Ask the Doctors

Hello, dear readers, and welcome to the monthly letters column. We are well into the third month of the new year, and for some of us -- the data say it’s probably most of us -- the resolutions we made on Jan. 1 have already fallen by the wayside. We have been hearing from readers asking for encouragement, and have also had readers sharing tips that are helping them stay on course. We’ll have a resolution reset column coming soon. And now, onward to the mail.

-- A column about how research shows the gut microbiome gradually recovers after the use of antibiotics has caused a reader a bit of confusion. “This column says that probiotics can delay recovery after antibiotics, but it also says taking fermented foods with live cultures is helpful,” he wrote. “Are these live cultures not considered probiotics? Please clarify what is meant by ‘probiotics.’”

When you take antibiotics, both the pathogen that made you sick and the beneficial bacteria living in the gut are killed off. After treatment, it takes a month or two for the microbial colonies of the gut microbiome to be restored. Probiotic supplements, which you can buy at drug and grocery stores, and fermented foods both contain probiotics. However, supplements contain high amounts of a limited variety of microbes, and because the gut is basically a clean slate after antibiotic treatment, taking a supplement can lead to an off-balance colonization of the gut. Researchers have found that this actually slows down the natural recolonization of the gut. Fermented foods also contain probiotics, but in a wider variety and smaller numbers. Eating them creates a gentler and more natural path to recolonizing the gut with your unique microbial profile.

-- We get a lot of letters about toenail fungus, a common infection that is notoriously difficult to cure. We recently heard from a reader who has been struggling with it for several months. “Last fall, I started getting a yellow and crumbling nail on the big toe of my right foot. I used Vicks VapoRub every day and soaked with tea tree oil, and it went away,” he wrote. “About a month after I stopped treating it, the yellow color started coming back. Why did that happen?”

Unfortunately, the scenario described is quite common. It is possible to manage a toenail fungus infection with topical treatments so that the appearance of the nail improves or even returns to normal. However, the chances the infection has been eradicated are small. Topical treatments can’t adequately penetrate the tough nail to completely kill off the fungus. Oral anti-fungal medications, while more effective, are not always completely successful. If you do wish to try that route, your doctor can prescribe the medication, explain the possible side effects and guide you through the treatment.

We are hearing from a lot of new readers, so it’s time for a reminder that we can’t look at medical records, comment on medications or treatments or offer a second opinion. And, as always, thank you for your letters. We love hearing from you.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: We live in the fire zone in Altadena, California. After the evacuations ended, we came home, and now my throat is constantly sore. There’s no smoke smell, but my husband says the air can still be unhealthy. Why would that be? The air quality numbers are good, so it’s confusing.

Dear Reader: We are near one of the fire zones in Southern California and are sadly familiar with the ongoing aftermath. Over the course of 24 days, fire tore through 60 square miles, destroyed more than 16,000 homes and businesses and damaged thousands more. At least 29 people died, and many more, including rescue workers, were injured. Now the flames are out, but the health dangers continue. This is due to fine particulates released by the fires. We touched on this in a column last month, but your question allows a more detailed look at the issue.

Particulates are the microscopic bits of burned materials that become suspended in wildfire smoke. Their extremely small size means they can be inhaled into the deepest recesses of the lungs. These are the alveoli, which are minute air sacs clustered at the ends of the bronchial tubes. The delicate membranes of these air sacs are where the oxygen we breathe in enters the bloodstream and the carbon dioxide produced by metabolic processes exits. To get a sense of just how small alveoli are, an adult has about 240 million in each lung.

The particulates released in urban fires differ from those generated by forest fires. In urban fires, particulates come from the vast array of manmade materials found in the built environment. They include building materials, appliances, electronics, plastics, vehicles, batteries, gasoline, propane, paints, stains and solvents, cleaning products, pesticides, carpets, wood and tile floors and furnishings. As these burn, dangerous substances are released into the air. They include heavy metals such as lead, zinc and chromium; toxic chemicals such as formaldehyde, benzene, ethylene glycol-toluene, chlorine and asbestos from older homes; and an array of carcinogens known as polycyclic aromatic hydrocarbons, or PAHs.

The AQI, or air quality index, warns about common pollutants such as ozone, carbon monoxide, sulfur dioxide and nitrogen dioxide. However, many of the particulates generated in urban fires are outside of its scope. That’s the disconnect -- and the ongoing health risks -- that your husband is referencing. Wildfire particulates mix with the ash and soot that fall to the ground. When blown by wind or disturbed during debris removal, they can once again become airborne. Updated air quality specific to wildfire particulates is available at fire.airnow.gov.

People returning to burn areas are advised to take precautions for several months. Keep windows and doors closed whenever there’s a smoky smell. Use an appropriately sized air purifier that has a HEPA filter, and change the filter often. When it’s windy, and when debris removal occurs, use an N95 mask while outdoors.

Wildfire particulates are known to ramp up inflammation throughout the respiratory tract. If the throat irritation you are experiencing doesn’t clear up, please check in with your health care provider.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I’m trying to lose the 18 pounds I have gained since the pandemic. It has been hard enough that I’m wondering about Ozempic. How does that work? I’m also hearing about people doing Ozempic microdosing. Do you know what that is and why you would do it?

Dear Reader: Ozempic is a drug that helps manage blood glucose levels in people living with Type 2 diabetes. It works by mimicking a hormone called glucagon-like peptide-1, or GLP-1, which stimulates the body’s production of insulin. This hormone also puts the brakes on both appetite and digestion, which is how Ozempic became popular as an aid for weight loss. Because this is an off-label use, insurance may not cover the weekly injections, which can be costly. And like many medications, Ozempic can cause side effects. These include feeling nauseated, vomiting, diarrhea, upset stomach, headache, dizziness and a complete loss of appetite. Also of concern is the loss of lean muscle mass that can occur during weight loss on the drug.

The cost and possible side effects of Ozempic appear to have led to yet another off-label use. That’s the microdosing you are asking about. For those who are not familiar, microdosing is the act of taking a fraction of the recommended dose of a drug. The practice dates back to the early 1990s, when it was used to safely study how a newly developed drug is absorbed, used and eliminated by the body. Microdosing later became popular in conjunction with psychedelics. Now, thanks to the reach of social media, microdosing Ozempic in order to reap its benefits is becoming increasingly popular.

The thinking is that a smaller amount of the drug can still trigger its effects, but on a more modest scale. For many people adopting the practice, the goal is to curb hunger just enough to make a weight-loss regimen easier to sustain. Smaller doses also lessen the cost of the drug, and may help avoid side effects. The practice involves using just a portion of the weekly dose.

Needless to say, because this is an experimental and unauthorized approach, there are no microdosing guidelines. There is also no reliable information about the safety of this practice, or the possible effects, either good or bad.

Interestingly, some people who have taken to microdosing Ozempic are in search of the unexpected side benefits that have emerged. Clinical trials of GLP-1 drugs have found they can lower inflammation, decrease the risk of cardiovascular and kidney disease and may help cut cravings for alcohol and tobacco. Newer research is looking at how the anti-inflammatory effects of these drugs might be helpful to people living with neurodegenerative diseases, such as Alzheimer’s and Parkinson’s.

If you are considering using a GLP-1 drug to aid in your weight-loss goal, it is important to talk it over with your health care provider. They will fully explain the benefits, as well as the possible side effects. If you move forward with this approach and side effects do occur, your physician can help you manage them.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)