How your blood may predict your future health

New research into bloodstream biomarkers aims to unlock the full impact of social status on peoples lifetime health outcomes. The key is exposure to stress

Health is a well-known inequality issue. While ageing is inevitable and most of us will get sick at some point, the rate of your decline is likely to be faster the lower down the socioeconomic ladder you started.

The intriguing thing is, nobody exactly knows why. Tempting though it is to blame the usual suspects poor diet, obesity, smoking they dont account for the whole story.

If you exactly knew somebodys diet, exercise level, smoking habit or alcohol consumption, you would be about 30 to 40% likely to accurately predict how long they are going to live, says Mel Bartley, professor emerita of medical sociology at University College London, who has dedicated her career to understanding the links between society and health. But whats the rest? Thats the big question.

Unpicking the biological connections between external socioeconomic forces and an individuals health is no easy task. But Bartley and others in her field believe important clues can be found in the very lifeblood of a nation.

The idea that measurable biological markers (biomarkers) in the bloodstream can reflect an individuals underlying health status and even offer some kind of prediction of their life expectancy gained popularity in the 1950s, as scientists started searching for tell-tale markers linked to the epidemic of heart disease spreading through the US.

High blood pressure was the obvious one, but they also discovered that the level of bad cholesterol in the bloodstream was a good indicator of risk. By monitoring blood cholesterol levels in healthy people before they show any outward signs of heart disease, doctors can predict who is most at risk. The resulting medical interventions, such as dietary changes and statin drugs, can demonstrably improve those peoples long-term health.

Now, researchers are using the same approach to measure the impact of social status on the body, in the hope of developing policies that can reduce the health toll on societys most deprived section (on average, the poorest people in the UK miss out on more than a decade of life compared with the richest).

One of the most ambitious projects, currently being undertaken by the University of Essexs Institute for Social and Economic Research (ISER), is looking at blood biomarkers from some of the 40,000 UK households taking part in its Understanding Society study, which covers the entire socioeconomic spectrum.

A biomarker is an objective measure of health, explains Professor Meena Kumari, the epidemiologist leading the study along with health economist Dr Apostolos Davillas. These chemicals are like molecular flags: they allow us to see what happens inside people as theyre going through their life course which they themselves might not be so aware of.

According to Kumari, Whats happened historically is that social scientists have tended to measure health in a simple way just asking people: How do you rate your health right now? But we wanted to bring together the biology and the social science.

Published in the journal Scientific Reports, the ISER teams initial analysis focused on measuring the levels of two molecules, fibrinogen and C-reactive protein (CRP), that are produced by inflammation the bodys response to infections, stress and other harmful stimuli. Chronic long-term inflammation is linked to poorer health outcomes including heart disease, diabetes and cancer.

According to Davillas and Kumari, measuring an individuals CRP and fibrinogen levels and matching them against their socioeconomic position starts to reveal the hidden mechanisms connecting social inequality and health. And the missing link appears to be stress.

The impact of chronic stress

When we experience something stressful, we activate the hypothalamic pituitary adrenal axis: a convoluted network involving the brain and the pituitary and adrenal glands. This results in the release of cortisol and other stress hormones such as adrenaline, which have a range of effects on the body.

The complex biological conversation between this stress response and the bodys inflammatory processes actually damps down inflammation in the short term. But this careful balance seems to shift in the face of chronic stress, resulting in more inflammation over time. Thus the levels of CRP and fibrinogen, as markers of chronic inflammation, are a proxy for the impact of long-term stress on a persons body.

CRP levels at different ages by household income, left, and education. Photograph: Davillas et al/Scientific Reports

For Kumari and Davillass biomarker study, blood samples were gathered from nearly 8,000 adults in the Understanding Society cohort. While CRP and fibrinogen levels increase in all of us as we age, the ISER team found that differences in the levels of CRP and fibrinogen between socioeconomic groups begin to show relatively early in life and on average rise faster and peak sooner in poorer people.

The research shows differences in CRP levels start around 30 years old and peak around the age of 55, Davillas says. Then the gap starts to narrow again theres not so much difference between the lowest and highest socio-economic groups in later life, although of course the social inequalities are still there. People in both groups end up with similar CRP readings by their mid-70s.

The analysis suggested people in lower socioeconomic groups have a demonstrably longer exposure to chronic inflammation with all its knock-on impacts on long-term health even once the team corrected for the usual suspects of health inequality, including diet and smoking. Theres clearly something else at work.

If you ask people about their health, you dont really see differences early in life people tend to become unhealthy later in life, Kumari says. But were starting to see these underlying biomarker differences in people in their 30s; so whats that about?

Fibrinogen levels at different ages by household income, left, and education. Photograph: Davillas et al/Scientific Reports

Kumari and Davillas are now considering the causes of chronic stress that might contribute to the patterns they have found, starting with employment or lack of it and the associated issues of poor pay, job insecurity, long hours and the burgeoning gig economy.

You have stressful life events such as bereavement or divorce, but were talking about understanding chronic long-term stresses, Kumari says. One of the things we think about is why is disadvantage stressful? For something like low income, it could be because you dont have the same levels of control over your life. Maybe you can manage it for a little while, but over the long term it becomes a chronic stress. These things are hard to measure and capture.

Bartley agrees more needs to be done to understand the financial causes of stress across society. Debt is deadly for people its the ultimate lack of control, she says. Housing is also a huge issue and it doesnt get researched enough living in poor situations is depressing, especially if youre bringing up children. People in poverty can end up in social isolation, and thats known to be associated with all kinds of unhealthy outcomes.

Changes in policy

Its all very well to be able to measure levels of inflammatory biomarkers, and link them to stress and worse health outcomes but the big question is what to do about it. If its as simple as lowering inflammation, then maybe we should just hand out anti-inflammatory drugs such as aspirin to poorer people?

I dont believe thats the answer, says Bartley. We need to understand what it is about living in a tougher social and economic situation that causes this underlying stress, in order to argue for more effective changes in policy.

From a policy perspective, if you know when health inequalities begin and when they peak, this can help you target these age groups and allocate resources more effectively, says Davillas, pointing to the example of retirement timing. If youre doing a stressful job and this impacts your health more compared to someone in a less stressful occupation, this is an important issue to consider from a public health perspective. Perhaps people in more stressful jobs should retire earlier.

Measuring biomarkers across society could also give researchers a way of monitoring the impact of policy interventions. But to do that effectively will require a lot more data. While the ISER teams findings suggest a link between inflammation, stress and poor health outcomes in the most disadvantaged sectors of society, the study is only a snapshot of biomarker levels in individuals of different ages at one point in time. Whats really needed is detailed, long-term research, monitoring and following people over decades as their lives change.

If we have 30-year-olds with high CRP, we want to know what happens to them five years later, says Bartley. We need to study people over their whole life course to find out if that early high CRP reading is fixed, and does high CRP at age 30 condemn someone to get sicker faster later on or does their health outcome change if they improve their situation and lower their stress levels?

The challenge with this long-term approach is finding ways of measuring biomarkers in large numbers of people across the full spectrum of society. It would be good if we could collect them by some electronic means, instead of having to stick needles in people for blood samples, Bartley speculates. Theres a lot of scope for improvements in technology such as mobile phones, in terms of understanding how society gets under the skin.

The ISER study also highlights another striking issue: the general lack of research focuses on people in midlife a time when life paths can become entrenched.

There are a lot of studies looking at older age groups, because thats when people get sick, and lots involving children because child development is interesting, but theres not a lot going on in the middle of the age span, Kumari says. And yet we found the difference between biomarker levels was biggest in working age groups, where we have the least amount of data.

Understanding the underlying biological pathways will help us to target what it is we should be focusing on. Our data suggest that it might be stress that we need to be thinking about, particularly for working age people. But this is just the beginning theres still a lot to do.

Share your experiences by emailing, or follow the Guardians Inequality Project on Twitter here

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Why Hustling May Be Bad For Your Health, According To A Wellness Guru

American millennial working culture is often inundated with the idea that you should always be “hustling.” We pat each other on the back and tell one another we’re “killin’ it” — a phrase that brings with it the notion of being in constant, maximum capacity work mode, focusing on productivity and achievements above all else. This culture seems to suggest you have to hustle hard if you really want to be successful in your chosen career path, and that you and your skills will be obsolete if you don’t measure up. But the reality of the constant hustle can feel pretty exhausting, stressful, and (dare I say) soul-crushing — which has left me wondering, is hustling a good thing?

Elite Daily had a chance to speak with wellness guru and soulful doula Latham Thomas (also known as Mama Glow, whose book  comes out Sept. 26) to talk about how hustling really all that great sometimes, and how it can negatively impact the well-being of your body, mind, and spirit.

According to Thomas, it’s easy to forget the importance of learning how to and focus more on life’s process, rather than life’s productivity — and the research pretty much says she’s right.

A report from The American Institute of Stress said 80 percent of workers feel stress on the job, and nearly half that population says they need help learning how to manage it. Plus, a 2015 study from  showed that people who are overworked actually die younger and are at a greater risk of heart attack and stroke.

With all of that in mind, Thomas says the “anti-hustle” is where it’s at if you’re looking to feel healthier and more fulfilled in the long run.

And what exactly is anti-hustling? Thomas defines the term:

It’s about honoring your need for self-care even in the face of things not getting done.

Shutting off your electronic devices, logging off from virtual life, and stepping into actual life. Grounding your physical and emotional body, and charging your soul.

If you’re deep in the habit of overworking, Thomas explains, keep in mind that no one is going to stop you. In fact, a workplace will often exploit your ability and willingness to transgress your own boundaries of self-care. “The obsession with productivity,” Thomas says, “has everyone, even over-scheduled children, fraught with anxiety.”

And all of this takes a major toll on your mental and physical health. Long-term effects of stress have been linked to several different types of health issues, including heart disease, diabetes, depression, and high blood pressure, according to Mayo Clinic.

Thomas says focusing on the outcome of your hard work, rather than the process, inevitably orients you toward feeling unfulfilled.

“We are no longer tapped into the intention of what we actually want or need when we move in this way,” she tells Elite Daily.

Everyone has a threshold for stress, Thomas adds, which is the amount you can handle it gets to a point of being too overwhelming, and potentially damaging to your health. For the sake of your well-being, it’s crucial to be able to identify your personal threshold of stress, so you can give yourself what you actually need, and know when your body is signaling for you to slow down.

This can be pretty difficult to figure out, but Thomas offers some helpful questions to ask yourself to start the process:

What does my body need from me now? What does my mind need to thrive? What provides me with spiritual fulfillment? What does the topography of my emotional landscape look like?

How can I design my life around freeing myself from the tyranny of my to-do list? How can I embrace the energy of ease?

Thomas says the thought of moving from a hustle-centered life to what she calls “a pace of grace” can actually feel alarming for many of us — but that doesn’t mean we shouldn’t try. Engaging in self-care is a great way to help you find your “pace of grace.”

And the way Thomas describes self-care makes it seem pretty damn amazing. She tells Elite Daily,

Don’t you feel like soaking in the bathtub until your fingers wrinkle, and reading a memoir with the dimmer on?

What about cupping your hands around a warm cup of tea and watching the steam dance through the air?

Slowing down can start with something as simple as taking a moment to put your phone down.

“Stop checking your status,” Thomas says, adding with humor, “and check your pulse [instead].” Find a way to ground yourself, be in the moment, and connect with your body in the here and now.

Another way Thomas encourages the anti-hustle? Take the time to do something each day that feels profound or sacred to you — things that step away from whatever it is you feel like you to do in order to keep “killin’ it” at work.

The wellness guru explains,

Mundane routines, like making your bed each morning, can be made into a ritual when we perform them with intention and mindfulness.

How we start and end each day matters, and can determine our overall mood. 

She also stresses the importance of taking time for yourself — and yourself — at the beginning and end of each day. Slowing down at these specific times can give you some much-needed space for reflection. Yes, that means no tweeting your clients and no late night emails to your boss.

And last but not least, Thomas encourages people everywhere to simply be grateful for themselves as human beings:

Consider your body and all that it does to hold you up and keep you moving in the world.

Slow down, listen, reflect, rest, and be thankful.

So, can we make the anti-hustle the new hustle, or nah?

Read more:

The most common pre-existing medical conditions

(CNN)By the numbers, it looks like Americans are one unhealthy nation and could therefore have a lot to lose, depending on how the health care debate concludes.

As many as one in two Americans has some kind of illness or condition that was, at one time, considered a pre-existing condition by insurance companies before Obamacare. For older Americans, that percentage is even higher: About 86% of your aging parents and grandparents, Americans between the ages of 55 and 64, have one, according to government estimates.
Before the Affordable Care Act, Americans could be denied health insurance if they had one of several of common health conditions like diabetes, asthma and even acne. Obamacare generally stopped that practice. The law, in most cases, made it illegal for insurers to deny coverage or to charge people more because they’d been sick. It also put an end to most of the lifetime and annual benefit payment caps carried by some insurance policies, even the typically more generous employer-provided ones.
    The debate about repealing Obamacare is ongoing, which means it is unclear what a final replacement law would look like. The latest Graham-Cassidy bill would eliminate federal funding for the Medicaid expansion. It would remove the subsidies that lower premiums for people on Obamacare and eliminate subsidies that help with deductibles and co-pays.
    Instead, states would get a lump sum annually through 2026, and the state would decide what to do with that money. Insurers would still have to cover everyone, regardless of pre-existing conditions, but insurance companies could charge people more based on their medical history. The 10 essential health benefits all plans must carry under Obamacare would also be eliminated.
    The last bill to make it through the House would leave 23 million uninsured by 2026, compared with who gets coverage under the current law, according to a Congressional Budget Office analysis. Polls show that this news worries many Americans, particularly the half who have had a condition once considered pre-existing.
    But who are these people who live with these pre-existing conditions? Have they failed to “lead good lives,” as Alabama Republican Rep. Mo Brooks said in May of healthy people, who he believes should pay less for coverage? Will they really be able to buy a policy as Republicans are promising, or will the costs make coverage prohibitive?
      CNN analyzed the top 10 most common conditions for Americans. People with these conditions come from all walks of life, but they each must cope with the illness they have or once had.


      Eric Brod may be a confident professional in the world of finance today, but when he was a freshman in high school, something made him self-conscious.
      Like a lot of high school freshmen, he had acne.
      “I was probablymore aware of it than my peers,” Brod said. “I was definitely thinking about it.”
      Acne is one of the most common chronic pre-existing conditions and is the most common skin condition in the United States. At least 50 million people have acne, according to a 2006 national study of skin disease, the latest data available.
      Acne happens when a pore in your skin gets clogged. Your body is constantly shedding dead skin cells. Sometimes, it over-produces the oil needed to keep your skin from drying out, and when that happens, dead cells can stick together and clog your pores. The bacteria that naturally live on your skin can also get caught in your pores and cause your skin to get inflamed and red. When the bacteria get deep into your skin, they can create an acne cyst.
        Acne can appear on your face, your back, your chest — essentially anywhere on your skin. When your hormones are out of whack with puberty, it increases your chance of having acne, but adults can get it, too.
        Prior to Obamacare, insurance companies could turn down your request for a policy or charge you more if you had this condition, even if you had it under control.
        In Brod’s case, his acne wasn’t too bad, but it was persistent, and he said it wasn’t being contained with the usual antibiotics or topical medications he tried throughout his high school years.
        “I was self-conscious about it and would nervously pick at it if it lingered,” Brod said. Running track and cross-country kept him fit, but it did not help his skin. He’d break out if practice was held on cold or hot days, and the sweat and dust didn’t help.
          He had breakouts throughout his high school years, but the summer before freshman year of college, he had a breakthrough. His father, a dermatologist, recommended a different treatment to get it under control once and for all.
          “I felt really lucky because, living with my dad, he saw how it looked from day to day and had an idea about what would help,” Brod said.
          Brod got a prescription for isotretinoin, better known as Accutane, which has since beenpulled from the market. It was a form of vitamin A that reduced the amount of oil released in your skin and helped the skin recover quickly. For Brod, it did the trick. He didn’t have any side effects, and the help came just in time.
          “When you are going to college and you don’t know anyone, you do want to look your best,” Brod said. “Acne is more than a cosmetic concern, though. I knew it could lead to permanent scarring. And while this was a relatively mild case, I didn’t want that and was glad we found something that worked.”


          Kat Kinsman has what she calls a kind of “autoimmune disease of the soul.” She struggles with anxiety and “came out” about it in a first-person story on CNN in 2014. She said it “freed me in so many ways that I felt really lucky that I had an employer and a husband who supported me through this and it didn’t blow back on me.”
          More than 39 million American adults struggle with anxiety. It’s the second-most common pre-existing condition in the country, according to a 2005 study.
          Kinsman now works as a senior food and drinks editor at Time Inc.’s all-breakfast site Extra Crispy, and she is the author of the book “Hi, Anxiety: Life with a Bad Case of Nerves,” published in November. However, it is something Kinsman has struggled with since kindergarten, long before she had words to describe it. In fact, when her parents first noticed something was wrong, they took her to a doctor, who tested her for such conditions as cancer and mono. It got so bad that she missed a part of her freshman year of high school.
          “Your parents can love you and take care of you the best they can,” Kinsman said. “Anxiety is not necessarily something that first comes to mind when you are looking at what is wrong.”
          When doctors did finally figure it out, her parents found Kinsman the counseling she needed. “At an early age of 13 or 14, I was given this gift of openness,” she said. “Talking about my anxiety saved my life.” Though medication was not for her, she said therapy helps. She sees a nutritionist. She does a lot of deep breathing. Kinsman is not cured, but she’s better at managing it.
          “I have almost 45 years of practice,” she said. “People tell me I have a real good poker face.” However, when her close friends suspect something is up, they ask to see her thumbs. She admits to a bad habit of picking at them when her anxiety is triggered. “I have sometimes picked them raw,” she said.
          Her anxiety can manifest itself in other physical ways. It makes her heart pound, her body tense; it can make her sick to her stomach. “My body can decide to be a real jackass,” she said. She also gets restless and cannot sleep, and then a lack of sleep exacerbates her anxiety. Not telling people about it also compounded the problem.
          “You find it so exhausting to put on your normal person suit every day and go out,” Kinsman said. “You don’t want people worried about you, and you get afraid of being thought of as crazy, or you are worried you would lose your job.”
          Over the years, it has clouded her judgment, and before she talked about it, it hurt some of her relationships. A few boyfriends never understood, an employer told her not to talk about it at the office, and some friends thought she was blowing them off when she really stayed home because something had triggered her anxiety.
          When she finally could talk about her anxiety, life got better. She learned that she wasn’t alone. After her essay ran, friends and even strangers would tell her about the mental illness in their own lives or within their own families.
          “It was an extraordinary time,” Kinsman said. “It’s like when you look out at a meadow and you see that first firefly, and then another lights up in response and then another and another, and finally the whole meadow looks like it is on fire. People started talking to me about their own struggles, and it made me feel less of a freak and opened up the possibility for conversation.”
          She hopes her talking about it can help end the stigma of mental illness. “Too many people are self-medicating or even dying because they can’t talk about it,” she said. She volunteers in the community and got certified to work on a crisis line. “I am well aware that I am in an incredible place of luxury to work where I do and to be so open and supported,” she said. “I feel like I can take this hit, and my goal is to make it easier for someone who, for whatever reason, cannot get help.”


          Peter Richardson, an avid biker in Spokane, Washington, said he nearly jumped into a river when the test strips used to monitor his diabetes fell out of his pocket and into the water. “I was on a 30-mile bike ride, and about 30 dropped in. It was awful,” Richardson said.
          Richardson is fit, but he’s a self-employed real estate broker who buys his own insurance, and his policy has its limits. When he went to the pharmacy to get more test strips, the pharmacist said Richardson would either have to wait four days for his insurance autorenewal to kick in or need to pay the full retail price. Unable to manage his disease without test strips, he paid. It cost him $338.
          “Luckily, I can afford it, but it could easily have been a whole different scenario,” Richardson said. “I’ve got a 3-year-old daughter and a wife who stays up late at night worrying about our finances. I was blown away when the pharmacy called.” Richardson couldn’t believe insurance couldn’t cover something he regularly uses to manage his care.
          Richardson is one of 30.3 million people with diabetes, according to the latest numbers from the US Centers for Disease Control and Prevention. It’s a pre-existing condition that left people uninsured prior to Obamacare. Luckily for Richardson, he had coverage when he was diagnosed, but his insurance didn’t cover much. He had what was known as a catastrophic policy that had high deductibles and limited benefits. His first vial of insulin cost almost $500.
          “When they told me that at the pharmacy, I nearly walked out without filling it,” Richardson said. But diabetics need insulin to live.
          With type 1 diabetes, the pancreases doesn’t create much, if any, insulin. Your body needs insulin to balance the glucose in your bloodstream. Glucose is what your body uses for energy. If your blood sugar is too high, it can lead to blindness or kidney or nerve damage. If your blood sugar gets too low, you could faint or even slip into a coma.
          Fortunately, Richardson found a medical study to volunteer for that gave him insulin for free. That held him over until he could get better insurance.
          “That really scared me,” he said. His policy is generally better now, but he can afford it. Business is doing well now. That could change if there’s another downturn in the real estate market or interest rates go up. That’s why he’s watched the health care debate with trepidation.
          “That’s what keeps me up at night, because you can’t control what they are going to decide, and some of what they are considering, especially for someone like me with diabetes, is scary.”
          Though he wants to stay an independent business owner, he’s been tempted to take jobs that provide benefits. “If I don’t have a sale, that may be what I’m faced with if they don’t provide coverage for people like me on the marketplace. What are you going to do?” he asked.
          In the meantime, he will continue to watch what he eats. He’ll keep biking to stay fit, and he’ll monitor his health with modern tools like a program called One Drop that gives him more up-to-date data about his daily health.
          Richardson hopes lawmakers will listen to the diabetic community. “Talk to the kids at the diabetic camps. Go talk to a group of people living with the condition to give you a real-life perspective,” he said. He hopes that motivates Congress to make the system better. “It has to get better.”


          When Cathy Stephens completed her first triathlon, she proudly held up a sign that said “Dear asthma, I win.”
          The endurance athlete who thinks nothing of a 100-mile bike ride has such bad asthma, there are days when she cannot breathe enough to speak and she can forget about walking across the collegecampus where she works.
          People with asthma have inflamed airways. Your lungs use airways to bring oxygen into and out of your body. When someone experiences asthma symptoms, the muscles around these airways tighten and narrow, making it hard to breathe. The cells that create mucus can also overproduce it, causing the airways to tighten more. This happens when an asthmatic encounters something that triggers an attack. It could be something they are allergic to — In Stephens’ case, it’s mold and dust — or it could be a virus. “When people are sick around me, I run screaming the other way,” she joked.
          Sometimes, asthma symptoms can be mild and make a person wheeze or cough. Sometimes, attacks can kill.
          Stephens is one of 25.2 million asthmatics in the United States, according 2015 numbers from theCenters for Disease Control and Prevention.
          Stephens said shewasn’t breathing when she was born, and doctors had to revive her. And asthma has troubled Stephens all her life. She’s the only one of her siblings to have it. “I tell them I took one for the team,” she said. Her mom also had asthma and died of related complications in August 2016.
          Despite having to raise five children by herself in small-town Idaho, Stephens said, hermother was the “real hero” who would get her through her attacks. She’d put her daughter in a hot shower so the steam could open her airways. She’d pin a towel with ice around her throat. Sometimes, she’d even sit up all night with her daughter, holding her upright.
          “I have vivid memories of my mom in that rocking chair, holding me up when I was too little to prop myself up, since you can’t lay down when your asthma is bad like that,” Stephens said. Doctors also put Stephens on massive doses of prednisone, which worked but packed on the pounds.
          “I was always the girl with the note for PE saying I couldn’t run, but if you looked at me, I looked fine, so I would always have to fight off that stigma that I was lazy or something,” she said.
          As an adult, she feels like she has a good handle on her disease. She avoids her triggers. She watches her diet and has eliminatedfoods that cause inflammation. She exercises, since excess pounds can exacerbate asthma symptoms.
          It’s paid off. She hasn’t been hospitalized in 20 years. She still needs to see the doctor regularly to get prescriptions for her rescue inhalers, and she’s got a nebulizer to use if her symptoms are bad. “Sometimes I’ll have to bring it to work,” said Stephens, who certifies teachers and principals and helps them find jobs. “When I have to do, that I’ll just close my door, and if someone comes in when I’m on what I call my peace pipe, no one seems to mind.”
          She feels fortunate to have good insurance through her work, but she didn’t always. When she was waitressing to put herself through college, those jobs didn’t always come with benefits. Even when they did, prior to Obamacare, sometimes insurance wasn’t an option. Companies could turn her down because of her pre-existing condition, or they would make her wait a certain amount of time before they’d cover her care. That meant she’d often put off going to the doctor or getting prescriptions filled even though she’d need to.
          “I muddled my way through and mostly was lucky, but there were times when a trip to the hospital was devastating to my budget,” she said. Even now, with good insurance, her $2,000 deductibleprompts her to use her inhaler — an Advair bronchodilator — sparingly. She’s been OK, but it’s not ideal.
          She hopes Congress doesn’t decide to “take 10 steps back to the past,” when coverage was not as affordable as it iswith the current health care bill. “It was scary when I’d have to make a choice between paying for college and paying for insurance,” Stephens said. “What bothers me about the current debate is that they talk about those of us with pre-existing conditions as being the sickest, but other than that one thing, I am much healthier than most.” She said she’d love to take a long bike ride with any legislator who says people don’t die from a lack of insurance and see whether they see can keep up.
          “They need to stop beating people up for having an illness,” Stephens said. “They should instead see what we can do when we have an environment in which we can stay healthy and live up to our full potential.”

          Sleep apnea

          Wendy Solon always described herself as an “active sleeper.” It never woke her up, nor did she remember any of it, but her husband told her that she’d toss and turn and snore. As she got older, her snoring got louder. She felt fine but remembered vivid dreams. After her husband continued to have problems sleeping, she talked to her doctor and asked for a recommendation to see a sleep specialist.
          “I went because I thought it would help me sleep calmer and I wouldn’t be bothering my husband as much,” said Solon, 47.
          She went to Emory University’s sleep clinic, where doctors “basically asked me a million questions” and suggested an overnight sleep study.
          When she went in, they hooked her up to a bunch of sensors on her legs and arms, and then she went to sleep.
          “I woke up, and I remember thinking, ‘Well, that’s not going to be a very interesting sleep study. I think I got a very good night’s sleep,’ and I thought for sure the doctor would tell me that he didn’t find anything,” she said.
          Instead, her doctor told Solon that she wokean “astronomical number of times,” she said. The doctor recommended that she get a continuous positive airway pressure machine, or CPAP machine, to help her breathe. He diagnosed her with sleep apnea.
          “I had no idea I had sleep apnea,” she said. “I wouldn’t have guessed that, ever.”
          More than 25 million American adults have sleep apnea, according to the Sleep Foundation. People with the condition pause when they breathe in their sleep. The pauses can last for seconds or minutes and may happen as many as 30 times an hour. People with sleep apnea don’t often breathe deeply when they sleep. Because they stop breathing, they go in and out of deep sleep, and that can leave them feeling tired during the day. It can have serious health consequences such as high blood pressure, stroke, obesity, diabetes and heart problems. It can cause accidents at work. It’s the No. 1 cause of sleepiness during the day, according to the National Institutes of Health.
          Solon feels like using a CPAP machine is a bit like needing braces: “medically necessary but not a big deal.”
          She said she doesn’t feel any more rested yet, but it helps. The CPAP machine gives her a constant stream of air pressure so her throat and airways don’t constrict and she keeps breathing during sleep. Insurance, which she gets through her husband’s company, covers the machine.
          “We were blessed that we have the insurance we do, but we know we are lucky,” she said. She hopes Congress will continue to help people like her with pre-existing conditions. “For me, the sleep apnea is not a big thing compared to the other health issues in my life, but treatment does matter. It’s not like these medical situations are your fault, and they should never every be treated that way.”


          The health care debate drove Mike Babb to write a highly public letter about a deeply personal issue.
          “For me keeping Obamacare is a matter of life or death,” the father of two wrote in his local newspaper in Pennsylvania..
          To Babb, this isn’t merely rhetoric. He is one of more than 20.8 million American adults who struggle with major depressive disorder.
          “I was constantly overwhelmed with suicidal thoughts,” he said. “When you have really bad depression, this is not laziness. This is not something easy to get over. You learn you have it, and it gets even worse, because you beat yourself up for having it.”
          Depression is a mental health disorder in which people have a constant feeling of despondency. It can cause them to lose interest in everyday activities and make them feel bad about themselves and others. It’s an intense sadness and feeling of hopelessness that, if not treated, can lead people to suicide.
          Doctors put Babb on nearly every medication available, but none seemed to work. They then suggested a treatment that sounded more radical: electroconvulsive therapy. Once a month, he would go under general anesthesia, and doctors would send small electric currents through his brain. The currents trigger a brief seizure, changing his brain chemistry. The treatment, he said, saved his life.
          “This really took a cross off my back,” he said. “It was amazing to find something that worked.”
          In addition to the electroconvulsive therapy, he sees a therapist weekly. He also sees an additional psychiatrist and takes three drugs. He pays about $675 a month for COBRA — employer-based insurance for people who lose or leave their jobs –plus at least $1,500 a year with various co-pays. It’s expensive, especially since he had to quit his teaching job due to his depression, but even when he got insurance through work, it was limited.
          When he started teaching chemistry 22 years ago, he noticed that his policy carried a $50,000 lifetime cap on mental health care. Quickly, he could have surpassed that and would have had to pay for his treatment out of his savings, he said.
          “Obamacare changed that,” Babb said. “Parity of service means they can’t exclude you because you suffer from something that is something mental, not physical. That has been a lifesaver for me.”
          He said Obamacare gave him his life back. Though he can’t work, he still feels he has something to offer his community in Fleetwood, Pennsylvania. He’s a regular volunteer, driving for the blind, and he stays active with his hometown Lions Club. He’s there for his teenage sons. And he promises to continue speaking up to urge congress to keep Obamacare, rather than merely repeal it. As someone who is about to get coverage through Medicaid, he worries about those proposed cuts.
          “I remain very concerned with what’s going on,” he said. “I know when to speak up when stuff seems rotten. I can’t believe these politicians would take hundreds of millions out of health care for people who really need it to give tax cuts to the rich. I hope they come to their senses soon.”


          In 2001, when Karen Deitemeyer was 55, she started having trouble walking up the stairs. She had been a smoker, but with the help of two visits to a psychologist who used hypnotherapy, she had kicked the habit about a decade before.
          Initially, she chalked it up to aging. “I was a little overweight at the time, and while I exercise, I probably don’t exercise nearly as much as I should,” she thought, but the problem continued.
          She went to see her primary care doctor, who sent her to a pulmonologist. Tests showed that it wasn’t normal aging. She had chronic obstructive pulmonary disease, known as COPD. It’s an umbrella term used to describe lung diseases that block airflow and make it difficult to breathe. More than 15.7 million Americans have it, according to a clinical review from 2013. Though many with COPD smoked at one point in their lives, it can also be genetic, and it can be caused by a person’s environment.
          COPD is the third leading cause of death in the United States, and yet Deitemeyer, who is a volunteer in the COPD community, regularly gets asked what it is. “It’s a relatively newer umbrella term, so when I ask them ‘did you have an older relative with chronic bronchitis or emphysema? That’s what we call COPD now,’ and then they start to recognize it,” she said.
          By the time she was diagnosed with COPD, it was considered severe, she said. “It comes on gradually. It’s not like one day you are fine and the next you can’t do anything,” she said.
          Despite the severity, Deitemeyer continued to work. She had a decent job with good insurance with the Oceolo County tax collector’s office. “I was determined to make it work and just brought my oxygen tanks to the office,” she said.
          She went to pulmonary rehabilitation and lost weight. Both helped her breathe better. She retired when she turned 62. “Then I finally thought it was time,” but she stays active. The 55-and-older community where she lives with her husband has an activity every day, she said. “You would not believe the calendar here. There is so much going on,” she said. She also travels the country raising awareness about COPD.
          Now, 16 years after her diagnosis, she uses a stationary oxygen tank when she sleeps anda portable oxygen concentrator when she exercises or travels, but “otherwise, I don’t have to drag it around with me, so I’m fortunate in that sense,” she said.
          Though she is old enough to be covered my Medicare, she is 71, she knows others with COPD who are not so lucky and she follows the health care debate closely and worries for others with pre-existing conditions.
          “Who exactly is exempt from that. I mean, If you think about it, essentially life is a pre-existing condition.”

          Extreme obesity

          Akilah Monifa Monifa had worked as the director of communications and public affairs for the San Francisco CBS affiliate for nearly 14 years but wanted to be an entrepreneur so she could make sure more voices were heard, and down the road, she hoped to employ others.
          She usedseverance and unemployment checks to co-found Arise 2.0 in November. It’s a multimedia publication by LGBTQ people of color created to fill a gap in coverage of that community.
          She’s excited about it, but this busy Oakland mother is uncertain about her future.
          “As I’ve been doing this, I’ve noticed most people who create online publications keep their day job for at least a couple of years, particularly when they have families,” Monifa said. “My big concern is health insurance.”
          Monifa is covered through COBRA — employer-based insurance for people who lose or leave their jobs — but she’ll have to buy her own plan soon. That’s got her watching the health care debate with concern.
          “It is something I worry about, because with the reality of this new law and what it might do with pre-existing conditions, I may not be able to afford what I need to stay healthy,” she said. “And I certainly can’t afford to go without.”
          Monifa has had three of the most common pre-existing conditions. She had sleep apnea and for decades had to use a CPAP machine to help her breathe as she slept. Asthma slowed her down when she walked, and both were exacerbated by her weight.
          Like more than 18.5 million American adults, she struggled with extreme obesity and has been doing everything she can to fight it.
          Starting around age 15, she’d gain about 10 to 15 pounds a year. “I wasn’t mindful about what I ate,” she said, and it became a problem. At her greatestweight, her 5’11” frame carried more than 400 pounds. Over the years, she tried to lose it.
          “I tried everything that I could, but I would lose 75 and then gain 100, and my weight would yo-yo back and forth, and it caused serious health problems,” she said. In addition to the asthma and sleep apnea, she had borderline high blood pressure. Her knees and back hurt. “I knew my overall life expectancy was not great,” she said
          In 2012, she elected to have gastric bypass surgery. She weighed 330 pounds at the time. She made several life changes, joining group therapy and signing up for two gyms, where she continues to exercise daily. She plans meals ahead, and instead of meeting friends for dinner, they go for walks.
          The effort paid off. She lost more than 222 pounds and feels great.She doesn’t even need her CPAP machine any more, and her asthma doesn’t bother her. But the fight isn’t over. She’ll need regular checkups so doctors can monitor her health and nutrition intake becauseshe physically can’t eat as much now. She’ll also continue to see a counselor to manage the emotional side of her eating, and she’ll stay devoted to exercise.
          Even with an ankle cast for arecent injury, she is signing up for races. She recently got a medal for walking the Bay to Breakers event. “I only walked 4½ miles because the ankle was bothering me, but I was determined to do it,” she said. “You don’t lose hundreds of pounds and give up.”


          Mika Leah did everything she could to have a healthy heart, but it didn’t work, which is why she’s concerned about the possibility that insurance guarantees for those with pre-existing conditions may be dropped if Obamacare is replaced.
          She’s been eating a healthy diet all her life. She developed a taste for healthy fare after her mom removed sugar and salt from the family meals when Leah’s father had his first heart attack at age 32. She’d been playing soccer since she was 5. She exercises about four to five times a week and enjoyed the gym so much, she started teaching a cycling class for fun. But when she started having trouble running, she wondered whether something was wrong. She had run a half-marathon fine, but when she started running short distances, she felt “horrible.”
          “I was extremely breathless, and when I came home, I threw up,” she said.
          At first, she thought she’d push through. But when her breathing didn’t get easier and she started getting headaches, she went to the doctor, who chalked it up to stress. When the doctor summed up her life — she had an intense job and two children under the age of 2 and was going through a divorce — she replied, “Well, when you put it that way, I guess I am.”
          So she kept exercising, but the symptoms got worse. The doctors continued to tell her it was stress. An EKG didn’t show any problems. It wasn’t until her 33rd birthday that they realized something else was wrong.
          She and a friend went on a hike thatwas supposed to be easy. Leah had completed itwithout trouble when she was nine months pregnant. But on the first mile, she had to sit down not once but twice, and she couldn’t catch her breath.
          “It felt like a 200-pound man was standing on my chest,” she said. She looked at her hiking partner, who she says could stand to lose a good 80 pounds and was a pack-a-day smoker, and realized he hadn’t broken a sweat. “I knew something was really wrong with me, and I was terrified,” she said.
          She went to the cardiologist who had looked at her EKG. He too thought it was stress, but she refused to accept that answer. She demanded a stress test.
          A couple weeks later, doctors put her on a treadmill to run. She stepped off, and a doctor came in to tell her she needed surgery right away, she said: Her left artery was 98% blocked. The blockage was extremely close to her heart.
          She’s since had threeprocedures and fivestents put in her heart.
          Heart disease is the No. 1 killer of women, and atherosclerosis,or clogged arteries, which can lead to heart problems, are one of the top 10 most common health conditions for Americans. About 16 million American adults struggle with it, according to a 2008 study.
          As she recovered, Leah became reflective and decided the job that brought her true joy, her cycling class, was what she wanted to do full-time. She founded Goomi, a wellness company that brings fitness and cooking and meditation classes to workplaces and schools across the country. Goomi means rubber band in Hebrew and is meant to symbolize bouncing back and flexibility.
          Leah said she is deeply concerned about insurance and tries not to get political, but as a new business owner, she watches the health care debate closely and remains concerned about the cost of care. She hopes her company and her volunteer work for the American Heart Association will help keep people healthy and especially empower patients. Though she knows it may sound cheesy, she hopes someday, it will save lives.
          “Had I not spoken up, I could easily have been one of those athletes that goes for a run and drops dead because of my heart,” she said. “It makes a difference if you speak up on behalf of your health.”


          Lori Dorn, a writer for Laughing Squid, an online site that covers arts, culture and technology, said she’s become a kind of “medical sherpa” over the years, trying to help friends and acquaintances navigate the medical system when they are diagnosed with cancer.
          “I tell friends, if you or someone you know who has been diagnosed with cancer and need someone to talk to or to get you through that void and darkness or someone who can help you navigate the health care system, I am there for you,” Dorn said. That’s because she has been there, too.
          Diagnosed with breast cancer in 2011, she meets the five-year definition of cancer-free but still goes in every three months for a checkup, and she’s still on medication.
          When she was diagnosed with cancer, she had surgery, chemotherapy and radiation and got through it without too much trouble. “I’ve been told I’m a tough cookie,” she said.
          She also has another condition: asthma. Her asthma symptoms were much worse when she was living in San Francisco, where there were a lot of old buildings with mold and dust, to which she is highly allergic, she says. “Thankfully, I haven’t had a serious attack in eight or nine years,” although she usesa rescue inhaler if neededbut hasn’t been to the hospital in years.
          Still, the medication for both are expensive. She is on her husband’s insurance, but without it, she says, the drugs would cost her about $20,000 a month.
          “It’s expensive without it, or what would happen if I was unemployed, which has happened in the past? I don’t know what I would do,” she said. “I can’t go without them, but you see where people can’t afford their medication and have to go without. Politicians keep saying people can have their choice with health care reform, but when health care is too expensive, there are not great options in the market. That is not a choice.”
          Dorn is particularly concerned that annual or lifetime limit caps could come back. She said her treatments could have easily put her over those limits.
          Dorn also has questions for politicians and insurance companies that talk about pre-existing conditions as if they were something they brought on themselves. She has a gene that makes her predisposed to breast cancer. “A lot of people like myself with the genetic marker,” Dorn said. “We were born with this. Does this mean I’ve always had a pre-existing condition? Does this mean that they want to punish people for being born with a proclivity toward a pre-existing condition? Legislation like this seems very cruel.”

          Read more:

          Collins to vote ‘no’ on Graham-Cassidy bill, likely killing latest Obamacare repeal

          (CNN)Sen. Susan Collins announced Monday afternoon that she will oppose the GOP’s latest plan to overhaul the Affordable Care Act, bringing the total number of public “no” votes to three and likely killing the last-ditch effort to repeal Obamacare this week.

          In a statement, the Maine Republican said the bill does not go far enough to protect people with pre-existing conditions and that the proposal’s cuts to Medicaid are too steep.
          “Sweeping reforms to our health care system and to Medicaid can’t be done well in a compressed time frame, especially when the actual bill is a moving target,” Collins said. The bill would also “open the door for states to weaken protections for people with pre-existing conditions, such as asthma, cancer, heart disease, arthritis and diabetes.”
            Collins told reporters that President Donald Trump talked to her on the phone Monday and that Vice President Mike Pence had called her over the weekend to discuss her stance on health care.

              Graham on health bill: It’s OK to fall short

            The decision, while widely expected, deals what is almost certain to be a lethal blow to Senate Majority Leader Mitch McConnell’s eleventh-hour attempt to find 50 “yes” votes in his caucus. Collins joins Sens. John McCain of Arizona and Rand Paul of Kentucky, who have both said they will oppose the legislation. Sen. Ted Cruz also said he opposed the legislation as written.
            Collins was one of three Republican senators to vote against an Obamacare repeal bill in July — along with McCain and Lisa Murkowski of Alaska — stopping the bill’s passage on the Senate floor.
            Her decision to once again buck her own party comes the day after Republican leaders released a revised version Graham-Cassidy bill, written by South Carolina Sen. Lindsey Graham and Louisiana Sen. Bill Cassidy. The changes included boosts in funding for states like Maine and Alaska, but did not address concerns that many have raised about the erosion of protections for people with pre-existing conditions.
            Collins had foreshadowed her announcement on CNN’s “State of the Union” Sunday, saying she had a “very difficult” time envisioning a scenario in which she would support the Graham-Cassidy health care bill, but she was not definitive.
            Collins announcement came after the CBO released a partial score Monday evening of the GOP’s plan, saying the Graham-Cassidy bill would reduce the budget deficit by at least $133 billion, but millions would lose comprehensive coverage.
            The non-partisan scoring agency estimates that between 2017 and 2026, “the legislation would reduce the on-budget deficit by at least $133 billion and result in millions fewer people with comprehensive health insurance that covers high-cost medical events.”

              CBO: Millions uninsured under Graham-Cassidy

            New version released Sunday fails to sway no votes

            On Sunday evening, the GOP released its latest version of the health care bill, which aimed to convince members who are still undecided to support the bill. The changes aim to increase funding for states like Alaska, but there’s no proof that the bill will bring the undecided senators onboard now.
            In one new provision particularly beneficial to Alaska, the state would receive a 25% boost in federal matching funds for Medicaid due to its defined high-level of poverty.
            Despite the new version, there are still plenty of obstacles ahead. An aide to Paul said that the Kentucky Republican opposed this version of the bill as well, citing how his requested changes were not included in Sunday’s version. Another aide to Cruz, said the Texas senator is “opposed” to the revised bill.
            “It doesn’t address our concerns or include his requested changes,” that aide told CNN.
            Cruz made headlines on Sunday when he said at the Texas Tribune Festival that the legislation as written did not currently have his support, though his answer did not definitively rule out backing the bill and added that he wants “to be a yes.”

            Protests in the Capitol

            Hundreds of protesters gathered outside the committee hearing room Monday afternoon, and some interrupted the panel’s chairman, Utah Republican Orrin Hatch, when he started speaking. Hatch gaveled the committee into recess for a short time while demonstrators were removed.
            The top Democrat on the committee, Sen. Ron Wyden of Oregon, hand delivered pizza to the crowd before the hearing — making an impromptu, impassioned speech to the crowd.The top Democrat on the committee, Sen. Ron Wyden of Oregon hand delivered pizza to the crowd before the hearing — making an impromptu, impassioned speech to the crowd.
            “You are the faces of political change in America,” he said. “I’m bringing you some pizza because you can’t win a big battle against special interests on an empty stomach.” He said they are with them “in this battle every step of the way. We are going to beat Trumpcare!” Chants of “kill the bill!”‎ and “Kill Trumpcare, don’t kill me” followed from the raucous crowd.
            A large group of people sat gathered outside Murkowski’s office Monday afternoon. Murkwoski’s not expected to be back in the Capitol before this evening, but her staff met with those outside the office and brought them cups of water.

              Protesters disrupt health care bill hearing

            Deadline approaches

            A partisan health care bill must be voted on by the end of the week, when the vehicle that Republicans are using to move their plan is expected to expire.
            Over the weekend, the administration and the bill’s sponsors continued to lobby on-the-fence members, with aides telling CNN that the effort wouldn’t end until Republicans saw that third and final “no.”
            “Whatever sports metaphor you want to use about how it would take a miracle, it’s that,” a source acknowledged, noting that even a “Hail Mary” pass might be too generous to describe the odds at the moment.
            The stakes are incredibly high for members and Republican leaders who have tried to forge ahead with the bill. Gutting Obamacare was the GOP’s promise for seven years, and facing a second defeat would only expose the party to more criticism from its donors and base. The party is now split between supporting a bill that appears unpopular with stakeholders and hasn’t had even two full weeks to be vetted or moving ahead in an effort to pass anything it can.
            Republican Sen. Chuck Grassley of Iowa made headlines last week when he openly acknowledged that fulfilling the GOP’s years-long campaign promise was just as important as the policy ramifications of the bill.
            “You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” the Iowa Republican said according to a report from The Des Moines Register. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.”
            Former Pennsylvania Sen. Rick Santorum, who has been working with Cassidy and Graham on the legislation, told CNN that not taking action now will leave Republicans stuck with the blame on any future problems that arise in the health care system.
            “It’s either fix it and do it the right way or own the debacle that’s coming,” Santorum, a Republican, said. “This may be Obamacare but they’re going to blame Trump if it doesn’t work.”
            The fact that the Senate vote in July failed by just one — McCain’s third “no” vote — has also made it difficult for some Republicans to move on.
            Another political reality at play: Republicans, including Trump and his top aides, are desperate for a legislative victory.
            Trump and his top advisers have spent much of this year moving from one controversy to the next, all as the investigation into the Trump campaign’s possible collusion with Russia has loomed over the White House.
            Getting anything done on repealing Obamacare would mark an important win in a year that has lacked good news for the President.
            “For the White House, the desire to have a significant legislative accomplishment remains a big and important goal,” said Lanhee Chen, former chief policy adviser to Republican presidential nominee Mitt Romney. “And the fact that they were so close suggests that they could get across the finish line, so the reality and possibility of success is there.”

            Read more:

            Jimmy Kimmel tears critics apart on the GOP’s new health care bill, again

            Jimmy Kimmel isn’t taking your shit lying down.

            On Tuesday night, Kimmel went to town on the Graham-Cassidy bill — proposed by Republican senators Lindsey Graham and Bill Cassidy — for failing the “Jimmy Kimmel test.” 

            In the monologue, Kimmel said Cassidy “lied right to my face” when he appeared on the show in May, where the senator promised coverage for kids like Kimmel’s son who was born with congenital heart disease.  

            In the day after Kimmel’s outburst on the bill, politicians and television personalities lined up to criticise the talk show host. Like Cassidy, who accused Kimmel of not understanding the bill, when talking to CNN‘s Chris Cuomo on Wednesday morning.  

            So, in his opening monologue on Wednesday night, Kimmel returned fire, calling out Cassidy for pulling out the “all comedians are dummies card.”

            “Which part of that am I not understanding? Or could it be Senator Cassidy, that I do understand, and you got caught with your GOPenis out. Is that possible?” he asked.

            Kimmel also hit back at Fox News’ Brian Kilmeade, who described the talk show host as a “Hollywood elite” who won’t stop “pushing their politics on the rest of the country.”

            “The reason I found this comment to be particularly annoying is because this is a guy, Brian Kilmeade, whenever I see him — kisses my ass like a little boy meeting Batman,” Kimmel said. 

            “Oh, he’s such a fan. He follows me on Twitter. He asks me to write a blurb for his book, which I did. He calls my agent looking for projects. He’s dying to be a member of the Hollywood elite.”

            Also on the hitlist was New Jersey Governor Chris Christie, who described Kimmel as “not a serious person” on MSNBC. But the talk show host took it easy onthe bill’s co-sponsor Lindsey Graham, who labelled what Kimmel said on Tuesday “garbage,” with the host saying Graham looked like his grandma.

            So, here’s the upshot, folks: Kimmel doesn’t want your shitty healthcare bill, and if you’re going to try talk smack about him, he’ll be fine with ripping you to shreds.

            Read more:

            Poor diet is a factor in one in five deaths, global disease study reveals

            Study compiling data from every country finds people are living longer but millions are eating wrong foods for their health

            Poor diet is a factor in one in five deaths around the world, according to the most comprehensive study ever carried out on the subject.

            Millions of people are eating the wrong sorts of food for good health. Eating a diet that is low in whole grains, fruit, nuts and seeds and fish oils and high in salt raises the risk of an early death, according to the huge and ongoing study Global Burden of Disease.

            The study, based at the Institute of Health Metrics and Evaluation at the University of Washington, compiles data from every country in the world and makes informed estimates where there are gaps. Five papers on life expectancy and the causes and risk factors of death and ill health have been published by the Lancet medical journal.

            It finds that people are living longer. Life expectancy in 2016 worldwide was 75.3 years for women and 69.8 for men. Japan has the highest life expectancy at 84 years and the Central African Republic has the lowest at just over 50. In the UK, life expectancy for a man born in 2016 is 79, and for a woman 82.9.

            Diet is the second highest risk factor for early death after smoking. Other high risks are high blood glucose which can lead to diabetes, high blood pressure, high body mass index (BMI) which is a measure of obesity, and high total cholesterol. All of these can be related to eating the wrong foods, although there are also other causes.

            causes of death graphic

            This is really large, Dr Christopher Murray, IHMEs director, told the Guardian. It is amongst the really big problems in the world. It is a cluster that is getting worse. While obesity gets attention, he was not sure policymakers were as focused on the area of diet and health as they needed to be. That constellation is a really, really big challenge for health and health systems, he said.

            The problem is often seen as the spread of western diets, taking over from traditional foods in the developing world. But it is not that simple, says Murray. Take fruit. It has lots of health benefits but only very wealthy people eat a lot of fruit, with some exceptions.

            Sugary drinks are harmful to health but eating a lot of red meat, the study finds, is not as big a risk to health as failing to eat whole grains. We need to look really carefully at what are the healthy compounds in diets that provide protection, he said.

            undernourishment graphic

            Prof John Newton, director of health improvement at Public Health England, said the studies show how quickly diet and obesity-related disease is spreading around the world. I dont think people realise how quickly the focus is shifting towards non-communicable disease [such as cancer, heart disease and stroke] and diseases that come with development, in particular related to poor diet. The numbers are quite shocking in my view, he said.

            The UK tracks childhood obesity through the school measurement programme and has brought in measures to try to tackle it. But no country in the world has been able to solve the problem and it is a concern that we really need to think about tackling globally, he said.

            Today, 72% of deaths are from non-communicable diseases for which obesity and diet are among the risk factors, with ischaemic heart disease as the leading cause worldwide of early deaths, including in the UK. Lung cancer, stroke, lung disease (chronic obstructive pulmonary disorder) and Alzheimers are the other main causes in the UK.

            The success story is children under five. In 2016, for the first time in modern history, fewer than 5 million children under five died in one year a significant fall compared with 1990, when 11 million died. Increased education for women, less poverty, having fewer children, vaccinations, anti-malaria bed-nets, improved water and sanitation are among the changes in low-income countries that have brought the death rate down, thanks to development aid.

            People are living longer but spending more years in ill health. Obesity is one of the major reasons. More than a billion people worldwide are living with mental health and substance misuse disorders. Depression features in the top 10 causes of ill health in all but four countries.

            Our findings indicate people are living longer and, over the past decade, we identified substantial progress in driving down death rates from some of the worlds most pernicious diseases and conditions, such as under age-five mortality and malaria, said Murray Yet, despite this progress, we are facing a triad of trouble holding back many nations and communities obesity, conflict, and mental illness, including substance use disorders.

            In the UK, the concern is particularly about the increase in ill-health that prevents people from working or having a fulfilling life, said Newton. A man in the UK born in 2016 can expect only 69 years in good health and a woman 71 years.

            This is yet another reminder that while were living longer, much of that extra time is spent in ill-health. It underlines the importance of preventing the conditions that keep people out of work and put their long term health in jeopardy, like musculoskeletal problems, poor hearing and mental ill health. Our priority is to help people, including during the crucial early years of life and in middle age, to give them the best chance of a long and healthy later life, he said.

            Read more:

            The True Danger Of Hurricane Season Is Much More Long-Term

            Greetings from the apocalypse! I’m writing from the Summer of 2017, when wildfires have made Idaho and California smell like the Devil’s Vegan Barbecue, the sun is the color of a fresh period stain, and the Gulf Coast is aligned with the first teat of a four-boobied hurribeast.


            In a moment when it feels blasphemous to send anything but prayers, goodwill, money, awareness, donations, and time to everyone suffering from Harvey and the triplets of evil following it, there’s another story that needs to be told about these hurricanes:

            There is no upside, silver lining, or good news coming.

            More hurricanes, floods, and fires are on their way, and no one, not even the Americans in the Middle, are immune to what future natural disasters will do to this country. Not even Texas. Actually, let’s start with Texas.


            Texas Explains Why We’re Never Ready For Hurricanes

            I’m from South Texas, where the school year doesn’t feel real until you’ve had a Meet the Teacher night and a hurricane warning, sometimes on the same day. In my fuzzy childhood memories, hurricanes were exciting moments at the end of summer when you got to fill up your bathtub with a reckless amount of water and pray for a day off from school.

            Which explains why hurricane parties are a thing, and why you can find all of your hurricane party decorating needs on Pinterest. No other natural disaster comes with such a slow build and a festive atmosphere. And when hurricane season is built into your seasonal routine — my little sister was named after a hurricane that hit Texas 19 years before she was born — you just roll with them as best you can.

            So I wasn’t surprised that most of my friends, family, and childhood friends’ families didn’t evacuate when they knew Harvey was coming. It is very hard to get on a bus going to a place you don’t know for a thing that may or may not ever come. And Houston? Forget it. If you thought Houston should have been 100 percent evacuated, you’ve probably never been there. During Hurricane Rita, there were 100 deaths in Texas, 60 of which were related to Houston’s disastrous attempt to evacuate three million residents all at once.

            I also wasn’t surprised that Texans went nuts helping each other out once the waters started rising. Not because Texans are uniquely neighborly compared to other humans in distress, but because we’re uniquely good at self-publicity. It’s kind of our thing. That said, if you have South Texas friends on your Facebook timeline like I do, you know there were convoys of volunteers ready with food and water before Harvey was even done with its dirty business. Behind every dramatic rescue moment that went viral, there were thousands that no one saw, and for every tone-deaf Joel Osteen, there were hundreds of churches (and synagogues, and mosques!) mobilizing to provide immediate relief. I said there wasn’t a silver lining to Harvey, but that’s actually not true; after a summer of awful news, the storm reminded us that people are good.

            The problem is that being good in dangerous moments isn’t going fix next season’s weather. And this season’s hurricane victims are only facing the beginning of their problems.


            The Next Round Of Rescues Won’t Have Viral Videos

            Here’s what’s coming: Ten years after Katrina, New Orleans doctors reported a three-fold increase in heart attack victims. The stress from the flooding, multiple relocations, and disruptions in medical care are still messing with the bodies of the people who survived the storm. In the next few months, we should expect to see people contracting gastrointestinal problems from wading in standing water (I mean, we won’t literally see their diarrhea, but you get it). People with chronic issues like diabetes, heart disease, and asthma will suffer from disruptions in their medical care, which will lead to more hospital visits and deaths. It’s probably worth noting that Texas and the rest of the Gulf Coast aren’t in good shape to begin with, health-wise.

            Wait! It gets worse! I haven’t even talked about the mosquitoes yet! The West Nile virus was completely wiped out of the population in the immediate aftermath of Katrina. A year later, West Nile cases doubled. This map shows the Texas counties that identified cases of West Nile virus back in May, before hurricane season started:

            Texas Health and Human Services

            Nine counties in Texas have already started asking pregnant women to get the Zika test, because as you probably remember, Zika means joint pain, rashes, and fever for adults, but severe brain damage, microcephaly, and even death for unborn children.

            Wait, it gets even worse! Texas slashed Planned Parenthood funding in 2011, and abortions have been on the rise in the state ever since. What does that mean for pregnant women wading through mosquito-infested waters or working on cleaning up the debris outside their house right now? Hopefully nothing. Hopefully we never see Zika again, and these pregnant women deliver healthy babies who have happy lives ahead of them. Hopefully Texas women who aren’t pregnant today will have plenty of access to contraceptives in the next few months, because the mosquitoes might last until Christmas this year. There’s just some more bad news from Katrina that we have to cover, though:

            Katrina’s kids never quite recovered from the storm, either.

            Experts say that we’ll never know how many Louisiana children lost a year or more of school after Katrina. They know that Louisiana has one of the country’s highest rates of young adults who aren’t in school and aren’t at work — not because the kids who suffered through the storm just quit school then and there and committed to the hobo lifestyle, but because the average Katrina student moved seven times after the storm. Seven moves would do a number on any student, even the rich ones who are moving because their parents are moving up the corporate ladder or the tough military kids who move because the government makes them. Combine seven moves with a traumatizing childhood event, separation from extended family and communities, economic hardship, and the struggle to rebuild a life in a place where most of your friends and family are suffering through the same problems you are, and yeah, it’s no wonder Katrina’s students didn’t have a great graduation rate.

            And not finishing school a is big deal, because …


            We Like To Help Drowning People, But We Suck At Helping Poor People

            At the end of the day, bad things happen to everyone, but bad things happen extra hard to poor people. Sickness, natural disasters, layoffs, and addiction can obviously hit anyone at any financial level, but the most vulnerable among us have the hardest time recovering, if they recover at all. In other words, when you’re poor, a flood can lead to a series of setbacks that have decades of consequences. It’s called the Bad Break Test, and America is failing it.

            One researcher put the Bad Break Test this way:

            “In societies that function well, there are various safety nets in place to prevent a bad break from leading to a tailspin for particularly vulnerable victims. Compared to many other rich nations, the U.S. is not such a society — all too often, when vulnerable Americans encounter a bad break, there’s nothing underneath them to stop their slide. Instead, devastation follows, sometimes in the form of bankruptcy and addiction and death.”

            For example, America’s opioid crisis didn’t happen in a vacuum, and it certainly didn’t happen because of Mexicans. Some economists call the increase in overdoses, alcohol poisoning, and suicides “deaths of despair.” Americans are killing themselves over their economic prospects. There comes a point at which people stop trying to break out of their hopelessness and just start numbing themselves to death.

            What does the Bad Break Test have to do with hurricanes? 22 percent of Houston’s residents live under the poverty line. Yes, Texans are #TexasStrong and #TexasProud and will rebuild, but let’s not kid ourselves over who will bear the brunt of this storm and every storm to come: poor people who don’t have savings, insurance, or a Plan B or C or D to rely on when everything they own is destroyed. They’re already living in their Plan D, and Plan D is underwater or covered in mold.

            How do we cope with the millions of coastal Americans who have decades of hurricane seasons to come? The ones who are forced to leave already have a name, by the way: “climate refugees.” One Louisiana town has been granted 48 million federal dollars to just get out before the Gulf swallows them. The entire town is the first community in the world to get federal money to rebuild somewhere else before their island is washed away, and they’re struggling with figuring out how to do it. Even though we’re only talking about 60 people, they haven’t figured out how to move, and aren’t totally sure they even want to go.

            And that’s why we should all be worried. Humans are great at handling danger when it’s at the door, but not when it’s a hundred miles or a year away.


            Americans Are Good Heroes But Terrible Planners

            Real talk: The American states that will need the most help tackling flooding and extreme weather in the coming years also voted to keep the government out of their lives in the 2016 election. The fierce independence and self-reliance that Texas is so proud of is exactly what will doom them. Houston didn’t just flood because of a lot of rain; it flooded because it let people build neighborhoods in known flood zones. Why? Because the only reason white people live in Texas in the first place is that Anglos wanted space. Every time people try to build something in Texas, no one has the guts to tell them “No.”

            Footnote: The previous statement is not true. Mexico had the guts to tell people to stop building houses in Texas.

            Extra footnote: There are lots of conservationists and environmentalists in Texas. They’re just not in charge.

            It’s going to take a lot of tax dollars, research, government oversight, discipline, and humility to keep the Atlantic Ocean from swallowing our coasts, and our red states aren’t up for the challenge yet. We listen to our weathermen when the storms are a few days away, but not our scientists and engineers when they tell us that planning for disasters takes years and money. The thing is, Texas has a TON of money. We don’t even have to reinvent the wheel to save lives; we can study how a little bitty country like the Netherlands tackled their own flood monster and lived to tell the tale. If it were up to me, I’d pay close attention to any country that landed on “FLOODPLAIN COUNTRY” as its official name.

            You can find more from Kristi deep in the heart of Twitter.

            You can help someone in need by donating to the Victoria Food Bank.

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            7 Outdoor Workouts That Are Perfect For The Beautiful Fall Weather

            When autumn rolls around, the sun is golden and bright, the leaves are crunchy, the air is crisp, and it’s the perfect time to take your sweat sesh outdoors. Summer workouts are basically a surefire way to sweat your ass off and dehydrate your body, and winter workouts? Forget about it; you can find me hibernating my life away until spring rolls around. That’s why there’s no better time than now to take advantage of this window of beautiful weather by making a list of outdoor workout ideas for the fall.

            Plus, the health benefits of taking your exercise outside every now and then are not to be ignored. According to , breathing fresh air during a workout (instead of the stagnant and recycled air of a typical gym) can inspire euphoric feelings because of the increase in feel-good endorphins pumping through your body. A 2011 review published in the journal even showed that outdoor workouts can inspire positive thoughts, improve energy levels, and spark feelings of revitalization. And when you feel happier, it becomes that much easier to push your body and challenge yourself during your sweat sesh.

            So if you’re considering taking advantage of the gorgeous fall weather while it lasts, here are seven outdoor workouts you can try.

            1. Scenic Hiking

            A good hike can literally make you happier and healthier, according to Huffington Post. From lowering blood pressure, to reducing the risk of stroke, diabetes, and heart disease, you have no reason to break out those hiking boots and find a buddy to head to the hills with.

            Hiking during the fall is seriously breathtaking, especially when the leaves begin to change colors, so you’re sure to enjoy an incredible view while you power through a little cardio.

            2. Trail Running

            If you’re over staring at your own reflection on a tedious treadmill trot, autumn is the ideal time to experiment with taking your jog to a new trail.

            Trail running improves balance and coordination (take it from a girl who’s face-planted after tripping over a tree stub many a time) and keeps your cardio sesh interesting by providing the most gorgeous views nature has to offer.

            3. Sunset Yoga

            If you’ve never taken your yoga flow outdoors, the fall weather is an amazing time to do so.

            There are so many outdoor yoga classes available to sign up for, or you could just grab a couple of friends and craft your own flow together.

            The “golden hour” at sunset will be beyond beautiful for all of your balances, and the lovely backdrop is perfect for a relaxing savasana.

            4. Jumping Rope

            Dig out your dusty jump rope and make a major crunch in the fall leaves with this heart-healthy workout.

            You could do this sweaty cardio exercise solo, or style with a friend — so many options, so many opportunities to embody Kronk.

            5. Outdoor Sports

            From football, to baseball, to lacrosse, to pickup games, there are endless ways to grab some family and friends and have some healthy fall fun.

            There are a bunch of autumn leagues you can sign up for, or you can make your own game and enjoy a little healthy competition. The teamwork will be a nice change if you’re used to sweating it out solo.

            6. Kayaking Or Canoeing

            Kayaking and canoeing are excellent low-impact activities that reduce stress and provide amazing #views.

            Plus, if you’re taking your boat out at a local beach, beaches are generally less crowded during fall, making it optimal for your paddling adventures.

            Trust me, the reflection of the fall foliage during your canoe cardio will be well worth the effort.

            7. Biking With A View

            Cycling outdoors is a great way to get a full-body workout while relishing your day in the perfect outdoor weather.

            Don’t worry, you can ditch your favorite Soul Cycle class for now. It’ll be waiting for you when winter comes.

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            George Michael’s new single gave Nile Rodgers ‘mixed feelings’ – BBC News

            Media playback is unsupported on your device

            Media captionChris Evans introduces the world premiere of George Michael’s first posthumous single

            Producer Nile Rodgers has admitted to feeling “uncertainty” about working on George Michael’s new single.

            Fantasy, a remix of a 1980s outtake, premiered on Radio 2 on Thursday.

            Rodgers’ confession came in response to a fan who expressed “mixed feelings” over the song’s release, eight months after Michael’s death.

            “You SHOULD have mixed feelings,” he said on Twitter. “No one’s heart was dragged through emotional ambiguity more than mine.”

            Rodgers said he approached the remix with “tears, uncertainty, happiness & #LOVE”.

            Fantasy sounds vastly different to the version that was released as a b-side in 1990, and later as a bonus track on 2011’s deluxe version of the Faith album.

            The tinny 80s production of the original has been completely overhauled in favour of a slinky funk groove, featuring Rodgers’ choppy guitar rhythms and championing Michael’s soulful harmonies.

            On first listen, it appears some of the vocals are alternate takes to the previously released version.

            But while it is refreshing to hear Michael’s voice on the radio again, the track still feels more like an offcut than an undiscovered gem.

            The decision to create a new “hook” from speeded-up samples of the star’s vocals also feels like a rare mis-step for Rodgers, whose production credits include Madonna, David Bowie and Duran Duran.

            “Fantasy was originally meant to be on Listen Without Prejudice and was intended to be one of the singles from the album, but somehow it got lost in the ether,” Michael’s manager David Austin told Radio 2’s Chris Evans in a letter, which the broadcaster read out on his breakfast show.

            While working on a reissue of Listen Without Prejudice before his death, he revisited the song and decided it could become a single.

            “George phoned up Nile Rodgers, his good pal, in early 2016 because the two of them have always spoken the same musical language, and Nile has reworked the record.”

            News of the single emerged on Wednesday as Michael’s sisters Melanie and Yioda posted an update on his official website, saying they will carry on his musical legacy “exactly as Yog would have wanted”.

            Fans embraced the track, and many tweeted about “listening with tears” in their eyes.

            Image copyright Getty Images

            But some were less enthusiastic, saying the track sounded “unfinished“.

            Michael, who rose to fame in band Wham!, died last year from heart disease and a build-up of fat in his liver.

            His body was found by his partner, hairdresser Fadi Fawaz, at his home in Goring-on-Thames, Oxfordshire, on Christmas Day.

            During his career, Michael enjoyed seven number ones on the UK singles charts, including Careless Whisper, A Different Corner, Jesus To a Child and Fast Love.

            The 53-year-old had 23 top 10 hits, including Faith, Father Figure, Outside and You Have Been Loved.

            The Fantasy remix will feature on a deluxe version of Listen Without Prejudice Vol 1 / MTV Unplugged, which is set for release on 20 October.

            Follow us on Facebook, on Twitter @BBCNewsEnts, or on Instagram at bbcnewsents. If you have a story suggestion email

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            The $37 Billion Supplement Industry Is Barely Regulated And It’s Allowing Dangerous Products To Slip Through The Cracks

            • The $37 billion supplement industry is largely unregulated
            • Some supplements (a category that includes vitamins and herbs) can be dangerous and have been linked with ER visits and death
            • The FDA is currently recalling supplements found to be contaminated with banned drugs and bacteria
            • New supplement companies like Gwyneth Paltrow’s Goop continue to advertise their products as healthy despite potential side effects, and some say they target vulnerable consumers

            When Pouya Jamshidi, a resident at Weill Cornell Medical College, delivered his first baby, the doctor on call told him to take the newborn away from its mother.

            The baby, a healthy girl with mocha-pink skin and a powerful set of lungs, was being quarantined.

            In the middle of the pregnancy, her mother had come down with tuberculosis. She’d contracted the contagious lung infection in her teens, and the illness came back despite preventative antibiotics and regular screenings. The cause: a popular herbal supplement called St. John’s wort.

            “The trouble is most people don’t consider it a medication because you don’t need a prescription for it, and so she didn’t tell us,” Jamshidi told Business Insider.

            St. John’s wort is one of the most popular herbal supplements sold in the United States. But in 2000, the National Institutes of Health published a study showing that St. John’s wort could severely curb the effectiveness of several important pharmaceutical drugs — including antibiotics, birth control, and antiretrovirals for infections like HIV — by speeding up their breakdown in the body.

            “It basically overmetabolized the antibiotics so they weren’t in her system in the correct dose,” Jamshidi said.

            The findings on St. John’s wort prompted the US Food and Drug Administration to warn doctors about the herbal remedy. But that did little to stem public sale or consumption of it. Over the past two decades, US poison-control centers have gotten about 275,000 reports — roughly one every 24 minutes — of people who reacted badly to supplements; a third of them were about herbal remedies like St. John’s wort.

            Overdosing on a ‘natural’ supplement

            The FDA defines supplements as products “intended to add further nutritional value to (supplement) the diet.” They aren’t regulated as drugs — only when a supplement is shown to cause significant harm is it called out as unsafe.

            Half of all adult participants in a survey in the mid-2000s said they took at least one supplement every day — almost the same percentage of Americans who took them two decades ago. Yet research has consistently found the pills and powders to be ineffective and sometimes dangerous.

            “Consumers should expect nothing from [supplements] because we don’t have any clear evidence that they’re beneficial, and they should be leery that they could be putting themselves at risk,” S. Bryn Austin, a professor of behavioral sciences at the Harvard T.H. Chan School of Public Health, told Business Insider. “Whether it’s on the bottle or not, there can be ingredients in there that can do harm.”

            Despite many such warnings, the supplement industry’s market is as much as $37 billion a year, according to one estimate. Ads for supplements can be found on internet pop-up windows, on social media, in magazine pages, and on TV. They’re sold in corner health stores, pharmacies, and big grocery conglomerates.

            But supplements do not come with explicit instructions on how much to take — only a suggested dose — or potential drug interactions. Jamshidi’s patient had no idea she was putting her life or that of her baby at risk.

            But she was not alone. Using data from 2004 to 2013, the authors of a 2016 study published in the New England Journal of Medicine estimated that 23,005 emergency-room visits a year were linked to supplements. Between 2000 and 2012, the annual rate of negative reactions to supplements — or “exposures” as they are known in scientific parlance — rose from 3.5 to 9.3 cases per 100,000 people, a 166% increase.

            Over that period, 34 people died as a result of using supplements, according to a 2017 study published in the Journal of Medical Toxicology. Six of the deaths resulted from ephedra, the once popular weight-loss supplement banned by the FDA in 2004, and three people died from homeopathic remedies. One person died after using yohimbe, an herbal supplement used for weight loss and erectile dysfunction. (Certain formulations of it can be prescribed to treat erectile dysfunction.)

            ‘You don’t know what you’re dealing with’

            Jamshidi said he knew many people who took a daily multivitamin and tried herbal formulations now and again when they were feeling tired or unwell and always withheld judgement. But he remembers the moment he became wary of supplements: when the pregnant woman his team was monitoring began coughing up phlegm.

            “She had been an incredibly cooperative patient, super engaged and always showing up on time for her visits, taking all of our instructions carefully — just a really good patient,” Jamshidi said.

            Business Insider / Skye Gould

            When Jamshidi and his team realized their patient’s tuberculosis was back, they asked if she’d started any new medications. She said no, but the next day she arrived at the clinic with a small bottle of St. John’s wort.

            She said she had been taking the herbal remedy for the feelings of depression she experienced after her last pregnancy. Although some small studies initially suggested St. John’s wort could have benefits for people with depressive symptoms, the NIH researchers failed to find enough evidence to support that.

            Jamshidi’s patient had to be isolated to ensure the infection didn’t spread. She spent the last three months of her pregnancy alone.

            “It was miserable — she was isolated for all that time, and then she couldn’t even hold the baby,” Jamshidi said.

            In his opinion, one of the reasons many people end up in emergency rooms after taking supplements is that the quantities of active ingredients in them can vary dramatically. A 2013 study published in the journal BMC Medicine found that doses of ingredients in supplements could even vary from pill to pill — which poses a significant hurdle for doctors trying to treat a negative reaction.

            “There are other medications that can have side effects, but patients come in and tell you the dose, and you can reverse it,” Jamshidi said. “But with supplements, you don’t know what you’re dealing with.”

            ‘Vitamines’ to prevent disease

            By isolating the first “vitamine” in 1912, the Polish chemist Casimir Funk unwittingly unleashed a frenzy among chemists to create or synthesize vitamins in the lab.

            Between 1929 and 1943, 10 Nobel Prizes were awarded for work in vitamin research. By the mid-1950s, scientists had synthesized 12 of the 13 essential vitamins. These were added to foods like bread, cereal, and milk, which were sold as “fortified.” Foods that lost nutrients during processing got these vitamins added back in and were labeled “enriched.”

            When supplements were introduced in the 1930s and 1940s, they were presented as a way to address nutrient deficiencies that caused illnesses like rickets and scurvy. They were also seen as a way to avoid expensive and difficult-to-access medical treatment.

            In recent years, however, a new generation of supplements has emerged targeting primarily middle-class and affluent women. These formulas ooze with the lifestyle trends of 2017: minimalism (“Everything you need and nothing you don’t!”), bright colors, “clean eating,” and personalization.

            The actress Gwyneth Paltrow’s new lineup of $90 monthly vitamin packs — released through her controversial wellness company, Goop — have appealing names like “Why Am I So Effing Tired” and “High School Genes.” They claim to deliver health benefits like energy boosts and metabolism jump-starts.

            “What is different about what Goop offers is that the combinations, the protocols put together, were done by doctors in Goop’s team,” Alejandro Junger, a cardiologist who helped design several of Goop’s multivitamin packs, told Business Insider.

            But a look at the ingredients in “Why Am I So Effing Tired,” which Junger helped design, suggests the formula is not based on rigorous science. The vitamin packets include 12.5 milligrams of vitamin B6 — about 960% of the recommended daily allowance (although on Goop’s label it is listed as 625%) — and ingredients like rosemary extract and Chinese yam, whose effects have never been studied in humans and for which no standard daily allowance exists.


            According to the Mayo Clinic, vitamin B6 is “likely safe” in the recommended daily intake amount: 1.3 milligrams for people ages 19-50. But taking too much of the supplement has been linked with abnormal heart rhythms, decreased muscle tone, and worsened asthma. High doses of B6 can also cause drops in blood pressure, the Mayo Clinic notes, and can interact with drugs like Advil, Motrin, and those prescribed for anxiety and Alzheimer’s.

            “People using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions,” the Mayo Clinic’s website says.

            Junger declined to comment on specific ingredients in the formula but said that many of them were added to “address the most common nutrient-mineral deficiencies of today: B, C, D, and E vitamins, iodine, magnesium, molybdenum, among others.”

            Other shiny new pills and powders that have materialized in recent months include one called Ritual, which arrives at your doorstep in a white-and-yellow box emblazoned with the words “The future of vitamins is clear.”

            A month’s supply of the glasslike capsules — filled with tiny white beads suspended in oil — costs $30. But the pills don’t differ much more than your standard, cheaper multivitamin — they have similar amounts of magnesium, vitamin K, folate, vitamin B12, iron, boron, vitamin E, and vitamin D.

            VitaMe, another new supplement manufacturer, ships personalized daily packets with names like “Good Hair Day” and “Bridal Boost” in a box resembling a tea-bag dispenser each month for $40.

            Its website says: “Our mission is peak nutrition. Delivered.” But its ingredients don’t differ drastically from those in conventional vitamins either.

            One of Ritual’s supplements. Ritual

            When vitamins can’t save us from ourselves  

            No matter how colorful their packaging or messaging, all these supplements fall prey to the same problem: We simply do not need them to be healthy.

            “We use vitamins as insurance policies against whatever else we might (or might not) be eating, as if by atoning for our other nutritional sins, vitamins can save us from ourselves,” Catherine Price, a science reporter, writes in the book “Vitamania.”

            A large recent review published in the Annals of Internal Medicine looked at 27 trials of vitamins involving more than 400,000 people. The researchers concluded that people who took vitamins did not live longer or have fewer cases of heart disease or cancer than people who did not take them.

            Another long-term study published in the Journal of the American Medical Association in May divided nearly 6,000 men into groups and gave them either a placebo or one of four supplements touted for their brain-protecting abilities. The results showed no decreased prevalence of dementia among any of the supplement-taking groups.

            Study after study has also found that many popular supplements can cause harm. A large, long-term study of male smokers found that those who regularly took vitamin A were more likely to get lung cancer than those who didn’t. And a 2007 review of trials of several types of antioxidant supplements put it this way: “Treatment with beta carotene, vitamin A, and vitamin E may increase mortality.”

            Risks aside, research has suggested that our bodies are better equipped to process the vitamins and minerals in whole foods than those in pills. When we bite into a juicy peach or a crunchy Brussels sprout, we’re ingesting dozens of nutrients, including phytochemicals like isothiocyanates, as well as carotenoids.

            Austin said that’s why “nutritionists recommend people get their nutrition from whole foods, not things that have been packaged and put into a box.”

            Virtually any registered dietitian, physician, or public health expert is likely to reiterate the advice health professionals have been giving for decades: Eat real food, like fruits and veggies, in moderation, and stay away from processed foods and sugary beverages. Or, in the words of the journalist and food writer Michael Pollan: “Eat food. Not too much. Mostly plants.”

            with wind/Flickr/CC BY 2.0

            Where’s the FDA regulation?

            After spending the last few months of her pregnancy and the first few weeks of her new baby’s life in isolation, Jamshidi’s patient was able to go home and be with her family. Jamshidi said the experience changed the way he thought about supplements for good.

            “I feel very negatively about them, and I didn’t feel this way going into it,” he said.

            Ask Steven Tave, the director of the office of dietary supplement programs at the FDA, why the agency isn’t stopping more similar situations, and he’ll give a simple answer: “We’re doing the best we can.”

            In 1994, Congress passed a controversial law called the Dietary Supplement Health and Education Act. Tave said that before DSHEA passed, the FDA was starting to regulate supplements more stringently, the way it does pharmaceutical drugs, but getting “pushback from the industry.” The law forced the agency to be more lenient.

            Before a new drug can be sold, the company making it has to apply for FDA approval, and the agency has to conclude that the drug is safe and does what it claims to do.

            “So if the drug says, you know, ‘used to treat cancer,’ then the agency’s reviewers are going to look at it and make a determination that there’s evidence that it does treat cancer,” Tave said.

            New supplements don’t face any burden of proof. The agency can review products that add new dietary ingredients when it gets a notification, Tave said, but it doesn’t “have the authority to stop anything from going to market.”

            When DSHEA was passed, Tave said, the bill still made sense. In 1994, about 600 supplement companies were producing about 4,000 products for a total revenue of about $4 billion. But that market has since ballooned — today, close to 6,000 companies pump out about 75,000 products.

            “We’re regulating that with 26 people and a budget of $5 million,” Tave said.

            Removing a supplement from store shelves comes down to documented emergency-room visits and calls to poison-control centers. Only when a supplement is reported to be unsafe as a result of one of these “adverse events,” as the FDA calls them, is the agency compelled to act.

            “Most of the time, we don’t know a product is on the market until we see something bad about it from an adverse-event report. It’s a very different regime from when we know everything is out there and we know what’s in it,” Tave said, adding: “We don’t want to be reactive. We want to be proactive. But we can’t be.

            ‘Consumers have no way to know’

            Most unsafe supplements have been found to contain ingredients that aren’t listed on their labels — usually, these are pharmaceutical drugs, some of which have been banned by the FDA.

            A study of product recalls published in 2013 in the Journal of the American Medical Association found that of the 274 supplements recalled by the FDA between 2009 and 2012, all contained banned drugs. A 2014 report found that more than two-thirds of the supplements purchased six months after being recalled still contained banned drugs.

            “The products we see today have gone way beyond that sort of core group that they were in 1994,” Tave said. “Now they’re promoted for all sorts of things — some are long term, some are short term, some are chemicals no one’s ever seen before. It’s a much different universe than it was at the time.”

            Austin says three categories of supplements are the “most lawless of the industry”: physical enhancement, weight loss, and sexual performance.

            “Some of these companies won’t identify ingredients that they purposefully put in the products,” she said. “Some weight-loss drugs, for example, that have been pulled from the market — we can still find these in the bottle even though they don’t put it on the label.”

            Tave’s 26-person team, the only government employees looking into these issues, didn’t even have a dedicated office until about a year and a half ago.

            “We’re pretty sure were not aware of everything that’s out there, but we do what we can,” he said. “All we can do is enforce the law.”

            Dangerous supplements continue to seep through the cracks, however.

            In 2016, the world’s largest supplement maker, GNC Holdings Inc., agreed to pay $2.25 million to avoid federal prosecution over allegations that it sold a performance-enhancing supplement that claimed to increase speed, strength, and endurance with an active ingredient called dimethylamylamine, or DMAA. Two soldiers who used the supplement died in 2011, which prompted the Defense Department to remove all products containing DMAA from stores on military bases.

            A recent indictment against USPlabs, the Texas-based company that made the supplement, accused it of falsely claiming the product was made of natural plant extracts when it really contained synthetic stimulants made in China.

            The problems are ongoing. Earlier this year, the FDA recalled several supplements after they were found to contain unapproved new drugs, and two more were recalled after they were found to contain unlisted anabolic steroids. On August 11, just days before this article was published, the FDA recalled another batch of supplements — this time pills manufactured by a company called PharmaTech — because of possible contamination with bacteria that can cause serious respiratory infection.

            “Consumers have no way to know that what’s in the label is what’s actually in the bottle or box,” Austin said. “There are many dubious companies out there that are willing to take a risk with consumers health and their lives.”

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