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Montana health officials are proposing to oversee and set standards for the charitable contributions that nonprofit hospitals make in their communities each year to justify their access to millions of dollars in tax exemptions.

The proposal is part of a package of legislation that the state Department of Public Health and Human Services will ask lawmakers to approve when they convene in January. It comes two years after a state audit called on the department to play more of a watchdog role and nine months after a KHN investigation found some of Montana’s wealthiest hospitals lag behind state and national averages in community giving.

A call for more transparency in what counts as charity

Montana state Sen. Bob Keenan, a Republican who has questioned whether nonprofit hospitals deserve their charity status, calls the proposal a start that could be expanded on later.

“Transparency is the name of the game here,” Keenan says.

The IRS requires nonprofit hospitals to tally what they spend to “promote health” to benefit “the community as a whole.” How hospitals count such contributions to justify their tax exemptions is opaque and varies widely. National researchers who study community benefits have called for tightening standards for what counts toward the requirement.

Montana is one of the most recent states to consider imposing new rules or increasing oversight of nonprofit hospitals amid questions about whether they pay their fair share. Dr. Vikas Saini, president of the national health care think tank Lown Institute, says that both at a state and local level, people in California are exploring whether to monitor hospital community benefits and enforce new standards. Last year, Oregon initiated a minimum amount that nonprofit hospitals must spend on community benefits. And Massachusetts has updated its community benefits guidelines in recent years, pushing hospitals to give more detailed assessments of how the spending lines up with identified health needs.

Montana hospital industry officials say they want to work with the state to shape the proposed legislation, which they say the industry would support if it doesn’t conflict with federal rules. Saini says that to have an impact, any legislation would have to go beyond federal requirements.

Major tax breaks are at stake

In recent years, more people, like Keenan and Saini, have questioned whether nonprofit hospitals are contributing enough to their communities to deserve the major tax breaks they get while becoming some of the largest businesses in town.

“The hospitals are sort of the pillars of communities, but people are starting to ask these questions,” Saini says.

Saini’s institute reviews hospitals’ giving each year and has found that the majority of nonprofit systems nationwide spend less on what the institute calls “meaningful” benefits than the estimated value of their tax breaks. Actions the institute counts include financial aid to patients and community investments such as food assistance, health education or services offered at a loss, including addiction treatment.

The 2020 Montana audit found that hospitals in the state report benefits vaguely and inconsistently, making it difficult to determine whether their charity status is justified. However, state lawmakers didn’t address the issue in their 2021 biennial legislative session, and a Legislative Audit Division memorandum issued in June found the state health department had “made no meaningful progress” toward developing oversight of nonprofit hospitals’ charitable giving since then.

KHN found that Montana’s nearly 50 nonprofit hospitals directed roughly 8% of their total annual expenses, on average, toward community benefits in the tax year that ended in 2019. The national average was 10%.

In some cases, hospitals’ giving percentages have declined since then. For example, in the tax year that ended in 2019, Logan Health-Whitefish — a small hospital that’s part of the larger Flathead Valley health system — reported that less than 2% of its overall spending went toward community benefits. In its latest available documents, for the period ending in 2021, the hospital reported spending less than 1% of its expenses on community benefits while it made $15 million more than it spent.

An alternative to oversight?

Logan Health spokesperson Mellody Sharpton says the medical system’s overall community benefit is equal to nearly 9% of its spending, reaching across its six hospitals. It also has clinics throughout the valley. “It’s important to consider our organization’s community benefit as a whole,” Sharpton says, “as our facilities collaborate to ensure the appropriate care is provided at the appropriate facility to meet our patients’ health needs.”

State health officials asked lawmakers to allow the agency to draft a bill that would give the health department clear authority to require hospitals to submit annual reports that include data on community benefit and charity care. The measure also would allow the department to develop standards for that spending on community benefit, according to the department’s description of its proposal.

“We see a great need here to move the ball forward,” state health department leader Charlie Brereton told lawmakers in August.

Montana Hospital Association President Rich Rasmussen says his organization wants to work with the health department in honing the legislation but says the definition of what counts as benefits should remain broad so hospitals can respond to their area’s most pressing needs.

Furthermore, he says, hospitals are already working on their own reporting standards. This year, the association created a handbook for members and set a 2023 goal for hospitals to uniformly report their community benefits, Rasmussen says. The association declined to provide a copy of the handbook, saying it would be available to the public once hospitals are trained on how to use it later this fall.

The association also plans to create a website that will serve as a one-stop shop for people who want to know how hospitals are reporting community benefits and addressing local health concerns, among other things.

Republican state Rep. Jane Gillette says she supports increased health department oversight and the idea behind the association’s website, but doesn’t think the hospital industry should produce that public resource alone. Gillette says she plans to introduce legislation to require hospitals to report community benefits data to a group outside the industry — such as the state — which would then post the information online.

Hospitals have resisted new rules like these in the past

In the past, hospitals have resisted attempts to impose new rules on community benefit spending. In an interview with KHN last year, Jason Smith, then Bozeman Health’s chief advancement officer, said the system supported efforts to improve reporting contributions “outside of new legislation,” adding that hospitals can do better work without “state oversight bodies being placed in the arena with us.”

Asked whether the health system still stands by that statement, Denise Juneau, Bozeman Health’s chief government and community affairs officer, says hospital officials hope any new legislation will align with existing federal guidelines. She says Bozeman Health will continue to work with the Montana Hospital Association to define and provide better information on community benefit, with or without new legislation.

A lawmaker would have to back the state’s proposal by mid-December to keep it alive.

KHN (Kaiser Health News) is a national, editorially independent project of the Kaiser Family Foundation.

Darius Tahir

David Confer, a bicyclist and an audio technician, told his doctor he “used to be Ph.D. level” during a 2019 appointment in Washington, D.C. Confer, then 50, was speaking figuratively: He was experiencing brain fog — a symptom of his liver problems. But did his doctor take him seriously? Now, after his death, Confer’s partner, Cate Cohen, doesn’t think so.

Confer, who was Black, had been diagnosed with non-Hodgkin lymphoma two years before. His prognosis was positive. But during chemotherapy, his symptoms — brain fog, vomiting, back pain — suggested trouble with his liver, and he was later diagnosed with cirrhosis. He died in 2020, unable to secure a transplant. Throughout, Cohen, now 45, felt her partner’s clinicians didn’t listen closely to him and had written him off.

That feeling crystallized once she read Confer’s records. The doctor described Confer’s fuzziness and then quoted his Ph.D. analogy. To Cohen, the language was dismissive, as if the doctor didn’t take Confer at his word. It reflected, she thought, a belief that he was likely to be noncompliant with his care — that he was a bad candidate for a liver transplant and would waste the donated organ.

For its part, MedStar Georgetown, where Confer received care, declined to comment on specific cases. But spokesperson Lisa Clough said the medical center considers a variety of factors for transplantation, including “compliance with medical therapy, health of both individuals, blood type, comorbidities, ability to care for themselves and be stable, and post-transplant social support system.” Not all potential recipients and donors meet those criteria, Clough said.

Doctors often send signals of their appraisals of patients’ personas. Researchers are increasingly finding that doctors can transmit prejudice under the guise of objective descriptions. Clinicians who later read those purportedly objective descriptions can be misled and deliver substandard care.

Discrimination in health care is “the secret, or silent, poison that taints interactions between providers and patients before, during, after the medical encounter,” said Dayna Bowen Matthew, dean of George Washington University’s law school and an expert in civil rights law and disparities in health care.

Bias can be seen in the way doctors speak during rounds. Some patients, Matthew said, are described simply by their conditions. Others are characterized by terms that communicate more about their social status or character than their health and what’s needed to address their symptoms. For example, a patient could be described as an “80-year-old nice Black gentleman.” Doctors mention that patients look well-dressed or that someone is a laborer or homeless.

The stereotypes that can find their way into patients’ records sometimes help determine the level of care patients receive. Are they spoken to as equals? Will they get the best, or merely the cheapest, treatment? Bias is “pervasive” and “causally related to inferior health outcomes, period,” Matthew said.

Narrow or prejudiced thinking is simple to write down and easy to copy and paste over and over. Descriptions such as “difficult” and “disruptive” can become hard to escape. Once so labeled, patients can experience “downstream effects,” said Dr. Hardeep Singh, an expert in misdiagnosis who works at the Michael E. DeBakey Veterans Affairs Medical Center in Houston. He estimates misdiagnosis affects 12 million patients a year.

Conveying bias can be as simple as a pair of quotation marks. One team of researchers found that Black patients, in particular, were quoted in their records more frequently than other patients when physicians were characterizing their symptoms or health issues. The quotation mark patterns detected by researchers could be a sign of disrespect, used to communicate irony or sarcasm to future clinical readers. Among the types of phrases the researchers spotlighted were colloquial language or statements made in Black or ethnic slang.

“Black patients may be subject to systematic bias in physicians’ perceptions of their credibility,” the authors of the paper wrote.

That’s just one study in an incoming tide focused on the variations in the language that clinicians use to describe patients of different races and genders. In many ways, the research is just catching up to what patients and doctors knew already, that discrimination can be conveyed and furthered by partial accounts.

Confer’s MedStar records, Cohen thought, were pockmarked with partial accounts — notes that included only a fraction of the full picture of his life and circumstances.

Cohen pointed to a write-up of a psychosocial evaluation, used to assess a patient’s readiness for a transplant. The evaluation stated that Confer drank a 12-pack of beer and perhaps as much as a pint of whiskey daily. But Confer had quit drinking after starting chemotherapy and had been only a social drinker before, Cohen said. It was “wildly inaccurate,” Cohen said.

“No matter what he did, that initial inaccurate description of the volume he consumed seemed to follow through his records,” she said.

Physicians frequently see a harsh tone in referrals from other programs, said Dr. John Fung, a transplant doctor at the University of Chicago who advised Cohen but didn’t review Confer’s records. “They kind of blame the patient for things that happen, not really giving credit for circumstances,” he said. But, he continued, those circumstances are important — looking beyond them, without bias, and at the patient himself or herself can result in successful transplants.

The History of One’s Medical History

That doctors pass private judgments on their patients has been a source of nervous humor for years. In an episode of the sitcom “Seinfeld,” Elaine Benes discovers that a doctor had condescendingly written that she was “difficult” in her file. When she asked about it, the doctor promised to erase it. But it was written in pen.

The jokes reflect long-standing conflicts between patients and doctors. In the 1970s, campaigners pushed doctors to open up records to patients and to use less stereotyping language about the people they treated.

Nevertheless, doctors’ notes historically have had a “stilted vocabulary,” said Dr. Leonor Fernandez, an internist and researcher at Beth Israel Deaconess Medical Center in Boston. Patients are often described as “denying” facts about their health, she said, as if they’re not reliable narrators of their conditions.

One doubting doctor’s judgment can alter the course of care for years. When she visited her doctor for kidney stones early in her life, “he was very dismissive about it,” recalled Melina Oien, who now lives in Tacoma, Washington. Afterward, when she sought care in the military health care system, providers — whom Oien presumed had read her history — assumed that her complaints were psychosomatic and that she was seeking drugs.

“Every time I had an appointment in that system — there’s that tone, that feel. It creates that sense of dread,” she said. “You know the doctor has read the records and has formed an opinion of who you are, what you’re looking for.”

When Oien left military care in the 1990s, her paper records didn’t follow her. Nor did those assumptions.

New Technology — Same Biases?

While Oien could leave her problems behind, the health system’s shift to electronic medical records and the data-sharing it encourages can intensify misconceptions. It’s easier than ever to maintain stale records, rife with false impressions or misreads, and to share or duplicate them with the click of a button.

“This thing perpetuates,” Singh said. When his team reviewed records of misdiagnosed cases, he found them full of identical notes. “It gets copy-pasted without freshness of thinking,” he said.

Research has found that misdiagnosis disproportionately happens to patients whom doctors have labeled as “difficult” in their electronic health record. Singh cited a pair of studies that presented hypothetical scenarios to doctors.

In the first study, participants reviewed two sets of notes, one in which the patient was described simply by her symptoms and a second in which descriptions of disruptive or difficult behaviors had been added. Diagnostic accuracy dropped with the difficult patients.

The second study assessed treatment decisions and found that medical students and residents were less likely to prescribe pain medications to patients whose records included stigmatizing language.

Digital records can also display prejudice in handy formats. A 2016 paper in JAMA discussed a small example: an unnamed digital record system that affixed an airplane logo to some patients to indicate that they were, in medical parlance, “frequent flyers.” That’s a pejorative term for patients who need plenty of care or are looking for medications.

But even as tech might amplify these problems, it can also expose them. Digitized medical records are easily shared — and not merely with fellow doctors, but also with patients.

Since the ’90s, patients have had the right to request their records, and doctors’ offices can charge only reasonable fees to cover the cost of clerical work. Penalties against practices or hospitals that failed to produce records were rarely assessed — at least until the Trump administration, when Roger Severino, previously known as a socially conservative champion of religious freedom, took the helm of the U.S. Department of Health and Human Services’ Office for Civil Rights.

During Severino’s tenure, the office assessed a spate of monetary fines against some practices. The complaints mostly came from higher-income people, Severino said, citing his own difficulties getting medical records. “I can only imagine how much harder it often is for people with less means and education,” he said.

Patients can now read the notes — the doctors’ descriptions of their conditions and treatments — because of 2016 legislation. The bill nationalized policies that had started earlier in the decade, in Boston, because of an organization called OpenNotes.

For most patients, most of the time, opening record notes has been beneficial. “By and large, patients wanted to have access to the notes,” said Fernandez, who has helped study and roll out the program. “They felt more in control of their health care. They felt they understood things better.” Studies suggest that open notes lead to increased compliance, as patients say they’re more likely to take medicines.

Conflicts Ahead?

But there’s also a darker side to opening records: if patients find something they don’t like. Fernandez’s research, focusing on some early hospital adopters, has found that slightly more than 1 in 10 patients report being offended by what they find in their notes.

And the wave of computer-driven research focusing on patterns of language has similarly found low but significant numbers of discriminatory descriptions in notes. A study published in the journal Health Affairs found negative descriptors in nearly 1 in 10 records. Another team found stigmatizing language in 2.5% of records.

Patients can also compare what happened in a visit with what was recorded. They can see what was really on doctors’ minds.

Oien, who has become a patient advocate since moving on from the military health care system, recalled an incident in which a client fainted while getting a drug infusion — treatments for thin skin, low iron, esophageal tears, and gastrointestinal conditions — and needed to be taken to the emergency room. Afterward, the patient visited a cardiologist. The cardiologist, who hadn’t seen her previously, was “very verbally professional,” Oien said. But what he wrote in the note — a story based on her ER visit — was very different. “Ninety percent of the record was about her quote-unquote drug use,” Oien said, noting that it’s rare to see the connection between a false belief about a patient and the person’s future care.

Spotting those contradictions will become easier now. “People are going to say, ‘The doc said what?’” predicted Singh.

But many patients — even ones with wealth and social standing — may be reluctant to talk to their doctors about errors or bias. Fernandez, the OpenNotes pioneer, didn’t. After one visit, she saw a physical exam listed on her record when none had occurred.

“I did not raise that to that clinician. It’s really hard to raise things like that,” she said. “You’re afraid they won’t like you and won’t take good care of you anymore.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Promise: “I’m never going to raise the white flag and surrender. We’re going to beat this virus. We’re going to get it under control, I promise you.”

President Joe Biden caused a stir in a “60 Minutes” interview on Sept. 18 when he declared that the covid-19 pandemic is over.

“We still have a problem with covid — we’re still doing a lot of work on it,” Biden said. “But the pandemic is over.”

Critics countered that the U.S. is still averaging about 400 deaths daily from the virus, that nearly 30,000 Americans remain hospitalized, and that many others are suffering from “long covid” symptoms stemming from previous infections.

Two days later, Biden acknowledged that despite the negative reactions by some, the pandemic “basically is not where it was.” White House press secretary Karine Jean-Pierre called the coronavirus “a lot more manageable.” Past experience means “we know what works,” she said.

PolitiFact has been tracking a campaign promise Biden made in 2020 that is closely related, but distinct, from what Biden told “60 Minutes.” During the presidential campaign, Biden said, “I’m never going to raise the white flag and surrender. We’re going to beat this virus. We’re going to get it under control, I promise you. “

Biden is on safer linguistic ground with his promise to get covid “under control” than saying “the pandemic is over.” 

There remains some debate among public health experts about whether the pandemic is “over” — or whether it realistically can ever be. There is no official arbiter for making that decision, and the word “over” suggests a finality that is not well suited for describing a pathogen that will exist in some form indefinitely.

However, we found broad agreement among infectious-disease specialists that the pandemic by now is “under control.”

When Biden was inaugurated, physical distancing was widely enforced, schools were often virtual, public events were rare or tightly controlled, and few Americans had yet received a vaccine. Today, life for many Americans is much closer to the pre-pandemic norm, with virtually all schools open, concerts and restaurants well attended, and travel back to its typical level.

“The nation clearly has made tremendous progress on covid-19 since President Biden’s election,” said Jen Kates, senior vice president and director of global health and HIV policy at KFF. “I would probably say that we are in a pandemic ‘transition’ phase — that is, moving from the pandemic into a post-pandemic period. But this is a continuum, not a cliff, where it’s a pandemic one day and over the next,” Kates added.

Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, added that the promise to get the pandemic under control “is certainly well on course, or perhaps even met, as far as what the federal government can provide to accomplish that.” 

And Dr. William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University, agreed that the “emergent phase of the pandemic is coming to a close. We’re now moving into the ongoing struggle — call it a truce with the virus.”

Medical experts said pandemics inevitably become “endemic,” meaning that the pathogen is here to stay but does not present a widespread emergency. 

“We will always have to manage covid in the medical system,” said Dr. Monica Gandhi, a professor of medicine at the University of California-San Francisco. “Unfortunately, although we can bring down deaths to very low, I don’t think we will ever get to zero deaths from covid-19.”

The level of U.S. deaths from covid is lower today than it has been during most of the pandemic, and it has been that way since the spring.

Notably, the number of “excess deaths” is also down. That’s a metric that gauges how many more deaths are occurring beyond the long-term average for that time of year. The number of excess deaths nationally per week has been consistently between zero and 5,000 since the spring, after peaking at 20,000 to 25,000 per week during four previous surges since the pandemic began.

Hospitalization has held steady recently at some of the lowest rates of the pandemic. And even this level may overstate the virus’s impact; routine testing upon admission often detects cases that are asymptomatic and largely coincidental to the reason a patient is admitted. 

Gandhi pointed to data from Massachusetts hospitals showing that most hospitalized patients who test positive for covid have only “incidental infections,” with only 1 in 3 being treated primarily for a covid-related illness.

Experts noted that hospitalizations and deaths, even at these reduced levels, remain too high, and they cautioned that infections could increase as winter forces people indoors. Still, they credit the availability of vaccines and therapeutics, as well as the knowledge gained from living with the virus for more than two years, for the likelihood that the darkest days of the pandemic are behind us.

“I am not worried at all that we will go back to the scale of hospitalizations and deaths of the worst days of the pandemic,” said Brooke Nichols, an infectious-disease mathematical modeler and health economist at the Boston University School of Public Health. “We will likely enter into a seasonal covid vaccine situation, potentially combined alongside the flu into the same vaccine, and these seasonal vaccines will become critical to avoiding hospitalizations and deaths during the flu and covid seasons.”

There has been no major new variant since omicron emerged in late 2021, and even the most recent omicron subvariant to emerge, BA.5, has had a long run as the dominant strain in the U.S., prevailing since early July. 

This doesn’t mean that a more dangerous new strain couldn’t emerge. However, public health experts take comfort from recent patterns. The trend during most of 2022 suggests that a rapid succession of ever-more-confounding — and vaccine-evading — variants is not inevitable. If a major new variant does emerge, mRNA vaccines like those made by Moderna and Pfizer-BioNTech can be updated fairly easily for it.

Vaccination uptake, though, remains an urgent question. About one-third of Americans are not fully vaccinated, and an even smaller percentage have received boosters. Plescia said “the main deciding factor right now is not going to be the president or the response of the federal government — it’s going to be the response of the public.” 

“I think there’s disease fatigue and vaccine fatigue and wearing-a-mask fatigue,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “People are just tired of covid and trying to wish it away, and it’s unfortunate because it’s not gone. We’re tired of it, but it’s not tired of us yet.”

Some experts caution that a pandemic “under control” doesn’t mean the costs will be minimal. 

“The degree of protection afforded by the current vaccines available, especially to the most vulnerable, is of limited duration, and nonfatal outcomes from covid can still have knock-on consequences to the population health,” said Babak Javid, an associate professor in the division of experimental medicine at UCSF.

These consequences are called “long covid,” and nearly 1 in 5 Americans who have had covid are suffering from it. The Centers for Disease Control and Prevention defines long covid as symptoms lasting three or more months after contracting the virus that weren’t experienced before.

“Under control” suggests progress on keeping further spread within modest limits. It does not mean that people haven’t lost loved ones or felt continuing effects from the virus; clearly, they have.

What Does Biden Still Need to Do?

Biden and his administration still have work to do, experts said.

Several public health experts urged Congress to pass Biden’s request for $22 billion in covid-related funds. The White House has framed this funding as a way to be ready for a resurgence even though case levels are low now. It proposes that the funding support testing, research on new vaccines and therapeutics, preparations for future variants, and global assistance. Biden’s open declaration that the pandemic is “over” could make congressional approval less likely, however. 

Gandhi said the federal government should do a better job targeting boosters and therapeutics at populations most at risk of severe breakthrough infections, notably older Americans and people who are immunocompromised.

And Schaffner urged more effective and unified messaging, with efforts to remove any hints of politics. “I wish the federal government would get together on who the main messenger is, and provide sustained, clear, simple messages,” he said.

Biden may not have used the most appropriate word when he described the pandemic as “over,” but the long-term statistical trends have been trending in the right direction, and the vaccines and treatments should dampen the severity of future waves. For these reasons, experts say it’s fair to declare that the pandemic is “under control.” If circumstances change, we will reassess our rating, but for now, this receives a Promise Kept.

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Contributed by Harleen kaur

Introduction 

Navratri is one of the greatest and most significant festivals celebrated in India, every year. This year, the festival of Navratri begins from September 26 to October 4. The devotees maintain a fast to honour Goddess Durga and worship her in her nine avatars to celebrate the event. We all celebrate these nine days with great enthusiasm.

During the Navratri celebrations, people frequently practise protracted fasts. You may detoxify your body by fasting for nine days. However, it can also result in issues like constipation and acidity since it changes your regular eating pattern.

Our bodies are detoxified when we fast, but in addition, fasting also has certain disadvantages, such as acidity and constipation. Taking all that in mind here are some tips that you should follow this Navratri.

6 Tips to avoid constipation

Eat at regular intervals 

Eating large quantities of food frequently can result in constipation. Give your stomach adequate time to digest so that it functions properly. Chronic hunger can result in acidity problems. So, when you’re hungry, remember to eat small amounts of fruits and fasting meals like sabudana, makhana, dry fruits, fruits and more.j 

Stay hydrated 

Keeping yourself hydrated throughout the fast will reduce stomach discomfort. Additionally, it will also prevent constipation. Three to four litres of water per day should be the standard daily intake. This promotes healthy digestion, avoids constipation, and lessens bloating. 

You can also sip on liquids like buttermilk, coconut water, and lemonade throughout the day. Your stomach will cool off as a result, and constipation won’t be an issue. Additionally, it raises your body’s electrolyte levels, which can also help you in maintaining constant energy.

Healthy diet 

Like the majority of bodily functions, a good immune system

depends on a balanced diet. This includes consuming a range of fruits, vegetables, legumes, whole grains, lean protein, and healthy fats. If you are fasting then try to include fibre-rich foods like makhana, sabudana, fruits and more. A balanced diet can help make sure you’re getting enough of the micronutrients that are important for keeping smooth bowel movements during fasting. 

Reduce the amount of tea and coffee

According to the Hindu culture, one should follow all the dos and don’ts during fasting. Some people take only fruits while some drink tea or coffee to rid themselves of lethargy. Caffeine, present in both tea and coffee, can give you stomach problems. Constipation arises more often if you consume more caffeine. However, it is always advised to avoid tea and coffee during fasting time. You can replace tea and coffee with a glass of juice or lassi. 

Workout daily 

Physical activity like walking, running, and yoga can help you with bowel movements which increase the blood flow to the stomach and give relief from constipation.

Moreover, going for a walk or performing yoga is important not only for muscle building or weight loss but also equally required for stress relief; it is also an important part of staying healthy and supporting a healthy immune system.

Final thoughts 

Navratri is one of the most celebrated festivals in India. As you cannot take a chance to miss any of the fun and frolic of the nine-day festivities because of fasting. By following a few simple fasting tips, you can stay active during the entire festival.

When fasting, the major health issue that arises is constipation. It is usually advised to keep making mindful choices regarding the type of food options during fasting such as avoiding fried foods and foods with too much sugar and consuming more fibre-rich foods and keeping yourself hydrated throughout the day. 

For better bowel movements and to avoid constipation in Navratri, one should consume one prepared meal in a day to detox your body fully and the remaining should inculcate enough fruits, dairy products, and liquids including water, soups, fruit shakes, buttermilk, and coconut water. Also, avoid overeating as it can cause constipation and acidity and can spoil the whole festive vibe. 

Furthermore, you should also undergo preventive health checkups. These health checks give a complete report about your health, allowing you to take necessary precautionary measures to improve your well-being and keep a host of ailments at bay.

Book The Full Body Good Health Test Today!

Contributed by: Rachna arya

If you have chronic psoriatic arthritis (PsA), there are many reasons to eat healthful foods. This autoimmune disease strikes about 30% of people who have the skin ailment psoriasis. 

General symptoms include: 

• Painful, stiffness and swelling in joints
• Nail changes
• Eye pain and redness
• Fatigue
• painful muscles and tendons
• scaly skin patches
• Stomach issues
• Tender joints

Psoriatic arthritis diet

While there is no single food or diet to cure PsA, a nutrient-dense and balanced diet can help reduce inflammation, ease symptoms and prevent psoriatic arthritis flare-ups.

Say No to Candy and Sugary Treats

Cutting down on your intake of sugar is a good strategy for anyone, but cutting back on the amount of added sugar in the diet is especially critical if you have PsA. Sugary treats and baked goods, packaged desserts, candies, or beverages with added sweeteners provide no nutritional value and have been linked to obesity, high cholesterol, and high blood pressure. Additionally, they cause an increased risk of type 2 diabetes, metabolic syndrome, cancer, and heart disease. Furthermore, refined starches and sugar increase the production of inflammatory chemicals known as cytokines.

The good news is that there are many fresh fruits that can still satisfy your sweet tooth.  When you do want to eat something sweet, consider eating fruits that are high in antioxidants, such as:

• tart cherries
• mangos
• strawberries
• blueberries
• red raspberries
• avocado
• watermelon
• grapes
• figs

Go Easy on Red and Processed Meat

People suffering from psoriatic arthritis should limit their intake of fatty meat—especially red meat—in order to maintain a healthy weight and keep inflammation under control. 

Fatty meats, especially processed meats like bacon are high in saturated fat, which can cause inflammation, increase levels of “bad” LDL cholesterol and raise your risk of heart disease.

Reduce Dairy Products If Necessary

Research suggests that people with psoriatic arthritis are more likely to be intolerant of dairy products.  Some people with psoriatic arthritis may experience worsened symptoms after consuming full-fat dairy products. With any inflammation, dairy can be a source of aggravated inflammation and so people with any type of inflammatory disease should limit dairy.

Eat Fatty Fish

If you have psoriatic arthritis, fatty fish—such as salmon, tuna, sardines, trout, mackerel, and oysters—should definitely be on the menu. Research shows that people with psoriatic arthritis, who consumed fish experienced reduced PsA symptoms like stiffness and tender joints, as well as pain. This can be attributed to the omega-3 fatty acids contained in these foods that have powerful anti-inflammatory effects. Packed with protein and vitamin D, fatty fish may be beneficial for your brain, help decreases morning stiffness, and protect people with psoriatic arthritis against heart disease.

Cut back on Processed Foods

People with PsA should avoid heavily processed foods such as baked goods and pre-packaged meals and snacks. These items contain large quantities of trans fats to help preserve them. It is a known fact that trans fats trigger inflammation in the body and exacerbate PsA symptoms.

Substitute Nuts for Red or Processed Meats

As long as you aren’t allergic, nuts are the perfect food for Psa. All nuts are loaded with monounsaturated fats that can have incredible anti-inflammatory properties. They are high in antioxidants, healthy fats, and fibre to keep you feeling full for hours. Eating a handful of nuts—such as walnuts, peanuts, almonds, or pistachios—is especially beneficial to patients with psoriatic arthritis. All nuts have their virtues, but research shows one reigns supreme as an inflammation warrior: Walnuts. They are a good source of alpha-linolenic acid (ALA), a type of omega-3 fatty acid whose health benefits include a role in the reduction of inflammation in the arteries after a heavy, fatty meal.

Bring on the Berries

Eating a heart-healthy diet rich in fresh fruits, and vegetables should be part of everyone’s routine. There is compelling evidence that a diet rich in fruits may be particularly therapeutic to ward off inflammation related to the condition. Colourful berries—strawberries, blueberries, raspberries, cranberries, and others—are loaded with antioxidants, which can rid the body of free radicals that promote inflammation.

Eating right is key to bringing down inflammation and reducing your chances of flare-ups when you suffer from psoriatic arthritis. While the above foods will not cure PsA, they could be a step in the right direction. By consuming an anti-inflammatory diet, you may be able to improve your symptoms of PsA and also prevent other chronic conditions like heart disease and diabetes. 

Here we have mentioned a few best, easy and most popular psoriatic arthritis diets you can try.

However, there might be chances that you are allergic to any of the food or might have an undiagnosed medical condition that can be aggravated by any of this food. 

In such a situation, you can also opt for genetic testing, which is a cutting-edge predictive health tool to ascertain your predisposition towards certain foods; that can have a positive or negative impact, depending from person to person.

Also,  it is advised to have frequent preventive health check-ups to keep an eye on overall health, especially your cholesterol levels.

Book The Full Body Good Health Test Today!