Author: books

Oct. 13, 2022 — Generations of Americans grew up being told that breakfast cereals like Corn Flakes and Raisin Bran were healthy ways to start their days.

But now, under new federal guidelines, those cereals and other mainstays of the breakfast table can no longer make that claim.

The guidance was proposed after the White House Conference on Hunger, Nutrition, and Health, “as well as the release of the related national strategy, which aims to end hunger, improve nutrition and physical activity, reduce diet-related diseases and close disparity gaps by 2030,” the FDA wrote in a press release.

To be considered “healthy,” foods must meet certain criteria. The FDA used cereal as an example to illustrate how the guidelines affect how food will be presented to consumers.

For that “healthy” label, cereals need three-fourth ounces of whole grains and no more than 1 gram of saturated fat, 230 milligrams of sodium, and 2.5 grams of added sugars, CNBC reported.

Here are seven common American brands that don’t meet the “healthy” label standards:

• Raisin Bran (9 grams of added sugars)
• Honey Nut Cheerios (12 grams of added sugars)
• Corn Flakes (300 milligrams of sodium; 4 grams of added sugars)
• Honey Bunches of Oats, Honey Roasted (8 grams of added sugars)
• Frosted Mini Wheats (12 grams of added sugars)
• Life (8 grams of added sugars)
• Special K (270 milligrams of sodium; 4 grams of added sugars)

“Nutrition is key to improving our nation’s health,” said Xavier Becerra, Health and Human Services secretary. “Healthy food can lower our risk for chronic disease. But too many people may not know what constitutes healthy food. FDA’s move will help educate more Americans to improve health outcomes, tackle health disparities and save lives.”

Oct. 12, 2022 – Another stoner stereotype bites the dust: Despite its appetite-boosting effects – better known as the “munchies” – cannabis may actually help keep your weight in check.

 Cannabis users may be less likely to become obese than people who abstain, according to a recent study in the journal Health Economics. The study tracked health data from the state of Washington before and after 2014, the year cannabis became widely available there for recreational use. 

According to the study: “Marijuana legalization, which allowed for recreational marijuana dispensaries to open, resulted [in] decreases in obesity rates for Washington State.” 

During the 4 years after legalization, the state’s obesity rate was 5.4% lower, on average, than it would have been had cannabis not been legalized. 

How Did They Figure That Out? 

The researchers set up something called a synthetic counterfactual. 

“It’s the best approximation of what Washington would have looked like had it not legalized marijuana,” says lead author Raymond March, PhD, an assistant professor of applied economics at North Dakota State University. March and his colleagues came up with a population that’s like Washington state’s by combining data from states that did not legalize during those same 4  years, including Arizona, Minnesota, Kansas, and New Hampshire.

Hence the “synthetic counterfactual” – what Washington might have looked like had it not legalized. The authors conclude that the state would have had 5.4% more obese people over the “post-treatment period” – the 4 years after legalization – with the medical expenses and human misery that go along with such obesity-related conditions as diabetes, heart disease, stroke, and increased risk of early death. 

The researchers also compared Washington state’s obesity numbers with the national trend. Both trend upward, but after 2014, Washington’s rate of increase declined significantly. 

Why Might This Be Happening?

Thomas Clark, PhD, a physiologist with the Department of Biological Sciences at Indiana University in South Bend, addressed one possible reason in a 2018 study in the journal Cannabis and Cannabinoid Research. According to the study, “Cannabis use appears to reverse the impact of the modern American diet on health by reducing the effects of an elevated ratio of omega-6/omega-3 fatty acids on endocannabinoid (eCB) tone.” 

Clark explains: “The 1970s saw increasing obesity in the United States, and it’s still rising today. It began with the government subsidies of corn- and soybean oil, which alter the body’s physiological regulation of metabolism. When you alter the balance of omega-6 fatty acids and omega-3 fatty acids – which you do by increasing vegetable oils such as soybean oil in the diet – the body’s endocannabinoid system becomes overactive, resulting in weight gain.” 

The endocannabinoid system – which promotes homeostasis, or balance, in the body – is regulated by signaling molecules that are mimicked by chemicals in cannabis. Yes, cannabis stimulates appetite, hence its therapeutic use by people with diseases like AIDS, or who are getting appetite-killing treatments like chemotherapy. But according to Clark, it also down-regulates the endocannabinoid system, bringing it into balance, preventing weight gain, and, theoretically at least, helping the people of Washington slow the tide of weight gain in their state.

“My research indicates that we should look at these metabolic diseases and their correlation with cannabis use,” he says. “There may be a significant health benefit to cannabis use.”

If those benefits can be confirmed, cannabis might be one answer to the swelling waistlines and health risks of the American public.

Your doctor may prescribe certain treatments, like nonsteroidal anti-inflammatory drugs and physical therapy, to help your ankylosing spondylitis. But everyone is different: What works for someone else might not work for you. If this happens, your doctor will most likely recommend that you try a new class of drugs known as biologics.

“These are amazing drugs that have really revolutionized how we treat this disease,” says Yale Medicine rheumatologist Deborah Desir, MD.

Though they won’t magically cure your ankylosing spondylitis, they can help slow the disease’s progression and make symptoms more manageable.

How Do Biologics Work?

Biologics stop the damaging inflammation that happens with ankylosing spondylitis.

“They’re genetically engineered proteins that target cytokines, specific molecules in your immune system,” says Lianne Gensler, MD, director of the University of California San Francisco’s Ankylosing Spondylitis Clinic.

Cytokines activate inflammation throughout your body, which keeps your immune system on its toes to fight off invaders. But if they go into overdrive, they can trigger inflammatory diseases such as ankylosing spondylitis.

There are two main classes of biologics used to treat ankylosing spondylitis:

Tumor necrosis factor alpha (TNF-α) inhibitors. These were the first approved in 2003. They work not only to ease joint inflammation, but related inflammation in the gut and eyes as well. There are five approved for ankylosing spondylitis:

• Adalimumab (Humira)
• Certolizumab (Cimzia)
• Entanercept (Enbrel)
• Golimumab (Simponi)
• Infliximab (Remicade)

IL-17 inhibitors. Two are FDA-approved for ankylosing spondylitis: ixekizumab (Taltz) and secukinumab (Cosentyx). They target different cytokines than the TNF inhibitors. They’re often used in people whose ankylosing spondylitis didn’t respond to several of the TNF medications.

Who Should Take Biologics?

While biologics are very effective, they’re not for everyone.

“These drugs are very powerful, but they also suppress the immune system, which means you’re more vulnerable to infection,” Gensler says. Because of this, most doctors hold off using them right away.

When you’re newly diagnosed with ankylosis spondylitis, your doctor will most likely start you on a course of nonsteroidal anti-inflammatory drugs (NSAIDS). These include over-the-counter versions such as ibuprofen, as well as prescription-strength drugs like celecoxib (Celebrex).

“These drugs are the most common ones we use, and for good reason: a huge percentage of patients are able to get control of their symptoms on them,” Desir says.

They’ll also prescribe physical therapy to help ward off the “frozen” spine and general stiffness that can occur with ankylosis spondylitis.

The downside of NSAIDs is that to stay symptom-free, most people need very high doses. Over time, this can lead to side effects such as stomach bleeding and higher risk of heart attack or stroke.

“We’re most worried about these side effects in older adults, since they are the ones who are already at risk for these diseases. But for a younger patient in their 20s or 30s newly diagnosed with the condition, that’s much less of a concern,” Gensler says. “We don’t have long-term safety data on biologics yet beyond about 2 decades, so it’s still unknown what the effects of these drugs would be on patients who are on them for most of their lives. That’s why we’d prefer to start with an NSAID, and then escalate if need be.”

In general, Gensler says you should consider a biologic if:

• You’ve tried a course of NSAIDs and physical therapy for a few weeks and are still bothered by symptoms.
• Your X-rays already show that you have a lot of damage to your sacroiliac joints, the joints that connect your spine to your pelvic bone.
• You’ve already lived with ankylosis spondylitis for a long time.

It can sometimes take up to 10 years for people to be diagnosed with this condition.

“Sometimes patients come in for the very first visit in extreme pain and very disabled, and they say that their quality of life is terrible and they’d do anything to get it back to where they can function again,” Gensler says.

What Should I Expect When I Take a Biologic?

If you and your doctor agree biologics are the next step, they’ll test you for tuberculous first.

“Some people have what’s known as latent TB, where the bacteria live silently in their lungs,” Desir says. “Since these drugs suppress your immune system, the TB can ‘wake up’ and cause an actual infection.”

All biologic treatments leave you more prone to infection, especially upper respiratory infections such as colds, flu, or COVID-19. To stay healthy, you should:

• Wash your hands often
• Avoid or wear a mask in crowded areas, enclosed spaces, public transportation, and childcare facilities
• Keep up to date on all your vaccines, including the flu and COVID-19 vaccines.

Some biologics are given at home via self-injection, and others are given through an IV in your doctor’s office. You may notice some pain, redness, and swelling. You can use antihistamines and an over-the-counter pain reliver such as acetaminophen to treat discomfort.

If you’re on the fence about trying a biologic, Gensler suggests giving it a 3-month trial.

“I stress to (people) that this does not have to be a lifetime commitment. They can always go off of the biologic and return to their original medications,” she says. “But oftentimes, after a few months, people are shocked at how much better they feel. They’ve suffered for so long they’ve just accepted their symptoms as normal. But thanks to biologics, it doesn’t have to be that way anymore.”

When you think of ankylosing spondylitis (AS), back pain is probably the first thing that comes to mind. But heart disease — an umbrella term for several types of heart conditions — should be on your radar, too.

Research suggests AS raises your risk for heart disease and stroke by as much as 60%. The possibility is highest among adults 20-39. Fortunately, there are things you can do to help lower your odds. Here’s how to care for your heart when you have AS.

Can Ankylosing Spondylitis Cause Heart Disease?

It depends. The inflammation that damages your joints can do the same to your heart, particularly the aorta. That’s the large artery that carries blood from the heart to the rest of the body.

“Over time, this can lead to high blood pressure, and also to aortic valve disease, which is when the valve between the left ventricle — your heart’s main pumping chamber — and the aorta doesn’t work properly,” says Elliott Antman, MD, a cardiologist at Brigham and Woman’s Hospital in Boston.

The valve begins to leak, which can lead to shortness of breath, chest pain, and dizziness.

“If you already have high blood pressure, the valve will leak even more,” Antman says.

People with ankylosing spondylitis are also at risk for other heart conditions. These include:

Heart arrhythmias. This is when your heart beats too fast or too slow. Problems with your heart’s electrical conduction system or other heart issues can trigger them.

Cardiomyopathy. This enlarges and weakens your heart muscle. That makes it harder to pump blood to the rest of the body. Without treatment, it could lead to heart failure.

Ischemic heart disease. Also called atherosclerosis, this type of heart disease cuts blood supply to your heart muscle.

Many people with AS are also placed on high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) to treat symptoms.

“These cause your body to hold on to salt and water, which in turn increases blood pressure,” Antman says. 

Research suggests people who take NSAIDs for a long time are at higher risk for a heart attack or stroke than those who don’t.

“We don’t rule these drugs out, as they can help a lot of patients, but we definitely try to keep people on the lowest dose possible for the shortest period of time,” Antman says.

Warning Signs to Watch for

If you have ankylosis spondylitis, you should be on the alert for signs of heart disease. These include:

• Shortness of breath
• Chest pain
• Dizziness
• Heart palpitations (you may feel like your heart is beating too fast or notice that it skips beats)
• Swelling of the legs, ankles, and feet
• Not able to exercise as much

Talk to your doctor if you notice any of these symptoms.

How to Help Your Heart

It’s important to make sure your heart is in good shape when you have ankylosing spondylitis. These tips can help:

Exercise often. It may be hard to stay active. But if you don’t, you’ll likely gain weight, which in turn will raise your blood pressure, Antman says. Aim for 30 minutes of low impact, moderate-intensity exercise, like walking or swimming, 5 days a week. Try to add 2 days of strength training. Yoga is also a good option. One small study found that people with AS who practiced yoga every day for 2 weeks reported less pain and lower blood pressure.

Know your numbers. This includes your blood pressure, cholesterol and triglyceride levels, blood glucose levels, and body weight.

“The more that these are under control, the better it is for your heart health,” Antman says.

If you’re prescribed medications to manage high blood pressure, high cholesterol, or type 2 diabetes, make sure you take them the way you’re supposed to. If you do have heart disease, ask your doctor if you should take a certain class of ankylosis spondylitis drugs known as TNF-inhibitors. A 2018 study found that patients with inflammatory arthritic conditions like AS who took these drugs had fewer cardiac events like heart attack or stroke.

Follow a heart-healthy diet. The two most well-studied eating patterns are the Mediterranean diet and the DASH diet, Antman says. Both are rich in fruits, veggies, whole grains, and healthy fats found in foods like fatty fish and olive oil. You also need to limit your salt intake. Aim for less than 1,500 milligrams daily, as it can worsen blood pressure.

Don’t smoke. It not only raises your risk of heart disease, but it also causes more joint damage in patients with ankylosis spondylitis.

When Should I See a Cardiologist?

Most of the time, your primary care doctor or rheumatologist can keep an eye on your heart, Antman says. But you should ask for a referral to a cardiologist if:

• You’re diagnosed with high blood pressure, cholesterol, or type 2 diabetes.
• Your doctor hears an abnormal sound (murmur) when listening to your heart with a stethoscope.
• You have symptoms that could be signs of heart disease, like breathlessness or chest pain.

Oct. 13, 2022 – It’s a devastating series of setbacks for long COVID patients. First, they get the debilitating symptoms of their condition. Then they are forced to give up their jobs, or severely curtail their work hours, as their symptoms linger. And next, for many, they lose their employer-sponsored health insurance. 

While not all long COVID patients are debilitated, the CDC’s ongoing survey on long COVID found a quarter of adults with long COVID report it significantly affects their day-to-day living activities.

Estimates have shown that long COVID has impacted the lives of anywhere from 16 million to 34 million Americans between the ages of 18 and 65. 

While hard data is still limited, a Kaiser Family Foundation analysis found that more than half of adults with long COVID who worked before getting the virus are now either out of work or working fewer hours. 

According to data from the Census Bureau’s Household Pulse Survey, out of the estimated 16 million working-age adults who currently have long COVID, 2 million to 4 million of them are out of work due to their symptoms. The cost of those lost wages ranges from $170 billion a year to as much as $230 billion, the Census Bureau says. And given that approximately 155 million Americans have employer-sponsored health insurance, the welfare of working-age adults may be under serious threat. 

“Millions of people are now impacted by long COVID, and oftentimes along with that comes the inability to work,” says Megan Cole Brahim, PhD, an assistant professor in the Department of Health Law, Policy, and Management at Boston University and co-director of the school’s Medicaid Policy Lab. “And because a lot of people get their health insurance coverage through employer-sponsored coverage, no longer being able to work means you may not have access to the health insurance that you once had.”

The CDC defines long COVID as a wide array of health conditions, including malaise, fatigue, shortness of breath, mental health issues, problems with the part of the nervous system that controls body functions, and more. 

Gwen Bishop was working remotely for the Human Resources Department at the University of Washington Medical Centers when she got COVID-19. When the infection passed, Bishop, 39, thought she’d start feeling well enough to get back to work – but that didn’t happen. 

“When I would log in to work and just try to read emails,” she says, “it was like they were written in Greek. It made no sense and was incredibly stressful.” . 

This falls in line with what researchers have found out about the nervous system issues reported by people with long COVID. People who have survived acute COVID infections have reported lasting sensory and motor function problems, brain fog, and memory problems. 

Bishop, who was diagnosed with ADHD when she was in grade school, says another complication she got from her long COVID was a new intolerance to stimulants like coffee and her ADHD medication, Vyvanse, which were normal parts of her everyday life. 

“Every time I would take my ADHD medicine or have a cup of coffee, I would have a panic attack until it wore off,” says Bishop. “Vyvanse is a very long-acting stimulant, so that would be an entire day of an endless panic attack.” 

In order for her to get a medical leave approved, Bishop needed to get documents by a certain date from her doctor’s office that confirmed her long COVID diagnosis. She was able to get a couple of extensions, but Bishop says that with the burden that has been placed on our medical systems, getting in to see a doctor through her employer insurance was taking much longer than expected. By the time she got an appointment, she says, she had already been fired for missing too much work. Emails she provided showing exchanges between her and her employer verify her story. And without her health insurance, her appointment through that provider would no longer have been covered.

In July 2021, the U.S. Department of Health and Human Services issued guidance recognizing long COVID as a disability “if the person’s condition or any of its symptoms is a ‘physical or mental’ impairment that ‘substantially limits’ one or more major life activities.” 

But getting access to disability benefits hasn’t been easy for people with long COVID. On top of having to be out of work for 12 months before being able to qualify for Social Security Disability Insurance, some of those who have applied say they have had to put up a fight to actually gain access to disability insurance. The Social Security Administration has yet to reveal just how many applications that cited long COVID have been denied so far.  

David Barnett, a former bartender in the Seattle area in his early 40s, got COVID-19 in March 2020. Before his infection, he spent much of his time working on his feet, bodybuilding, and hiking with his partner. But for the last nearly 3 years, even just going for a walk has been a major challenge. He says he has spent much of his post-COVID life either chair-bound or bed-bound due to his symptoms. 

He is currently on his partner’s health insurance plan but is still responsible for copays and out-of-network appointments and treatments. After being unable to bartend any more, he started a GoFundMe account and dug into his personal savings. He says he applied for food stamps and is getting ready to sell his truck. Barnett applied for disability in March of this year but says he was denied benefits by the Social Security Administration and has hired a lawyer to appeal.

He runs a 24-hour online support group on Zoom for people with long COVID and says that no one in his close circle has successfully gotten access to disability payments. 

Alba Azola, MD, co-director of Johns Hopkins School of Medicine’s Post-Acute COVID-19 Team, says at least half of her patients need some level of accommodations to get back to work; most can, if given the proper accommodations, such as switching to a job that can be done sitting down, or with limited time standing. But there are still patients who have been more severely disabled by their long COVID symptoms. 

“Work is such a part of people’s identity. The people who are very impaired, all they want to do is to get back to work and their normal lives,” she says.

Many of Azola’s long COVID patients aren’t able to return to their original jobs. She says they often have to find new positions more tailored to their new realities. One patient, a nurse and mother of five who previously worked in a facility where she got COVID-19, was out of work for 9 months after her infection. She ultimately lost her job, and Azola says the patient’s employer was hesitant to provide her with any accommodations. The patient was finally able to find a different job as a nurse coordinator where she doesn’t have to be standing for more than 10 minutes at a time.  

Ge Bai, PhD, a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health, says the novelty of long COVID and the continued uncertainty around it raise questions for health insurance providers. 

“There’s no well-defined pathway to treat or cure this condition,” Bai says. “Right now, employers have discretion to determine when a condition is being covered or not being covered. So people with long COVID do have a risk that their treatments won’t be covered.”