Malaria arrived in Rome in the first century AD, possibly via Greek traders who traveled to Africa. It has been suggested by some historians that malaria epidemics may have played a part in the fall of the Roman Empire, as in 79 AD, a malaria epidemic led farmers to abandon their fields around Rome, reducing agricultural productivity. Roman soldiers and traders spread malaria further throughout Europe. The disease was also reported in India and China. Malaria was once known as Roman fever. Because diseases at that time were thought to arise from miasmas or evil vapors, the name was later derived from Medieval Italian, mal aria (bad air). Malaria may have come to the Americas with early explorers, but it also was later brought in with the transatlantic slave trade from Africa. Both Abraham Lincoln and George Washington reportedly suffered bouts of malaria during their lives. In the Civil War, many soldiers were infected. Malaria continued to plague the South long after the war and it was not until the 1930s, after the Tennessee Valley Authority brought hydroelectric power and modernization to the rural U.S. South, that malaria was controlled there. During World War II, soldiers fighting in the Pacific region also suffered from significant malaria cases. It was in Africa where malaria claimed most of its victims. Indigenous populations were exposed throughout their lives, and those who survived developed a form of partial immunity. European colonists in the 18th century did not possess this immunity and consequently parts of West Africa were commonly referred to as “the White man’s grave” due to malaria and other tropical diseases. In 1946, the Malaria Control in War Areas program, which had successfully kept the southeastern states malaria-free during World War II, was reorganized as the Communicable Disease Center (CDC), which later became the Centers for Disease Control and Prevention. Discovery of the Cause of Malaria In 1880, a French army doctor, Charles Louis Alphonse Laveran, theorized that malaria was caused by a “germ”. While looking at blood from an infected soldier, he noticed pigments in red blood cells caused by hemoglobin digestion by the Plasmodium parasite. He then examined blood smears from more patients with malaria and found the parasite in the majority of patients. Laveran received the Nobel Prize in 1907 for discovering that Plasmodium parasites caused malaria. Malaria Parasites in Red Blood Cells In 1886, Camillo Golgi linked the fevers seen in malaria with the release of malaria parasites in the blood. In 1897, Surgeon-Major Ronald Ross of the British Indian Medical Service discovered that the malaria parasites develop within mosquitoes. Ross received the Nobel Prize for demonstrating that mosquitoes transmit malaria. In 1948, Henry Edward Shortt and Percy Cyril Claude Garnham, doctors and researchers, discovered that after infecting a host, the malaria parasite’s early development occurs in the human liver. Sickle Cell Trait and Malaria It is thought that sickle cell anemia and trait are genetic adaptations to resist malarial infections. Sickle cell trait is found in approximately 10 to 40% of Africans. Unlike sickle cell anemia, where the gene is inherited from both parents and causes severe disease, people with sickle cell trait inherit one normal hemoglobin gene and one sickle hemoglobin gene. Trait carriers are generally healthy unless subjected to extreme physiological stress, such as a low oxygen environment. Under severe stress, red blood cells in people with the trait will also sickle. It is thought that the malaria parasite entering a red blood cell in a person with sickle cell trait consumes oxygen and nutrients which causes the cell to sickle. Sickled cells make it harder for the parasite to survive. Sickled cells are eliminated by the body before the red blood cells full of malarial parasites can rupture and continue the spread of the infection. Thus, people who carry sickle cell trait generally experience lower rates of severe malaria and malaria-related mortality. Treatments According to legend, a Native South American accidentally discovered that the bark of the cinchona tree (Cinchona officinalis) was a treatment for malaria. When ill with a fever, he drank from a pool of bitter, stagnant water surrounded by cinchona trees and recovered. The bark contains quinine and other alkaloids, which can treat malaria. The Journey of Quinine from Peru to Europe The Spanish discovered that indigenous inhabitants of Peru were using cinchona bark in the 1600s. It then also became known as “Jesuit’s bark” and became a favorite European medicine for treating malaria. The bark was dried and grounded down to a powder to produce quinine. In 1820, French chemists Joseph Pelletier and Jean Bienaimé Caventou isolated quinine from cinchona bark. Quinine then became a therapy for malaria throughout the world. The gin and tonic was said to have originated during British rule in India, in the mid-1800s when soldiers mixed gin with quinine-containing tonic water to make the bitter antimalarial medication more palatable. Malaria and the World Wars The Dutch engineered a hardy form of cinchona and eventually produced 80% of the world's quinine on the Indonesian island of Java. During World War I the Allies controlled Java and much of the world’s quinine supply, and the Germans were unable to access antimalarial drugs which reportedly caused illness in their troops. After the war, the Germans wanted to avoid being unable to access antimalarial drugs again, so they commissioned the chemical company I.G. Farben to develop new alternatives. They subsequently synthesized pamaquine and later quinacrine, although toxic side effects limited their use. In 1934 they synthesized chloroquine (called Resochin) and 3-methyl chloroquine but overestimated their toxicity and did not do further research on the compounds. During World War II, the Allies were deprived of quinine by the German occupation of Holland and the Japanese occupation of Java. French soldiers reportedly raided a supply of German-manufactured 3-methyl chloroquine in Tunis and handed it over to American investigators who made minor modifications to the formulation and named it chloroquine. It was later recognized that the compound the Germans had called Resochin was chloroquine. After World War II chloroquine was used extensively throughout the world to treat malaria, although some strains started to develop resistance to the drug. Later Therapy Advances Sulfadoxine-pyrimethamine (Fansidar, Swidar and Amalar tablet ). This medication, first introduced in 1967, is a combination of two drugs that block folate production required by the malaria parasite. It has been used for both the treatment and prevention of malaria. Mefloquine (Lariam) was produced as a replacement for chloroquine and was initially used as a prophylactic drug before later being used to treat malaria in the mid-1970s. It is administered weekly and may be taken for more than a year for malaria prevention as long as it is well tolerated. Potential neurologic, psychiatric, and cardiac adverse effects have limited its use. Malarone (a combination of atovaquone and proguanil) is generally well tolerated and has largely replaced mefloquine as the drug of choice for malaria prophylaxis. It is taken daily and may be taken for extended periods when necessary. Malarone is also a highly effective treatment of acute, uncomplicated Plasmodium falciparum malaria. Taking the oral antibiotic doxycycline is another option for malaria prophylaxis. Generally, it is less well tolerated than Malarone (more drug interactions, increased sun sensitivity, and contraindicated during pregnancy), but it is a cheaper, effective option. Duration of administration should be considered carefully, as it must be continued for four weeks after leaving a malaria-endemic area. Artemisinin, derived from wormwood, has been used in Chinese medicine for thousands of years. In 1979, scientists published a study demonstrating its effectiveness, and today artemisinin-derived drugs, typically combined with a longer-acting medication to prevent drug resistance, are used as first-line treatment for drug-resistant malaria. There are a number of medications that travelers to endemic areas may take to prevent malaria, although none is 100% effective. There are currently two vaccines approved for malaria: RTS,S/AS01 (approved in 2021) and R21/Matrix-M (approved in 2023). Malaria vaccines may reduce uncomplicated malaria by approximately 40%, severe malaria by approximately 30%, and all-cause mortality by 13%. They are currently recommended for children living in areas where malaria is endemic. The vaccines mimic the surface of the malaria sporozoite, helping the recipient produce antibodies against it. Vaccinated individuals can then eliminate sporozoites injected into the bloodstream by mosquitoes before the parasites settle in the liver and reproduce. They also stimulate T-cell immunity that can help destroy any organisms not picked up by the immediately available circulating antibodies. Genetically Modified Mosquitoes Some regions of the world have introduced genetically modified Anopheles mosquitoes in an effort to control malaria. Scientists insert a gene that prevents female offspring from surviving to adulthood. Genetically modified mosquito eggs are released into a target area, and after hatching, the resulting males pass the gene to their offspring. This reduces the Anopheles mosquito population, particularly the females responsible for transmitting malaria. Using gene-drive technology, the inserted gene can be copied onto both chromosomes, allowing it to be inherited by nearly 100% of offspring and spread more rapidly through successive generations. Summary Malaria has afflicted the human race since antiquity, and despite present-day vaccines, medications, and mosquito control measures, it still persists, adversely affecting millions of people each year. If you liked this article, you may also enjoy reading The Creation of the Gin and Tonic; a Medical Odyssey , which also discusses malaria treatment. You may also find these other FibonacciMedicine history of medicine articles interesting: The Discovery of Radium and the Start of the “Radium Cure Craze” Era The History of Mercury as Medicine How Gila Monsters and Gut Hormones Changed Modern Medicine - The History of GLP-1 Drugs The History of Insulin and Type 1 Diabetes The History of “Snake Oil” and “Snake Oil Salesmen” The History of Nitroglycerin, an Explosive with Medical Benefits The History of Heroin, the “Non-addictive” Substitute for Morphine The Story of the Most “Kissed” Face in the World “Gentlemen this is no humbug” - The First Use of General Anesthesia in Surgery and the Battle for Recognition that Ensued The History of the Coney Island Incubator Babies The Tobacco Smoke Enema, One of the First CPR Techniques? The Dancing Plague of 1518 Benjamin Franklin, Mesmerism, and the First Use of Placebos in Science Penicillin, the Accidental Antibiotic The History of Leeches in Medicine and the Era of the “Leech Mania” The History of the “Whale Cure” for Rheumatism The History of Antiseptic Surgery The History of the Electrocardiogram (EKG/ECG) The History of Phrenology; Just Another Bump in the Road? References Malaria. WHO. 4 December 2025. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/malaria Aliouche H. News-Medical.Net. The Malaria Parasite Life Cycle. https://www.news-medical.net/life-sciences/The-Malaria-Parasite-Life-Cycle.aspx Institute of Medicine (US) Committee on the Economics of Antimalarial Drugs; Arrow KJ, Panosian C, Gelband H, editors. Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance. Washington (DC): National Academies Press (US); 2004. 5, A Brief History of Malaria. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK215638/ Thompson A. Malaria and the Fall of Rome. BBC. Last updated 2011-02-17. Retrieved from: https://www.bbc.co.uk/history/ancient/romans/malaria_01.shtml Historical Perspectives History of CDC. MMWR- CDC. June 28, 1996, 45(25);526-530.Retrieved from: https://www.cdc.gov/mmwr/preview/mmwrhtml/00042732.htm Adigwe OP, Onoja SO, Onavbavba G. A Critical Review of Sickle Cell Disease Burden and Challenges in Sub-Saharan Africa. J Blood Med. 2023;14:367-376. Published 2023 May 31. Retrieved from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10239624/ Malaria Vaccines. CDC. April 2, 2024. Retrieved from: https://www.cdc.gov/malaria/php/public-health-strategy/malaria-vaccines.html Malaria. Countries with indigenous cases in 2000 and their status by 2024WHO Global Health Observatory. Retrieved from: https://www.who.int/data/gho/data/themes/malaria Caplen S. The Creation of the Gin and Tonic; a Medical Odyssey. FibonacciMedicine. Nov 8, 2024. Retrieved from: https://www.fibonaccimd.com/post/gin-and-tonic-medical-odyssey

Understanding the Causes, Symptoms, Diagnosis, and Treatment of Femoroacetabular Impingement (FAI) FibonacciBrief Orthopedics Author: Allan Strongwater, MD AKA FAI femoral acetabular impingement femoral cam morphology Cam impingement is a form of femoral acetabular impingement (FAI) that results from a misshapen femoral head. The femoral head is more ovoid than spherical. As the ovoid femoral head passes through a range of motion, the radius of curvature changes. The reduced radius allows the relatively widened femoral neck to contact the acetabular rim, resulting in pain and injury to the labrum and adjacent articular cartilage. FAI may also be associated with femoral head cysts that are degenerative in nature. Causes and Risk Factors FAI is usually the result of a misshapen femoral head due to childhood illnesses such as Legg Calve Perthes disease, slipped capital femoral epiphysis, or avascular necrosis. Certain genetic or familial diseases (e.g., multiple epiphyseal dysplasia, developmental coxa vara) can also produce femoral head malformation. Signs and Symptoms The pain from cam impingement of the hip usually occurs with activities that bring the hip close to its maximum range of motion in adduction, flexion, and internal rotation. The pain is often referred to the groin. Diagnostic Evaluation and Differential Diagnosis Generally, cam impingement can be diagnosed by reproducing the patient's pain during physical examination. The pain from cam impingement is increased by placing the hip into flexion and internal rotation. However, pain elicited by this maneuver is not unique to FAI, and radiographic and magnetic resonance imaging is needed to rule out other pathological conditions (e.g., osteoarthritis, fracture, tumor). Treatment and Recommended Follow-Up A majority of patients with cam impingement can be managed successfully with physical therapy, activity modification, and anti-inflammatories. Because FAI causes injury to the acetabular labrum and surrounding articular cartilage, degenerative arthritis of the hip will ensue. If possible, activity modification to avoid impingement may be helpful. Exercise that causes pain is not good and can further injure the joint. Surgical reduction of the area of impingement (i.e., cam bump) is now possible arthroscopically. Use of nonsteroidal anti-inflammatory medications may alleviate the pain. Last resort is THR. Pearl to Know Cam impingement also may result from pincer impingement, which involves extension of bone over the normal acetabular rim.

Is Beef Tallow a Healthy Cooking Fat or Just the Latest Food Trend? Culinary Medicine by Mary B Grosvenor, MS, RD and Lori A Smolin, PhD For centuries, people have cooked with tallow. The use of this animal fat in American kitchens began to decline early in the 20th century when inexpensive vegetable oils and shortenings became available.[1] In the 1950s, when the “diet-heart hypothesis” suggested that the high saturated fat content of animal fats increased the risk of heart disease, the use of tallow and other animal fats further declined.[2] Today however, tallow is making a comeback. Advocates of tallow contend that it is a healthy, natural cooking fat, while traditional nutritional recommendations caution that its high saturated fat content may override any potential advantages. Should you switch to tallow or stick with vegetable oils? What is Tallow? Tallow is fat rendered from the tissues, mostly those that surround the internal organs, of ruminant animals such as cows, sheep, and goats. The rendering process slowly heats the fat and then strains it to remove leftover tissue, producing a product that is solid at room temperature.[3] Beef tallow is commonly used in frying, roasting, and even baking. Mary Recommends As an Amazon Associate FibonacciMD earns from qualifying purchases. 100% Grass-Fed Beef Tallow – 14 oz Jar [https://amzn.to/49Ztckx] Evil Goods Whipped Tallow & Honey Balm: Nutrient-rich skincare made from 100% grass-fed beef tallow and Manuka honey. Features a light, whipped texture that deeply hydrates sensitive skin without feeling greasy. [https://amzn.to/4vqU6KZ] Tallow Nutrition Nutritionally, beef tallow is primarily fat; it contains no protein or carbohydrate and only small amounts of some fat-soluble vitamins. A tablespoon provides 13 grams of fat, with a high percentage of both monounsaturated and saturated fatty acids.[4] Monounsaturated fats do not increase heart disease risk. Saturated fats have been linked to a greater risk of heart disease. However, recent research suggests that to accurately assess risk the type of saturated fat needs to be considered.[5] The most prevalent saturated fatty acid in beef tallow is palmitic acid, which is associated with increased LDL cholesterol levels and has been shown to play a significant role in the development of atherosclerotic heart disease.[4,6] The second most prevalent fatty acid is stearic acid, which has been shown to have less impact on blood lipid levels than other saturated fatty acids.[5] Studies in humans have shown that diets high in stearic acid do not increase cardiac risk.[7,8,9] Therefore, based on available data regarding the risk of different saturated fatty acids, beef tallow may be less atherogenic than butter but there is no evidence that it is a healthier alternative to vegetable oils.[10,11] Why is Tallow Trending? One reason people are choosing tallow is because advocates suggest that it is a less processed, more nutritious alternative to vegetable oils, but the facts do not fully support this. Beef tallow is minimally processed; it is simply heated and strained. Some vegetable oils are highly processed, but there are cold-pressed vegetable oils that are no more processed than tallow. As to nutrient content, tallow does provide small amounts of vitamins D and E. If the tallow is from grass-fed beef, it also provides a small amount of the vitamin A precursor beta-carotene.[12] In contrast, vegetable oils are one of the best sources of vitamin E in our diet and are also a good source of vitamin K.[13,14] Vegetable oils do not provide vitamin A or vitamin D, unless they are fortified. Another reason people may choose tallow is its relatively high smoke point. The smoke point is the temperature at which a heated fat begins to produce visible smoke. At this temperature, the fat is being oxidized, producing off-flavors and aromas. The saturated fat in tallow reduces its susceptibility to oxidation, decreasing the likelihood that it will develop off flavors.[15] Fats with a high smoke point allow high temperature cooking, which creates a crisp exterior and reduces the absorption of fat into the food. So, for foods that require a high cooking temperature, tallow offers some benefits. The famous crispiness and savory flavor of pre-1990 McDonald’s French fries are attributed to the beef tallow in the cooking fat.[16] But tallow is not the only cooking fat that works for high-temperature cooking. Vegetable oils such as avocado oil, extra-virgin olive oil, and peanut oil also have a high smoke point. Can Tallow be Part of a Healthy Diet? No one food makes or breaks a diet; the healthfulness of a diet is determined by the overall pattern of what we choose to eat. A healthy pattern focuses on whole foods such as fruits, vegetables, whole grains, and lean proteins. It limits highly processed foods and keeps saturated fat intake to less than 20 g per day.[17] Tallow consumed in moderation can be part of a healthy dietary pattern. A serving of tallow fries for example contains only about 2 grams of saturated fat compared with 24g in a 10-oz steak. So, try some tallow fries, but be sure to balance them with healthy choices throughout the day. References [1] Legaspi CH. Is Beef Tallow Good for You? Kennedy Thinks So, but Experts Disagree. The New York Times. https://www.nytimes.com/2025/03/20/well/eat/beef-tallow-oil-health.html. Published March 20, 2025. [2] Teicholz N. A short history of saturated fat: the making and unmaking of a scientific consensus. Current Opinion in Endocrinology, Diabetes & Obesity. 2022;30(1):65-71. doi:https://doi.org/10.1097/med.0000000000000791 [3] Russell L, What is beef tallow? Is it good for me? - Mayo Clinic Press. Mayo Clinic Press. Published June 20, 2024. https://mcpress.mayoclinic.org/nutrition-fitness/what-is-beef-tallow-is-it-good-for-me/ [4] Chemical Composition of Beef Tallow. Accessed May 29, 2026. https://pdf.benchchem.com/1178/chemical_composition_of_beef_tallow.pdf [5] Al-Subari AA, AL-Khatib BY, Al-Tamimi AHS, Al-Arami AM, Naji KM. Ameliorative effects of tallow and olive oil on hyperlipidemia-induced atherogenesis in male albino rats. Scientific Reports. 2026;16(1). doi:https://doi.org/10.1038/s41598-025-34795-6 [6] Jiang H, Chen Na, Zhu Y, et al. Multiple Roles of Palmitic Acid in Cardiovascular Diseases. Journal of Inflammation Research. 2025;Volume 18:14515-14533. doi:https://doi.org/10.2147/jir.s530054 [7] Meng H, Matthan NR, Wu D, Li L, Rodríguez-Morató J, Cohen R, Galluccio JM, Dolnikowski GG, Lichtenstein AH Comparison of diets enriched in stearic, oleic, and palmitic acids on inflammation, immune response, cardiometabolic risk factors, and fecal bile acid concentrations in mildly hypercholesterolemic postmenopausal women—randomized crossover trial AJCN,110,2019. https://doi.org/10.1093/ajcn/nqz095. [8] Gebauer SK, Tracy RP, Baer DJ. Impact of stearic acid and oleic acid on hemostatic factors in the context of controlled diets consumed by healthy men. European Journal of Clinical Nutrition. 2014;68(9):1072-1074. doi:https://doi.org/10.1038/ejcn.2014.62 [9] Hunter JE, Zhang J, Kris-Etherton PM. Cardiovascular disease risk of dietary stearic acid compared with trans, other saturated, and unsaturated fatty acids: a systematic review. The American Journal of Clinical Nutrition. 2009;91(1):46-63. doi:https://doi.org/10.3945/ajcn.2009.27661 [10] Denke MA, Grundy SM. Effects of fats high in stearic acid on lipid and lipoprotein concentrations in men. Am J Clin Nutr. 1991 Dec;54(6):1036-40. doi: 10.1093/ajcn/54.6.1036. PMID: 1845606 [11] Miller M, Aggarwal M, Allen K, et al. A Clinician’s Guide for Trending Cardiovascular Nutritional Controversies in 2026. JACC Advances. 2026;5(3):102591-102591. doi:https://doi.org/10.1016/j.jacadv.2026.102591 [12] Daley CA, Abbott A, Doyle PS, Nader GA, Larson S. A review of fatty acid profiles and antioxidant content in grass-fed and grain-fed beef. Nutrition Journal. 2010;9(1). doi:https://doi.org/10.1186/1475-2891-9-10 [13] What Is Vitamin E and What Does It Do? https://ods.od.nih.gov/pdf/factsheets/VitaminE-Consumer.pdf [14] Office of Dietary Supplements - Vitamin K. ods.od.nih.gov. https://ods.od.nih.gov/factsheets/VitaminK-HealthProfessional/#h3 [15] Vieira SA, McClements DJ, Decker EA. Challenges of utilizing healthy fats in foods. Adv Nutr. 2015 May 15;6(3):309S-17S. doi: 10.3945/an.114.006965. [16] Mamane R. The Greasy, Glorious History of the McDonald’s Fry. Food Republic. Published November 10, 2025. https://www.foodrepublic.com/2018016/history-of-the-mcdonalds-fry/ [17] U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2025–2030. 2026, https://cdn.realfood.gov/DGA.pdf.

This colorful Farro Fruit Salad is packed with fiber and heart-healthy ingredients, making it a delicious choice for those following a low-cholesterol, low saturated fat vegetarian lifestyle. Creative Cooking for the Health-Conscious Gourmet FibonacciRECIPES | Culinary Medicine by Mary B Grosvenor, MS, RD and Lori A. Smolin, PhD Fruit and whole grains make a great combination for a cool summer meal. This refreshing salad combines the natural sweetness of grapes, cherries, and blueberries with the hearty chew of farro. Enjoy it as a side or as a satisfying meal on its own. Ingredients 1 cup cherries 1 cup blueberries 1cup grapes 1/3 cup pecans, chopped 1/4 cup olive oil ½ tsp salt 2 tbsp apple cider vinegar ½ tsp ground cinnamon ½ tsp ground cloves 2 tbsp honey Instructions Add 3 cups water and 1 cup farro to pot. Bring to boil and then reduce heat to a simmer and cover the pot. Cook for 10 minutes. Drain any excess liquid and fluff with a fork. Let cool. Meanwhile, whisk together the olive oil, salt, vinegar, cinnamon, cloves and honey to make the dressing. Preheat small frypan to medium, add the pecans and cook for 3-4 minutes, stirring to prevent burning. Rinse fruit, cut grapes into halves or quarters. Transfer cooled farro to bowl, add fruit, and gently toss with dressing. Sprinkle with pecans and serve. Makes 6 servings Nutrition Information per serving Calories 350, Total Fat 16g, Saturated Fat 1.8g, Cholesterol 0mg, Total Carbohydrate 44g, Dietary fiber 7g, Protein 6g, Potassium 330mg, Sodium 195mg Editor’s Note- This recipe is appropriate for a low-cholesterol, low saturated fat, and low carb vegetarian dietary regimen. And an excellent source of fiber. Mary Recommends As an Amazon Associate FibonacciMD earns from qualifying purchases. This set of Lotus Shaped Ceramic Bowls includes both serving bowls and individual bowls, making it perfect for presenting and enjoying salads, fruit dishes, and recipes like Farro Fruit Salad. [https://amzn.to/43MoGCy] Selamica's colorful porcelain bowls feature a wide, shallow design that's perfect for pasta, salads, grain bowls, soups, and fruit dishes, while being microwave-safe, dishwasher-safe, and stackable for easy storage. [https://amzn.to/4w4T8ns]

This colorful Greek Salad with Orzo is a perfect light meal or summer side. It’s a good source of fiber, low in cholesterol, low in saturated fat, and lacto-vegetarian. Creative Cooking for the Health-Conscious Gourmet FibonacciRECIPES | Culinary Medicine by Mary B Grosvenor, MS, RD and Lori A. Smolin, PhD This pasta salad is a colorful dish with classic Mediterranean flavors. It combines crisp cucumbers, juicy tomatoes, and protein-packed chickpeas with olives, feta cheese, and a zesty dressing. It is refreshing, easy-to-make, and works as a light main course or a flavorful side that is perfect for a picnic and pairs well with anything from the grill. Ingredients 1 cup orzo, cooked 1 cucumber 3/4 cup grape tomatoes 3 mini sweet peppers 2 Tbsp Kalamata olives, pitted 4 oz artichoke hearts, in water ½ cup chickpeas, drained & rinsed 2 Tbsp Italian dressing 2 Tbsp feta cheese, crumbled Mary Recommends As an Amazon Associate FibonacciMD earns from qualifying purchases. DeLallo Orzo is made in Italy from premium durum wheat semolina and is all-natural, Non-GMO, vegan, and available in a convenient 4-pack. [https://amzn.to/4actp3X] Mezzetta Pitted Kalamata Olives add rich, savory Mediterranean flavor to this Greek Orzo Salad recipe. They are also a delicious addition to antipasto platters, appetizers, salads, and other Mediterranean-inspired dishes. [https://amzn.to/4oxRoQY] Instructions Wash the cucumber and peel leaving a few stripes of skin. Slice into rounds. Drain artichoke hearts and cut in halves or thirds. Wash the peppers, remove seeds and slice into rings. Combine cucumber, tomatoes, peppers, olives, artichoke hearts, chickpeas, and orzo. Toss with dressing and refrigerate for at least 3 hours (overnight is fine) to allow the flavors to blend. Sprinkle with feta and serve. Makes 4 Servings Nutrition Information per serving Calories 105, Total Fat 4.5 g, Saturated Fat 1.3g, Cholesterol 5mg, Total Carbohydrate 12g, Dietary fiber 3.3g, Protein 4.2g, Potassium 522mg, Sodium 425mg Editor’s Note- appropriate for a low-cholesterol, low carb, and low saturated fat lacto-vegetarian dietary regimen. And a good source of fiber!

The History of GLP-1 Drugs by Stuart M. Caplen, MD Today, glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) are a medical and cultural phenomenon, now used by 12% of U.S. adults at an estimated cost of $132 billion per year. The GLP-1 class of drugs has revolutionized the treatment of diabetes and obesity while also reducing cardiovascular adverse events. Scientists are now investigating their ability to treat alcoholism and drug addiction, as these drugs appear to have a number of positive effects on both the body and the brain. History The Discovery That the Gut Produced Hormones In 1902, it was discovered that the small intestine (duodenum) secreted a hormone called secretin that stimulated pancreatic secretions and reduced acidity when food passed from the stomach into the duodenum. In 1930, another hormone secreted by the small intestine, called incretin, was discovered. It causes the pancreas to release insulin following oral exposure to glucose. By the 1960s, it was recognized that incretin hormones were responsible for 50-70% of the insulin response to oral glucose. In the 1970s, glucose-dependent insulinotropic polypeptide (GIP), an incretin hormone that stimulates the release of insulin after glucose ingestion, was isolated, synthesized and characterized. Discovery of GLP-1 and the Lizard Breakthrough In the 1980s, the incretin hormone GLP-1, which causes glucose-dependent glucagon suppression, delayed gastric emptying, appetite suppression, and increased insulin release from the pancreas, was discovered. (Glucagon is a hormone produced by the pancreas that raises blood sugar levels by prompting the liver to release stored glucose). Scientists were initially excited by this discovery as a potential treatment for diabetes, but human GLP-1 has a half-life of approximately two minutes in the bloodstream, making it unsuitable as a treatment. However, in 1992, while investigating biologically active peptides in Gila monster venom, scientists identified the exendin-4 compound, a polypeptide that exhibited GLP-1-like properties. Exendin-4 lacked the amino acid alanine at one position in the polypeptide chain, making it more resistant to breakdown than human GLP-1. This markedly increased its half-life in the body, making it more suitable for clinical use than human GLP-1. Amylin Pharmaceuticals initiated the development of a synthetic form of exendin-4, later named exenatide. Preclinical studies demonstrated exenatide's sustained glucose-lowering effects and body weight reduction in animal models. Human studies published in 2002 demonstrated weight loss and significant decreases in blood glucose levels without hypoglycemia. The brand name for exenatide became Byetta, which was approved by the FDA in 2005 for the treatment of type 2 diabetes. The Race to Produce Longer-Lasting Drugs Because Byetta had to be injected twice daily, drug companies began searching for longer-lasting GLP-1 medications. In 2007, Novo Nordisk developed the once-daily drug liraglutide (Victoza for type 2 diabetes and Saxenda for weight management). Victoza was approved by the FDA in 2010, while Saxenda followed in 2014. Note that Victoza and Saxenda are the same drug, just given distinct brand names for different indications. In 2014, the FDA approved Eli Lilly’s drug dulaglutide (Trulicity), a once-weekly injection for the treatment of type 2 diabetes and for reducing the risk of major adverse cardiovascular events in patients with type 2 diabetes. In 2015, Novo Nordisk synthesized injectable semaglutide from liraglutide (Ozempic for type 2 diabetes and Wegovy for weight management), which gained FDA approval in 2017 as Ozempic and in 2021 as Wegovy. In 2025, Wegovy was given additional FDA approval for treating a liver disease known as metabolic dysfunction-associated steatohepatitis (MASH), which causes inflammation, scarring, and fat deposits in the liver. Wegovy and Ozempic are the same medication, but branded differently due to different FDA approved indications. Oral, Dual-, and Triple-Action, and New Drug Formulations In 2019, Novo Nordisk introduced an oral semaglutide known as Rybelsus for type 2 diabetes and later oral Wegovy for weight management. The FDA approved Rybelsus in 2019 and oral Wegovy in 2025 (Rybelsus was rebranded as oral Ozempic in 2026). Clinical studies demonstrated both cardioprotective effects and substantial weight loss. In 2020, Eli Lilly developed the dual-action drug, injectable tirzepatide administered once weekly (Mounjaro for type 2 diabetes and Zepbound for weight management) that activates both GLP-1 and GIP receptors. Clinical testing found this dual action more effective than some other GLP-1 receptor agonists. FDA approval occurred in 2022 and 2023, respectively. In 2023, Eli Lilly synthesized injectable retatrutide, the first triple-action agonist targeting GLP-1, GIP, and glucagon receptors, which is currently undergoing Phase 3 clinical trials. In April 2026, the FDA approved the Eli Lilly drug orforglipron (Foundayo), the first non-peptide small-molecule, once-daily oral GLP-1 receptor agonist for weight management. A non-peptide small molecule is a chemical compound not made of amino acids and therefore not broken down by stomach acid, allowing it to be taken orally. These molecules are small enough to pass easily through cell membranes and work inside cells. Studies are ongoing to obtain approval for type 2 diabetes treatment. Summary What began as the study of gut hormones and lizard venom has evolved into one of the most important pharmaceutical advances in modern medicine. That discovery has led to the development of some of the most widely prescribed drugs in use today, treating obesity, type 2 diabetes, cardiovascular complications, and certain forms of severe liver disease. These medications have also been found to reduce cravings associated with substance abuse and alcoholism, and there is even a possibility that they may slow the progression of some cancers. Scientists do not yet understand the full effects of these drugs, and it is possible that they, or related compounds, may be used to treat additional medical conditions in the future. Editor’s Note- These drugs are generally well-tolerated, but they do have a number of potentially serious adverse effects. These risks should always be discussed with your clinician before starting treatment. A few words of caution if starting a GLP-1 agonist Titrate your dosage slowly and carefully. Be patient Hold your medication at least two weeks before any scheduled future procedures under anesthesia Make sure you drink water while taking GLP-1’s or GLP-1/GIP drugs. Dehydration is very common Report any vomiting, light-headedness, upper abdominal pain, or upper or mid-back pain to your clinician Consult with your ophthalmologist and let them know you are on a GLP-1 agonist These are not all the risks or potential adverse effects If you liked this article, you may also enjoy reading The History of Insulin and Type 1 Diabetes. You may also find these other FibonacciMedicine articles interesting: The History of “Snake Oil” and “Snake Oil Salesmen” The History of Nitroglycerin, an Explosive with Medical Benefits The History of Heroin, the “Non-addictive” Substitute for Morphine The Story of the Most “Kissed” Face in the World “Gentlemen this is no humbug” - The First Use of General Anesthesia in Surgery and the Battle for Recognition that Ensued The History of the Coney Island Incubator Babies The Dancing Plague of 1518 Benjamin Franklin, Mesmerism, and the First Use of Placebos in Science Penicillin, the Accidental Antibiotic The History of Leeches in Medicine and the Era of the “Leech Mania” The History of the “Whale Cure” for Rheumatism The History of Antiseptic Surgery The History of the Electrocardiogram (EKG/ECG) References Darwish R, Abu-Sharia G, & Butler AE. History of glucagon-like peptide-1 receptor agonists. Pharmacological Research, Volume 222, 2025. Retrieved from: https://www.sciencedirect.com/science/article/pii/S1043661825004700#bib15 Twenter P. Becker’s hospital Review. 3 big shifts for the GLP-1 market. 5/21/26. Retrieved from: https://www.beckershospitalreview.com/glp-1s/3-big-shifts-for-the-glp-1-market/ Martinex X. Weight-Loss Drugs May Have Surprising Side Effect: Stalling Cancer. May 21, 2026. Retrieved from: https://www.wsj.com/health/pharma/popular-weight-loss-drugs-may-have-surprising-side-effect-stalling-cancer-dec90596 Stewart J. Wegovy FDA Approval History. Drugs.com. Last updated May 18, 2026. Retrieved from: https://www.drugs.com/history/wegovy.html Stewart J. Rybelsus FDA Approval History. Drugs.com. Last updated April 23, 2026. Retrieved from: https://www.drugs.com/history/rybelsus.html

by Stuart M. Caplen, MD In 1898, Marie and Pierre Curie discovered and isolated the radioactive element radium from uranium ore. Previously, Marie Curie had coined the term “radioactivity” to describe the emissions of uranium first described by Henri Becquerel. Those three scientists were awarded the Nobel Prize in Physics in 1903 for their study of radiation, and in 1911 Marie Curie was awarded the Nobel Prize in Chemistry for her discovery of the elements radium and polonium. The “Radium Cure Craze” Era The discovery of radium led to an era known as the “radium cure craze” or “radium mania”, during which many commonly sold items, such as hair products, toothpaste and cosmetics, promised almost magical disease cures and included radium as an ingredient. The exciting prospect of this mysterious, newly discovered radioactive substance helping to treat many of mankind’s ills was tantalizing to the public. The dangers of radiation exposure were not yet understood, and the radium business flourished. Radium was expensive at that time, and many of the products sold were fraudulently marketed as containing radium. This may have been fortunate as it limited the public’s exposure and reduced the ultimate number of radium victims. Radium Ads The New York Times published a story in 1908 that the price of radium was then $40 million per pound. ($1.4 billion today) In the early 1900s, the New York Times started publishing true stories about radium curing cancers, which only increased its mystique as a miracle cure. The Mild Radium Therapy movement was a phenomenon occurring shortly after the Curies discovered radium. Followers believed that radiation, taken in minute doses, gave a metabolic boost to the body's endocrine system and infused organs with energy. Radium Water Ceramic water dispensers with some radium blended into the walls were sold to allow users to get the benefit of the miraculous cure. Trace amounts of radium were discovered in some mineral water at spa resorts and marketed as a bathing cure-all. The “Afternoon Radium Cure” In Paris, in 1911, the “Afternoon Radium Cure” was a fad where people spent a few hours playing bridge, reading, and talking, while breathing in radium mist. There was a device in a well-appointed drawing room where oxygen was passed through a reservoir containing several thousand dollars’ worth of radium. The mist was then dispersed throughout the room by a small electric fan. A New York Times article noted that although the establishment had only been open a few days it was already “the talk of Paris”, and “it is astonishing how many society women have suddenly discovered that they are suffering from rheumatism in order not to miss the 3 to 5 o’clock Radium Tea.” Patent Medicines Patent medicines began to be marketed, such as Radol and Radithor claiming to cure a multitude of diseases. Radol was later found to have no radium in it, and banned from the marketplace, but Radithor did contain real radium and became part of a larger story. Radol Ad Radithor Public Sentiment Starts to Shift Radithor was a health drink marketed by entrepreneur William J. A. Bailey, which contained radium and was promoted as a cure for more than 150 ailments, as well as an aphrodisiac. It cost $1 a bottle (about $18.63 today), and only the affluent could afford to use it regularly. It contained distilled water with one microcurie each of two radium isotopes. He ended up selling 400,000 bottles of Radithor (worth about $7.45 million today). In 1927, a wealthy steel mogul and socialite named Eben MacBurney Byers fell while travelling by train and injured his arm. After which, to try to get pain relief, a doctor recommended he try Radithor. He liked it so much (in addition to the pain relief, there are rumors the “supposed aphrodisiac effect” was also a factor), that he began drinking two to three bottles a day for the next few years. It has been estimated he drank over 1,400 bottles. He sent cases of Radithor to business associates and girlfriends and even fed it to his racehorses. He finally quit in 1930 after he started complaining about headaches, weight loss, losing his “toned-up feeling” and teeth falling out. U.S. regulatory agencies in that era were more concerned with truth in advertising than about potential harmful effects. The Federal Trade Commission (FTC) took action against makers of patent medicines that lacked their advertised levels of radioactivity. By 1930 the FTC started investigating the issue of whether radium was actually harmful. As Mr. Byers’s case had gained significant publicity, he was asked to testify at a hearing in 1931 but was too ill to do so. An FTC lawyer sent to take a deposition at his house was horrified to find that most of Byers’s jaw had been removed and holes were forming in his skull. As radium is similar in composition to calcium, the human body cannot distinguish between them. After radium exposure, the isotope is incorporated into a person’s bones, where it produces harmful effects. Later that year the FTC shut down Radithor production. In March of 1932, Byers died of radium poisoning, and his publicized death marked the end of the radium patent medicine era. Due to his body’s radioactivity, he was buried in a lead-lined coffin. Marie Curie died of radiation-induced aplastic anemia in 1934, and due to her constant exposure to radioactive materials her body was radioactive and also had to be buried in a lead-lined coffin. Her radioactive books and possessions were stored away, possibly for thousands of years, in lead-lined containers. While some isotopes of radium have half-lives measured in days, radium-226 has a radioactive half-life of about 1,600 years. The “Radium Girls” Radium Dial Painter In 1917, women started working at the United States Radium Corporation plant in Orange, New Jersey. They used radium-infused paint to coat watch dials and military instruments so they would glow in the dark. In 1922, another factory was opened by the Radium Dial company in Ottawa, Illinois, to make watches for the general public. The women were instructed to point their paintbrush tips by licking them to get the best results, while they painted the numbers and watch hands on the dials. They were not warned about any danger but then they began to suffer severe symptoms, including anemia, deterioration of their jaw bones (known as radium jaw), and deadly cancers. Five women who had worked at the United States Radium Corporation plant sued the company in a widely publicized case, in which they were called the “Radium Girls” by the press. The case was eventually settled out of court with a payment of $10,000 ($189,000 today), a $600 yearly annuity and payment of all medical and legal expenses for each of the five women. The World, May 10, 1928 Women at the Radium Dial company then decided to sue and that case, after much litigation, including appeals going up to the U.S. Supreme Court, was won by the women. Connecticut’s Waterbury Clock Company also settled claims with 16 workers. It is thought that over 100 women died from radiation poisoning from radium clockmaking. In the 1930s, as the dangers of radium became more well-known, radium was voluntarily discontinued from consumer products such as toothpaste and cosmetics. In 1938, The U.S. Federal Food, Drug, and Cosmetic Act banned radioactive consumer products. However, radium was still used in some watches and airplane controls until the 1960s. In 1968, a formal ban on using radium in consumer watch products was implemented in the United States, and in the early 1970s its use in aircraft dials was stopped. The publicity of the “Radium Girls’” plight led to the Illinois Occupational Diseases Act, which took effect in 1936. It included provisions requiring employer coverage for industrial poisonings. It has been suggested that the Illinois Occupational Diseases Act was a steppingstone that eventually led to the creation of OSHA (Occupational Health and Safety Administration) to protect workers’ rights. Worcester Democrat and the Ledger-Enterprise, March 4, 1938 Summary The discovery of radium led to an era of unbridled enthusiasm for its ability to cure disease. The damaging effects of radiation were still mostly unknown and led to radium being marketed fraudulently as a cure for many diseases. The New York Herald, October 14, 1921 Radium was able to cure some cancers but has been replaced in modern cancer treatment by other man-made radioactive isotopes that are safer to use and easier to manufacture. As the stories of Eben Byers, the “Radium Girls”, and even Marie Curie illustrate, the unfortunate effects of radium exposure were not fully appreciated until later on. The plight of the “Radium girls” led to legislation that provided greater protection for workers. If you liked this article, you may enjoy reading The History of Nitroglycerin, an Explosive with Medical Benefits You may also find these other FibonacciMedicine articles interesting: The History of Insulin and Type 1 Diabetes. The Story of the Most “Kissed” Face in the World “Gentlemen this is no humbug” - The First Use of General Anesthesia in Surgery and the Battle for Recognition that Ensued Benjamin Franklin, Mesmerism, and the First Use of Placebos in Science Penicillin, the Accidental Antibiotic The History of Leeches in Medicine and the Era of the “Leech Mania” References This Month in Physics History, December 1898: The Curies Discover Radium. The American Physical Society. https://www.aps.org/archives/publications/apsnews/200412/history.cfm Santos LJ. Half Lives: The Unlikely History of Radium. July 4, 2020. Retrieved from: https://we-make-money-not-art.com/half-lives-the-unlikely-history-of-radium/ Cinémagazine, 14 février 1935 – https://gallica.bnf.fr/ark:/12148/bpt6k2000628h, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=97956453 Price of Radium Now Up to $40,000,000 a Pound. The New York Times. May 3, 1908. Retrieved from: https://timesmachine.nytimes.com/timesmachine/1908/05/03/issue.html RADIUM AS A CANCER CURE.; Astonishing Results Obtained in the Case of a Patient Whose Condition Apparently Was Hopeless. The New York Times. Dec. 30, 1903. Retrieved from: https://www.nytimes.com/1903/12/30/archives/radium-as-a-cancer-cure-astonishing-results-obtained-in-the-case-of.html Tells of Cancer Cures by Radium. The New York Times. January 31, 1910. https://timesmachine.nytimes.com/timesmachine/1910/01/31/105985215.html?pageNumber=8 Radium Cure a Fad of Paris Society. The New York Times December 10, 1911. Retrieved from: https://timesmachine.nytimes.com/timesmachine/1911/12/10/100342941.html?pageNumber=39 Radol. The Museum of Radium. Retrieved from: http://museumofradium.co.uk/radol/ Tontonoz M. Hot Times in “Radium Hospital”: The History of Radium Therapy at MSK. September 22, 2016. https://www.mskcc.org/news/hot-times-radium-hospital-history-radium-therapy-msk Tasch B. Marie Curie's Belongings Will Be Radioactive for Another 1,500 Years. Science Alert. 27 August 2015. Retrieved from: https://www.sciencealert.com/these-personal-effects-of-marie-curie-will-be-radioactive-for-another-1-500-years Everline T. Radium Hound. The Magazine on Medium. Feb 26, 2014. Retrieved from: https://medium.com/the-magazine/radium-hound-85d9bac2d95d Beese J. “The Radium Water Worked Fine Until His Jaw Came Off” . The Diary of an Anatomist, a Fistful of Neurons. May 9, 2018. Retrieved from: https://afistfulofneurons.com/radium-water-radithor/ “The Radium Water Worked Fine Until His Jaw Came Off.” The Wall Steet Journal. August 1990. Retrieved from: https://web.archive.org/web/20181214144013/http://case.edu/affil/MeMA/MCA/11-20/1991-Nov.pdf Radium dial painter - public domain photo - Wikimedia Commons [commons.wikimedia.org] Balkansky A. Radium Girls: Living Dead Women. Library of Congress Blogs. March 19, 2019. Retrieved from: https://blogs.loc.gov/headlinesandheroes/2019/03/radium-girls-living-dead-women/ “Five Women Doomed to Die,” The World (New York, NY), May 10, 1928, p. 14. Retrieved from: https://blogs.loc.gov/headlinesandheroes/2019/03/radium-girls-living-dead-women/ “Hear Case of Dying Woman,” Worcester Democrat and the Ledger-Enterprise (Pocomoke City, MD), March 4, 1938, p. 9. Retrieved from: https://blogs.loc.gov/headlinesandheroes/2019/03/radium-girls-living-dead-women/ “Radium to Extend Life to 100 Years,” The New York Herald, October 14, 1921, p. 1. Retrieved from: https://blogs.loc.gov/headlinesandheroes/2019/03/radium-girls-living-dead-women/ Morgan Kate. The Radium Girls' Dark Story Still Glows with Death and Deceit. Updated: Jun 7, 2024. https://history.howstuffworks.com/historical-events/radium-girls.htm Friedman J. How the Radium Girls Forced Workplace Safety Reforms. History. Last Updated: August 11, 2025. Retrieved from: https://www.history.com/articles/radium-girls-workplace-safety