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Most people think about their health when something goes wrong.
Next Phase Human is for everyone who wants to start thinking about it before that moment arrives.
Hosted by Dr. Sandhu — a cardiologist with a focus on prevention, longevity, and whole-body wellness — this podcast brings together physicians, researchers, and wellness professionals for honest, evidence-based conversations about the topics that actually move the needle on your long-term health.
Each episode covers the intersection of cardiovascular wellness, modern medicine, lifestyle optimization, and human performance — translated into practical, approachable conversations for professionals, business owners, and anyone serious about living better longer.Topics include heart health, metabolic health, sleep, stress, nutrition, longevity diagnostics, wearable technology, recovery, burnout, and the future of preventative care.
This is not clickbait wellness. This is a forward-thinking physician who believes the best healthcare happens before you need it.
New episodes weekly.
This is something that comes up. Raw milk is healthier than
pasteurized milk, true or false?
Not in my book.
You can get brucella and can die from raw milk, and we see that.
Welcome to Next Phase Human, where medicine meets performance and science
meets longevity.
I'm your host, Dr Rasham Sandhu, and with me today is Dr Rasha
Quran for a second part of our conversation that we started about infectious
disease, the life that we live with microbes, microbiome.
So if you want to hear more about the microbiome and
COVID-19 and antibiotics in kids, do listen to the previous
episode. But today, we carry on our conversation starting from Valley fever.
And
just for people who are joining us, Dr Quran
is an infectious disease specialist at Kern Medical Center and UCLA and
is the director of infectious disease fellowship.
Thank you, Dr Quran, for joining.
Thank you. Thank you for inviting me.
So
what exactly is Valley fever? There's a lot of talk.
These spores, they lay in the dust. They are living amongst us.
And
what is it? How does it impact us? How dangerous it is?
Valley fever is an infection caused by a fungus
that lives in the soil of the central San Joaquin Valley.
Think of it as, if you've seen the compost heap and you see mold
growing in the compost heap, molds grow in the dirt, and they
compost and
decompose organic matter.
Now, what's interesting about this fungus, along
with other fungi, we call the dimorphic fungi, is
that it acquired the ability to also
grow or infect animals in addition to plant matter.
And so
it lives in the soil, and when it gets hot and
dry and windy, the wind picks it up, and we can breathe it,
and it can cause an infection that manifests
as the flu or pneumonia. It's usually a pneumonia
or no symptoms. So out of 100 people who get the infection, 60%
will have no symptoms, and 40% will develop the symptoms
that look like the flu or pneumonia.
And out of those, the majority will
be fine. Some of them will require treatment, some of them will not require
treatment, but about 1% to 5% will end up with
severe complications.
Who should worry?
Everybody who breathes in the Central Valley or the areas where this
fungus exists.
Is it only in Central Valley?
In California, we have it in the Central Valley,
and sometimes it spills over if there's dust storm or
an earthquake, for example. It spilled over to the north areas in Los
Angeles.
But really, the Central Valley and then Arizona and other
states.
So it is there in Arizona, Texas, Nevada.
You see cases there also?
Yes.
Arizona and California are--
They used to be similar in numbers.
I think we exceeded them last year, but those are the two hotspots,
Arizona-
So mostly it's a disease of desert Southwest.
Yes. Arid areas, arid climates where it rains and then it gets dry.
And then Central and South America, some countries have it too.
And is there a particular kind of person who's more likely to get in trouble with
this?
So there are two questions. Who's more likely to get
infected, and then who's more likely to get severe
disease once infected? And who's more likely to get infected
depends on the exposure, who works outside and
who is exposed to the outside more.
But who's more likely to
go
into severe stage of the disease? That is
an interesting
thing
to study because some people
are susceptible for severe disease because their immune system is weak and they're
taking steroids or chemotherapy or transplantation.
But others,
it's just genetic predisposition, and
really not all of those genetic differences are known to
this day.
They run
differently in different ancestry,
so based on the ethnic background or race, actually.
So we're actively now studying those differences, and we're sending
our patients' blood to UCLA for genetic analysis and
DNA sequencing and all that to figure out what are
those genetic differences. If they were all genetic, some
might be epigenetic, but we're working on figuring that out.
So as a parent, kids play outside all the time.
Should parents worry about it, and what can they do?
If it's dusty, if the wind is dusty or windy
outside, I would bring the kids inside.
Okay.
I mean, that's the highest-
So that's the single most-
Yes. I wouldn't have any-
... effective intervention.
Yeah. The soil that's higher in
risk is the soil that hasn't been disturbed for a long time.
It's not the soil that's been tilled every year, like the agricultural areas.
That soil is usually not
containing the fungus. But the wind can bring it from 70 miles
away. So yeah, if it's windy or dusty
or playing or working in areas
with the soil and getting it disturbed, that puts someone
at high risk.
And is it becoming more common compared to before?
It's becoming more common.
Why is that?
In part because people are moving here.
The population is growing, and people are moving into the area.
It's more affordable than other parts of California.
But also because of other factors such as climate changes
And
increased temperatures, et cetera,
and more
advancement of urban structures into
new areas all the time, it's more common.
So as a patient,
or for any healthcare provider who's listening,
when should they think about a patient having valley fever? When should they test?
So anyone who lives in areas where valley fever is common,
and in California, that's the Central Valley.
Anyone who has pneumonia, and by pneumonia, I mean the
symptoms of fever, cough, chest pain, headache, shortness of
breath,
plus minus rash, should think valley fever.
And whether it's a
provider or a patient,
community-acquired pneumonia in this area, a third of it
approximately is valley fever. And so the question becomes,
do you test them the first time or the second time or the third time if they do
not respond to antibiotics?
And my answer is I would check them the first time.
Now, if someone does get a prescription for antibiotics and doesn't get
better, the possibility is really high that this is valley fever.
So there's really no point in giving another prescription of
antibiotics,
without testing for valley fever, at least,
to someone who didn't respond to antibiotics the first time.
And what does that test involve?
And that's tricky. So it's a blood test that can
be negative for the first eight weeks-
Oh, wow
... from symptom onset. So it's confusing.
And that's why everybody should really be familiar with valley fever
when it comes to healthcare providers.
So you want to test with the blood test.
That blood test doesn't come back immediately. It takes a week or two to come back.
But even if it's negative, that doesn't mean it's not valley fever.
And if the patient's really sick, there's no
problem in giving the patient the treatment for valley fever until the test is
repeated, and we know it's positive or negative.
So if someone is not getting better, two tests would be the minimum that you would
do eight weeks apart? Is that it?
We repeat it weekly until eight weeks have passed.
Okay. So every week you repeat it.
Yes. Until eight weeks have passed from the onset of symptoms.
So anyone who has pneumonia in these areas where valley fever is
endemic, whether that entire Southwest, let's just think US-
Mm-hmm
... desert Southwest,
should be tested, or at least it should be in the back of the mind to look for
valley fever-
Yes
... in these people.
Yes. I would test them the first time and repeat if it's still a
possibility. Like patient's not better or there's another
possibility that's been ruled in, I would repeat the testing.
What are the big misconceptions that you see, like that you hear in your office
about valley fever? You talk to someone about it, and
in terms of treatment or prevention, is there anything that we should
tell people or healthcare providers about this?
So one thing is that it's not contagious.
People cannot give it
to other people.
Another one,
for the providers, is titrating the medication. I see this all the time.
We don't titrate antibiotics like pain medicines or
corticosteroids. I see the
practitioners in the community titrating the medications up and down, and I'm
not sure where that came from, but we don't titrate
antibiotics. And then like people with valley fever
meningitis stopping the treatment because they feel better or to
see, and that can often lead to devastating consequences
that are irreversible.
People with diabetes are the ones who are high
risk for their lung problem not getting better
until they
control their blood sugar.
So, they can be on medications for a long
time, and as long as their blood sugars are not controlled,
the lung problems-
Your immune system is not helping you
... may not get better, despite the medications.
How long is the treatment?
Until the patient gets better. There's really no-
So it could be months?
Yeah. We're counting weeks and months with valley fever as opposed to
days with-
Antibiotics
... bacterial infections. So people who do require treatment, on
average, require three to six months of treatment.
We follow the blood test that is done at the public health department
closely because that test is really helpful and
accurate. So we treat until the titers
are negative, but that's different from one provider to the other.
We happen to be more
strict with it because we want
the lesser
likelihood of relapse. Valley fever can relapse.
After we stop the treatment, it can come back, and there's really no way to
guarantee that it's gone from the body for the rest of someone's life,
unfortunately.
There are no medications that kill it in a guaranteed way.
The medicine weakens it enough to allow the immune system to
control it, but not really guarantee cure from it.
So there's always a possibility that it can come back for the rest of someone's
life.
So anyone who has had valley fever, in future
illnesses should be mindful-
Yes
... that it can come back.
Yes. And that likelihood of relapse is the highest in the first two
years after the discontinuation of treatment of medications.
So we watch everyone for two years after we stop the
medicine.
Got it.
So are fungal infections becoming more of a concern than bacterial
infections now?
So valley fever aside, that's a geographic
concern. Other fungal infections
Go with immunity, so the immune system.
People with weakened immune systems are more susceptible to fungal
infections, such as yeast infections with diabetes, with
corticosteroids or cortisone treatments.
People who are on medications that lower their immune system
are susceptible for fungal infections.
And
tick-borne illnesses. So illnesses like Lyme
disease or whatnot, not common in where we live, but do you
see them increasing in general?
Yeah.
Insects
do change, and migrate,
and change with the climate and with many different factors.
So they are
changing in location and increasing.
So we talked
about a lot of infections, and
as someone who is otherwise generally healthy,
what can I do to minimize my risk? One, in general,
to protect myself of day-to-day infections, and second,
things like valley fever, if you are living or traveling in the area.
So two things. There are the communicable diseases, and
then there are the infections that we get from within our body.
Communicable diseases, you don't want to be exposed to them.
So as we said, the staph aureus infection, going
to the gym, you want to be mindful, disinfect the equipment before
sitting on it, et cetera.
There are infections you get by traveling to certain areas or being exposed to
others, like tuberculosis.
For tuberculosis,
if
someone's coughing or appears
ill, you want them to get checked out or tested and treated.
But also traveling to endemic areas for tuberculosis,
you want to be cautious.
If you have been to other areas and you got tested and you have the
infection with tuberculosis, which is what we call the positive skin test or
the positive blood test, it is a good idea to be
treated for the infection so it doesn't turn into disease later on when we
are older or weaker.
So, there's the exposure part,
for brucellosis, for example, drinking raw milk.
You can get infections that way even if you're healthy.
The sexually transmitted diseases, you want to be mindful of the
safe precautions. Injecting drugs will transfer infections.
So behaviors that put someone at a higher risk for
acquiring infection, we need to know what they are.
Now, the other types of infections, such as urinary tract
infection and pneumonia, those depend on
how strong your immune system is. And I can tell you probably
the most common
problem that weakens the immune system is high blood sugar.
And I tend to say high blood sugar, not diabetes, because people who do
have diabetes, if they control their blood sugar, they act like someone who doesn't
have diabetes. So it's the high blood sugar or
uncontrolled diabetes that
is an immunocompromised state.
So preventing that, diabetes is preventable,
a lot of the time. I'm not saying everybody.
Not all.
Yes, not all of them, for sure. But a lot of the times you can control it,
and live a healthy life,
by choosing what to eat and what not to eat.
So,
yeah, eating the right things, being active,
and avoiding risky practices,
generally speaking.
Does exercise help?
Yes. Exercise affects the immune system in a positive way,
and so it just makes us healthier.
So in twofolds at least,
the blood sugar control with exercise-
Mm-hmm
... and exercise itself will make your immune cells-
Absolutely
... work better.
Yes.
Yeah.
Any particular kind of exercise or any kind of activity should do
that?
Aerobic exercise,
what do you call it? Cardio.
Mm-hmm.
That has been associated with better
immune system.
But I think generally being active is always a good idea.
Does sleep have impact-
Yes
... on infections?
There's so much that happens when we're asleep where that regenerates
our health, and I do not claim to be an expert on that, but I
just know that
a lot of the changes that occur when we sleep are
necessary to reset our health.
Yeah. So there is data on even increased risk of cancer with poor sleep.
Mm-hmm.
So our immune cells just don't work well when we don't sleep.
Absolutely, yeah. And I believe it because how do you feel if you don't sleep for a
couple of days?
Exactly. The recovery is as important, and I think as a country, we are
under-recovered.
There's even studies on
the position of the head and the glymphatic
drainage of the brain fluids,
how it changes. So we really need to sleep and actually recline like
that.
In a reclining position.
Yeah.
We were meant to lay down and sleep.
Yes. It makes a difference. So-
Yeah, absolutely.
Mm-hmm.
Vitamin D, any evidence of that helping with infections?
I'm not aware of it, if it's there, so I don't know.
We talked a little bit on the last episode about
hormones and infections.
Can you touch up a little bit on that?
Yeah.
How that works and-
The one that affects my patients the most is urinary tract
infections in ladies who are post-menopausal.
This is one of the most
Beneficial things I have learned about
where topical treatment with the hormone
can prevent urinary tract infections.
This is way underutilized.
People don't know much about it yet.
It's now becoming more common that
patients are receiving this, but it's really,
really helpful in preventing urinary tract infections.
Do you usually recommend estrogen patches or gels topically in the vaginal area
for that?
The studies did not show the same benefit
when taking systemically. So this benefit is only
shown with topical treatment, local treatment,
and that could be because of the levels, the amount of hormone, but for now, it's
topical. So even if the lady is taking systemic
estrogen,
she still might need to take the topical one.
Got it.
Are there any supplements that you routinely recommend
or tell people to avoid?
Other than just eating? No. Supplements, I
do not.
Avoid, I would say, I will avoid supplements
unless I know that they are good for me.
I'm not a supplement person, so I focus on eating healthy food.
Eating healthy, living good-
Yes
... exercise.
Yes. And I'm not saying there are no good supplements out there, but I just have
not dived into them or found something that I want to take.
So we'll go through a few quick myth or fact, true or false,
and just want to get your take on these.
Mm-hmm.
So, do antibiotics help viral infections?
No.
So that's a hard no.
That's a hard no. Antibacterials do not help viral
infections.
So that's another one you hear a lot.
You should always finish every antibiotic prescription exactly as prescribed.
Is there truth to it?
There's truth to it, yes. Although, when
it's prescribed, as a patient, yes, take the prescribed
antibiotic as taken because what other guidance will
you take? I mean-
A lot of times I hear people, "Okay, I got better, and I stopped it." Is there a
downside to it?
It's probably not really wrong,
because we're now inching towards using less and
less. So we're studying shorter courses, and the
shorter courses that we can get away with that work, we will take in the medical
community. So, I think once patients feel better, it's
probably not very harmful to stop the antibiotic.
But at this time, what other guidance can I give the patient?
And so I would take it until-
So if you stop it, you're kind of in unchartered territory.
We just don't know enough yet.
Yeah. Because again, without the medical
practitioner knowing what they're looking at, I would say take it
all.
Hand sanitizer or soap and water?
I would go for soap and water-
Why is that?
... if it's available. It feels cleaner, right? So it's cleaner.
No, so soap and water will remove the residue
of solid material on the hands as well as remove the germs.
The sanitizer will kill the germs, not 100% of them, but for the
most part, yes, it will.
But all the precipitated residues, solid residues, will
continue to accumulate. So, there's a number of times you can use the
sanitizer before you have to wash again.
If they're both available, I like to go for the hand washing, but the sanitizer is
good.
This is something that comes up. Raw milk is healthier than
pasteurized milk. True or false?
Not in my book.
You can get brucella and can die from raw milk, and we see that.
I see patients-
What does brucella do? What does it look like?
It's an infection. So, it's a bacteria that lives or
infects
cattle, and it can go out in their milk if they're infected,
and
sometimes it's hard to tell if they're infected or not.
And so, it's inevitable that sometimes it gets in the milk,
and if people drink it, they can get brucellosis.
Brucellosis is an infection that manifests as fever of unknown
origin or meningitis or endocarditis,
infection of the heart.
So it's a pretty serious infection.
Yes.
Can it be treated?
It can be treated if it's diagnosed early and
thought about, because it doesn't grow in the cultures that we do that
easily.
So it can be missed also.
You have to be looking for it.
Yeah. It can be missed easily.
Everyone should take probiotics. True or false?
To me, no. If someone's healthy, I don't see a reason
to take probiotics, if there's no reason
to.
Does sugar impact your immune system?
Yes.
Big time?
Especially fructose, yes.
Zinc, does it prevent colds?
Yeah, there's data for that. So-
So, for someone who is coming down with a cold-
There's, yes
... is there a reason to use it?
There's data that it can prevent
colds, yes. And it came out in a topical form once,
and then they took it off the market because of loss of
smell
side effects, but there's now the lozenges, and there's data
behind them.
So, we talked about sugar impacting immune system.
So, does keto diet help with infections?
This is interesting. So,
I was looking into UTI treatment once, and I don't know why
I went to papers that were published before antibiotics
were discovered
And so,
I found a bunch of them that talk about treating
UTIs with ketogenic diet. And so apparently that was a
thing, and that was the treatment.
And it worked.
And it worked. And the way they discovered that was some
microbiologist noted in the lab that the urine sample
from patients who are on the ketogenic diet to treat
epilepsy, which was the treatment for epilepsy at that time,
doesn't overgrow with molds and bacteria in the lab when it's left on the shelf
for too long. And all the other ones do. That's just natural.
They start growing stuff. And so they
started using the ketogenic diet to treat UTIs at that time.
This
ended when antibiotics became available and more convenient.
But that really goes back to how
what we eat and what we do affects our immune system, and
affects our susceptibility to infections.
So interesting. Yeah. I knew about the ketogenic diet to treat
epilepsy back in the day.
Mm-hmm.
But I didn't know about the UTI treatment-
Yeah
... with ketogenic diet.
Oh, that was a nice surprise. It was-
Yeah
... it was a bunch of papers, not just one or two.
So it was apparently working for them.
Is natural immunity always better than vaccine-induced?
It's powerful immunity, usually.
But again, you're gambling with
the infection that you're gonna get, and the possibility that the infection
might harm more than the benefit.
But if you have it-
But if you survive, it's usually more-
Robust
... robust. Yes.
Should fever always be treated immediately?
Not all the time.
So if it's a flu, if it's a cold, if it's a viral
infection. And by treated, it depends on what you mean by
treated.
Like antibiotics and stuff.
Yeah. If I have a cold or the flu, and I get a little fever,
I would not take medications for it.
And as a matter of fact, even
medications to lower my
body temperature, there's benefits from having your
body temperature go up a little bit.
So a low-grade fever or a moderate fever helps the immune system
fight.
If it's really high, obviously, there are some risks.
So that's when people would want to lower it.
But not every fever needs to be treated.
So if every family were to adopt certain habits to live a
healthier life from infectious disease standpoint,
what would be your recommendation on that?
So my first recommendation is, if you can, cook
food at home. That's been proven by studies to lead to less
disease.
And then, be active and
exercise together. And the third one is,
do activities together and be
a healthy family with a good relationship.
You can use the cooking itself as a communal activity
where you can do it together. So people who do pray or
dance together, they're known to have healthier lives.
And so,
having a close relationship and doing things together is also
healthy.
And
so we talked a lot about the doom and gloom scenarios on the
antibiotic resistance and whatnot, about the valley fever.
What gives you optimism
about people with infections? What does the future hold?
What gives me optimism is I'm naturally an optimistic person.
But,
with infections, we're actually sitting at a
milestone in the history of infectious diseases.
If you think of the era prior to antibiotics, and
then there's the era of antibiotics as started with
penicillin until today, we are
at the onset of the era of treating
infections with immune modulation, which is the next phase.
And I'm privileged to work with the people who are doing this.
There's
Dr. Manish Bhut, who's a colleague from UCLA, who published a paper
a couple of years ago, where they treated a young boy with
valley fever disseminated to bone and everywhere,
with immune modulation, meaning-
So what does that mean?
They gave the child cytokines, which are
compounds that our body makes to steer the immune
system in one way or the other. The immune system has many arms, and they go in
many directions, and the cell can be activated to go this way or that way.
And so there are cytokines that would make the
white cell
fight fungus versus no, get activated to fight
allergies. And so he looked at which ones do what, and he gave
that boy two of the ones that steer the
white cells to treat fungus, and the boy got better.
Wow. Impressive.
Yeah. I'm very excited to see the fruits of that
observation and
even further,
start looking into immune modulation to treat infection.
That would be great because we wouldn't have the side effects.
Of antibiotics.
Of antibiotics.
So there is an era that's coming in which we may need less antibiotics.
I look forward to it, yeah. I would hope that I could be part of this transition,
but it's happening right now.
Wow, that is great. So on that positive note, we'll
close today. Thank you so much for joining us.
This has been a lot of great information. Thank you.
It's my pleasure. Thank you, Dr. Sandhu, for inviting me.
Thank you.