Lower Your Cortisol! (Here’s Why & How)
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Cortisol, or “the stress hormone” to its friends, is produced by your adrenal glands, and is generally considered “not fun”.
It does serve a purpose, of course, just like almost everything else our body does. It serves as part of the “fight or flight” response, for example, and helps you to wake up in the morning.
While you do need some cortisol (and a small percentage of people have too little), most of us have too much.
Why? Simply put, modern life is not what 200,000* years of human evolution prepared us for:
- Agriculture (which allowed us to settle down and cease being nomadic) happened during the last 6% of those 200,000 years.
- The Industrial Revolution and the onset of modern capitalism happened during only during the last 0.1% of those 200,000 years.
*the 200,000 years figure is conservative and doesn’t take into account the 200,000,000 years of pre-hominid mammalian evolution. Doing so, on the basis of the mammalian brain & physiology being what’s important here, means our modern stressors have been around for <0.0001% of the time we have.
So guess what, our bodies haven’t caught up. As far as our bodies are concerned, we are supposed to be enjoying the sunshine of grassy plains and the shade of woodland while eating fruit.
- When the alarm clock goes off, our body panics and prepares us to either flee or help fight the predator, because why else would we have been woken so?
- When we have a pressing deadline for work, our brain processes this as “if we don’t do this, we will literally starve and die”.
- When people are upset or angry with us, there’s a part of our brain that fears exile from the tribe and resultant death.
…and so on.
Health Risks of High Cortisol
The long-term stressors are the biggest issue for health. Unless you have a heart condition or other relevant health problem, almost anyone can weather a brief unpleasant surprise. But if something persists? That prompts the body to try to protect you, bless it. The body’s attempts backfire, because…
- One way it does this by making sure to save as much food as possible in the form of body fat
- It’ll also increase your appetite, to make sure you eat anything you can while you still can
- It additionally tries to protect you by keeping you on the brink of fight-or-flight readiness, e.g:
- High blood pressure
- High blood sugar levels
- Rapid mood changes—gotta be able to do those heel-turns as necessary and react quickly to any possible threat!
Suffice it to say, these things are not good for your long-term health.
That’s the “Why”—now here’s the “How”:
Lowering your cortisol levels mostly means lowering your stress and/or lowering your stress response. We previously gave some powerful tools for lowering anxiety, which for these purposes amounts to the same thing.
However, we can also make nutritional and lifestyle changes that will reduce our cortisol levels, for example:
- Reduce (ideally: eliminate from your lifestyle) caffeine
- Reduce (ideally: eliminate from your lifestyle) alcohol
- Yes, really. While many understandably turn to alcohol specifically to help manage stress, it only makes it worse long-term.
- Additionally, alcohol directly stimulates cortisol production, counterintuitive as that may be.
Read: Alcohol, Aging, and the Stress Response ← full article (with 37 sources of its own) from the NYMC covering how alcohol stimulates cortisol production and what that means for us
As well as reductions/eliminations, are some things you can add into your lifestyle that will help!
We’ve written previously about some:
Read: Ashwagandha / Read: L-Theanine / Read: CBD Oil
Other things include, no surprises here:
- The Mediterranean diet (nutritious and delicious): https://10almonds.com/mediterranean-diet
- Get 7–9 hours (good quality!) sleep per night: https://10almonds.com/time-pillow-talk
- Get regular exercise (the regularity matters most!): https://10almonds.com/keep-on-keeping-on
Progressive Relaxation
We’ll give this one its own section because we’ve not talked about it before. Maybe you’re familiar. If not, then in a nutshell: progressive relaxation means progressively tensing and then relaxing each part of your body in turn.
Why does this work? Part of it is just a physical trick involving biofeedback and the natural function of muscles to contract and relax in turn, but the other part is even cleverer:
It basically tricks the most primitive part of your brain, the limbic system, into thinking you had a fight and won, telling it “thank you very much for the cortisol but we don’t need it anymore”.
Take a Hike! Or a Stroll… You Do You!
Last but not least: go connect with your roots. Spend time in the park, or at least the garden. Have a picnic, if the weather suits. Go somewhere you can spend time around leafy green things under a blue sky (we realize the blue sky may be subject to availability in some locations, but do what you can!).
Remember also: just as your body’s responses will be tricked by the alarm clock or the housework, they will also be easily tricked by blue and green stuff around you. If a sunny garden isn’t available in your location, a picture of one as your desktop background is the next best thing.
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Why Some People Get Sick More (And How To Not Be One Of Them)
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Some people have never yet had COVID (so far so good, this writer included); others are on their third bout already; others have not been so lucky and are no longer with us to share their stories.
Obviously, even the healthiest and/or most careful person can get sick, and it would be folly to be complacent and think “I’m not a person who gets sick; that happens to other people”.
Nor is COVID the only thing out there to worry about; there’s always the latest outbreak-du-jour of something, and there are always the perennials such as cold and flu—which are also not to be underestimated, because both weaken us to other things, and flu has killed very many, from the 50,000,000+ in the 1918 pandemic, to the 700,000ish that it kills each year nowadays.
And then there are the combination viruses:
Move over, COVID and Flu! We Have “Hybrid Viruses” To Contend With Now
So, why are some people more susceptible?
Firstly, some people are simply immunocompromised. This means for example that:
- perhaps they have an inflammatory/autoimmune disease of some kind (e.g. lupus, rheumatoid arthritis, type 1 diabetes), or…
- perhaps they are taking immunosuppressants for some reason (e.g. because they had an organ transplant), or…
- perhaps they have a primary infection that leaves them vulnerable to secondary infections. Most infections will do this to some degree or another, but some are worse for it than others; untreated HIV is a clear example. The HIV itself may not kill people, but (if untreated) the resultant AIDS will leave a person open to being killed by almost any passing opportunistic pathogen. Pneumonia of various kinds being high on the list, but it could even be something as simple as the common cold, without a working immune system to fight it.
See also: How To Prevent (Or Reduce) Inflammation
And for that matter, since pneumonia is a very common last-nail-in-the-coffin secondary infection (especially: older people going into hospital with one thing, getting a secondary infection and ultimately dying as a result), it’s particularly important to avoid that, so…
See also: Pneumonia: What We Can & Can’t Do About It
Secondly, some people are not immunocompromised per the usual definition of the word, but their immune system is, arguably, compromised.
Cortisol, the stress hormone, is an immunosuppressant. We need cortisol to live, but we only need it in small bursts here and there (such as when we are waking up the morning). When high cortisol levels become chronic, so too does cortisol’s immunosuppressant effect.
Top things that cause elevated cortisol levels include:
- Stress
- Alcohol
- Smoking
Thus, the keys here are to 1) not smoke 2) not drink, ideally, or at least keep consumption low, but honestly even one drink will elevate cortisol levels, so it’s better not to, and 3) manage stress.
See also: Lower Your Cortisol! (Here’s Why & How)
Other modifiable factors
Being aware of infection risk and taking steps to reduce it (e.g. avoiding being with many people in confined indoor places, masking as appropriate, handwashing frequently) is a good preventative strategy, along with of course getting any recommended vaccines as they come available.
What if they fail? How can we boost the immune system?
We talked about not sabotaging the immune system, but what about actively boosting it? The answer is yes, we certainly can (barring serious medical reasons why not), as there are some very important lifestyle factors too:
Beyond Supplements: The Real Immune-Boosters!
One final last-line thing…
Since if we do get an infection, it’s better to know sooner rather than later… A recent study shows that wearable activity trackers can (if we pay attention to the right things) help predict disease, including highlighting COVID status (positive or negative) about as accurately (88% accuracy) as rapid screening tests. Here’s a pop-science article about it:
Wearable activity trackers show promise in detecting early signals of disease
Take care!
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Oral retinoids can harm unborn babies. But many women taking them for acne may not be using contraception
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Oral retinoids are a type of medicine used to treat severe acne. They’re sold under the brand name Roaccutane, among others.
While oral retinoids are very effective, they can have harmful effects if taken during pregnancy. These medicines can cause miscarriages and major congenital abnormalities (harm to unborn babies) including in the brain, heart and face. At least 30% of children exposed to oral retinoids in pregnancy have severe congenital abnormalities.
Neurodevelopmental problems (in learning, reading, social skills, memory and attention) are also common.
Because of these risks, the Australasian College of Dermatologists advises oral retinoids should not be prescribed a month before or during pregnancy under any circumstances. Dermatologists are instructed to make sure a woman isn’t pregnant before starting this treatment, and discuss the risks with women of childbearing age.
But despite this, and warnings on the medicines’ packaging, pregnancies exposed to oral retinoids continue to be reported in Australia and around the world.
In a study published this month, we wanted to find out what proportion of Australian women of reproductive age were taking oral retinoids, and how many of these women were using contraception.
Our results suggest a high proportion of women are not using effective contraception while on these drugs, indicating Australia needs a strategy to reduce the risk oral retinoids pose to unborn babies.
Contraception options
Using birth control to avoid pregnancy during oral retinoid treatment is essential for women who are sexually active. Some contraception methods, however, are more reliable than others.
Long-acting-reversible contraceptives include intrauterine devices (IUDs) inserted into the womb (such as Mirena, Kyleena, or copper devices) and implants under the skin (such as Implanon). These “set and forget” methods are more than 99% effective.
Oral retinoids taken during pregnancy can cause complications in babies. Gorodenkoff/Shutterstock The effectiveness of oral contraceptive pills among “perfect” users (following the directions, with no missed or late pills) is similarly more than 99%. But in typical users, this can fall as low as 91%.
Condoms, when used as the sole method of contraception, have higher failure rates. Their effectiveness can be as low as 82% in typical users.
Oral retinoid use over time
For our study, we analysed medicine dispensing data among women aged 15–44 from Australia’s Pharmaceutical Benefit Scheme (PBS) between 2013 and 2021.
We found the dispensing rate for oral retinoids doubled from one in every 71 women in 2013, to one in every 36 in 2021. The increase occurred across all ages but was most notable in young women.
Most women were not dispensed contraception at the same time they were using the oral retinoids. To be sure we weren’t missing any contraception that was supplied before the oral retinoids, we looked back in the data. For example, for an IUD that lasts five years, we looked back five years before the oral retinoid prescription.
Our analysis showed only one in four women provided oral retinoids were dispensed contraception simultaneously. This was even lower for 15- to 19-year-olds, where only about one in eight women who filled a prescription for oral retinoids were dispensed contraception.
A recent study found 43% of Australian year 10 and 69% of year 12 students are sexually active, so we can’t assume this younger age group largely had no need for contraception.
One limitation of our study is that it may underestimate contraception coverage, because not all contraceptive options are listed on the PBS. Those options not listed include male and female sterilisation, contraceptive rings, condoms, copper IUDs, and certain oral contraceptive pills.
But even if we presume some of the women in our study were using forms of contraception not listed on the PBS, we’re still left with a significant portion without evidence of contraception.
What are the solutions?
Other countries such as the United States and countries in Europe have pregnancy prevention programs for women taking oral retinoids. These programs include contraception requirements, risk acknowledgement forms and regular pregnancy tests. Despite these programs, unintended pregnancies among women using oral retinoids still occur in these countries.
But Australia has no official strategy for preventing pregnancies exposed to oral retinoids. Currently oral retinoids are prescribed by dermatologists, and most contraception is prescribed by GPs. Women therefore need to see two different doctors, which adds costs and burden.
Preventing pregnancy during oral retinoid treatment is essential. Krakenimages.com/Shutterstock Rather than a single fix, there are likely to be multiple solutions to this problem. Some dermatologists may not feel confident discussing sex or contraception with patients, so educating dermatologists about contraception is important. Education for women is equally important.
A clinical pathway is needed for reproductive-aged women to obtain both oral retinoids and effective contraception. Options may include GPs prescribing both medications, or dermatologists only prescribing oral retinoids when there’s a contraception plan already in place.
Some women may initially not be sexually active, but change their sexual behaviour while taking oral retinoids, so constant reminders and education are likely to be required.
Further, contraception access needs to be improved in Australia. Teenagers and young women in particular face barriers to accessing contraception, including costs, stigma and lack of knowledge.
Many doctors and women are doing the right thing. But every woman should have an effective contraception plan in place well before starting oral retinoids. Only if this happens can we reduce unintended pregnancies among women taking these medicines, and thereby reduce the risk of harm to unborn babies.
Dr Laura Gerhardy from NSW Health contributed to this article.
Antonia Shand, Research Fellow, Obstetrician, University of Sydney and Natasha Nassar, Professor of Paediatric and Perinatal Epidemiology and Chair in Translational Childhood Medicine, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Sun-dried Tomatoes vs Black Olives – Which is Healthier?
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Our Verdict
When comparing sun-dried tomatoes to black olives, we picked the sun-dried tomatoes.
Why?
These common snack-salad items may seem similar in consistency, but their macros are very different: the tomatoes, being dried, have proportionally a lot more protein, carbs, and fiber. The olives, meanwhile, have more fat (and/but yes, a very healthy blend of fats). Note that these comments are true for the things themselves; be aware that sun-dried tomatoes are often sold in vegetable oil, which would obviously change the macros considerably and be much less healthy. So, for the sake of statistics, we’re assuming you got sun-dried tomatoes that aren’t soaked in oil. All in all, we’re calling this category a win for the tomatoes, but those fats from the olives are very good too.
In terms of vitamins, the sun-dried tomatoes being dried again means that the loss of water weight means the vitamin content is proportionally much higher; the tomatoes are higher in vitamins A, B1, B2, B3, B5, B6, B9, C, and K, while olives are higher only in vitamin E (but in their defence, olives have 165x more vitamin E than sun-dried tomatoes). Still, a win for sun-dried tomatoes here.
When it comes to minerals, it’s a similar story for the same reason; the loss of water weight in the sun-dried tomatoes makes them much more nutritionally dense; they are higher in calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while the olives are higher only in sodium. Note, we’re looking at black olives today; green olives would be even higher in sodium than black ones, as they are “cured” for longer.
Lastly, in terms of polyphenols, they both have a lot of great things to bring, but sun-dried tomatoes are pretty much the richest natural source of lycopene, which itself a very powerful polyphenol even my general polyphenol standards, so we’d call this one a win for the sun-dried tomatoes too.
Want to learn more?
You might like to read:
Lycopene’s Benefits For The Gut, Heart, Brain, & More
Take care!
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Pasteurization: What It Does And Doesn’t Do
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Pasteurization’s Effect On Risks & Nutrients
In Wednesday’s newsletter, we asked you for your health-related opinions of raw (cow’s) milk, and got the above-depicted, below-described, set of responses:
- About 47% said “raw milk is dangerous to consume, whereas pasteurization makes it safer”
- About 31% said “raw milk is a good source of vital nutrients which pasteurization would destroy”
- About 14% said “both raw milk and pasteurized milk are equally unhealthy”
- About 9% said “both raw milk and pasteurized milk are equally healthy”
Quite polarizing! So, what does the science say?
“Raw milk is dangerous to consume, whereas pasteurization makes it safer: True or False?”
True! Coincidentally, the 47% who voted for this are mirrored by the 47% of the general US population in a similar poll, deciding between the options of whether raw milk is less safe to drink (47%), just as safe to drink (15%), safer to drink (9%), or not sure (30%):
Public Fails to Appreciate Risk of Consuming Raw Milk, Survey Finds
As for what those risks are, by the way, unpasteurized dairy products are estimated to cause 840x more illness and 45x more hospitalizations than pasteurized products.
This is because unpasteurized milk can (and often does) contain E. coli, Listeria, Salmonella, Cryptosporidium, and other such unpleasantries, which pasteurization kills.
Source for both of the above claims:
(we know the title sounds vague, but all this information is easily visible in the abstract, specifically, the first two paragraphs)
Raw milk is a good source of vital nutrients which pasteurization would destroy: True or False?
False! Whether it’s a “good” source can be debated depending on other factors (e.g., if we considered milk’s inflammatory qualities against its positive nutritional content), but it’s undeniably a rich source. However, pasteurization doesn’t destroy or damage those nutrients.
Incidentally, in the same survey we linked up top, 16% of the general US public believed that pasteurization destroys nutrients, while 41% were not sure (and 43% knew that it doesn’t).
Note: for our confidence here, we are skipping over studies published by, for example, dairy farming lobbies and so forth. Those do agree, by the way, but nevertheless we like sources to be as unbiased as possible. The FDA, which is not completely unbiased, has produced a good list of references for this, about half of which we would consider biased, and half unbiased; the clue is generally in the journal names. For example, Food Chemistry and the Journal of Food Science and Journal of Nutrition are probably less biased than the International Dairy Association and the Journal of Dairy Science:
FDA | Raw Milk Misconceptions and the Danger of Raw Milk Consumption
this page covers a lot of other myths too, more than we have room to “bust” here, but it’s very interesting reading and we recommend to check it out!
Notably, we also weren’t able to find any refutation by counterexample on PubMed, with the very slight exception that some studies sometimes found that in the case of milks that were of low quality, pasteurization can reduce the vitamin E content while increasing the vitamin A content. For most milks however, no significant change was found, and in all cases we looked at, B-vitamins were comparable and vitamin D, popularly touted as a benefit of cow’s milk, is actually added later in any case. And, importantly, because this is a common argument, no change in lipid profiles appears to be findable either.
In science, when something has been well-studied and there aren’t clear refutations by counterexample, and the weight of evidence is clearly very much tipped into one camp, that usually means that camp has it right.
Milk generally is good/bad for the health: True or False?
True or False, depending on what we want to look at. It’s definitely not good for inflammation, but the whole it seems to be cancer-neutral and only increases heart disease risk very slightly:
- Keep Inflammation At Bay ← short version is milk is bad, fermented milk products are fine in moderation
- Is Dairy Scary? ← short version is that milk is neither good nor terrible; fermented dairy products however are health-positive in numerous ways when consumed in moderation
You may be wondering…
…how this goes for the safety of dairy products when it comes to the bird flu currently affecting dairy cows, so:
Take care!
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Resistance Is Useful! (Especially As We Get Older)
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Resistance Is Useful!
At 10almonds we talk a lot about the importance of regular moderate exercise (e.g. walking, gardening, housework, etc), and with good reason: getting in those minutes (at least 150 minutes per week, so, a little over 20 minutes per day, or 25 minutes per day with one day off) is the exericise most consistently linked to better general health outcomes and reduced mortality risk.
We also often come back to mobility, because at the end of the day, being able to reach for something from a kitchen cabinet without doing oneself an injury is generally more important in life than being able to leg-press a car.
Today though, we’re going to talk about resistance training.
What is resistance training?
It can be weight-lifting, or it can be bodyweight exercises. In those cases, what you’re resisting is gravity. It can also be exercises with resistance bands or machines. In all cases, it’s about building and/or maintaining strength.
Why does it matter?
Let’s say you’re not an athlete, soldier, or laborer, and the heaviest thing you have to pick up is a bag of groceries. Strength still matters, for two main reasons:
- Muscle strength correlates to bone strength. You can’t build (or maintain) strong muscles on weak bones, so if you take care of your muscles, then your body will keep your bones strong too.
- That’s assuming you have a good diet as well—but today’s not about that. If you’d like to know more about eating for bone health though, do check out this previous article about that!
- Muscle strength correlates to balance and stability. You can’t keep yourself from falling over if you are physically frail.
Both of those things matter, because falls and fractures often have terrible health outcomes (e.g., slower recovery and more complications) the older we get. So, we want to:
- Ideally, not fall in the first place
- If we do fall, have robust bones
See also: Effects of Resistance Exercise on Bone Health
How much should we do?
Let’s go to the Journal of Strength and Conditioning Research on this one:
❝There is strong evidence to support the benefits of resistance exercise for countering many age-related processes of sarcopenia, muscle weakness, mobility loss, chronic disease, disability, and even premature mortality.
In addition, this Position Statement provides specific evidence-based practice recommendations to aid in the implementation of resistance exercise programs for healthy older adults and those with special considerations.
While there are instances where low-intensity, low-volume programs are appropriate (i.e., beginning programs for individuals with frailty or CVDs), the greatest benefits are possible with progression to moderate to higher intensity programs.❞
~ Fragala et al
Read the statement in full:
There’s a lot of science there and it’s well worth reading if you have the time. It’s particularly good at delineating how much is not enough vs how much is too much, and the extent to which we should (or shouldn’t) train to exhaustion.
If you don’t fancy that, though, and/or just want to start with something accessible and work your way up, the below is a very good (and also evidence-based) start-up plan:
Healthline’s Exercise Plan For Seniors—For Strength, Balance, & Flexibility
(it has a weekly planner, step-by-step guides to the exercises, and very clear illustrative animations of each)
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- Muscle strength correlates to bone strength. You can’t build (or maintain) strong muscles on weak bones, so if you take care of your muscles, then your body will keep your bones strong too.
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Their First Baby Came With Medical Debt. These Illinois Parents Won’t Have Another.
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JACKSONVILLE, Ill. — Heather Crivilare was a month from her due date when she was rushed to an operating room for an emergency cesarean section.
The first-time mother, a high school teacher in rural Illinois, had developed high blood pressure, a sometimes life-threatening condition in pregnancy that prompted doctors to hospitalize her. Then Crivilare’s blood pressure spiked, and the baby’s heart rate dropped. “It was terrifying,” Crivilare said.
She gave birth to a healthy daughter. What followed, though, was another ordeal: thousands of dollars in medical debt that sent Crivilare and her husband scrambling for nearly a year to keep collectors at bay.
The Crivilares would eventually get on nine payment plans as they juggled close to $5,000 in bills.
“It really felt like a full-time job some days,” Crivilare recalled. “Getting the baby down to sleep and then getting on the phone. I’d set up one payment plan, and then a new bill would come that afternoon. And I’d have to set up another one.”
Crivilare’s pregnancy may have been more dramatic than most. But for millions of new parents, medical debt is now as much a hallmark of having children as long nights and dirty diapers.
About 12% of the 100 million U.S. adults with health care debt attribute at least some of it to pregnancy or childbirth, according to a KFF poll.
These people are more likely to report they’ve had to take on extra work, change their living situation, or make other sacrifices.
Overall, women between 18 and 35 who have had a baby in the past year and a half are twice as likely to have medical debt as women of the same age who haven’t given birth recently, other KFF research conducted for this project found.
“You feel bad for the patient because you know that they want the best for their pregnancy,” said Eilean Attwood, a Rhode Island OB-GYN who said she routinely sees pregnant women anxious about going into debt.
“So often, they may be coming to the office or the hospital with preexisting debt from school, from other financial pressures of starting adult life,” Attwood said. “They are having to make real choices, and what those real choices may entail can include the choice to not get certain services or medications or what may be needed for the care of themselves or their fetus.”
Best-Laid Plans
Crivilare and her husband, Andrew, also a teacher, anticipated some of the costs.
The young couple settled in Jacksonville, in part because the farming community less than two hours north of St. Louis was the kind of place two public school teachers could afford a house. They saved aggressively. They bought life insurance.
And before Crivilare got pregnant in 2021, they enrolled in the most robust health insurance plan they could, paying higher premiums to minimize their deductible and out-of-pocket costs.
Then, two months before their baby was due, Crivilare learned she had developed preeclampsia. Her pregnancy would no longer be routine. Crivilare was put on blood pressure medication, and doctors at the local hospital recommended bed rest at a larger medical center in Springfield, about 35 miles away.
“I remember thinking when they insisted that I ride an ambulance from Jacksonville to Springfield … ‘I’m never going to financially recover from this,’” she said. “‘But I want my baby to be OK.’”
For weeks, Crivilare remained in the hospital alone as covid protocols limited visitors. Meanwhile, doctors steadily upped her medications while monitoring the fetus. It was, she said, “the scariest month of my life.”
Fear turned to relief after her daughter, Rita, was born. The baby was small and had to spend nearly two weeks in the neonatal intensive care unit. But there were no complications. “We were incredibly lucky,” Crivilare said.
When she and Rita finally came home, a stack of medical bills awaited. One was already past due.
Crivilare rushed to set up payment plans with the hospitals in Jacksonville and Springfield, as well as the anesthesiologist, the surgeon, and the labs. Some providers demanded hundreds of dollars a month. Some settled for monthly payments of $20 or $25. Some pushed Crivilare to apply for new credit cards to pay the bills.
“It was a blur of just being on the phone constantly with all the different people collecting money,” she recalled. “That was a nightmare.”
Big Bills, Big Consequences
The Crivilares’ bills weren’t unusual. Parents with private health coverage now face on average more than $3,000 in medical bills related to a pregnancy and childbirth that aren’t covered by insurance, researchers at the University of Michigan found.
Out-of-pocket costs are even higher for families with a newborn who needs to stay in a neonatal ICU, averaging $5,000. And for 1 in 11 of these families, medical bills related to pregnancy and childbirth exceed $10,000, the researchers found.
“This forces very difficult trade-offs for families,” said Michelle Moniz, a University of Michigan OB-GYN who worked on the study. “Even though they have insurance, they still have these very high bills.”
Nationwide polls suggest millions of these families end up in debt, with sometimes devastating consequences.
About three-quarters of U.S. adults with debt related to pregnancy or childbirth have cut spending on food, clothing, or other essentials, KFF polling found.
About half have put off buying a home or delayed their own or their children’s education.
These burdens have spurred calls to limit what families must pay out-of-pocket for medical care related to pregnancy and childbirth.
In Massachusetts, state Sen. Cindy Friedman has proposed legislation to exempt all these bills from copays, deductibles, and other cost sharing. This would parallel federal rules that require health plans to cover recommended preventive services like annual physicals without cost sharing for patients. “We want … healthy children, and that starts with healthy mothers,” Friedman said. Massachusetts health insurers have warned the proposal will raise costs, but an independent state analysis estimated the bill would add only $1.24 to monthly insurance premiums.
Tough Lessons
For her part, Crivilare said she wishes new parents could catch their breath before paying down medical debt.
“No one is in the right frame of mind to deal with that when they have a new baby,” she said, noting that college graduates get such a break. “When I graduated with my college degree, it was like: ‘Hey, new adult, it’s going to take you six months to kind of figure out your life, so we’ll give you this six-month grace period before your student loans kick in and you can get a job.’”
Rita is now 2. The family scraped by on their payment plans, retiring the medical debt within a year, with help from Crivilare’s side job selling resources for teachers online.
But they are now back in debt, after Rita’s recurrent ear infections required surgery last year, leaving the family with thousands of dollars in new medical bills.
Crivilare said the stress has made her think twice about seeing a doctor, even for Rita. And, she added, she and her husband have decided their family is complete.
“It’s not for us to have another child,” she said. “I just hope that we can put some of these big bills behind us and give [Rita] the life that we want to give her.”
About This Project
“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.
The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country.
Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.
The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability.
KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.
Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.
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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