Did you know you have more cells living in your gut than you have cells that make up your body? This population is called your gut microbiome, and Johns Hopkins dietician Ashley Greenwald says its health underlies your health.

Greenwald: Bacteria and yeast in the stomach are really involved in immune competence and regulation of inflammation. When these are off it’s called dysbiosis. Dysbiosis of the gut has been linked to obesity in diabetes, certain autoimmune diseases, asthma and allergies, inflammatory bowel disease. Your gut microbiome could even be influenced starting as young as delivery as an infant, whether you were vaginal or C-section, exposure to antibiotics, your hygiene, certain infections and stress.  :30

Greenwald says it’s known that diet has a profound influence on the gut microbiome, so if you’re experiencing any chronic disease with an inflammation component it may be worth exploring how you can modify it. At Johns Hopkins, I’m Elizabeth Tracey.


Maybe you’ve noticed that each time you eat a certain food, your gut seems unhappy. If you’re intolerant to certain foods or substances added to it, this could be a source of chronic inflammation and pain. That’s according to Ashley Greenwald, a dietician at Johns Hopkins.

Greenwald: Food intolerance is a trigger that can influence inflammation. It happens within the gut, and it’s the result of an enzyme deficiency or a sensitivity to a certain additive. Or it can even naturally occur in food. Intolerances such as lactose intolerance or a gluten sensitivity, tyromine, MSG, food dyes and additives, are something else that can trigger chronic inflammation as well as exacerbate certain symptoms.  :25

Greenwald says getting your arms around this starts with a food diary, where you record what you eat and how you are reacting to it. Over time certain patterns may emerge and you can identify your triggers. A gastroenterologist and a dietician can help. At Johns Hopkins, I’m Elizabeth Tracey.


Chronic pain is often the result of inflammation, and Ashley Greenwald, a dietician at Johns Hopkins, says the inflammation itself may be the result of conditions like obesity.

Greenwald: There has been a plethora of research that found that people with obesity, especially in the middle section, abdominal fat, definitely have higher inflammatory potential and increased risk for developing diabetes, heart disease, certain cancers, digestive problems, sleep apnea, and even in current research they find more severe Covid symptoms. That’s in the middle fat, which is more dangerous than the subcutaneous fat, which is that fat that kind of sits on the hip area, it’s a little looser, there’s a little bit of shake to it, versus the visceral abdominal fat, which is fat that’s surrounding the organs inside.  :32

Greenwald notes an easy way to determine if you have abdominal obesity is by measuring your waist circumference, a method increasingly employed in primary care practices. At Johns Hopkins, I’m Elizabeth Tracey.


Biosimilars are a class of drugs that are essentially generic versions of others used to treat cancer, and if you’re undergoing cancer treatment you may have concerns about whether they’re really as effective. Rest easy, says William Nelson, director of the Kimmel Cancer Center at Johns Hopkins.

Nelson: They conducted an analysis of the clinical trials that were used to support the idea that these were equally effective. The biosimilar clinical trials ultimately ended up with 12,000 participants. The trials of the biosimilars were more likely to be larger, more likely to be double blinded. I think what it does tell you is the evidence that these things are equivalent in their effectiveness and their side effect profile is very strong. It’s based on a large number of people in very tightly done clinical trials.  :31

Nelson says biosimilars are less expensive than their counterparts and may lessen the financial burden of cancer treatment for some. At Johns Hopkins, I’m Elizabeth Tracey.


If you’re Hispanic, you’re more likely to respond to health promotion programs that are tailored to you, using language that resonates and is meaningful to you. While that may seem obvious, a new study demonstrates clearly just how effective it can be when it comes to colorectal cancer screening. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, reviews the data.

Nelson: This built what they called the culturally tailored patient navigation program. they were able to enroll 773 folks, 85% of these folks ended up with a colonoscopy. Only about 9% of them canceled the appointments that were established, and about 6% failed to show up. Logistics is a significant issue whether it’s getting them to the screening, worries about the cost, the cost of missing a day of work, all these kinds of things. If these can be managed I think we can get more proactive healthcare maneuvers in place.  :31

Nelson notes that development of such programs is expensive, but the payoff is clear. At Johns Hopkins, I’m Elizabeth Tracey.


Your DNA is constantly being modified throughout your lifetime, and one way involves adding or taking away chemical groups called methyl groups. These modifications are known as epigenetics, and two new studies point to using them to find cancers of the breast and ovary in pap smears. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the studies.

Nelson: Is this a record, in the genome, of certain cells and certain tissues, of the life someone lived. Whether you were a smoker, whether you were overweight, these things that we know are associated with cancer risk. And in this case it’s a giant clue that has something to do with progesterone action. They built another classifier associated with ovarian cancer. The marks that they saw suggested that some of these marks are the same kind of marks you see in the fallopian tubes of women who are carriers of increased risk for ovarian cancer, BRCA1 andf BRCA2.  :32

Nelson predicts that this strategy will become a practical means of cancer screening. At Johns Hopkins, I’m Elizabeth Tracey.


When a woman has a Pap smear cells are collected from the uterine cervix to check for the presence of cancer. Now two new studies demonstrate that using this sample, cancers of the breast and ovary may also be identified. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: The DNA carries marks which tell which cells what genes are available for use. So different genes are used in cells in the eye than are used in cells in the kneecap for instance so these marks tell the cells which genes can be used. So this was a test developed by looking at the marks. They found a significant correlation between looking at marks in cells recovered by Pap smear basically and women who had breast cancer.  :28

These marks on the DNA are called methylation, where a chemical group known as a methyl group is added in certain locations. The study of these methyl groups is known as epigenetics, and may one day simplify and advance cancer detection. At Johns Hopkins, I’m Elizabeth Tracey.