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1942, Europe. Soldiers find a boy surviving alone in the woods. They make him a member of Hitler's army. But what no one would know for decades, he was Jewish. Could a story so unbelievable be true? I'm Dan Goldberg. I'm from CBC's Personally. Toy Soldier. Available now wherever you get your podcasts. This is a CBC Podcast.
Hi, I'm Dr. Brian Goldman. Welcome to The Dose. If you're on TikTok, you may have noticed a number of influencers showing off blue tongues, maybe even blue urine. The
The reason, methylene blue, which is a chemical originally used as a dye for textiles. Now, it is also a bona fide treatment for a rare medical condition called methemoglobinemia. But lately, it's being touted as yet another miracle compound for everything from boosting concentration to preventing Alzheimer's. So this week, we're asking, what do we know about methylene blue? Hi, Joe. Welcome to The Dose. Hi, Brian. Thanks for having me.
So, Joe, how do you find out about topics like methylene blue? You must watch a lot of TikToks. Actually, I don't, but I have about a thousand students in my class who do. So I get alerted to just about everything that is on there. And I've been told about methylene blue several times this past year. But I have actually been interested in this fascinating compound since 1975, believe it or not.
Way back in the middle 70s, with a colleague of mine, we put together a chemistry magic show. And one of the demonstrations that we did is called the shaking dye demonstration. The way that this works is that methylene blue actually exists in two different possible states, the so-called oxidized and the reduced state. And one state it is blue and the other state is colorless. So when there's plenty of oxygen around, then it turns blue. In the absence of oxygen, it's colorless.
So we start out by taking methylene blue, turning it colorless by adding glucose that converts it into a color stage. And then when you shake it, the shaking process exposes it to the air. So then it turns blue. Joe, you are clearly the right person to talk to about this subject. But before we begin, can you give us a hi, my name is, tell us what you do and where you do it. Hi, I'm Joe Schwartz. I'm a professor of chemistry at McGill University in Montreal.
And I also direct McGill's Office for Science and Society, where we have a mandate to separate sense from nonsense and distinguish myth from fact. So what prompted you to write about methylene blue in your Montreal Gazette column at this particular moment? What prompted me was being made aware that Robert Kennedy Jr. was seen in a TikTok video putting a squirt of a blue liquid into a glass of water that presumably he was going to
There was all sorts of conjecture and social media about what he was doing. But to anyone who knows anything about chemistry, you look at that video and it's very clear that he's squirting methylene blue into the glass. It has a very distinct color and the bottle has a very distinct shape. That's the small bottle that methylene blue comes in.
And then, of course, there was the question of what on earth is he doing? So that's really what prompted me to write the column. You know, I had interesting history with methylene blue. So I was particularly in tune with looking into Robert Kennedy's antics in detail. So before we get to the claims made on social media, what is methylene blue and how did it become a medical treatment?
So, methylene blue originally was synthesized in the late 1800s as a dye for fabrics. That's not really the most fascinating part of the story. The most interesting part is how it got into medical science. And for that, we go back to the late 1800s when it was found that
that some of these synthetic dyes, when you put them on a microscope slide that had various microbes on it, the dyes would preferentially color in the microbes. This was particularly noteworthy with methylene blue because it colored in the parasite that is responsible for malaria.
And then possibility arose that, you know, if this particular dye is so specific that it taints only the parasite that causes malaria, maybe it does something else to that parasite as well. And indeed it did. Not only did it color it, but it actually killed it. So methylene blue turned out to be the first ever treatment for malaria.
It competed with quinine, but it was much cheaper to produce than extracting the bark of the cinchona tree, which is what you had to do for quinine.
then of course what chemists try to do is improve on the activity. So by playing around with the molecular structure, sort of like molecular roulette, they were able to change the structure of the molecule eventually into chloroquine, which is still widely used today to treat malaria. So methylene blue has this fascinating history of being linked on one hand to an accidental discovery,
from where it emerged as a treatment for malaria. For ER physicians like me, as well as toxicologists, methylene blue is still on the books as a treatment for a rare blood condition called methemoglobinemia. For lay people, what is that?
My daughter is an emergency physician too. I just asked her yesterday if she had ever had to use methylene blue for methemoglobinia, and she hasn't, but she's only been practicing 15 years, so maybe there's still time for this to come up. But methemoglobinia is a condition whereby the red blood cells' ability to bind to oxygen is impaired. Red blood cells, of course, are the vehicle by which oxygen is transported around the system.
and the active molecule is hemoglobin. Hemoglobin has an ion of iron in the plus two state embedded in the middle of the molecule, and it is to that ion of iron that oxygen binds. However, if that ion loses an electron and goes from what we call a ferrous to a ferric state, a higher oxidation state, it no longer can bind oxygen,
And the hemoglobin changes then into what we call methemoglobin. And therefore, methemoglobinemia is a condition whereby the blood doesn't transport enough oxygen and leads to anemia. Now, fascinatingly, it turns out that methylene blue is an antidote to this because when you administer this to the patient,
actually in the body, it changes into the colorless form that I originally talked about in my shaking eye demonstration. And that colorless form has the ability to donate an electron to the ferric ion, converting it back to ferrous, and the oxygen carrying ability of the molecule is restored. So it is really a fascinating intervention for this very, very rare condition.
And it arises usually due to toxicity by nitrites. So it's a far cry from methemoglobinemia to some of the so-called benefits that are being touted on TikTok these days, preventing Alzheimer's, improving cognition, improving mood. Any idea where people might be getting these ideas from?
Yes. And actually, the Alzheimer's connection has been known now for, I'd say, four or five years. A Scottish physician actually first tried to use methylene blue as a stain on dissected Alzheimer's brains. As you know, the classic sign of Alzheimer's disease are these tangled proteins in the brain called tau proteins. And when you want to look at these under a microscope, again, you want to stain them.
It turns out that methylene blue was not only able to visualize and stain those tangled proteins that characterize Alzheimer's disease, but amazingly, under the microscope, as they were watching, it actually untangled those proteins, which of course suggested that this could be a possible treatment for Alzheimer's disease. So that was a springboard for research.
Well, it turned out that giving methylene blue orally to patients did nothing in terms of Alzheimer's disease. So what is it then you try to do? And synthetic chemists, of course, go to work and once again try to modify the structure of the molecule to see if you can find an improved version.
In this case, they did do a little molecular roulette and they came up with a molecule that is similar to methylene blue. In fact, it is made from methylene blue called LMTX. And that showed some interesting possibilities in animal studies in terms of untangling these tau proteins. There is no substantial clinical data yet available. There have been a couple of pilot studies on humans where
where it seems that their deterioration in terms of Alzheimer's was slowed down somewhat. It's sort of optimistic, but we need a lot more work there. But what has to be pointed out is that this was a derivative of methylene blue that was used, not methylene blue itself. Of course, that got lost in the social media translation of the scientific research, as very often happens.
And all of a sudden, methylene blue became the magical treatment for Alzheimer's disease. I'm Sarah Trelevan, and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who's faking pregnancies. I started like warning everybody.
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For people who are impacted by Alzheimer's disease, those early lab studies might seem encouraging to them. So what's the harm in taking it?
I don't think that there's any harm. I think, you know, you can see some exciting colors in your urine, but I don't know of any benefit. And as you know, when it comes to any kind of medical intervention, what we always look for is the risk-benefit ratio, right? Or the number needed to treat. Well, I mean, in this case, there's no benefit that we know of.
So why take any kind of risk? And I can't say that there's no long-term risk because no one has ever studied this over the long term. I mean, obviously, the only time you get to know anything about chronic use of a substance is by actually subjecting it to trials that last a long time, which has not been done.
I think there's no acute risk. Nobody thinks that if you do the blue tongue experiment that there's going to be any kind of catastrophe because we would know that enough people have tried this and nothing really bad has happened. But that doesn't mean that it doesn't have any consequence over the long term. On the other hand, I don't think we really have to worry about long term use because I don't think people are going to use it for long term.
They might try it for some reason and discover that it doesn't work and they'll give it up. So I don't think we have to worry about an epidemic of long-term uses of methylene blue that eventually culminates in some kind of side effect.
I don't think that's a realistic expectation. This is one of those things that rides the wave of the internet for a short time. And then like all the other magical remedies that have gone before, it will disappear and something else will take its place.
There is one red flag about self-medicating with methylene blue that I think we should highlight here. And that is for the people, the many people who are taking antidepressants that raise serotonin levels. What can you tell us about that? That is a real concern. Selective serotonin reuptake inhibitors or so-called SSRIs are very widely used antidepressants because they are effective and
Serotonin is a naturally occurring neurotransmitter in the body and it's linked with improved mood. It turns out that we have an enzyme in our body called monoamine oxidase, which selectively will degrade serotonin. And methylene blue happens to be an inhibitor of this enzyme. And because it inhibits the enzyme, it means that serotonin levels in the body will rise to abnormal levels.
And that can result in something called serotonin syndrome, which has a number of symptoms from tachycardia to hallucinations. Certainly not something that you want to experience, but that is very specific to someone who is taking SSRIs. So no, for them, absolutely methylene blue would be contraindicated. Have you by any chance seen a case of serotonin syndrome secondary to methylene blue?
Not to methylene blue, but I've certainly seen serotonin syndrome recently. And I can tell you that this patient required all the sedative medications in the medical armamentarium to control the agitation, which was extreme. Well, that's a typical serotonin syndrome and nobody wants to get into that.
So anyone who is taking an SSRI, absolutely methylene blue is not something to play around with. And in our society, in North America, the prevalence of people, of North Americans who are taking SSRIs must be huge enough
that this could potentially be an issue. It could be, especially people who suffer from depression. They are likely to try any sort of remedy that they think has a possibility. Although so far, I mean, of all the claims that I've seen about methylene blue, I've not seen a claim that it's an antidepressant. So I don't know why someone would try that. But someone who's depressed may be trying it for some other reason.
Last question I want to ask you, we've been doing a lot of debunking this season on the dose. What do you think is behind the proliferation of dubious health information that is circulating on TikTok and other social media? For one, of course, it's the amazing virtually exponential growth of the social media.
And, you know, I mean, I see this in my students. I watch them, you know, they sit in the hallway outside my office. They're constantly on their phone and they're not reviewing their notes. They're there on TikTok or they're on Instagram.
They're getting their information mostly from social media, from soundbites, because everything there is a minute, minute and a half. So they're getting wrong information because that minute, a minute and a half generally contains a lot of false information because that is what spreads. You know, there are a lot of social media influencers these days. Some of them are fine, who have expertise in the area, but
But many of them are sort of self-proclaimed experts who have done, quote, their own research and then put out the information. They don't understand the underlying science and they will make mountains out of molehills. And unfortunately, this is just the way things are working these days. Social media has taken over information spread.
And unfortunately, we now have this situation where people are very suspicious of science.
And a lot of this, of course, has happened because of the politicians. When you have someone like Robert Kennedy Jr. at the head of the NIH in the U.S., which is an extremely scary situation, you have someone who has zero scientific background and who now wields this unbelievable power and who basically doesn't believe in vaccines, who doesn't understand the
the difference between artificial and natural. He just doesn't understand how the scientific world works, and yet he has this ability to spread information. People have become suspicious of science, in many cases because I think they overestimate what science is able to do. We have an atmosphere now in politics which is dominated by lies, and unfortunately, science is suffering.
Well, Joe Schwartz, just as you know from your magic trick days, how to turn methylene blue clear, you have provided clarity on the science behind methylene blue and why it is not.
a treatment for all of these conditions like Alzheimer's and mood disorders and is not a cure for aging. So I want to thank you for coming on The Dose to talk about this important subject. Well, thanks very much, Brian. Joe Schwartz is a professor of chemistry at McGill University and director of the university's Office for Science and Society.
Here's your dose of smart advice. Methylene blue was originally synthesized as a textile dye back in the 19th century. Before the century was out, doctors began looking at the dye for its medical applications. It was found to be useful in surgical procedures and for identifying and targeting cancer cells. In the pre-antibiotic era, methylene blue was used to treat urinary tract infections and was also found to reduce the severity of symptoms and speed up recovery in people with malaria.
It still plays a role in modern medicine. For instance, we use it to treat a rare blood disorder called methemoglobinemia. Studies in the laboratory have suggested that the dye possesses antioxidant and anti-inflammatory properties. It has also been shown to support the growth and function of mitochondria, which are essential for providing energy for cells in the human body.
Researchers have explored the potential of a derivative of methylene blue in Alzheimer's disease, Parkinson's disease, depression and other mental health disorders. That derivative may have some promise, but studies in humans have not shown that the dye itself is an effective treatment for any of these conditions.
That hasn't stopped proponents from claiming that methylene blue significantly improves memory, cognition, energy, or sleep, or that it slows the aging process. Clinical studies have not demonstrated any of these so-called benefits. You should not self-medicate with methylene blue based on any of these claims.
The dye causes side effects such as headache, nausea and diarrhea. It can also cause anaphylaxis in people who are allergic to the dye. People who take antidepressants that raise the level of serotonin should never take methylene blue. The combination causes serotonin syndrome, a potentially lethal condition whose symptoms include agitation, rapid heartbeat, hallucinations and lack of muscle coordination.
Until there's strong evidence from clinical studies, no one should be taking methylene blue as a dietary supplement. If you have topics you'd like discussed or questions answered, our email address is thedoseatcbc.ca. If you liked this episode, please give us a rating and review wherever you listen. This edition of The Dose was produced by Samir Chhabra and Brandi Weichle. Our senior producer is Colleen Ross. The Dose wants you to be better informed about your health. If you're looking for medical advice, see your healthcare provider. I'm Dr. Brian Goldman. Until your next dose...
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