How Primary Care Is Being Disrupted: A Video Primer
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How patients are seeing their doctor is changing, and that could shape access to and quality of care for decades to come.
More than 100 million Americans don’t have regular access to primary care, a number that has nearly doubled since 2014. Yet demand for primary care is up, spurred partly by record enrollment in Affordable Care Act plans. Under pressure from increased demand, consolidation, and changing patient expectations, the model of care no longer means visiting the same doctor for decades.
KFF Health News senior correspondent Julie Appleby breaks down what is happening — and what it means for patients.
More From This Investigation
Primary Care Disrupted
Known as the “front door” to the health system, primary care is changing. Under pressure from increased demand, consolidation, and changing patient expectations, the model of care no longer means visiting the same doctor for decades. KFF Health News looks at what this means for patients.
Credits
Hannah Norman Video producer and animator Oona Tempest Illustrator and creative director KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Bacopa Monnieri: A Well-Evidenced Cognitive Enhancer
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Bacopa monnieri: a powerful nootropic
Bacopa monnieri is one of those “from traditional use” herbs that has made its way into science.
It’s been used for at least 1,400 years in Ayurvedic medicine, for cognitive enhancement, against anxiety, and some disease-specific treatments.
See: Pharmacological attributes of Bacopa monnieri extract: current updates and clinical manifestation
What are its claimed health benefits?
Bacopa monnieri is these days mostly sold and bought as a nootropic, and that’s what the science supports best.
Nootropic benefits claimed:
- Improves attention, learning, and memory
- Reduces depression, anxiety, and stress
- Reduces restlessness and impulsivity
Other benefits claimed:
- Antioxidant properties
- Anti-inflammatory properties
- Anticancer properties
What does the science say?
Those last three, the antioxidant / anti-inflammatory / anticancer properties, when something has one of those qualities it often has all three, because there are overlapping systems at hand when it comes to oxidative stress, inflammation, and cellular damage.
Bacopa monnieri is no exception to this “rule of thumb”, and/but studies to support these benefits have mostly been animal studies and/or in vitro studies (i.e., cell cultures in a petri dish in lab conditions).
For example:
- Inhibition of lipoxygenases and cyclooxygenase-2 enzymes by extracts isolated from Bacopa monnieri
- Assessing the anti-inflammatory effects of Bacopa-derived bioactive compounds using network pharmacology and in vitro studies
- The evolving roles of Bacopa monnieri as potential anticancer agent: a review
In the category of antioxidant and anti-inflammatory effects in the brain, sometimes results differ depending on the test population, for example:
- Neuroprotective effects of Bacopa monnieri in experimental model of dementia (it worked for rats)
- Use of Bacopa monnieri in the treatment of dementia due to Alzheimer’s disease: systematic review of randomized controlled trials (it didn’t work for humans)
Anything more promising than that?
Yes! The nootropic effects have been much better-studied in humans, and with much better results.
For example, in this 12-week study in healthy adults, taking 300mg/day significantly improved visual information processing, learning, and memory (tested against placebo):
The chronic effects of an extract of Bacopa monnieri on cognitive function in healthy human subjects
Another 12-week study showed older adults enjoyed the same cognitive enhancement benefits as their younger peers:
Children taking 225mg/day, meanwhile, saw a significant reduction in ADHD symptoms, such as restlessness and impulsivity:
And as for the mood benefits, 300mg/day significantly reduced anxiety and depression in elderly adults:
In summary
Bacopa monnieri, taken at 300mg/day (studies ranged from 225mg/day to 600mg/day, but 300mg is most common) has well-evidenced cognitive benefits, including:
- Improved attention, learning, and memory
- Reduced depression, anxiety, and stress
- Reduced restlessness and impulsivity
It may also have other benefits, including against oxidative stress, inflammation, and cancer, but the research is thinner and/or not as conclusive for those.
Where to get it
As ever, we don’t sell it (or anything else), but for your convenience, here is an example product on Amazon.
Enjoy!
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Chickpeas vs Pinto Beans – Which is Healthier?
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Our Verdict
When comparing chickpeas to pinto beans, we picked the pinto beans.
Why?
Both are great! And an argument could be made for either…
In terms of macros, pinto beans have slightly more fiber and slightly more protein, while chickpeas have slightly more carbs, and thus predictably higher net carbs. In the category of those proteins, they both have a comparable spread of amino acods, with pinto beans having very slightly more of each amino acid. All this adds up to a clear, but moderate, win for pinto beans.
When it comes to vitamins, technically chickpeas have more of vitamins A, B3, B5, C, K, and choline, but the margins are so small as to be almost meaningless. Meanwhile, pinto beans have more of vitamins B1, B6, and E, and/but the only one where the margin is enough to really care about is vitamin E (a little over 2x what chickpeas have). So, an argument could be made either way, but we’re going to call this category a tie.
The story with minerals is similar; chickpeas have more copper, iron, manganese, phosphorus, and zinc, all with small margins, while pinto beans have more potassium and selenium, and/but also less sodium. We’d call this either a tie, or a very slight win for chickpeas.
Adding up the sections gives for a very modest win for pinto beans, but as we say, an argument could be made for either.
Certainly, enjoy both!
Want to learn more?
You might like to read:
- Chickpeas vs Black Beans – Which is Healthier?
- Kidney Beans vs Fava Beans – Which is Healthier?
- What Matters Most For Your Heart? Eat More (Of This) For Lower Blood Pressure
Take care!
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What does it mean to be transgender?
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Transgender media coverage has surged in recent years for a wide range of reasons. While there are more transgender television characters than ever before, hundreds of bills are targeting transgender people’s access to medical care, sports teams, gender-specific public spaces, and other institutions.
Despite the increase in conversation about the transgender community, public confusion around transgender identity remains.
Read on to learn more about what it means to be transgender and understand challenges transgender people may face.
What does it mean to be transgender?
Transgender—or “trans”—is an umbrella term for people whose gender identity or gender expression does not conform to their sex assigned at birth. People can discover they are trans at any age.
Gender identity refers to a person’s inner sense of being a woman, a man, neither, both, or something else entirely. Trans people who don’t feel like women or men might describe themselves as nonbinary, agender, genderqueer, or two-spirit, among other terms.
Gender expression describes the way a person communicates their gender through their appearance—such as their clothing or hairstyle—and behavior.
A person whose gender expression doesn’t conform to the expectations of their assigned sex may not identify as trans. The only way to know for sure if someone is trans is if they tell you.
Cisgender—or “cis”—describes people whose gender identities match the sex they were assigned at birth.
How long have transgender people existed?
Being trans isn’t new. Although the word “transgender” only dates back to the 1960s, people whose identities defy traditional gender expectations have existed across cultures throughout recorded history.
How many people are transgender?
A 2022 Williams Institute study estimates that 1.6 million people over the age of 13 identify as transgender in the United States.
Is being transgender a mental health condition?
No. Conveying and communicating about your gender in a way that feels authentic to you is a normal and necessary part of self-expression.
Social and legal stigma, bullying, discrimination, harassment, negative media messages, and barriers to gender-affirming medical care can cause psychological distress for trans people. This is especially true for trans people of color, who face significantly higher rates of violence, poverty, housing instability, and incarceration—but trans identity itself is not a mental health condition.
What is gender dysphoria?
Gender dysphoria describes a feeling of unease that some trans people experience when their perceived gender doesn’t match their gender identity, or their internal sense of gender. A 2021 study of trans adults pursuing gender-affirming medical care found that most participants started experiencing gender dysphoria by the time they were 7.
When trans people don’t receive the support they need to manage gender dysphoria, they may experience depression, anxiety, social isolation, suicidal ideation, substance use disorder, eating disorders, and self-injury.
How do trans people manage gender dysphoria?
Every trans person’s experience with gender dysphoria is unique. Some trans people may alleviate dysphoria by wearing gender-affirming clothing or by asking others to refer to them by a new name and use pronouns that accurately reflect their gender identity. The 2022 U.S. Trans Survey found that nearly all trans participants who lived as a different gender than the sex they were assigned at birth reported that they were more satisfied with their lives.
Some trans people may also manage dysphoria by pursuing medical transition, which may involve taking hormones and getting gender-affirming surgery.
Access to gender-affirming medical care has been shown to reduce the risk of depression and suicide among trans youth and adults.
To learn more about the trans community, visit resources from the National Center for Transgender Equality, the Trevor Project, PFLAG, and Planned Parenthood.
If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Minimize Aging’s Metabolic Slump
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I know that metabolism slows with age, are there any waypoints or things to look out for? I don’t know whether I should be eating less, or doing less, or taking some other approach entirely. What’s recommended?❞
Age and sex count for a lot with this one! As metabolism is in large part directed by hormones:
- For men, declining testosterone (often from around 45 onwards) can result in a metabolic slump
- For women, declining estrogen with the menopause does have an effect, but progesterone is the bigger factor for metabolism in the sense you are talking about.
In both cases, simply taking more of those hormones can often help, but please of course speak with an endocrinologist if that seems like a possible option for you, as your circumstances (and physiology) may vary.
If you’d like to go to that conversation well-armed with information, here are some good starting points, by the way:
- The Testosterone Drop, & Topping Up Testosterone
- Menopausal HRT: Bioidentical vs Animal (It Makes A Difference!)
And if you’re wondering about the natural vs pharmaceutical approaches…
- What Does “Balance Your Hormones” Even Mean?
- What You Should Have Been Told About The Menopause Beforehand
About your metabolic base rate
We tend to think of “fast metabolism good, slow metabolism bad”, and that’s a reasonable general premise… but it’s not necessarily always so.
After all, if you could double your metabolism and keep it there all the time, without changing anything else, well… You’ve heard the phrase “burning the candle at both ends”? So, having at least some downtime is important too.
See for example: Sleep Deprivation & Diabetes Risk
What’s critical, when it comes to base metabolic rate, is that your body must be capable of adequately processing what you are putting into it. Because if your body can’t keep up with the input, it’ll just start storing the excess chemical energy in the quickest and easiest way possible.
…which is a fast track to metabolic disorder in general and type 2 diabetes in particular. For more on the science and mechanics of this, see:
How To Prevent And Reverse Type 2 Diabetes
As for portion sizes…
Your body knows what you need, so listen to it. There is no external source of knowledge that can tell you how much food you need better than your own body itself can tell you.
You may be wondering “how exactly do I listen to my body, though?”, in which case, check out:
The Kitchen Doctor: Interoception & Mindful Eating
As for exercise…
When you exercise, your metabolic rate temporarily increases. After most kinds of exercise, your metabolism slumps again afterwards to compensate.
There are two ways to avoid this:
- Exercise Less, Move More ← it’s about maximizing time spent not sitting still
- High Intensity Interval Training ← a special kind of exercise, the only one known to keep the metabolism running high for a couple of hours afterwards, with no counter-slump
…which makes it pretty effective indeed
Would you like this section to be bigger? If so, send us more questions!
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Peas vs Broad Beans – Which is Healthier?
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Our Verdict
When comparing peas to broad beans, we picked the peas.
Why?
Both are great of course, but…
Looking at the macros to start with, peas have more protein and more fiber. The differences aren’t huge, but they are clear.
In terms of vitamins, peas have more of vitamins A, B1, B2, B3, B5, B6, B9, E, K, and choline (some with very large margins, some with small), while broad beans contain a little more vitamin C (the margin is quite narrow though).
When it comes to minerals, peas have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while broad beans have more sodium. So this category wasn’t close.
Adding up the win from each of the categories makes for a clear triple-win for peas.
Easy-peasy!
Want to learn more?
You might like to read:
Take care!
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Successful Aging – by Dr. Daniel Levitin
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We all know about age-related cognitive decline. What if there’s a flipside, though?
Neuroscientist Dr. Daniel Levitin explores the changes that the brain undergoes with age, and notes that it’s not all downhill.
From cumulative improvements in the hippocampi to a dialling-down of the (often overfunctioning) amygdalae, there are benefits too.
The book examines the things that shape our brains from childhood into our eighties and beyond. Many milestones may be behind us, but neuroplasticity means there’s always time for rewiring. Yes, it also covers the “how”.
We learn also about the neurogenesis promoted by such simple acts as taking a different route and/or going somewhere new, and what other things improve the brain’s healthspan.
The writing style is very accessible “pop-science”, and is focused on being of practical use to the reader.
Bottom line: if you want to get the most out of your aging wizening brain, this book is a great how-to manual.
Click here to check out Successful Aging and level up your later years!
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