
The Science of Nutrition – by Rhiannon Lambert
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While there are a lot of conflicting dietary approaches out there, the science itself is actually fairly cohesive in most regards. This book does a lot of what we do here at 10almonds, and presents the science in a clear fashion without having any particular agenda to push.
The author is a nutritionist (BSc, MSc, RNutr) and therefore provides an up-to-date evidence-based approach for eating.
As a result, the only part of this book that brings it down in this reviewer’s opinion is the section on Intermittent Fasting. Being not strictly about nutrition, she has less expertise on that topic, and it shows.
The information is largely presented in double-page spreads each answering a particular question. Because of this, and the fact there are colorful graphic representations of information too, we do recommend the print version over Kindle*.
Bottom line: if you like the notion of real science being presented in a clear and simple fashion (we like to think our subscribers do!), then you’ll surely enjoy this book.
Click here to check out the Science of Nutrition, and get a clear overview!
*Writer’s note: I realize I’ve two days in a row recommended this (yesterday because there are checkboxes to check, worksheets to complete, etc), but it’s not a new trend; just how it happened to be with these two books. I love my Kindle dearly, but sometimes print has the edge for one reason or another!
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Lycopene’s Benefits For The Gut, Heart, Brain, & More
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What Doesn’t Lycopene Do?
Lycopene is an antioxidant carotenoid famously found in tomatoes; it actually appears in even higher levels in watermelon, though. If you are going to get it from tomato, know that cooking improves the lycopene content rather than removing it (watermelon, on the other hand, can be enjoyed as-is and already has the higher lycopene content).
Antioxidant properties
Let’s reiterate the obvious first, for the sake of being methodical and adding a source. Lycopene is a potent antioxidant with multiple health benefits:
Lycopene: A Potent Antioxidant with Multiple Health Benefits
…and as such, it does all the things you might reasonably expect and antioxidant to do. For example…
Anti-inflammatory properties
In particular, it regulates macrophage activity, reducing inflammation while improving immune response:
Lycopene Regulates Macrophage Immune Response through the Autophagy Pathway Mediated by RIPK1
As can be expected of most antioxidants and anti-inflammatory agents, it also has…
Anticancer properties
Scientific papers tend to be “per cancer type”, so we’re just going to give one example, but there’s pretty much evidence for its utility against most if not all types of cancer. We’re picking prostate cancer though, as it’s one that’s been studied the most in the context of lycopene intake—in this study, for example, it was found that men who enjoyed at least two servings of lycopene-rich tomato sauce per week were 30% less likely to develop prostate cancer than those who didn’t:
Dietary lycopene intake and risk of prostate cancer defined by ERG protein expression
If you’d like to see something more general, however, then check out:
Potential Use of Tomato Peel, a Rich Source of Lycopene, for Cancer Treatment
It also fights Candida albicans
Ok, this is not (usually) so life-and-death as cancer, but reducing our C. albicans content (specifically: in our gut) has a lot of knock-on effects for other aspects of our health, so this isn’t one to overlook:
The title does not make this clear, but yes: this does mean it has an antifungal effect. We mention this because often cellular apoptosis is good for an overall organism, but in this case, it simply kills the Candida.
It’s good for the heart
A lot of studies focus just on triglyceride markers (which lycopene improves), but more tellingly, here’s a 10-year observational study in which diets rich in lycopene were associated to a 17–26% lower risk of heart disease:
Relationship of lycopene intake and consumption of tomato products to incident CVD
…and a 39% overall reduced mortality in, well, we’ll let the study title tell it:
…which means also:
It’s good for the brain
As a general rule of thumb, what’s good for the heart is good for the brain (because the brain needs healthy blood flow to stay healthy, and is especially vulnerable when it doesn’t get that), and in this case that rule of thumb is also borne out by the post hoc evidence, specifically yielding a 31% decreased incidence of stroke:
Dietary and circulating lycopene and stroke risk: a meta-analysis of prospective studies
Is it safe?
As a common food product, it is considered very safe.
If you drink nothing but tomato juice all day for a long time, your skin will take on a reddish hue, which will go away if you stop getting all your daily water intake in tomato juice.
In all likelihood, even if you went to extremes, you would get sick from the excess of vitamin A (generally present in the same foods) sooner than you’d get sick from the excess of lycopene.
Want to try some?
We don’t sell it, and also we recommend simply enjoying tomatoes, watermelons, etc, but if you do want a supplement, here’s an example product on Amazon
Enjoy!
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10 Simple Japanese Habits For Healthier & Longer Life
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You don’t have to be Japanese or live in Okinawa to enjoy the benefits of healthy longevity. A lot of it comes down to simple habits:
Easy to implement
We’ll not keep the 10 habits a mystery; they are:
- Start the day with hot water: drinking hot water in the morning helps with hydration, warming the body, and aiding digestion.
- Enjoy a hearty breakfast: Japanese breakfasts are traditionally filling, nutritious, and help promote energy and longevity. Typical components include rice, miso soup, fish, and pickles.
- Take balanced meals: Japanese education emphasizes nutrition from a young age, promoting balanced meals with proteins, fiber, and vitamins & minerals.
- Enjoy fermented foods: fermented foods, such as nattō and soy-based condiments, support digestion, heart health, and the immune system.
- Drink green tea and matcha: both are rich in health benefits; preparing matcha mindfully adds a peaceful ritual to daily life too.
- Keep the “80% full” rule: “hara hachi bu” encourages eating until 80% full, which can improve longevity and, of course, prevent overeating.
- Use multiple small dishes: small servings and a variety of dishes help prevent overeating and ensure a diverse intake of nutrients.
- Gratitude before and after meals: saying “itadakimasu” and “gochisousama” promotes mindful eating, and afterwards, good digestion. Speaking Japanese is of course not the key factor here, but rather, do give yourself a moment of reflection before and after meals.
- Use vinegar in cooking: vinegar, often used in sushi rice and sauces like ponzu, adds flavor and offers health benefits, mostly pertaining to blood sugar balance.
- Eat slowly: Eating at a slower pace will improve digestion, and can enhance satiety and prevent accidentally overeating.
For more on all of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
How To Get More Out Of What’s On Your Plate
Take care!
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Lemon Balm For Stressful Times And More
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Balm For The Mind: In More Ways Than One!
Lemon balm(Melissa officinalis) is quite unrelated to lemons, and is actually a closer relative to mint. It does have a lemony fragrance, though!
You’ll find it in a lot of relaxing/sleepy preparations, so…
What does the science say?
Relaxation
Lemon balm has indeed been found to be a potent anti-stress herb. Laboratories that need to test anything to do with stress generally create that stress in one of two main ways:
- If it’s not humans: a forced swimming test that’s a lot like waterboarding
- If it is humans: cognitive tests completed under time-pressure while multitasking
Consequently, studies that have set out to examine lemon balm’s anti-stress potential in humans, have often ended up also highlighting its potential as a cognitive enhancer, like this one in which…
❝Both active lemon balm treatments were generally associated with improvements in mood and/or cognitive performance❞
~ Dr. Anastasia Ossoukhova et al.
Read in full: Anti-Stress Effects of Lemon Balm-Containing Foods
And this one, which found…
❝The results showed that the 600-mg dose of Melissa ameliorated the negative mood effects of the DISS, with significantly increased self-ratings of calmness and reduced self-ratings of alertness.
In addition, a significant increase in the speed of mathematical processing, with no reduction in accuracy, was observed after ingestion of the 300-mg dose.❞
The appropriately named “DISS” is the Defined Intensity Stress Simulation we talked about.
Sleep
There’s a lot less research for lemon balm’s properties in this regard than for stress/anxiety, and it’s probably because sleep studies are much more expensive than stress studies.
It’s not for a lack of popular academic interest—for example, typing “Melissa officinalis” into PubMed (the vast library of studies we often cite from) autosuggests “Melissa officinalis sleep”. But alas, autosuggestions do not Randomized Controlled Trials make.
There are some, but they’re often small, old, and combined with other things, like this one:
This is interesting, because generally speaking there is little to no evidence that valerian actually helps sleep, so if this mixture worked, we might reasonably assume it was because of the lemon balm—but there’s an outside chance it could be that it only works in the presence of valerian (unlikely, but in science we must consider all possibilities).
Beyond that, we just have meta-reviews to work from, like this one that noted:
❝M. officinalis contains several phytochemicals such as phenolic acids, flavonoids, terpenoids, and many others at the basis of its pharmacological activities. Indeed, the plant can have antioxidant, anti-inflammatory, antispasmodic, antimicrobial, neuroprotective, nephroprotective, antinociceptive effects.
Given its consolidated use, M. officinalis has also been experimented with clinical settings, demonstrating interesting properties against different human diseases, such as anxiety, sleeping difficulties, palpitation, hypertension, depression, dementia, infantile colic, bruxism, metabolic problems, Alzheimer’s disease, and sexual disorders. ❞
You see why we don’t try to cover everything here, by the way!
But if you want to read this one in full, you can, at:
An Updated Review on The Properties of Melissa officinalis L.: Not Exclusively Anti-anxiety
Is it safe?
Lemon balm is generally recognized as safe, and/but please check with your doctor/pharmacist in case of any contraindications due to medicines you may be on or conditions you may have.
Want to try some?
We don’t sell it, but here for your convenience is an example product on Amazon
Want to know your other options?
You might like our previous main features:
What Teas To Drink Before Bed (By Science!)
and
Safe Effective Sleep Aids For Seniors
Enjoy!
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Escape Self-Sabotage
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Stop Making The Same Mistakes
It’s easy to think that a self-destructive cycle is easy to avoid if you have no special will to self-destruction. However, the cycle is sneaky.
It’s sneaky because it can be passive, and/or omissions rather than actions, procrastinations rather than obvious acts of impulse, and so forth.
So, they’re often things that specifically aren’t there to see.
How to catch them
How often do you think “I wish I had [done xyz]” or “I wish I had [done yxz] sooner”?
Now, how often have you thought that about the same thing more than once? For example, “I should have kept up my exercise”.
For things like this, habit-trackers are a great way to, well, keep track of habits. If for example you planned to do a 10-minute exercise session daily but you’ve been postponing it since you got distracted on January the 2nd, then it’ll highlight that. See also:
How To Really Pick Up (And Keep!) Those Habits
Speaking of habits, this goes for other forms of procrastination, too. For example, if you are always slow to get medical check-ups, or renew your prescriptions, or get ready for some regularly-occurring thing in your schedule, then set a reminder in your preferred way (phone app, calendar on the wall, whatever) and when the appointed time arrives (to book the check-up, renew the prescription, do your taxes, whatever), do it on the day you set your reminder for, as a personal rule for you that you keep to, barring extreme calamity.
By “extreme calamity” we mean less “running late today” and more “house burned down”.
Digital traps
Bad habits can be insidious in other ways too, like getting sucked into social media scrolling (it is literally designed to do that to you; you are not immune modern programming hijacking evolutionary dopamine responses).
Setting a screentime limit (you can specify “just these apps” if you like) will help with this. On most devices, this feature includes a sticky notification in the notification bar, that’ll remind you “27 out of 30 minutes remaining” or whatever you set it for. That’ll remind you to do what you went there to do, instead of getting caught in the endless scroll (and if you went there to just browse, to do so briefly).
Here’s how to set that:
Instructions for iOS devices | Instructions for Android devices
Oh, and on the topic of social media? If you find yourself getting caught up in unproductive arguments on the Internet, try the three-response rule:
- You reply; they reply (no progress made)
- You reply; they reply (still no progress made)
- You reply; they reply (still yet no progress made)
You reply just one more time: “I have a personal rule that if I’m arguing on the Internet and no progress has been made after three replies, I don’t reply further—I find this is helpful to avoid a lot of time lost to pointless arguing that isn’t going anywhere. Best wishes.”
(and then stick to it, no matter how they try to provoke you; best is to just not look until at least the next day)
When “swept up in love” gets to one of those little whirlpools…
The same works in personal relationships, by the way. If for example you are arguing with a loved one and not making progress, it can be good if you both have a pre-arranged agreement that either of you can, up to once on any given day, invoke a “time-out” (e.g. 30 minutes, but you agree the time between you when you first make this standing policy) during which you will both keep out of the other’s way, and come back with a more productive head on (remembering that things go best when it’s you both vs the problem, rather than vs each other).
See also:
Seriously Useful Communication Skills: Conflict Resolution
What if the self-sabotaging cycle is active and apparent?
Well, that is less sneaky, but certainly no less serious, and sometimes moreso. An obvious example is drinking too much; this is often cyclical in nature. We wrote about this one previously:
That article’s alcohol-specific, but the same advices go for other harmful activities, including other substance abuse (which in turn includes binge-eating), as well psychological addictions (such as gambling, for example).
Finally…
If your destructive cycle is more of a rut you’ve got stuck in, a common advice is to change something, anything, to get out of the rut.
That can be very bad advice! Because sometimes the change you go for is absolutely not the change that was needed, and is rather just cracking under pressure and doing something impulsive.
Here’s one way to actively get out of a slump:
Behavioral Activation Against Depression & Anxiety
Note: you do not have to be depressed or anxious to do this. But the point is, it’s a tool you can use even if you are depressed and/or anxious, so it’s a good thing to try for getting out of most kinds of slumps.
And really finally, here’s a resource for, well, the title speaks for itself:
When You Know What You “Should” Do (But Knowing Isn’t The Problem)
Take care!
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Her Mental Health Treatment Was Helping. That’s Why Insurance Cut Off Her Coverage.
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Reporting Highlights
- Progress Denials: Insurers use a patient’s improvement to justify denying mental health coverage.
- Providers Disagree: Therapists argue with insurers and the doctors they employ to continue covering treatment for their patients.
- Patient Harm: Some patients backslid when insurers cut off coverage for treatment at key moments.
These highlights were written by the reporters and editors who worked on this story.
Geneva Moore’s therapist pulled out her spiral notebook. At the top of the page, she jotted down the date, Jan. 30, 2024, Moore’s initials and the name of the doctor from the insurance company to whom she’d be making her case.
She had only one chance to persuade him, and by extension Blue Cross and Blue Shield of Texas, to continue covering intensive outpatient care for Moore, a patient she had come to know well over the past few months.
The therapist, who spoke on the condition of anonymity out of fear of retaliation from insurers, spent the next three hours cramming, as if she were studying for a big exam. She combed through Moore’s weekly suicide and depression assessments, group therapy notes and write-ups from their past few sessions together.
She filled two pages with her notes: Moore had suicidal thoughts almost every day and a plan for how she would take her own life. Even though she expressed a desire to stop cutting her wrists, she still did as often as three times a week to feel the release of pain. She only had a small group of family and friends to offer support. And she was just beginning to deal with her grief and trauma over sexual and emotional abuse, but she had no healthy coping skills.
Less than two weeks earlier, the therapist’s supervisor had struck out with another BCBS doctor. During that call, the insurance company psychiatrist concluded Moore had shown enough improvement that she no longer needed intensive treatment. “You have made progress,” the denial letter from BCBS Texas read.
When the therapist finally got on the phone with a second insurance company doctor, she spoke as fast as she could to get across as many of her points as possible.
“The biggest concern was the abnormal thoughts — the suicidal ideation, self-harm urges — and extensive trauma history,” the therapist recalled in an interview with ProPublica. “I was really trying to emphasize that those urges were present, and they were consistent.”
She told the company doctor that if Moore could continue on her treatment plan, she would likely be able to leave the program in 10 weeks. If not, her recovery could be derailed.
The doctor wasn’t convinced. He told the therapist that he would be upholding the initial denial. Internal notes from the BCBS Texas doctors say that Moore exhibited “an absence of suicidal thoughts,” her symptoms had “stabilized” and she could “participate in a lower level of care.”
The call lasted just seven minutes.
Moore was sitting in her car during her lunch break when her therapist called to give her the news. She was shocked and had to pull herself together to resume her shift as a technician at a veterinary clinic.
“The fact that it was effective immediately,” Moore said later, “I think that was the hardest blow of it all.”
Many Americans must rely on insurers when they or family members are in need of higher-touch mental health treatment, such as intensive outpatient programs or round-the-clock care in a residential facility. The costs are high, and the stakes for patients often are, too. In 2019 alone, the U.S. spent more than $106.5 billion treating adults with mental illness, of which private insurance paid about a third. One 2024 study found that the average quoted cost for a month at a residential addiction treatment facility for adolescents was more than $26,000.
Health insurers frequently review patients’ progress to see if they can be moved down to a lower — and almost always cheaper — level of care. That can cut both ways. They sometimes cite a lack of progress as a reason to deny coverage, labeling patients’ conditions as chronic and asserting that they have reached their baseline level of functioning. And if they make progress, which would normally be celebrated, insurers have used that against patients to argue they no longer need the care being provided.
Their doctors are left to walk a tightrope trying to convince insurers that patients are making enough progress to stay in treatment as long as they actually need it, but not so much that the companies prematurely cut them off from care. And when insurers demand that providers spend their time justifying care, it takes them away from their patients.
“The issues that we grapple with are in the real world,” said Dr. Robert Trestman, the chair of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine and chair of the American Psychiatric Association’s Council on Healthcare Systems and Financing. “People are sicker with more complex conditions.”
Mental health care can be particularly prone to these progress-based denials. While certain tests reveal when cancer cells are no longer present and X-rays show when bones have healed, psychiatrists say they have to determine whether someone has returned to a certain level of functioning before they can end or change their treatment. That can be particularly tricky when dealing with mental illness, which can be fluid, with a patient improving slightly one day only to worsen the next.
Though there is no way to know how often coverage gets cut off mid-treatment, ProPublica has found scores of lawsuits over the past decade in which judges have sharply criticized insurance companies for citing a patient’s improvement to deny mental health coverage. In a number of those cases, federal courts ruled that the insurance companies had broken a federal law designed to provide protections for people who get health insurance through their jobs.
Reporters reviewed thousands of pages of court documents and interviewed more than 50 insiders, lawyers, patients and providers. Over and over, people said these denials can lead to real — sometimes devastating — harm. An official at an Illinois facility with intensive mental health programs said that this past year, two patients who left before their clinicians felt they were ready due to insurance denials had attempted suicide.
Dr. Eric Plakun, a Massachusetts psychiatrist with more than 40 years of experience in residential and intensive outpatient programs, and a former board member of the American Psychiatric Association, said the “proprietary standards” insurers use as a basis for denying coverage often simply stabilize patients in crisis and “shortcut real treatment.”
Plakun offered an analogy: If someone’s house is on fire, he said, putting out the fire doesn’t restore the house. “I got a hole in the roof, and the windows have been smashed in, and all the furniture is charred, and nothing’s working electrically,” he said. “How do we achieve recovery? How do we get back to living in that home?”
Unable to pay the $350-a-day out-of-pocket cost for additional intensive outpatient treatment, Moore left her program within a week of BCBS Texas’ denial. The insurer would only cover outpatient talk therapy.
During her final day at the program, records show, Moore’s suicidal thoughts and intent to carry them out had escalated from a 7 to a 10 on a 1-to-10 scale. She was barely eating or sleeping.
A few hours after the session, Moore drove herself to a hospital and was admitted to the emergency room, accelerating a downward spiral that would eventually cost the insurer tens of thousands of dollars, more than the cost of the treatment she initially requested.
How Insurers Justify Denials
Buried in the denial letters that insurance companies send patients are a variety of expressions that convey the same idea: Improvement is a reason to deny coverage.
“You are better.” “Your child has made progress.” “You have improved.”
In one instance, a doctor working for Regence Blue Cross and Blue Shield of Oregon wrote that a patient who had been diagnosed with major depression was “sufficiently stable,” even as her own doctors wrote that she “continued to display a pattern of severe impairment” and needed round-the-clock care. A judge ruled that “a preponderance of the evidence” demonstrated that the teen’s continued residential treatment was medically necessary. The insurer said it can’t comment on the case because it ended with a confidential settlement.
In another, a doctor working for UnitedHealth Group wrote in 2019 that a teenage girl with a history of major depression who had been hospitalized after trying to take her own life by overdosing “was doing better.” The insurer denied ongoing coverage at a residential treatment facility. A judge ruled that the insurer’s determination “lacked any reasoning or citations” from the girl’s medical records and found that the insurer violated federal law. United did not comment on this case but previously argued that the girl no longer had “concerning medical issues” and didn’t need treatment in a 24-hour monitored setting.
To justify denials, the insurers cite guidelines that they use to determine how well a patient is doing and, ultimately, whether to continue paying for care. Companies, including United, have said these guidelines are independent, widely accepted and evidence-based.
Insurers most often turn to two sets: MCG (formerly known as Milliman Care Guidelines), developed by a division of the multibillion-dollar media and information company Hearst, and InterQual, produced by a unit of UnitedHealth’s mental health division, Optum. Insurers have also used guidelines they have developed themselves.
MCG Health did not respond to multiple requests for comment. A spokesperson for the Optum division that works on the InterQual guidelines said that the criteria “is a collection of established scientific evidence and medical practice intended for use as a first level screening tool” and “helps to move patients safely and efficiently through the continuum of care.”
A separate spokesperson for Optum also said the company’s “priority is ensuring the people we serve receive safe and effective care for their individual needs.” A Regence spokesperson said that the company does “not make coverage decisions based on cost or length of stay,” and that its “number one priority is to ensure our members have access to the care they need when they need it.”
In interviews, several current and former insurance employees from multiple companies said that they were required to prioritize the proprietary guidelines their company used, even if their own clinical judgment pointed in the opposite direction.
“It’s very hard when you come up against all these rules that are kind of setting you up to fail the patient,” said Brittainy Lindsey, a licensed mental health counselor who worked at the Anthem subsidiary Beacon and at Humana for a total of six years before leaving the industry in 2022. In her role, Lindsey said, she would suggest approving or denying coverage, which — for the latter — required a staff doctor’s sign-off. She is now a mental health consultant for behavioral health businesses and clinicians.
A spokesperson for Elevance Health, formerly known as Anthem, said Lindsey’s “recollection is inaccurate, both in terms of the processes that were in place when she was a Beacon employee, and how we operate today.” The spokesperson said “clinical judgment by a physician — which Ms. Lindsey was not — always takes precedence over guidelines.”
In an emailed statement, a Humana spokesperson said the company’s clinician reviewers “are essential to evaluating the facts and circumstances of each case.” But, the spokesperson said, “having objective criteria is also important to provide checks and balances and consistently comply with” federal requirements.
The guidelines are a pillar of the health insurance system known as utilization management, which paves the way for coverage denials. The process involves reviewing patients’ cases against relevant criteria every handful of days or so to assess if the company will continue paying for treatment, requiring providers and patients to repeatedly defend the need for ongoing care.
Federal judges have criticized insurance company doctors for using such guidelines in cases where they were not actually relevant to the treatment being requested or for “solely” basing their decisions on them.
Wit v. United Behavioral Health, a class-action lawsuit involving a subsidiary of UnitedHealth, has become one of the most consequential mental health cases of this century. In that case, a federal judge in California concluded that a number of United’s in-house guidelines did not adhere to generally accepted standards of care. The judge found that the guidelines allowed the company to wrongly deny coverage for certain mental health and substance use services the moment patients’ immediate problems improved. He ruled that the insurer would need to change its practices. United appealed the ruling on grounds other than the court’s findings about the defects in its guidelines, and a panel of judges partially upheld the decision. The case has been sent back to the district court for further proceedings.
Largely in response to the Wit case, nine states have passed laws requiring health insurers to use guidelines that align with the leading standards of mental health care, like those developed by nonprofit professional organizations.
Cigna has said that it “has chosen not to adopt private, proprietary medical necessity criteria” like MCG. But, according to a review of lawsuits, denial letters have continued to reference MCG. One federal judge in Utah called out the company, writing that Cigna doctors “reviewed the claims under medical necessity guidelines it had disavowed.” Cigna did not respond to specific questions about this.
Timothy Stock, one of the BCBS doctors who denied Moore’s request to cover ongoing care, had cited MCG guidelines when determining she had improved enough — something judges noted he had done before. In 2016, Stock upheld a decision on appeal to deny continued coverage for a teenage girl who was in residential treatment for major depression, post-traumatic stress disorder and anxiety. Pointing to the guidelines, Stock concluded she had shown enough improvement.
The patient’s family sued the insurer, alleging it had wrongly denied coverage. Blue Cross and Blue Shield of Illinois argued that there was evidence that showed the patient had been improving. But, a federal judge found the insurer misstated its significance. The judge partially ruled in the family’s favor, zeroing in on Stock and another BCBS doctor’s use of improvement to recommend denying additional care.
“The mere incidence of some improvement does not mean treatment was no longer medically necessary,” the Illinois judge wrote.
In another case, BCBS Illinois denied coverage for a girl with a long history of mental illness just a few weeks into her stay at a residential treatment facility, noting that she was “making progressive improvements.” Stock upheld the denial after an appeal.
Less than two weeks after Stock’s decision, court records show, she cut herself on the arm and leg with a broken light bulb. The insurer defended the company’s reasoning by noting that the girl “consistently denied suicidal ideation,” but a judge wrote that medical records show the girl was “not forthcoming” with her doctors about her behaviors. The judge ruled against the insurer, writing that Stock and another BCBS doctor “unreasonably ignored the weight of the medical evidence” showing that the girl required residential treatment.
Stock declined to comment. A spokesperson for BCBS said the company’s doctors who review requests for mental health coverage are board certified psychiatrists with multiple years of practice experience. The spokesperson added that the psychiatrists review all information received “from the provider, program and members to ensure members are receiving benefits for the right care, at the right place and at the right time.”
The BCBS spokesperson did not address specific questions related to Moore or Stock. The spokesperson said that the examples ProPublica asked about “are not indicative of the experience of the vast majority of our members,” and that it is committed to providing “access to quality, cost-effective physical and behavioral health care.”
A Lifelong Struggle
A former contemporary dancer with a bright smile and infectious laugh, Moore’s love of animals is eclipsed only by her affinity for plants. She moved from Indiana to Austin, Texas, about six years ago and started as a receptionist at a clinic before working her way up to technician.
Moore’s depression has been a constant in her life. It began as a child, when, she said, she was sexually and emotionally abused. She was able to manage as she grew up, getting through high school and attending Indiana University. But, she said, she fell back into a deep sadness after she learned in 2022 that the church she found comfort in as a college student turned out to be what she and others deemed a cult. In September of last year, she began an intensive outpatient program, which included multiple group and individual therapy sessions every week.
Moore, 32, had spent much of the past eight months in treatment for severe depression, post-traumatic stress disorder and anxiety when BCBS said it would no longer pay for the program in January.
The denial had come to her without warning.
“I was starting to get to the point where I did have some hope, and I was like, maybe I can see an actual end to this,” Moore said. “And it was just cut off prematurely.”
At the Austin emergency room where she drove herself after her treatment stopped, her heart raced. She was given medication as a sedative for her anxiety. According to hospital records she provided to ProPublica, Moore’s symptoms were brought on after “insurance said they would no longer pay.”
A hospital social worker frantically tried to get her back into the intensive outpatient program.
“That’s the sad thing,” said Kandyce Walker, the program’s director of nursing and chief operating officer, who initially argued Moore’s case with BCBS Texas. “To have her go from doing a little bit better to ‘I’m going to kill myself.’ It is so frustrating, and it’s heartbreaking.”
After the denial and her brief admission to the hospital emergency department in January, Moore began slicing her wrists more frequently, sometimes twice a day. She began to down six to seven glasses of wine a night.
“I really had thought and hoped that with the amount of work I’d put in, that I at least would have had some fumes to run on,” she said.
She felt embarrassed when she realized she had nothing to show for months of treatment. The skills she’d just begun to practice seemed to disappear under the weight of her despair. She considered going into debt to cover the cost of ongoing treatment but began to think that she’d rather end her life.
“In my mind,” she said, “that was the most practical thing to do.”
Whenever the thought crossed her mind — and it usually did multiple times a day — she remembered that she had promised her therapist that she wouldn’t.
Moore’s therapist encouraged her to continue calling BCBS Texas to try to restore coverage for more intensive treatment. In late February, about five weeks after Stock’s denial, records show that the company approved a request that sent her back to the same facility and at the same level of care as before.
But by that time, her condition had deteriorated so severely that it wasn’t enough.
Eight days later, Moore was admitted to a psychiatric hospital about half an hour from Austin. Medical records paint a harrowing picture of her condition. She had a plan to overdose and the medicine to do it. The doctor wrote that she required monitoring and had “substantial ongoing suicidality.” The denial continued to torment her. She told her doctor that her condition worsened after “insurance stopped covering” her treatment.
Her few weeks stay at the psychiatric hospital cost $38,945.06. The remaining 10 weeks of treatment at the intensive outpatient program — the treatment BCBS denied — would have cost about $10,000.
Moore was discharged from the hospital in March and went back into the program Stock had initially said she no longer needed.
It marked the third time she was admitted to the intensive outpatient program.
A few months later, as Moore picked at her lunch, her oversized glasses sliding down the bridge of her nose every so often, she wrestled with another painful realization. Had the BCBS doctors not issued the denial, she probably would have completed her treatment by now.
“I was really looking forward to that,” Moore said softly. As she spoke, she played with the thick stack of bracelets hiding the scars on her wrists.
A few weeks later, that small facility closed in part because of delays and denials from insurance companies, according to staff and billing records. Moore found herself calling around to treatment facilities to see which ones would accept her insurance. She finally found one, but in October, her depression had become so severe that she needed to be stepped up to a higher level of care.
Moore was able to get a leave of absence from work to attend treatment, which she worried would affect the promotion she had been working toward. To tide her over until she could go back to work, she used up the money her mother sent for her 30th birthday.
She smiles less than she did even a few months ago. When her roommates ask her to hang out downstairs, she usually declines. She has taken some steps forward, though. She stopped drinking and cutting her wrists, allowing scar tissue to cover her wounds.
But she’s still grieving what the denial took from her.
“I believed I could get better,” she said recently, her voice shaking. “With just a little more time, I could discharge, and I could live life finally.”
Kirsten Berg contributed research.
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Why You Should Diversify Your Nuts!
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Time to go nuts for nuts!
Nuts, in popular perception, range from “basically the healthiest food anyone can eat” to “basically high calorie salty snacks”. And, they can be either!
Some notes, then:
- Raw is generally better that not
- Dry roasted is generally better than the kind with added oils
- Added salt is neither necessary nor good
Quick tip: if “roasted salted” are the cheapest or most convenient to buy, you can at least mitigate that by soaking them in warm water for 5 minutes, before rinsing and (if you don’t want wet nuts) drying.
You may be wondering: who does want wet nuts? And the answer is, if for example you’re making a delicious cashew and chickpea balti, the fact you didn’t dry them before throwing them in won’t make a difference.
Now, let’s do a quick run-down; we don’t usually do “listicles” but it seemed a good format here, so we’ve picked a top 5 for nutritional potency:
Almonds
We may have a bias. We accept it. But almonds are also one of the healthiest nuts around, and generally considered by most popular metrics the healthiest.
Not only are they high in protein, healthy fat, fiber, vitamins, and minerals, but they’re even a natural prebiotic that increases the populations of healthy gut bacteria, while simultaneously keeping down the populations of gut pathogens—what more can we ask of a nut?
Read more: Prebiotic effects of almonds and almond skins on intestinal microbiota in healthy adult humans
Pistachios
Not only are these super tasty and fun to eat (and mindful eating is all but guaranteed, as shelling them by hand slows us down and makes us more likely to eat them one at a time rather than by the handful), but also they contain lots of nutrients and are lower in calories than most nuts, so they’re a great option for anyone who’d like to eat more nuts but is doing a calorie-controlled diet and doesn’t want to have half a day’s calories in a tiny dish of nuts.
Walnuts
Popularly associated with brain health (perhaps easy to remember because of their appearance), they really are good for the brain:
Check it out: Beneficial Effects of Walnuts on Cognition and Brain Health
Cashews
A personal favorite of this writer for their versatility in cooking, food prep, or just as a snack, they also do wonders for metabolic health:
Brazil nuts
The most exciting thing about these nuts is that they’re an incredibly potent source of selenium, which is important not just for hair/skin/nails as popularly marketed, but also for thyroid hormone production and DNA synthesis.
But don’t eat too many, because selenium is definitely one of those “you can have too much of a good thing” nutrients, and selenium poisoning can make your hair (however beautiful and shiny it got because of the selenium) fall out if you take too much.
Know the numbers: Brazil nuts and selenium—health benefits and risks
Bottom line on nuts:
- Nuts are a great and healthful part of almost anyone’s diet
- Obviously, if you have a nut allergy, then we’re sorry; this one won’t have helped you so much
- Almonds are one of the most healthful nuts out there
- Brazil nuts are incredibly potent, to the point where moderation is recommended
- A handful of mixed nuts per day is a very respectable option—when it comes to food and health, diversity is almost always good!
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