Gutbliss – by Dr. Robynne Chutkan
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We’ve previously reviewed another of (gastroenterologist) Dr. Chutkan’s books, “The Anti-Viral Gut”, but Gutbliss is her most well-known book, and here’s why:
This book goes into a lot more detail than most gut health books. You probably already know to eat fiber and enjoy an occasional probiotic, and chances are good you’ve already at least considered screening for food sensitivities/intolerances/allergies, especially common ones like lactose and gluten.
So, well beyond such, Dr. Chutkan talks about the very many things that affect our gut health, and countless small tweaks we can make to improve things, and the very least not sabotage ourselves. A lot of the advice is of course dietary, but some is other aspects of lifestyle, and a lot of items are things like “do this at this time of day, not that time of day”, or “do this and this, but not together”, and similar such advices that come from a place of deep professional knowledge.
The “10-day plan” promised by the subtitle is of course delivered, and while it may seem a bold claim, do remember that the life cycle of things in your gut is very very short, so 10 days is more than enough time for a complete reset, if doing things correctly.
The style is very accessible pop science, making this very easy to implement.
Bottom line: if you’d like your gut health to be better than it is, this book has a wealth of information to guide you through doing exactly that.
Click here to check out Gutbliss, and enjoy how much healthier you can feel!
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Black Forest Chia Pudding
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This pudding tastes so decadent, it’s hard to believe it’s so healthy, but it is! Not only is it delicious, it’s also packed with nutrients including protein, carbohydrates, healthy fats (including omega-3s), fiber, vitamins, minerals, and assorted antioxidant polyphenols. Perfect dessert or breakfast!
You will need
- 1½ cups pitted fresh or thawed-from-frozen cherries
- ½ cup mashed banana
- 3 tbsp unsweetened cocoa powder
- 2 tbsp chia seeds, ground
- Optional: 2 pitted dates, soaked in hot water for 10 minutes and then drained (include these if you prefer a sweeter pudding)
- Garnish: a few almonds, and/or berries, and/or cherries and/or cacao nibs
Method
(we suggest you read everything at least once before doing anything)
1) Blend the ingredients except for the chia seeds and the garnish, with ½ cup of water, until completely smooth
2) Divide into two small bowls or glass jars
3) Add 1 tbsp ground chia seeds to each, and stir until evenly distributed
4) Add the garnish and refrigerate overnight or at least for some hours. There’s plenty of wiggle-room here, so make it at your convenience and serve at your leisure.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Cherries’ Very Healthy Wealth Of Benefits!
- If You’re Not Taking Chia, You’re Missing Out
- Cacao vs Carob – Which is Healthier?
Take care!
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Brain Wash – by Dr. David Perlmutter, Dr. Austin Perlmutter, and Kristen Loberg
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You may be familiar with the lead author of this book, Dr. David Perlmutter, as a big name in the world of preventative healthcare. A lot of his work has focused specifically on carbohydrate metabolism, and he is as associated with grains and he is with brains. This book focuses on the latter.
Dr. Perlmutter et al. take a methodical look at all that is ailing our brains in this modern world, and systematically lay out a plan for improving each aspect.
The advice is far from just dietary, though the chapter on diet takes a clear stance:
❝The food you eat and the beverages you drink change your emotions, your thoughts, and the way you perceive the world❞
The style is explanatory, and the book can be read comfortably as a “sit down and read it cover to cover” book; it’s an enjoyable, informative, and useful read.
Bottom line: if you’d like to give your brain a gentle overhaul, this is the one-stop-shop book to give you the tools to do just that.
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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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ADHD medication – can you take it long term? What are the risks and do benefits continue?
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Attention deficit hyperactivity disorder (ADHD) is a condition that can affect all stages of life. Medication is not the only treatment, but it is often the treatment that can make the most obvious difference to a person who has difficulties focusing attention, sitting still or not acting on impulse.
But what happens once you’ve found the medication that works for you or your child? Do you just keep taking it forever? Here’s what to consider.
What are ADHD medications?
The mainstay of medication for ADHD is stimulants. These include methylphenidate (with brand names Ritalin, Concerta) and dexamfetamine. There is also lisdexamfetamine (branded Vyvanse), a “prodrug” of dexamfetamine (it has a protein molecule attached, which is removed in the body to release dexamfetamine).
There are also non-stimulants, in particular atomoxetine and guanfacine, which are used less often but can also be highly effective. Non-stimulants can be prescribed by GPs but this may not always be covered by the Pharmaceutical Benefits Scheme and could cost more.
How stimulants work
Some stimulants prescribed for ADHD are “short acting”. This means the effect comes on after around 20 minutes and lasts around four hours.
Longer-acting stimulants give a longer-lasting effect, usually by releasing medication more slowly. The choice between the two will be guided by whether the person wants to take medication once a day or prefers to target the medication effect to specific times or tasks.
For the stimulants (with the possible exception of lisdexamfetamine) there is very little carry-over effect to the next day. This means the symptoms of ADHD may be very obvious until the first dose of the morning takes effect.
One of the main aims of treatment is the person with ADHD should live their best life and achieve their goals. In young children it is the parents who have to consider the risks and benefits on behalf of the child. As children mature, their role in decision making increases.
What about side effects?
The most consistent side effects of the stimulants are they suppress appetite, resulting in weight loss. In children this is associated with temporary slowing of the growth rate and perhaps a slight delay in pubertal development. They can also increase the heart rate and may cause a rise in blood pressure. Stimulants often cause insomnia.
These changes are largely reversible on stopping medication. However, there is concern the small rises in blood pressure could accelerate the rate of heart disease, so people who take medication over a number of years might have heart attacks or strokes slightly sooner than would have happened otherwise.
This does not mean older adults should not have their ADHD treated. Rather, they should be aware of the potential risks so they can make an informed decision. They should also make sure high blood pressure and attacks of chest pain are taken seriously.
Stimulants can be associated with stomach ache or headache. These effects may lessen over time or with a reduction in dose. While there have been reports about stimulants being misused by students, research on the risks of long-term prescription stimulant dependence is lacking.
Will medication be needed long term?
Although ADHD can affect a person’s functioning at all stages of their life, most people stop medication within the first two years.
People may stop taking it because they don’t like the way it makes them feel, or don’t like taking medication at all. Their short period on medication may have helped them develop a better understanding of themselves and how best to manage their ADHD.
In teenagers the medication may lose its effectiveness as they outgrow their dose and so they stop taking it. But this should be differentiated from tolerance, when the dose becomes less effective and there are only temporary improvements with dose increases.
Tolerance may be managed by taking short breaks from medication, switching from one stimulant to another or using a non-stimulant.
Medication is usually prescribed by a specialist but rules differ around Australia.
Ground Picture/ShutterstockToo many prescriptions?
ADHD is becoming increasingly recognised, with more people – 2–5% of adults and 5–10% of children – being diagnosed. In Australia stimulants are highly regulated and mainly prescribed by specialists (paediatricians or psychiatrists), though this differs from state to state. As case loads grow for this lifelong diagnosis, there just aren’t enough specialists to fit everyone in.
In November, a Senate inquiry report into ADHD assessment and support services highlighted the desperation experienced by people seeking treatment.
There have already been changes to the legislation in New South Wales that may lead to more GPs being able to treat ADHD. Further training could help GPs feel more confident to manage ADHD. This could be in a shared-care arrangement or independent management of ADHD by GPs like a model being piloted at Nepean Blue Mountains Local Health District, with GPs training within an ADHD clinic (where I am a specialist clinician).
Not every person with ADHD will need or want to take medication. However, it should be more easily available for those who could find it helpful.
Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Be A Plant-Based Woman Warrior – by Jane Esselstyn & Ann Esselstyn
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Notwithstanding the title, this book is not about being a woman or a warrior, but let us share what one reviewer on Amazon wrote:
❝I don’t want to become a plant based woman warrior. The sex change would be traumatic for me. However, as a man who proudly takes ballet classes and Pilates, I am old enough not to worry about stereotypes. When I see a good thing, I am going to use it❞
The authors, a mother-and-daughter team in their 80s and 50s respectively, do give a focus on things that disproportionally affect women, and rectifying those things with diet, especially in one of the opening chapters.
Most the book, however, is about preventing/reversing things that can affect everyone, such as heart disease, diabetes, inflammation and the autoimmune diseases associated with such, and cancer in general, hence the dietary advice being good for most people (unless you have an unusually restrictive diet).
We get an overview of the pantry we should cultivate and curate, as well as some basic kitchen skills that will see us well for the rest of the book, such as how to make oat flour and other similar mini-recipes, before getting into the main recipes themselves.
About the recipes: they are mostly quite simple, though often rely on having pre-prepared items from the mini-recipes we mentioned earlier. They’re all vegan, mostly but not all gluten-free, whole foods, no added sugar, and as for oil… Well, it seems to be not necessarily oil-free, but rather oil-taboo. You see, they just don’t mention it. For example, when they say to caramelize onions, they say to heat a skillet, and when it is hot, add the onions, and stir until browned. They don’t mention any oil in the ingredients or in the steps. It is a mystery. 10almonds note: we recommend olive oil, or avocado oil if you prefer a milder taste and/or need a higher smoke point.
Bottom line: the odd oil taboo aside, this is a good book of simple recipes that teaches some good plant-based kitchen skills while working with a healthy, whole food pantry.
Click here to check out Be A Plant-Based Woman Warrior, and be a plant-based woman warrior!
Or at the very least: be a plant-based cook regardless of gender, hopefully without war, and enjoy the additions to your culinary repertoire
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A drug that can extend your life by 25%? Don’t hold your breath
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Every few weeks or months, the media reports on a new study that tantalisingly dangles the possibility of a new drug to give us longer, healthier lives.
The latest study centres around a drug involved in targeting interleukin-11, a protein involved in inflammation. Blocking this protein appeared to help mice stave off disease and extend their life by more than 20%.
If only defying the ravages of time could be achieved through such a simple and effort-free way – by taking a pill. But as is so often the case, the real-world significance of these findings falls a fair way short of the hype.
Halfpoint/Shutterstock The role of inflammation in disease and ageing
Chronic inflammation in the body plays a role in causing disease and accelerating ageing. In fact, a relatively new label has been coined to represent this: “inflammaging”.
While acute inflammation is an important response to infection or injury, if inflammation persists in the body, it can be very damaging.
A number of lifestyle, environmental and societal drivers contribute to chronic inflammation in the modern world. These are largely the factors we already know are associated with disease and ageing, including poor diet, lack of exercise, obesity, stress, lack of sleep, lack of social connection and pollution.
While addressing these issues directly is one of the keys to addressing chronic inflammation, disease and ageing, there are a number of research groups also exploring how to treat chronic inflammation with pharmaceuticals. Their goal is to target and modify the molecular and chemical pathways involved in the inflammatory process itself.
What the latest research shows
This new interleukin-11 research was conducted in mice and involved a number of separate components.
In one component of this research, interleukin-11 was genetically knocked out in mice. This means the gene for this chemical mediator was removed from these mice, resulting in the mice no longer being able to produce this mediator at all.
In this part of the study, the mice’s lives were extended by over 20%, on average.
Another component of this research involved treating older mice with a drug that blocks interleukin-11.
Injecting this drug into 75-week old mice (equivalent to 55-year-old humans) was found to extend the life of mice by 22-25%.
These treated mice were less likely to get cancer and had lower cholesterol levels, lower body weight and improved muscle strength and metabolism.
From these combined results, the authors concluded, quite reasonably, that blocking interleukin-11 may potentially be a key to mitigating age-related health effects and improving lifespan in both mice and humans.
Why you shouldn’t be getting excited just yet
There are several reasons to be cautious of these findings.
First and most importantly, this was a study in mice. It may be stating the obvious, but mice are very different to humans. As such, this finding in a mouse model is a long way down the evidence hierarchy in terms of its weight.
Research shows only about 5% of promising findings in animals carry over to humans. Put another way, approximately 95% of promising findings in animals may not be translated to specific therapies for humans.
Second, this is only one study. Ideally, we would be looking to have these findings confirmed by other researchers before even considering moving on to the next stage in the knowledge discovery process and examining whether these findings may be true for humans.
We generally require a larger body of evidence before we get too excited about any new research findings and even consider the possibility of human trials.
Third, even if everything remains positive and follow-up studies support the findings of this current study, it can take decades for a new finding like this to be translated to successful therapies in humans.
Until then, we can focus on doing the things we already know make a huge difference to health and longevity: eating well, exercising, maintaining a healthy weight, reducing stress and nurturing social relationships.
Hassan Vally, Associate Professor, Epidemiology, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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