Do You Have A Personalized Health Plan? (Here’s How)
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“Good health” is quite a broad umbrella, and while we all have a general idea of what “healthy” looks like, it’s easy to focus on some areas and overlook others.
Of course, how much one does this will still depend on one’s level of interest in health, which can change over the course of life, and (barring serious midlife health-related curveballs such as a cancer diagnosis or something) often looks like an inverse bell curve:
- As small kids, we probably barely thought about health
- As teenagers, we probably had a narrow view of health (often related to whatever is considered sexually attractive at the time)
- In our 20s, may have a bit of a health kick in which we learn and apply a lot… Which often then gets to later take a bit of a back seat to work responsibilities and so forth
- This is commonly followed by a few decades of just trying to make it to Friday by any means necessary (definite risk factor for substance abuse of various kinds), double if we have kids, triple if we have work, kids, and are also solely responsible for managing the household.
- Then just as suddenly as it is predictably, we are ambushed when approaching retirement age by a cluster of age-related increased health risks that we now get to do our best to mitigate—the focus here is “not dying early”. A lot of health education occurs at this time.
- Finally, upon retirement, we actually get the time to truly focus on our health again, and now it’s easier to learn about all aspects of health, even if now there’s a need to juggle many health issues all at once, most of which affect the others.
See also: How Likely Are You To Live To 100? ← in which we can also see a graph of 10almonds subscribers’ ages, consistent with the above
So, let’s recap, and personalize our health plan
There are often things we wish we could have focused on sooner, so now’s the time to figure out what future-you in your next decade (or later!) is going to thank you for having done now.
So, while 20-year-old us might have been focusing on fat levels or athletic performance, how much does that really help us now? (With apologies to any readers in their 20s, but also, with the bonus for you: now’s the perfect time to plan ahead!)
At 10almonds, while we cover very many health topics, we often especially focus on:
- Brain health
- Heart health
- Gut health
…because they affect everything else so much. We’ve listed them there in the order they appear in the body, but in fact it can be useful to view them upside down, because:
- Gut health is critical for good metabolic health (a happy efficient gut allows us to process nutrients, including energy, efficiently)
- Metabolic health is critical for good heart health (a nicely ticking metabolism will not strain our heart)
- Heart health is critical for good brain health (a strong heart will nourish the brain with well-oxygenated blood and the nutrients it also carries)
So, this isn’t a catch-22 at all! There is a clear starting point:
“How do I do the other bits, though?”
We have you covered here: Your Health Audit, From Head To Toe
“Wait, where’s the personalization?”
This comes once you’ve got those above things in order.
Hopefully you know what particular health risks you have—as in, particular to you.
First, you will have any current diagnoses, and a plan for treating those. Many chronic illnesses can be reversed or at least lessened with lifestyle changes, in particular, if we reduce chronic inflammation, which is implicated in countless chronic illnesses, and exacerbates most of the rest.
So: How to Prevent (or Reduce) Inflammation
The same goes for any heightened risks you have as a result of those current diagnoses.
Next, you will have any genetic health risks—so here’s where genetic testing is a good one-shot tool, to get a lot of information all in one go.
Learn more: The Real Benefit Of Genetic Testing
…and then, of course, take appropriate steps to avoid suffering the things of which you are at increased genetic risk.
Finally, you will have any personal concerns or goals—in other words, what do you want to still be able to do, later in life? It’s easy to say “everything”, but what’s most important?
This writer’s example: I want to remain mobile, free from pain, and sharp of mind.
That doesn’t mean I’ll neglect the rest of my health, but it does mean that I will regularly weigh my choices against whether they are consistent with those three things.
As for how to plan for that?
Check out: Train For The Event Of Your Life! ← this one is mostly about the mobility aspect; staying free from pain is in large part a matter of avoiding inflammation which we already discussed, and staying sharp of mind relies on the gut-heart-brain pipeline we also covered.
You can also, of course, personalize your diet per which areas of health are the most important for you:
Four Ways To Upgrade The Mediterranean (most anti-inflammatory, gut-healthiest, heart-healthiest, brain-healthiest)
Take care!
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Healthy Kids, Happy Kids – by Dr. Elisa Song
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If you have young children or perhaps grandchildren, you probably care deeply about those children and their wellbeing, but there can often be a lot more guesswork than would be ideal, when it comes to ensuring they be and remain healthy.
Nevertheless, a lot of common treatments for children are based (whether parents know it or not—and often they dont) on what is most convenient for the parent, not necessarily what is best for the child. Dr. Song looks to correct that.
Rather than dosing kids with acetaminophen or even antibiotics, assuming eczema can be best fixed with a topical cream (treating the symptom rather than the cause, much?), and that some things like asthma “just are”, and “that’s unfortunate”, Dr. Song takes us on a tour of pediatric health, centered around the gut.
Why the gut? Well, it’s pretty central to us as adults, and it’s the same for kids, except one difference: their gut microbiome is changing even more quickly than ours (along with the rest of their body), and as such, is even more susceptible to little nudges for better or for worse, having a big impact in either direction. So, might as well make it a good one!
After an explanatory overview, most of the book is given over to recognizing and correcting what things can go wrong, including the top 25 acute childhood conditions, and the most critical chronic ones, and how to keep things on-track as a team (the child is part of the team! An important part!).
The style of the book is very direct and instructional; easy to understand throughout. It’s a lot like being in a room with a very competent pediatrician who knows her stuff and explains it well, thus neither patronizing nor mystifying.
Bottom line: if there are kids in your life, be they yours or your grandkids or someone else, this is a fine book for giving them the best foundational health.
Click here to check out Healthy Kids, Happy Kids, and take care of yours!
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How they did it: STAT reporters expose how ailing seniors suffer when Medicare Advantage plans use algorithms to deny care
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In a call with a long-time source, what stood out most to STAT reporters Bob Herman and Casey Ross was just how viscerally frustrated and angry the source was about an algorithm used by insurance companies to decide how long patients should stay in a nursing home or rehab facility before being sent home.
The STAT stories had a far-reaching impact:
- The U.S. Senate Committee on Homeland Security and Government Affairs took a rare step of launching a formal investigation into the use of algorithms by the country’s three largest Medicare Advantage insurers.
- Thirty-two House members urged the Centers for Medicare and Medicaid Services to increase the oversight of algorithms that health insurers use to make coverage decisions.
- In a rare step, CMS launched its own investigation into UnitedHealth. It also stiffened its regulations on the use of proprietary algorithms and introduced plans to audit denials across Medicare Advantage plans in 2024.
- Based on STAT’s reporting, Medicare Advantage beneficiaries filed two class-action lawsuits against UnitedHealth and its NaviHealth subsidiary, the maker of the algorithm, and against Humana, another major health insurance company that was also using the algorithm.
- Amid scrutiny, UnitedHealth renamed NaviHealth.
The companies never allowed an on-the-record interview with their executives, but they acknowledged that STAT’s reporting was true, according to the news organization.
Ross and Herman spoke with The Journalist’s Resource about their project and shared the following eight tips.
1. Search public comments on proposed federal rules to find sources.
Herman and Ross knew that the Centers for Medicare and Medicaid Services had put out a request for public comments, asking stakeholders within the Medicare Advantage industry how the system could improve.
There are two main ways to get Medicare coverage: original Medicare, which is a fee-for-service health plan, and Medicare Advantage, which is a type of Medicare health plan offered by private insurance companies that contract with Medicare. Medicare Advantage plans have increasingly become popular in recent years.
Under the Social Security Act, the public has the opportunity to submit comments on Medicare’s proposed national coverage determinations. CMS uses public comments to inform its proposed and final decisions. It responds in detail to all public comments when issuing a final decision.
The reporters began combing through hundreds of public comments attached to a proposed Medicare Advantage rule that was undergoing federal review. NaviHealth, the UnitedHealth subsidiary and the maker of the algorithm, came up in many of the comments, which include the submitters’ information.
“These are screaming all-caps comments to federal regulators about YOU NEED TO SOMETHING ABOUT THIS BECAUSE IT’S DISGUSTING,” Ross says.
“The federal government is proposing rules and regulations all the time,” adds Herman, STAT’s business of health care reporter. “If someone’s going to take the time and effort to comment on them, they must have at least some knowledge of what’s going on. It’s just a great tool for any journalist to use to figure out more and who to contact.”
The reporters also found several attorneys who had complained in the comments. They began reaching out to them, eventually gaining access to confidential documents and intermediaries who put them in touch with patients to show the human impact of the algorithm.
2. Harness the power of the reader submission box.
At the suggestion of an editor, the reporters added a reader submission box at the bottom of their first story, asking them to share their own experiences with Medicare Advantage denials.
The floodgates opened. Hundreds of submissions arrived.
By the end of their first story, Herman and Ross had confidential records and some patients, but they had no internal sources in the companies they were investigating, including Navihealth. The submission box led them to their first internal source.
(Screenshot of STAT’s submission box.) The journalists also combed through LinkedIn and reached out to former and current employees, but the response rate was much lower than what they received via the submission box.
The submission box “is just right there,” Herman says. “People who would want to reach out to us can do it right then and there after they read the story and it’s fresh in their minds.”
3. Mine podcasts relevant to your story.
The reporters weren’t sure if they could get interviews with some of the key figures in the story, including Tom Scully, the former head of the Centers for Medicare and Medicaid Services who drew up the initial plans for NaviHealth years before UnitedHealth acquired it.
But Herman and another colleague had written previously about Scully’s private equity firm and they had found a podcast where he talked about his work. So Herman went back to the podcast — where he discovered Scully had also discussed NaviHealth.
The reporters also used the podcast to get Scully on the phone for an interview.
“So we knew we had a good jumping off point there to be like, ‘OK, you’ve talked about NaviHealth on a podcast, let’s talk about this,’” Herman says. “I think that helped make him more willing to speak with us.”
4. When covering AI initiatives, proceed with caution.
“A source of mine once said to me, ‘AI is not magic,’” Ross says. “People need to just ask questions about it because AI has this aura about it that it’s objective, that it’s accurate, that it’s unquestionable, that it never fails. And that is not true.”
AI is not a neutral, objective machine, Ross says. “It’s based on data that’s fed into it and people need to ask questions about that data.”
He suggests several questions to ask about the data behind AI tools:
- Where does the data come from?
- Who does it represent?
- How is this tool being applied?
- Do the people to whom the tool is being applied match the data on which it was trained? “If racial groups or genders or age of economic situations are not adequately represented in the training set, then there can be an awful lot of bias in the output of the tool and how it’s applied,” Ross says.
- How is the tool applied within the institution? Are people being forced to forsake their judgment and their own ability to do their jobs to follow the algorithm?
5. Localize the story.
More than half of all Medicare beneficiaries have Medicare Advantage and there’s a high likelihood that there are multiple Medicare Advantage plans in every county across the nation.
“So it’s worth looking to see how Medicare Advantage plans are growing in your area,” Herman says.
Finding out about AI use will most likely rely on shoe-leather reporting of speaking with providers, nursing homes and rehab facilities, attorneys and patients in your community, he says. Another source is home health agencies, which may be caring for patients who were kicked out of nursing homes and rehab facilities too soon because of a decision by an algorithm.
The anecdote that opens their first story involves a small regional health insurer in Wisconsin, which was using NaviHealth and a contractor to manage post-acute care services, Ross says.
“It’s happening to people in small communities who have no idea that this insurer they’ve signed up with is using this tool made by this other company that operates nationally,” Ross says.
There are also plenty of other companies like NaviHealth that are being used by Medicare Advantage plans, Herman says. “So it’s understanding which Medicare Advantage plans are being sold in your area and then which post-acute management companies they’re using,” he adds.
Some regional insurers have online documents that show which contractors they use to evaluate post-acute care services.
6. Get familiar with Medicare’s appeals databases
Medicare beneficiaries can contest Medicare Advantage denials through a five-stage process, which can last months to years. The appeals can be filed via the Office of Medicare Hearings and Appeals.
“Between 2020 and 2022, the number of appeals filed to contest Medicare Advantage denials shot up 58%, with nearly 150,000 requests to review a denial filed in 2022, according to a federal database,” Ross and Herman write in their first story. “Federal records show most denials for skilled nursing care are eventually overturned, either by the plan itself or an independent body that adjudicates Medicare appeals.”
There are several sources to find appeals data. Be mindful that the cases themselves are not public to protect patient privacy, but you can find the number of appeals filed and the rationale for decisions.
CMS has two quality improvement organizations, or QIOs, Livanta and Kepro, which are required to file free, publicly-available annual reports, about the cases they handle, Ross says.
Another company, Maximus, a Quality Improvement Contractor, also files reports on prior authorization cases it adjudicates for Medicare. The free annual reports include data on raw numbers of cases and basic information about the percentage denials either overturned or upheld on appeal, Ross explains.
CMS also maintains its own database on appeals for Medicare Part C (Medicare Advantage plans) and Part D, which covers prescription drugs, although the data is not complete, Ross explains.
7. Give your editor regular updates.
“Sprinkle the breadcrumbs in front of your editors,” Ross says.
“If you wrap your editors in the process, you’re more likely to be able to get to the end of [the story] before they say, ‘That’s it! Give me your copy,’” Ross says.
8. Get that first story out.
“You don’t have to know everything before you write that first story,” Ross says. “Because with that first story, if it has credibility and it resonates with people, sources will come forward and sources will continue to come forward.”
Read the stories
Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need
UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care
UnitedHealth used secret rules to restrict rehab care for seriously ill Medicare Advantage patients
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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Cranberries vs Goji Berries – Which is Healthier?
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Our Verdict
When comparing cranberries to goji berries, we picked the cranberries.
Why?
Both are great! And your priorities may differ. Here’s how they stack up:
In terms of macros, goji berries have more protein, carbs, and fiber. This is consistent with them generally being eaten very dried, whereas cranberries are more often eaten fresh or from frozen, or partially rehydrated. In any case, goji berries are the “more food per food” option, so it wins this category. The glycemic indices are both low, by the way, though goji berries are the lower.
When it comes to vitamins, cranberries have more of vitamins B1, B2, B3, B5, B6, B9, E, K, and choline, while goji berries have more of vitamins A and C. Admittedly it’s a lot more, but still, on strength of overall vitamin coverage, the clear winner here is cranberries.
We see a similar story when it comes to minerals: cranberries have more copper, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while goji berries have (a lot) more calcium and iron. Again, by strength of overall mineral coverage, the clear winner here is cranberries.
Cranberries do also have some extra phytochemical benefits, including their prevention/cure status when it comes to UTIs—see our link below for more on that.
At any rate, enjoy either or both, but those are the strengths and weaknesses of these two berries!
Want to learn more?
You might like to read:
- Health Benefits Of Cranberries (But: You’d Better Watch Out)
- Goji Berries: Which Benefits Do They Really Have?
- The Sugary Food That Lowers Blood Sugars ← this is also about goji berries
Take care!
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The Gym For Your Mental Health
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Getting The Most Out Of Therapy
If you’ve never had therapy, what image do you have of it? Perhaps you imagine a bearded and bespectacled man in a suit, impassively making notes on a clipboard. Perhaps you imagine an empathetic woman, with tissues and camomile tea on standby.
The reality is: the experience of therapy can vary, a lot.
In its results, too! Sometimes we may try therapy and think “well that was a waste of time and money”. Sometimes we may try therapy and it’ll change our life.
So… Is there any way to make it less of a lottery?
First: knowledge is power
And while the therapist-client relationship certainly shouldn’t be a power struggle, you do want to be empowered.
So, read about different styles of therapy, and also, read some how-to guides for self-therapy. We’ve recommended some before in previous editions of 10almonds; you can check those books out here:
- How to Be Your Own Therapist: Boost your mood and reduce your anxiety in 10 minutes a day – by Owen O’Kane
- You Are the One You’ve Been Waiting For: Applying Internal Family Systems to Intimate Relationships – by Dr. Richard Schwartz
- DBT Made Simple: A Step-by-Step Guide to Dialectical Behavior Therapy – by Sheri van Dijk
- How to Do the Work: Recognize Your Patterns, Heal from Your Past, and Create Your Self – by Dr. Nicole LaPera
This will serve two purposes:
- You’ll know what to expect out of a therapist
- You can more efficiently “get to work” in therapy
It also, of course, could help you already, without even going to therapy!
Second: begin with the end in mind
A person who does not know what they want to get out of therapy, will likely not get much out of therapy. Or rather, their first task will be to figure that out. So, figure it out in advance, if you can.
Maybe you have a problem that has a specific name, for example poor self-esteem, anxiety, stress, depression, trauma, neuroticism, phobia, etc.
This isn’t Alcoholics Anonymous, and in this case you don’t want a lifetime of “Hello, my name is ______ and I have ______”, if you can help it.
So, what do you want?
- Maybe you want to be able to go to social events without feeling anxious
- Maybe you want your relationship(s) to be more secure and fulfilling
- Maybe you want to no longer have nightmares about that traumatic thing
- Maybe you want to be able to greet each day’s tasks with confidence and without overwhelm
…etc.
A good therapist will help you to set such goals (if you haven’t already), and attain them.
If you’re going the self-therapy route, then this is your job now!
It will probably start with the question: imagine that everything currently troubling you is now healed.
What would that look like, to you?
Third: get a good match for you
Unless you are going entirely the self-therapy route (which can work for some), you will want a therapist who’s a good match for you.
It may take a degree of “suck it and see” trial runs before you find the right one, but that takes time and money, so you’ll want to streamline the process as much as you can. If you do this well, you may be able to find a good therapist for you first time.
For this, personal recommendations (such as from friends) may help more than exmaining academic and institutional affiliations.
Yes, you want a well-qualified therapist who is a member in good standing of a respectable regulated body… but whether your therapist is easy for you to “get on with” will matter at least as much as whether their approach is psychodynamic, or 4th wave CBT, or IFS, or whatever seems popular in your time and place.
Bear in mind:
- Some therapists are specialized in helping with some kinds of things and not others. It will obviously help if the therapist you choose is specialized in the thing you are seeking help for.
- Some therapists may be able to relate to you better (or not), based on simple factors of who they are. To this end, while your therapist certainly doesn’t have to be a mirror image of you, factors like age, gender, race, etc can be relevant and may be worth considering, depending on what you are seeking help with, and what factors impact that thing.
Prefer keeping things to yourself?
Therapy isn’t for everyone, but having a good relationship with oneself definitely is. You might want to invest in one of the books whose reviews we linked above, and you might also get value from previous Psychology Sunday articles, which you can find in our archive (every seventh edition here has a Psychology Sunday main feature):
Click Here To Check Out The 10almonds Archive
To borrow the catchphrase of Dr. Kirk Honda (a therapist and therapy educator with decades of experience):
❝Take care of yourself, because you deserve it; you really, really do.❞
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Can You Reverse Gray Hair? A Dermatologist Explains
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Betteridge’s Law of Headlines states “any headline that ends in a question mark can be answered by the word no“—it’s not really a universal truth, but it’s true surprisingly often, and, as board certified dermatologist “The Beauty MD” Dr. Sam Ellis explains, it’s true in this case.
But, all is not lost.
Physiological Factors
Hair color is initially determined by genes and gene expression, instructing the body to color it with melanin (brown and black) and/or pheomelanin (blonde and red). If and when the body produces less of those pigments, our hair will go gray.
Factors that affect if/when our hair will go gray include:
- Genetics: primary determinant, essentially a programmed change
- Age: related to the above, but critically, the probability of going gray in any given year increases with age
- Ethnicity: the level of melanin in our skin is an indicator of how long we are likely to maintain melanin in our hair. Black people with the darkest skintones will thus generally go gray last, whereas white people with the lightest skintones will generally go gray first, and so on for a spectrum between the two.
- Medical conditions: immune conditions such as vitiligo, thyroid disease, and pernicious anemia promote an earlier loss of pigmentation
- Stress: oxidative stress, mainly, so factors like smoking will cause earlier graying. But yes, also chronic emotional stress does lead to oxidative stress too. Interestingly, this seems to be more about norepinephrine than cortisol, though.
- Nutrient deficiencies: the body can make a lot of things, but it needs the raw ingredients. Not having the right amounts of important vitamins and minerals will result in a loss of pigmentation (amongst other more serious problems). Vitamins B6, B9, and B12 are talked about in the video, as are iron and zinc. Copper is also needed for some hair colors. Selenium is needed for good hair health in general (but not too much, as an excess of selenium paradoxically causes hair loss), and many related things will stop working properly without adequate magnesium. Hair health will also benefit a lot from plenty of vitamin B7.
So, managing the above factors (where possible; obviously some of the above aren’t things we can influence) will result in maintaining one’s hair pigment for longer. As for texture, by the way, the reason gray hair tends to have a rougher texture is not for the lack of pigment itself, but is due to decreased sebum production. Judicious use of exogenous hair oils (e.g. argan oil, coconut oil, or whatever your preference may be) is a fine way to keep your grays conditioned.
However, once your hair has gone gray, there is no definitive treatment with good evidence for reversing that, at present. Dye it if you want to, or don’t. Many people (including this writer, who has just a couple of streaks of gray herself) find gray hair gives a distinguished look, and such harmless signs of age are a privilege not everyone gets to reach, and thus may be reasonably considered a cause for celebration
For more on all of the above, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Take care!
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Apple vs Pear – Which is Healthier?
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Our Verdict
When comparing apple to pear, we picked the pear.
Why?
Both are great! But there’s a category that puts pears ahead of apples…
Looking at their macros first, pears contain more carbs but also more fiber. Both are low glycemic index foods, though.
In the category of vitamins, things are moderately even: apples contain more of vitamins A, B1, B6, and E, while pears contain more of vitamins B3, B9, K, and choline. That’s a 4:4 split, and the two fruits are about equal in the other vitamins they both contain.
When it comes to minerals, pears contain more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. A resounding victory for pears, as apples are not higher in any mineral.
In short, if an apple a day keeps the doctor away, a pear should keep the doctor away for about a day and a half, based on the extra nutrients ← this is slightly facetious as medicine doesn’t work like that, but you get the idea: pears simply have more to offer. Apples are still great though! Enjoy both! Diversity is good.
Want to learn more?
You might like to read:
From Apples To Bees, And High-Fructose Cs: Which Sugars Are Healthier, And Which Are Just The Same?
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
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