Are you over 75? Here’s what you need to know about vitamin D
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Vitamin D is essential for bone health, immune function and overall wellbeing. And it becomes even more crucial as we age.
New guidelines from the international Endocrine Society recommend people aged 75 and over should consider taking vitamin D supplements.
But why is vitamin D so important for older adults? And how much should they take?
Young people get most vitamin D from the sun
In Australia, it is possible for most people under 75 to get enough vitamin D from the sun throughout the year. For those who live in the top half of Australia – and for all of us during summer – we only need to have skin exposed to the sun for a few minutes on most days.
The body can only produce a certain amount of vitamin D at a time. So staying in the sun any longer than needed is not going to help increase your vitamin D levels, while it will increase your risk of skin cancer.
But it’s difficult for people aged over 75 to get enough vitamin D from a few minutes of sunshine, so the Endocrine Society recommends people get 800 IU (international units) of vitamin D a day from food or supplements.
Why you need more as you age
This is higher than the recommendation for younger adults, reflecting the increased needs and reduced ability of older bodies to produce and absorb vitamin D.
Overall, older adults also tend to have less exposure to sunlight, which is the primary source of natural vitamin D production. Older adults may spend more time indoors and wear more clothing when outdoors.
As we age, our skin also becomes less efficient at synthesising vitamin D from sunlight.
The kidneys and the liver, which help convert vitamin D into its active form, also lose some of their efficiency with age. This makes it harder for the body to maintain adequate levels of the vitamin.
All of this combined means older adults need more vitamin D.
Deficiency is common in older adults
Despite their higher needs for vitamin D, people over 75 may not get enough of it.
Studies have shown one in five older adults in Australia have vitamin D deficiency.
In higher-latitude parts of the world, such as the United Kingdom, almost half don’t reach sufficient levels.
This increased risk of deficiency is partly due to lifestyle factors, such as spending less time outdoors and insufficient dietary intakes of vitamin D.
It’s difficult to get enough vitamin D from food alone. Oily fish, eggs and some mushrooms are good sources of vitamin D, but few other foods contain much of the vitamin. While foods can be fortified with the vitamin D (margarine, some milk and cereals), these may not be readily available or be consumed in sufficient amounts to make a difference.
In some countries such as the United States, most of the dietary vitamin D comes from fortified products. However, in Australia, dietary intakes of vitamin D are typically very low because only a few foods are fortified with it.
Why vitamin D is so important as we age
Vitamin D helps the body absorb calcium, which is essential for maintaining bone density and strength. As we age, our bones become more fragile, increasing the risk of fractures and conditions like osteoporosis.
Keeping bones healthy is crucial. Studies have shown older people hospitalised with hip fractures are 3.5 times more likely to die in the next 12 months compared to people who aren’t injured.
Vitamin D may also help lower the risk of respiratory infections, which can be more serious in this age group.
There is also emerging evidence for other potential benefits, including better brain health. However, this requires more research.
According to the society’s systematic review, which summarises evidence from randomised controlled trials of vitamin D supplementation in humans, there is moderate evidence to suggest vitamin D supplementation can lower the risk of premature death.
The society estimates supplements can prevent six deaths per 1,000 people. When considering the uncertainty in the available evidence, the actual number could range from as many as 11 fewer deaths to no benefit at all.
Should we get our vitamin D levels tested?
The Endocrine Society’s guidelines suggest routine blood tests to measure vitamin D levels are not necessary for most healthy people over 75.
There is no clear evidence that regular testing provides significant benefits, unless the person has a specific medical condition that affects vitamin D metabolism, such as kidney disease or certain bone disorders.
Routine testing can also be expensive and inconvenient.
In most cases, the recommended approach to over-75s is to consider a daily supplement, without the need for testing.
You can also try to boost your vitamin D by adding fortified foods to your diet, which might lower the dose you need from supplementation.
Even if you’re getting a few minutes of sunlight a day, a daily vitamin D is still recommended.
Elina Hypponen, Professor of Nutritional and Genetic Epidemiology, University of South Australia and Joshua Sutherland, PhD Candidate – Nutrition and Genetic Epidemiology, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Without Medicare Part B’s Shield, Patient’s Family Owes $81,000 for a Single Air-Ambulance Flight
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Without Medicare Part B’s Shield, Patient’s Family Owes $81,000 for a Single Air-Ambulance Flight
Debra Prichard was a retired factory worker who was careful with her money, including what she spent on medical care, said her daughter, Alicia Wieberg. “She was the kind of person who didn’t go to the doctor for anything.”
That ended last year, when the rural Tennessee resident suffered a devastating stroke and several aneurysms. She twice was rushed from her local hospital to Vanderbilt University Medical Center in Nashville, 79 miles away, where she was treated by brain specialists. She died Oct. 31 at age 70.
One of Prichard’s trips to the Nashville hospital was via helicopter ambulance. Wieberg said she had heard such flights could be pricey, but she didn’t realize how extraordinary the charge would be — or how her mother’s skimping on Medicare coverage could leave the family on the hook.
Then the bill came.
The Patient: Debra Prichard, who had Medicare Part A insurance before she died.
Medical Service: An air-ambulance flight to Vanderbilt University Medical Center.
Service Provider: Med-Trans Corp., a medical transportation service that is part of Global Medical Response, an industry giant backed by private equity investors. The larger company operates in all 50 states and says it has a total of 498 helicopters and airplanes.
Total Bill: $81,739.40, none of which was covered by insurance.
What Gives: Sky-high bills from air-ambulance providers have sparked complaints and federal action in recent years.
For patients with private insurance coverage, the No Surprises Act, which went into effect in 2022, bars air-ambulance companies from billing people more than they would pay if the service were considered “in-network” with their health insurers. For patients with public coverage, such as Medicare or Medicaid, the government sets payment rates at much lower levels than the companies charge.
But Prichard had opted out of the portion of Medicare that covers ambulance services.
That meant when the bill arrived less than two weeks after her death, her estate was expected to pay the full air-ambulance fee of nearly $82,000. The main assets are 12 acres of land and her home in Decherd, Tennessee, where she lived for 48 years and raised two children. The bill for a single helicopter ride could eat up roughly a third of the estate’s value, said Wieberg, who is executor.
The family’s predicament stems from the complicated nature of Medicare coverage.
Prichard was enrolled only in Medicare Part A, which is free to most Americans 65 or older. That section of the federal insurance program covers inpatient care, and it paid most of her hospital bills, her daughter said.
But Prichard declined other Medicare coverage, including Part B, which handles such things as doctor visits, outpatient treatment, and ambulance rides. Her daughter suspects she skipped that coverage to avoid the premiums most recipients pay, which currently are about $175 a month.
Loren Adler, a health economist for the Brookings Institution who studies ambulance bills, estimated the maximum charge that Medicare would have allowed for Prichard’s flight would have been less than $10,000 if she’d signed up for Part B. The patient’s share of that would have been less than $2,000. Her estate might have owed nothing if she’d also purchased supplemental “Medigap” coverage, as many Medicare members do to cover things like coinsurance, he said.
Nicole Michel, a spokesperson for Global Medical Response, the ambulance provider, agreed with Adler’s estimate that Medicare would have limited the charge for the flight to less than $10,000. But she said the federal program’s payment rates don’t cover the cost of providing air-ambulance services.
“Our patient advocacy team is actively engaged with Ms. Wieberg’s attorney to determine if there was any other applicable medical coverage on the date of service that we could bill to,” Michel wrote in an email to KFF Health News. “If not, we are fully committed to working with Ms. Wieberg, as we do with all our patients, to find an equitable solution.”
The Resolution: In mid-February, Wieberg said the company had not offered to reduce the bill.
Wieberg said she and the attorney handling her mother’s estate both contacted the company, seeking a reduction in the bill. She said she also contacted Medicare officials, filled out a form on the No Surprises Act website, and filed a complaint with Tennessee regulators who oversee ambulance services. She said she was notified Feb. 12 that the company filed a legal claim against the estate for the entire amount.
Wieberg said other health care providers, including ground ambulance services and the Vanderbilt hospital, wound up waiving several thousand dollars in unpaid fees for services they provided to Prichard that are normally covered by Medicare Part B.
But as it stands, Prichard’s estate owes about $81,740 to the air-ambulance company.
More from Bill of the Month
- The Colonoscopies Were Free. But the ‘Surgical Trays’ Came With $600 Price Tags. Jan 25, 2024
- When a Quick Telehealth Visit Yields Multiple Surprises Beyond a Big Bill Dec 19, 2023
- Out for Blood? For Routine Lab Work, the Hospital Billed Her $2,400 Nov 21, 2023
The Takeaway: People who are eligible for Medicare are encouraged to sign up for Part B, unless they have private health insurance through an employer or spouse.
“If someone with Medicare finds that they are having difficulty paying the Medicare Part B premiums, there are resources available to help compare Medicare coverage choices and learn about options to help pay for Medicare costs,” Meena Seshamani, director of the federal Center for Medicare, said in an email to KFF Health News.
She noted that every state offers free counseling to help people navigate Medicare.
In Tennessee, that counseling is offered by the State Health Insurance Assistance Program. Its director, Lori Galbreath, told KFF Health News she wishes more seniors would discuss their health coverage options with trained counselors like hers.
“Every Medicare recipient’s experience is different,” she said. “We can look at their different situations and give them an unbiased view of what their next best steps could be.”
Counselors advise that many people with modest incomes enroll in a Medicare Savings Program, which can cover their Part B premiums. In 2023, Tennessee residents could qualify for such assistance if they made less than $1,660 monthly as a single person or $2,239 as a married couple. Many people also could obtain help with other out-of-pocket expenses, such as copays for medical services.
Wieberg, who lives in Missouri, has been preparing the family home for sale.
She said the struggle over her mother’s air-ambulance bill makes her wonder why Medicare is split into pieces, with free coverage for inpatient care under Part A, but premiums for coverage of other crucial services under Part B.
“Anybody past the age of 70 is likely going to need both,” she said. “And so why make it a decision of what you can afford or not afford, or what you think you’re going to use or not use?”
Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!
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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End the Insomnia Struggle – by Dr. Colleen Ehrnstrom and Dr. Alisha Brosse
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We’ve reviewed sleep books before, and we always try to recommend books that have something a little different than the rest, so what makes this one stand out?
While there is the usual quick overview of the basics that we’re sure you already know (sleep hygiene etc), most of the attention here is given to cold, hard clinical psychology… in a highly personalized way.
How, you may ask, can they personalize a book, that is the same for everyone?
The answer is, by guiding the reader through examining our own situation. With template logbooks, worksheets, and the like—for this reason we recommend getting a paper copy of the book, rather than the Kindle version, in case you’d like to use/photocopy those.
Essentially, reading this book is much like having your own psychologist (or two) to guide you through finding a path to better sleep.
The therapeutic approach, by the way, is a combination of Cognitive Behavioral Therapy (CBT) and Acceptance-Commitment Therapy (ACT), which work very well together here.
Bottom line: if you’ve changed your bedsheets and turned off your electronic devices and need something a little more, this book is the psychological “big guns” for removing the barriers between you and good sleep.
Click here to check out End the Insomnia Struggle, and end yours once and for all!
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Dopamine Nation – by Dr. Anna Lembke
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We live in an age of abundance, though it often doesn’t feel like it. Some of that is due to artificial scarcity, but a lot of it is due to effectively whiting out our dopamine circuitry through chronic overuse.
Psychiatrist Dr. Anna Lembke explores the neurophysiology of pleasure and pain, and how each can (and does) lead to the other. Is the answer to lead a life of extreme neutrality? Not quite.
Rather, simply by being more mindful of how we seek each (yes, both pleasure and pain), we can leverage our neurophysiology to live a better, healthier life—and break/avoid compulsive habits, while we’re at it.
That said, the book itself is quite compelling reading, but as Dr. Lembke shows us, that certainly doesn’t have to be a bad thing.
Bottom line: if you sometimes find yourself restlessly cycling through the same few apps (or TV channels) looking for dopamine that you’re not going to find there, this is the book for you.
Click here to check out Dopamine Nation, and get a handle on yours!
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Cheeky diet soft drink getting you through the work day? Here’s what that may mean for your health
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Many people are drinking less sugary soft drink than in the past. This is a great win for public health, given the recognised risks of diets high in sugar-sweetened drinks.
But over time, intake of diet soft drinks has grown. In fact, it’s so high that these products are now regularly detected in wastewater.
So what does the research say about how your health is affected in the long term if you drink them often?
What makes diet soft drinks sweet?
The World Health Organization (WHO) advises people “reduce their daily intake of free sugars to less than 10% of their total energy intake. A further reduction to below 5% or roughly 25 grams (six teaspoons) per day would provide additional health benefits.”
But most regular soft drinks contain a lot of sugar. A regular 335 millilitre can of original Coca-Cola contains at least seven teaspoons of added sugar.
Diet soft drinks are designed to taste similar to regular soft drinks but without the sugar. Instead of sugar, diet soft drinks contain artificial or natural sweeteners. The artificial sweeteners include aspartame, saccharin and sucralose. The natural sweeteners include stevia and monk fruit extract, which come from plant sources.
Many artificial sweeteners are much sweeter than sugar so less is needed to provide the same burst of sweetness.
Diet soft drinks are marketed as healthier alternatives to regular soft drinks, particularly for people who want to reduce their sugar intake or manage their weight.
But while surveys of Australian adults and adolescents show most people understand the benefits of reducing their sugar intake, they often aren’t as aware about how diet drinks may affect health more broadly.
What does the research say about aspartame?
The artificial sweeteners in soft drinks are considered safe for consumption by food authorities, including in the US and Australia. However, some researchers have raised concern about the long-term risks of consumption.
People who drink diet soft drinks regularly and often are more likely to develop certain metabolic conditions (such as diabetes and heart disease) than those who don’t drink diet soft drinks.
The link was found even after accounting for other dietary and lifestyle factors (such as physical activity).
In 2023, the WHO announced reports had found aspartame – the main sweetener used in diet soft drinks – was “possibly carcinogenic to humans” (carcinogenic means cancer-causing).
Importantly though, the report noted there is not enough current scientific evidence to be truly confident aspartame may increase the risk of cancer and emphasised it’s safe to consume occasionally.
Will diet soft drinks help manage weight?
Despite the word “diet” in the name, diet soft drinks are not strongly linked with weight management.
In 2022, the WHO conducted a systematic review (where researchers look at all available evidence on a topic) on whether the use of artificial sweeteners is beneficial for weight management.
Overall, the randomised controlled trials they looked at suggested slightly more weight loss in people who used artificial sweeteners.
But the observational studies (where no intervention occurs and participants are monitored over time) found people who consume high amounts of artificial sweeteners tended to have an increased risk of higher body mass index and a 76% increased likelihood of having obesity.
In other words, artificial sweeteners may not directly help manage weight over the long term. This resulted in the WHO advising artificial sweeteners should not be used to manage weight.
Studies in animals have suggested consuming high levels of artificial sweeteners can signal to the brain it is being starved of fuel, which can lead to more eating. However, the evidence for this happening in humans is still unproven.
What about inflammation and dental issues?
There is some early evidence artificial sweeteners may irritate the lining of the digestive system, causing inflammation and increasing the likelihood of diarrhoea, constipation, bloating and other symptoms often associated with irritable bowel syndrome. However, this study noted more research is needed.
High amounts of diet soft drinks have also been linked with liver disease, which is based on inflammation.
The consumption of diet soft drinks is also associated with dental erosion.
Many soft drinks contain phosphoric and citric acid, which can damage your tooth enamel and contribute to dental erosion.
Moderation is key
As with many aspects of nutrition, moderation is key with diet soft drinks.
Drinking diet soft drinks occasionally is unlikely to harm your health, but frequent or excessive intake may increase health risks in the longer term.
Plain water, infused water, sparkling water, herbal teas or milks remain the best options for hydration.
Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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7 Days Of Celery Juice: What’s The Verdict?
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Laura “Try” tries many popular trends, and reports on the benefits (or problems, or both). In this case, it’s 7 days of celery juice… Not as a fast, though, i.e. she doesn’t just have celery juice for 7 days, but rather, it’s how she kicks off each morning, with half a liter (16oz) on an empty stomach.
What she found
First, she bought a masticating juicer and organic celery. So, those are expenses to consider, especially the one-off expense of the juicer, and the ongoing expense of organic celery—estimated $90/month).
In terms of taste, she was surprised it wasn’t as bitter as expected, but from the second day onwards, she did use the juicer’s filter to remove the frothy sludge, and she also switched to juicing only the stalks, not the leaves—which are more bitter.
10almonds note: the leaves are more bitter because that’s where the polyphenols are more densely concentrated. The leaves are better for you than the stalks. Enjoy the leaves. Really: if you chop them finely you can use them as herbs in your cooking, and if you’re making a salad, just chop them into that too.
The reason she picked the quantity of half a liter is because this is what she found recommended to coat the stomach lining—on the promise of increased stomach acid production, reduced bacteria overgrowth, as well as antiviral, antifungal, and anti-inflammatory properties. As she’s just one woman without a personal lab, she couldn’t test and thus verify any of these though—but she did still have benefits to report:
She did experience clearer skin, more energy, and better sleep after a few days.
Ultimately, she decided to continue to do it just at the weekends, due to its positive effects, despite the cost and time consumption.
For more personal insights, enjoy:
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Want to learn more?
You might also like to read:
Enjoy Bitter Foods For Your Heart & Brain
Take care!
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Too Much Or Too Little Testosterone?
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One Man’s Saw Palmetto Is Another Woman’s Serenoa Repens…
Today we’re going to look at saw palmetto. So, first:
What is it?
Saw palmetto is a type of palm native to the southeastern United States. Its scientific name is “Serenoa repens”, so if that name appears in studies we cite, it’s the same thing. By whichever name, it’s widely enjoyed as a herbal supplement.
Why do people take it?
Here’s where it gets interesting, because people take it for some completely opposite reasons…
Indeed, searching for it on the Internet will cause Google to suggest “…for men” and “…for women” as the top suggestions.
That’s because it works on testosterone, and testosterone can be a bit of a double-edged sword, so some people want to increase or decrease certain testosterone-related effects on their body.
And it works for both! Here be science:
- Testosterone (henceforth, “T”) is produced in the human body.
- Yes, all human bodies, to some extent.
- An enzyme called 5-alpha-reductase converts T in to DHT (dihydrogen testosterone)
- DHT is a much more potent androgen (masculinizing agent) than T alone, such that its effects are often unwanted, including:
- Enlarged prostate (if you have one)
- Hair loss (especially in men)
- New facial hair growth (usually unwanted by women)
- Women are more likely to get this due to PCOS and/or the menopause
To avoid those effects, you really want less of your T to be converted into DHT.
Saw palmetto is a 5α-reductase inhibitor, so if you take it, you’ll have less DHT, and you’ll consequently lose less hair, have fewer prostate problems, etc.
^The above study showed that saw palmetto extract performed comparably to finasteride. Finasteride is the world’s main go-to prescription drug for treating enlarged prostate and/or hair loss.
See also: Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia
Hair today… Growing tomorrow!
So, what was that about increasing T levels?
Men usually suffer declining T levels as they get older, with a marked drop around the age of 45. With lower T comes lower energy, lower mood, lower libido, erectile dysfunction, etc.
Guess what… It’s T that’s needed for those things, not DHT. So if you block the conversion of T to DHT, you’ll have higher blood serum T levels, higher energy, higher mood, higher libido, and all that.
(the above assumes you have testicles, without which, your T levels will certainly not increase)
Saw Palmetto Against Enlarged Prostate?
With higher DHT levels in mid-late life, prostate enlargement (benign prostatic hyperlasia) can become a problem for many men. The size of that problem ranges from urinary inconvenience (common, when the prostate presses against the bladder) to prostate cancer (less common, much more serious). Saw palmetto, like other 5α-reductase inhibitors such as finasteride, may be used to prevent or treat this.
Wondering how safe/reliable it is? We found a very high-quality fifteen-year longitudinal observational study of the use of saw palmetto, and it found:
❝The 15 years’ study results suggest that taking S. repens plant extract continuously at a daily dose of 320 mg is an effective and safe way to prevent the progression of benign prostatic hyperplasia.❞
Want a second opinion? We also found a 10-year study (by different researchers with different people taking it), which reached the same conclusion:
❝The results of study showed the absence of progression, both on subjective criteria (IPSS, and QoL scores), and objective criteria (prostate volume, the rate of urination, residual urine volume). Furthermore, patients had no undesirable effects directly related to the use of this drug.❞
- IPSS = International Prostate Symptom Score
- QoL = Quality of Life
❝But wait a minute; I, a man over the age of 45 with potentially declining T levels but a fabulous beard, remember that you said just a minute ago that saw palmetto is used by women to avoid having facial hair; I don’t want to lose mine!❞
You won’t. Once your facial hair follicles were fully developed and activated during puberty, they’ll carry on doing what they do for life. That’s no longer regulated by hormones once they’re up and running.
The use of saw palmetto can only be used to limit facial hair if caught early—so it’s more useful at the onset of menopause, for those who have (or will have) such, or else upon the arrival of PCOS symptoms or hirsuitism from some other cause.
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Bottom Line on Saw Palmetto
- It blocks the conversion of T into DHT
- It will increase blood serum T levels, thus boosting mood, energy, libido, etc in men (who typically have more T, but whose T levels decline with age)
- It will decrease DHT levels, thus limiting hair loss (especially in men) and later-life new facial hair growth (especially in women).
- It can be used to prevent or treat prostate enlargement
- Bonus: it’s a potent antioxidant and thus reduces general inflammation (in everyone)
Want To Try Saw Palmetto?
We don’t sell it (or anything else), but for your convenience…
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- Testosterone (henceforth, “T”) is produced in the human body.