New California Laws Target Medical Debt, AI Care Decisions, Detention Centers
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SACRAMENTO, Calif. — As the nation braces for potential policy shifts under President-elect Donald Trump’s “Make America Healthy Again” mantra, the nation’s most populous state and largest health care market is preparing for a few changes of its own.
With supermajorities in both houses, Democrats in the California Legislature passed — and Democratic Gov. Gavin Newsom signed — laws taking effect this year that will erase medical debt from credit reports, allow public health officials to inspect immigrant detention centers, and require health insurance companies to cover fertility services such as in vitro fertilization.
Still, industry experts say it was a relatively quiet year for health policy in the Golden State, with more attention on a divisive presidential election and with several state legislators seeking to avoid controversial issues as they ran for Congress in competitive swing districts.
Newsom shot down some of legislators’ most ambitious health care policies, including proposals that would have regulated pharmaceutical industry middlemen and given the state more power to stop private equity deals in health care.
Health policy experts say advocates and legislators are now focused on how to defend progressive California policies such as sweeping abortion access in the state and health coverage for immigrants living in the U.S. without authorization.
“I think everyone’s just thinking about how we’re going to enter 2025,” said Rachel Linn Gish, a spokesperson with the consumer health advocacy group Health Access California. “We’re figuring out what is vulnerable, what we are exposed to on the federal side, and what do budget changes mean for our work. That’s kind of putting a cloud over everything.”
Here are some of the biggest new health care laws Californians should know about:
Medical debt
California becomes the eighth state in which medical debt will no longer affect patients’ credit reports or credit scores. SB 1061 bars health care providers and debt collectors from reporting unpaid medical bills to credit bureaus, a practice that supporters of the law say penalizes people for seeking critical care and can make it harder for patients to get a job, buy a car, or secure a mortgage.
Critics including the California Association of Collectors called the measure from Sen. Monique Limón (D-Santa Barbara) a “tremendous overreach” and successfully lobbied for amendments that limited the scope of the bill, including an exemption for any medical debt incurred on credit cards.
The Biden administration has finalized federal rules that would stop unpaid medical bills from affecting patients’ credit scores, but the fate of those changes remains unclear as Trump takes office.
Psychiatric hospital stays for violent offenders
Violent offenders with severe mental illness can now be held longer after a judge orders them released from a state mental hospital.
State officials and local law enforcement will now have 30 days to coordinate housing, medication, and behavioral health treatment for those parolees, giving them far more time than the five-day deadline previously in effect.
The bill drew overwhelming bipartisan support after a high-profile case in San Francisco in which a 61-year-old man was charged in the repeated stabbing of a bakery employee just days after his release from a state mental hospital. The bill’s author, Assembly member Matt Haney (D-San Francisco), called the previous five-day timeline “dangerously short.”
Cosmetics and ‘forever chemicals’
California was the first state to ban PFAS chemicals, also known as “forever chemicals,” in all cosmetics sold and manufactured within its borders. The synthetic compounds, found in everyday products including rain jackets, food packaging, lipstick, and shaving cream, have been linked to cancer, birth defects, and diminished immune function and have been increasingly detected in drinking water.
Industry representatives have argued that use of PFAS — perfluoroalkyl and polyfluoroalkyl substances — is critical in some products and that some can be safely used at certain levels.
Immigration detention facilities
After covid-19 outbreaks, contaminated water, and moldy food became the subjects of detainee complaints and lawsuits, state legislators gave local county health officials the authority to enter and inspect privately run immigrant detention centers. SB 1132, from Sen. María Elena Durazo (D-Los Angeles), gives public health officials the ability to evaluate whether privately run facilities are complying with state and local public health regulations regarding proper ventilation, basic mental and physical health care, and food safety.
Although the federal government regulates immigration, six federal detention centers in California are operated by the GEO Group. One of the country’s largest private prison contractors, GEO has faced a litany of complaints related to health and safety. Unlike public prisons and jails, which are inspected annually, these facilities would be inspected only as deemed necessary.
The contractor filed suit in October to stop implementation of the law, saying it unconstitutionally oversteps the federal government’s authority to regulate immigration detention centers. A hearing in the case is set for March 3, said Bethany Lesser, a spokesperson for California Attorney General Rob Bonta. The law took effect Jan. 1.
Doctors vs. insurance companies using AI
As major insurance companies increasingly use artificial intelligence as a tool to analyze patient claims and authorize some treatment, trade groups representing doctors are concerned that AI algorithms are driving an increase in denials for necessary care. Legislators unanimously agreed.
SB 1120 states that decisions about whether a treatment is medically necessary can be made only by licensed, qualified physicians or other health care providers who review a patient’s medical history and other records.
Sick leave and protected time off
Two new laws expand the circumstances under which California workers may use sick days and other leave. SB 1105 entitles farmworkers who work outdoors to take paid sick leave to avoid heat, smoke, or flooding when local or state officials declare an emergency.
AB 2499 expands the list of reasons employees may take paid sick days or use protected unpaid leave to include assisting a family member who is experiencing domestic violence or other violent crimes.
Prescription labels for the visually impaired
Starting this year, pharmacies will be required to provide drug labels and use instructions in Braille, large print, or audio for blind patients.
Advocates of the move said state law, which already required translated instructions in five languages for non-English speakers, has overlooked blind patients, making it difficult for them to monitor prescriptions and take the correct dosage.
Maternal mental health screenings
Health insurers will be required to bolster maternal mental health programs by mandating additional screenings to better detect perinatal depression, which affects 1 in 5 people who give birth in California, according to state data. Pregnant people will now undergo screenings at least once during pregnancy and then six weeks postpartum, with further screenings as providers deem necessary.
Penalties for threatening health care workers (abortion clinics)
With abortion care at the center of national policy fights, California is cracking down on those who threaten, post personal information about, or otherwise target providers or patients at clinics that perform abortions. Penalties for such behavior will increase under AB 2099, and offenders can face felony charges, up to three years in jail, and $50,000 in fines for repeat or violent offenses. Previously, state law classified many of those offenses as misdemeanors.
Insurance coverage for IVF
Starting in July, state-regulated health plans covering 50 employees or more would be required to cover fertility services under SB 729, passed and signed last year. Advocates have long fought for this benefit, which they say is essential care for many families who have trouble getting pregnant and would ensure LGBTQ+ couples aren’t required to pay more out-of-pocket costs than straight couples when starting a family.
In a signing statement, Newsom asked legislators to delay implementation of the law until 2026 as state officials consider whether to add infertility treatments to the list of benefits that insurance plans are required to cover.
It’s unclear whether legislators intend to address that this session, but a spokesperson for the governor said that Newsom “clearly stated his position on the need for an extension” and that he “will continue to work with the legislature” on the matter.
Plans under CalPERS, the California Public Employees’ Retirement System, would have to comply by July 2027.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
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.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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Vitamin B6 is essential – but too much can be toxic. Here’s what to know to stay safe
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In recent weeks, reports have been circulating about severe reactions in people who’ve taken over-the-counter vitamin B6 supplements.
Vitamin B6 poisoning can injure nerves and lead to symptoms including numbness, tingling and even trouble walking and moving.
In some cases, those affected didn’t know the product contained any vitamin B6.
So what is vitamin B6, where is it found and how much is too much? Here’s what you need to know about this essential nutrient.
Kim Kuperkova/Shutterstock What is vitamin B6?
Vitamin B6 (also known as pyridoxine) is a group of six compounds that share a similar chemical structure.
It is an essential nutrient, meaning we need it for normal body functions, but we can’t produce it ourselves.
Adults aged 19–50 need 1.3mg of vitamin B6 per day. The recommended dose is lower for teens and children, and higher for those aged 51 and over (1.7mg for men and 1.5mg for women) and people who are breastfeeding or pregnant (1.9mg).
Most of us get this in our diet – largely from animal products, including meat, dairy and eggs.
The vitamin is also available in a range of different plant foods, including spinach, kale, bananas and potatoes, so deficiency is rare, even for vegetarians and vegans.
The vitamin B6 we consume in the diet is inactive, meaning the body can’t use it. To activate B6, the liver transforms it into a compound called pyridoxal-5’-phosphate (PLP).
In this form, vitamin B6 helps the body with more than 140 cellular functions, including building and breaking down proteins, producing red blood cells, regulating blood sugar and supporting brain function.
Vitamin B6 is important for overall health and has also been associated with reduced cancer risk and inflammation.
Despite being readily available in the diet, vitamin B6 is also widely included in various supplements, multivitamins and other products, such as Berocca and energy drinks.
Most people get enough vitamin B6 from their diet. Tatjana Baibakova/Shutterstock Should we be worried about toxicity?
Vitamin B6 toxicity is extremely rare. It almost never occurs from dietary intake alone, unless there is a genetic disorders or disease that stops nutrient absorption (such as coeliac disease).
This is because all eight vitamins in the B group are water-soluble. If you consume more of the vitamin than your body needs, it can be excreted readily and harmlessly in your urine.
However, in some rare cases, excessive vitamin B6 accumulates in the blood, resulting in a condition called peripheral neuropathy. We’re still not sure why this occurs in some people but not others.
Peripheral neuropathy occurs when the sensory nerves – those outside our brain and spinal cord that send information to the central nervous system – are damaged and unable to function. This can be caused by a wide range of diseases (and is most well known in type 2 diabetes).
The most common symptoms are numbness and tingling, though in some cases patients may experience difficulty with balance or walking.
We don’t know exactly how excess vitamin B6 causes peripheral neuropathy, but it is thought to interfere with how the neurotransmitter GABA sends signals to the sensory nerves.
Vitamin B6 can cause permanent damage to nerves. Studies have shown symptoms improved when the person stopped taking the supplement, although they didn’t completely resolve.
What is considered excessive? And has this changed?
Toxicity usually occurs only when people take supplements with high doses of B6.
Until 2022, only products with more than 50mg of vitamin B6 were required to display a warning about peripheral neuropathy. But the Therapeutic Goods Administration lowered this and now requires any product containing more than 10mg of vitamin B6 to carry a warning.
The Therapeutic Goods Administration has also halved the daily upper limit of vitamin B6 a product can provide – from 200mg to 100mg.
These changes followed a review by the administration, after receiving 32 reports of peripheral neuropathy in people taking supplements. Two thirds of these people were taking less than 50mg of vitamin B6.
The Therapeutic Goods Administration acknowledges the risk varies between individuals and a lot is unknown. Its review could not identify a minimum dose, duration of use or patient risk factors.
But I thought B vitamins were good for me?
Too much of anything can cause problems.
The updated guidelines are likely to significantly lower the risk of toxicity. They also make consumers more aware of which products contain B6, and the risks.
The Therapeutic Goods Administration will continue to monitor evidence and revise guidelines if necessary.
While vitamin B6 toxicity remains very rare, there are still many questions about why some people get peripheral neuropathy with lower dose supplements.
It could be that some specific vitamin B compounds have a stronger effect, or some people may have genetic vulnerabilities or diseases which put them at higher risk.
So what should I do?
Most people don’t need to actively seek vitamin B6 in supplements.
However, many reports to the Therapeutic Goods Administration were of vitamin B6 being added to supplements labelled as magnesium or zinc – and some weren’t aware they were consuming it.
It is important to always check the label if you are taking a new medicine or supplement, especially if it hasn’t been explicitly prescribed by a health-care professional.
Be particularly cautious if you are taking multiple supplements. While one multivitamin is unlikely to cause an issue, adding a magnesium supplement for cramping, or a zinc supplement for cold and flu symptoms, may cause an excessive vitamin B6 dose over time, and increase your risk.
Importantly, pay attention to symptoms that may indicate peripheral neuropathy, such as pins and needles, numbness, or pain in the feet or hands, if you do change or add a supplement.
Most importantly, if you need advice, you should talk to your doctor, dietitian or pharmacist.
Vasso Apostolopoulos, Distinguished Professor, Professor of Immunology, RMIT University and Jack Feehan, Vice Chancellors Senior Research Fellow in Immunology, RMIT University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Garden Cress vs Watercress – Which is Healthier?
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Our Verdict
When comparing garden cress to watercress, we picked the garden cress.
Why?
While watercress is (rightly!) popularly viewed as a superfood for its nutritional density, the garden variety actually outperforms it.
In terms of macros first, garden cress has more protein, carbs, and fiber, while also having the lower glycemic index. Not that anyone’s getting blood sugar spikes from eating any kind of cress, but still, by the numbers, this is a clear win on the whole for garden cress in the category of macros.
When it comes to vitamins, garden cress has a lot (tens of times) more of vitamins A, B2, B3, B6, B7, B9, C, K, and choline, while watercress has (slightly) more of vitamins B1, B5, and E. An easy win for garden cress.
In the category of minerals, garden cress has more copper, iron, magnesium, manganese, phosphorus, and potassium, while watercress has more calcium. Another clear win for garden cress.
Taking a quick peep at polyphenols in case there’s anything to offset the above, garden cress has 13x more kaempferol (13mg/100g to watercress’s 1mg/100g), and/but watercress, in its favor, has quercetin (at 4mg/100g), which garden cress doesn’t. So, we say this category is also a win for garden cress, but watercress has its merits too.
👆 Let’s clarify: those numbers are all very good, and garden cress’s 13mg/100g kaempferol is absurdly high; most such quotients of most edible plants are orders of magnitude smaller; not to shoehorn in another vegetable, but just to give an example, savoy cabbage, which won on nutritional density vs bok choi recently, has 0.26mg/100g kaempferol and 0.12mg/100g quercetin (which were already very respectable numbers), so you see the difference in cress’s exceptionally generous delivery of these polyphenols!
Adding up the sections makes for an overwhelming win for garden cress!
Want to learn more?
You might like to read:
Sprout Your Seeds, Grains, Beans, Etc ← cress is a great example of this!
Take care!
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Hemp Seeds vs Flax Seeds – Which is Healthier?
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Our Verdict
When comparing hemp seeds to flax seeds, we picked the flax.
Why?
Both are great, but quite differently so! In other words, they both have their advantages, but on balance, we prefer the flax’s advantages.
Part of this come from the way in which they are sold/consumed—hemp seeds must be hulled first, which means two things as a result:
- Flax seeds have much more fiber (about 8x more)
- Hemp seeds have more protein (about 2x more), proportionally, at least ← this is partly because they lost a bunch of weight by losing their fiber to the hulling, so the “per 100g” values of everything else go up, even though the amount per seed didn’t change
Since people’s diets are more commonly deficient in fiber than protein, and also since 8x is better than 2x, we consider this a win for flax.
Of course, many people enjoy hemp or flax specifically for the healthy fatty acids, so how do they stack up in that regard?
- Flax seeds have more omega-3s
- Hemp seeds have more omega-6s
This, for us, is a win for flax too, as the omega-3s are generally what we need more likely to be deficient in. Hemp enthusiasts, however, may argue that the internal balance of omega-3s to omega-6s is closer to an ideal ratio in hemp—but nutrition doesn’t exist in a vacuum, so we have to consider things “as part of a balanced diet” (because if one were trying to just live on hemp seeds, one would die), and most people’s diets are skewed far too far in favor or omega-6 compared to omega-3. So for most people, the higher levels of omega-3s are the more useful.
Want to learn more?
Take care!
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How To Nap Like A Pro (No More “Sleep Hangovers”!)
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How To Be An Expert Nap-Artist
There’s a lot of science to say that napping can bring us health benefits—but mistiming it can just make us more tired. So, how to get some refreshing shut-eye, without ending up with a case of the midday melatonin blues?
First, why do we want to nap?
Well, maybe we’re just tired, but there are specific benefits even if we’re not. For example:
- Increased alertness
- Helps with learning
- Improved memory
- Boost to immunity
- Enhance athletic performance
What can go wrong?
There are two main things that can go wrong, physiologically speaking:
- We can overdo it, and not sleep well at night
- We can awake groggy and confused and tired
The first is self-explanatory—it messes with the circadian rhythm. For this reason, we should not sleep more than 90 minutes during the day. If that seems like a lot, and maybe you’ve heard that we shouldn’t sleep more than half an hour, there is science here, so read on…
The second is a matter of sleep cycles. Our brain naturally organizes our sleep into multiples of 20-minute segments, with a slight break of a few minutes between each. Consequently, naps should be:
- 25ish minutes
- 40–45 minutes
- 90ish minutes
If you wake up mid-cycle—for example, because your alarm went off, or someone disturbed you, or even because you needed to pee, you will be groggy, disoriented, and exhausted.
For this reason, a nap of one hour (a common choice, since people like “round” numbers) is a recipe for disaster, and will only work if you take 15 minutes to fall asleep. In which case, it’d really be a nap of 45 minutes, made up of two 20-minute sleep cycles.
Some interruptions are better/worse than others
If you’re in light or REM sleep, a disruption will leave you not very refreshed, but not wiped out either. And as a bonus, if you’re interrupted during a REM cycle, you’re more likely to remember your dreams.
If you’re in deep sleep, a disruption will leave you with what feels like an incredible hangover, minus the headache, and you’ll be far more tired than you were before you started the nap.
The best way to nap
Taking these factors into account, one of the “safest” ways to nap is to set your alarm for the top end of the time-bracket above the one you actually want to nap for (e.g., if you want to nap for 25ish minutes, set your alarm for 45).
Unless you’re very sleep-deprived, you’ll probably wake up briefly after 20–25 minutes of sleep. This may seem like nearer 30 minutes, if it took you some minutes to fall asleep!
If you don’t wake up then, or otherwise fail to get up, your alarm will catch you later at what will hopefully be between your next sleep cycles, or at the very least not right in the middle of one.
When you wake up from a nap before your alarm, get up. This is not the time for “5 more minutes” because “5 more minutes” will never, ever, be refreshing.
Rest well!
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Breaking The Age Code – by Dr. Becca Levy
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The author, a social psychologist, sets out to not only bust ageist expectations, but also boost life expectancy by 7.5 years.
How? By examining the extent to which how we think about our age affects our actual aging. Lest this sound wishy-washy, there are 52 pages of scientific references at the back.
We’ve written about this before at 10almonds, for example about the famous “Counterclockwise” study that saw reversals in biological markers of aging after a one-week intervention that consisted only of a (albeit rather intensive) mental reframe with regard to their age.
This book goes into such ideas much more than we can in a single article here, and in more ways, both on the personal level and the societal level.
The style is (despite its heavy leanings on hundreds of scientific studies) quite conversational in tone, with many personal anecdotes padding the pages a little, but it does get the message across and helps to illustrate things.
Bottom line: if you’d like a fresh take on aging, to make a big difference to yours, this book tackles that.
Click here to check out Breaking The Age Code, and break the age code!
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Lies I Taught in Medical School – by Dr. Robert Lufkin
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There seems to be a pattern of doctors who practice medicine one way, get a serious disease personally, and then completely change their practice of medicine afterwards. This is one of those cases.
Dr. Lufkin here presents, on a chapter-by-chapter basis, the titularly promised “lies” or, in more legally compliant speak (as he acknowledges in his preface), flawed hypotheses that are generally taught as truths. In many cases, the “lie” is some manner of “xyz is normal and nothing to worry about”, and/or “there is nothing to be done about xyz; suck it up”.
The end result of the information is not complicated—enjoy a plants-forward whole foods low-carb diet to avoid metabolic diseases and all the other things to branch off from same (Dr. Lufkin makes a fair case for metabolic disease leading to a lot of secondary diseases that aren’t considered metabolic diseases per se). But, the journey there is actually important, as it answers a lot of questions that are much less commonly understood, and often not even especially talked-about, despite their great import and how they may affect health decisions beyond the dietary. Things like understanding the downsides of statins, or the statistical models that can be used to skew studies, per relative risk reduction and so forth.
Bottom line: this book gives the ins and outs of what can go right or wrong with metabolic health and why, and how to make sure you don’t sabotage your health through missing information.
Click here to check out Lies I Taught In Medical School, and arm yourself with knowledge!
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