Millennials Are Racking Up More Chronic Health Conditions Compared To Other Generations: Study

Millennials are racking up more chronic health conditions compared to other  generations: study

Millennials are seeking more professional help for health issues than ever, a new study revealed.

Conducted by United Healthcare and Health Action Council, the study explored factors and claims data from policyholders ages 27 to 42 — a total of 126,000 individuals. It compared current data from April 2021 through March 2022 to historical data dating back to 2012. The findings were presented in the groups’ sixth annual white paper.

Millennials with common chronic medical conditions and their children are “high utilizers” of the health care system compared to Generation X, the research found.

This includes 106% more hospital admissions for millennials with diabetes and 55% more emergency room (ER) and urgent care (UC) visits for hypertension.

Even though obesity rates for millennials are lower, there have been 31% more ER and UC visits and 29% more hospital admissions for those with obesity.

Millennials with back disorders have visited the ER and UC 22% more than Gen X, with 46% higher hospital admissions.

There have been 36% higher ER and UC visits for millennials with osteoarthritis.

Behavioral health use is up 35% for millennials and their children compared to pre-pandemic levels.

This includes anxiety, depression and trauma disorders, which make up 66% of behavioral diagnoses for the generation.

In 2019, 31% of PTSD diagnoses were given to millennials. In 2022, that number increased to 38%.

Additionally, millennials and their children account for 41% of neurodevelopment disorder claims, according to the study.

The most common diagnoses include attention deficit disorder (ADD) at 43% and autism spectrum disorders at 35%.

As health care costs continue to rise, the top clinical cost driver for millennials is pregnancy.

These costs increase with complications such as fertility treatment, high-risk pregnancies, multiple births, C-section deliveries and extended hospital stays.

Millennial parents with Generation Alpha kids have a 38% higher health care utilization rate than those born in other generations.

This includes 22% higher ER visits, 9% higher UC visits and 76% higher outpatient surgeries.

Millennial parents of Gen Alpha kids also scheduled virtual health care visits a whopping 543% more than other generations.

Expert says millennials are ‘breaking stigmas’

Dr. Mykale Elbe, director of the MSN Nurse Practitioner Program and assistant professor of nursing at Maryville University in Town and Country, Missouri, told Fox News Digital that she’s “not surprised by these findings.” She was not involved with the study.

Behavioral health utilization is up 35% for millennials and their children compared to pre-pandemic levels.

In terms of mental health, Elbe pointed out that millennials and younger generations are “breaking down the stigma,” which is leading to more symptom awareness and sought-after help from health care providers.

“Since the pandemic, health care providers in all settings have seen a surge in patients having mental health disorders and seeking help,” she said.

She added that she hopes “this surge will decrease as we move toward the post-pandemic period, but that has yet to be seen.”

Elbe attributed the rise in health care utilization to the recent arrival of accessible medical facilities, such as urgent care, in the last decade.

“This makes health care available at the public’s fingertips for anything from a sore throat and lacerations to more serious concerns,” she said.

“With the pandemic and [with] everyone being on heightened alert for any upper respiratory symptoms, we continue to see a surge of health care utilization for minor disorders, as we have now trained the public that if you have a cough, you need to be tested for COVID,” Elbe added.

In her experience of working in pediatrics, Elbe said she’s seen more parents bringing in their kids for viral upper respiratory infections than pre-pandemic.

“We have now trained the public that if you have a cough, you need to be tested for COVID.”

“With new health care formats being available with urgent care and convenient care clinics, we see patients utilizing health care and being more proactive in seeking care on a regular basis,” she said.

Elbe expressed shock at the major increase in diabetes hospital admissions, though it does match up with other millennial health care utilizations.

“While their cost for diabetes care is higher, the control of their diabetes is better than older populations,” she said. “That does make sense, as they are younger, generally healthier and more active than their older counterparts with diabetes.”

Overall, Elbe said she’s concerned about the amount of health care utilization and cost among millennials, as well as the issue surrounding provider shortages.

“With this shortage, we are seeing longer wait times for patients to be seen by health care providers,” she said.

Medical Tourism To Mexico Is On The Rise, But It Can Come With Risks

Medical tourism is rising, but experts say it can come with risks

One of the four Americans who were kidnapped in Mexico last week was traveling for medical tourism, a friend said. A growing number of US residents are traveling internationally to seek more affordable medical care, more timely care or access to certain treatments or procedures that are unapproved or unavailable in the United States.

Latavia “Tay” Washington McGee, 33, drove to Mexico with Shaeed Woodard, Zindell Brown and Eric Williams for cosmetic surgery that was scheduled to take place Friday, according to a close friend of Washington McGee’s who did not want to be identified.

The four Americans were found Tuesday near the border city of Matamoros, officials said. Washington McGee and Williams were found alive, and Woodard and Brown were found dead, a US official familiar with the investigation told CNN. Investigators are still piecing together what happened after they were abducted.

Medical tourism takes people all over the world, including to Mexico, India and Eastern Europe. Violence against medical tourists is generally thought to be rare, but the US Centers for Disease Control and Prevention warns about other risks such as quality of care, infection control and communication challenges with medical staff.

“It’s on the daily, without a doubt. There are people going daily to get this kind of stuff done,” said Dr. Nolan Perez, a gastroenterologist in Brownsville, Texas, which is across the border from Matamoros. “Whether it’s primary care provider visits or dental procedures or something more significant, like elective or weight loss surgery, there’s no doubt that people are doing that because of low cost and easier access.”

A growing trend

One study published in the American Journal of Medicine estimated that fewer than 800,000 Americans traveled to other countries for medical care in 2007, but by 2017, more than 1 million did.

More current estimates suggest that those numbers have continued to grow.

“People travel because there may be a long waiting time, wait lists or other reasons why they can’t get treatment as quickly as they would like it. So they explore their options outside the United States to see what’s available,” said Elizabeth Ziemba, president of Medical Tourism Training, which provides training and accreditation to international health travel organizations.

Also, “price is a big issue in the United States. We know that the US health care system is incredibly expensive,” she added. “Even for people with insurance, there may be high deductibles or out-of-pocket costs that are not covered by insurance, so that people will look based on price for what’s available in other destinations.”

The most common procedures that prompt medical tourism trips include dental care, surgery, cosmetic surgery, fertility treatments, organ and tissue transplants and cancer treatment, according to the CDC.

“With Mexico and Costa Rica, it’s overwhelmingly dental and cosmetic surgery. However, certain countries are known for specialties. For example, in Singapore, stem cell and oncology is huge. In India, South India and Chennai Apollo hospitals does incredible work with hip and knee surgeries,” said Josef Woodman, founder of Patients Beyond Borders, an international health care consulting company.

“In Eastern Europe, a lot of people from the UK – but also people from the United States – travel to Hungary, Croatia and Turkey for everything from dental to light cosmetic surgery,” he said.

Mexico is the second most popular destination for medical tourism globally, with an estimated 1.4 million to 3 million people coming into the country to take advantage of inexpensive treatment in 2020, according to Patients Beyond Borders.

Matamoros – where officials said the four kidnapped Americans were found – is “not considered a primary medical travel destination,” Woodman said, “largely because there are no internationally accredited medical centers/specialty clinics there or in the immediate region.”

Mexico City, Cancun and Tijuana are more frequented and reliable destinations in the country, Woodman said.

On average, Americans can save 40% to 60% across the most common major procedures received by medical tourists in Mexico, according to an analysis of 2020 health ministry data conducted by Patients Beyond Borders.

Woodman said that violence against medical tourists was extremely rare, but he added that “price shopping” – searching for the cheapest location for a procedure – is a “blueprint for trouble,” namely substandard medical care.

‘There are the complexities’

Medical tourism can be dangerous, depending on the destination and the person’s condition.

“There are the complexities of traveling if you have a medically complex situation. There are fit-to-fly rules. And your health care providers should take into consideration the impact of traveling if you have orthopedic injuries or issues,” Ziemba said.

“The quality of care may be an unknown,” she said. “It may be that the quality of care is not up to the standards that you would like. So there’s a bit of an unknown there, and then the last thing I would say is, if something goes wrong, what’s going to happen?”

Perez said he commonly manages complications from medical tourism in his practice.

“There are a lot of bad outcomes. There are a lot of infections and a lot of botched procedures gone wrong, and patients have to come back to the United States and then have a revision of the surgery,” he said. “So it’s really unfortunate.”

Yet Ziemba added that there can be benefits to medical tourism, including that someone could receive a service that they need faster overseas than locally.

“And price: If you simply can’t afford the out-of-pocket costs of health care in the United States, and assuming the risks involved, it may make much more sense for you financially to travel outside the United States,” she said.

Medical tourism is not just for people traveling around the world. Many living along the US-Mexico border, where access to health care can be scarce, cross into Mexico for care.

The Rio Grande Valley, at the southernmost point of Texas, is considered to be a medically underserved area. The region has some of the nation’s highest rates of comorbidities, including obesity and diabetes, and one of the lowest physician-to-patient ratios.

There is a “dire need” for health care professionals along the border, Perez said.

“There are not as many doctors given our big and our growing population down here. So the demands on primary care doctors and specialists are very high because there are not enough of us for this population,” he said. “So that’s one reason why people end up going to Mexico to visit with physicians, because of easier access.”

People interested in medical tourism can take some steps to help minimize their risk, the CDC says.

Those planning to travel to another country for medical care should see their health care provider or a travel medicine provider at least four to six weeks before the trip and get international travel health insurance that covers medical evacuation back to the United States.

The CDC advises taking copies of your medical records with you and checking the qualifications of the providers who will be overseeing your medical care. Also, make sure you can get any follow-up care you may need.

Telehealth Startup Cerebral Shared Millions Of Patients’ Data With Advertisers

Mental Health Startup Shared Patient Data With Google, Facebook, Meta |  PCMagCerebral has revealed it shared the private health information, including mental health assessments, of more than 3.1 million patients in the United States with advertisers and social media giants like Facebook, Google and TikTok.

The telehealth startup, which exploded in popularity during the COVID-19 pandemic after rolling lockdowns and a surge in online-only virtual health services, disclosed the security lapse in a filing with the federal government that it shared patients’ personal and health information who used the app to search for therapy or other mental health care services.

Cerebral said that it collected and shared names, phone numbers, email addresses, dates of birth, IP addresses and other demographics, as well as data collected from Cerebral’s online mental health self-assessment, which may have also included the services that the patient selected, assessment responses and other associated health information.

The full disclosure follows:

If an individual created a Cerebral account, the information disclosed may have included name, phone number, email address, date of birth, IP address, Cerebral client ID number, and other demographic or information. If, in addition to creating a Cerebral account, an individual also completed any portion of Cerebral’s online mental health self-assessment, the information disclosed may also have included the service the individual selected, assessment responses, and certain associated health information.

If, in addition to creating a Cerebral account and completing Cerebral’s online mental health self-assessment, an individual also purchased a subscription plan from Cerebral, the information disclosed may also have included subscription plan type, appointment dates and other booking information, treatment, and other clinical information, health insurance/pharmacy benefit information (for example, plan name and group/member numbers), and insurance co-pay amount.

Cerebral was sharing patients’ data with tech giants in real-time by way of trackers and other data-collecting code that the startup embedded within its apps. Tech companies and advertisers, like Google, Facebook and TikTok, allow developers to include snippets of their custom-built code, which allows the developers to share information about their app users’ activity with the tech giants, often under the guise of analytics but also for advertising.

But users often have no idea that they are opting-in to this tracking simply by accepting the app’s terms of use and privacy policies, which many people don’t read.

Cerebral said in its notice to customers — buried at the bottom of its website — that the data collection and sharing has been going on since October 2019 when the startup was founded. The startup said it has removed the tracking code from its apps. While not mentioned, the tech giants are under no obligations to delete the data that Cerebral shared with them.

Because of how Cerebral handles confidential patient data, it’s covered under the U.S. health privacy law known as HIPAA. According to a list of health-related security lapses under investigation by the U.S. Department of Health and Human Services, which oversees and enforces HIPAA, Cerebral’s data lapse is the second-largest breach of health data in 2023.

News of Cerebral’s years-long data lapse comes just weeks after the U.S. Federal Trade Commission slapped GoodRx with a $1.5 million fine and ordered it to stop sharing patients’ health data with advertisers, and BetterHelp was ordered to pay customers $8.5 million for mishandling users’ data.

If you were wondering why startups today should terrify you, Cerebral is just the latest example.

Economists Warn Of Costs If Medicare Covers New Obesity Drugs

Economists warn of costs if US Medicare covers new obesity drugs | Health

The cost of expanding U.S. Medicare prescription drug coverage to pay for expensive, new obesity medications could be catastrophic, health economists warned in a report published on Saturday.

Big-selling diabetes drugs have been repurposed as obesity treatments after demonstrating weight loss of more than 20% in clinical trials. While they are far more effective than older drugs, lifetime use might be required to keep lost weight off.

Once-weekly injections of Novo Nordisk’s (NOVOb.CO) Wegovy, for example, cost more than $13,000 per year in the U.S. after rebates and discounts. Mounjaro from Eli Lilly and Co (LLY.N), expected to gain U.S. approval for obesity next year, retails at $1,540 for a one-month supply for diabetes.

Presently, Medicare is forbidden by law from paying for antiobesity prescriptions. But should the bipartisan The Treat and Reduce Obesity Act get reintroduced and passed by Congress, Medicare will be compelled to cover drugs for weight loss.

Health economists writing in The New England Journal of Medicine estimate that if 10% of Medicare recipients with obesity diagnoses used prescription weight loss drugs, annual part D spending would be $26.8 billion for Wegovy compared with $1.32 billion for a generic version older Qysmia from Vivus Inc.

That amounts to nearly 20% of the total 2019 Medicare Part D spending, Khrysta Baig of Vanderbilt University School of Medicine and colleagues said.

“The burden of obesity and obesity-related conditions is unquestionably high, but the value of Medicare coverage of antiobesity medications remains unclear,” they said, adding that more research is needed to know whether weight loss induced by these drugs translates to better long-term health outcomes.

The Medicare health program covers more than 60 million Americans, most over age 65. The authors point out that many people in the program have already incurred the health problems associated with long-term obesity, unlike younger populations typically included in clinical trials.

Obesity prevalence in the United States is 41.5% among adults aged 60 and older, according to the Centers for Disease Control and Prevention.

The influential Institute for Clinical and Economic Review (ICER) has said the annual price of Wegovy would need to decrease to $7,500 to $9,700 for it to be cost effective compared with lifestyle modification alone. Even at that price range, it still would not be cost-effective compared with generic Qysmia, ICER said.

“Given the outstanding questions about the benefits of these drugs for Medicare beneficiaries, it would be prudent for Congress and CMS (the Centers for Medicare & Medicaid Services) to fully consider tradeoffs before passing legislation of this magnitude,” Baig said.

White House Budget Leans Into Drug Pricing, Obamacare Expansion

Here are the top health items in Biden's new budget

President Biden’s budget proposal focuses heavily on expanding access to health care and lowering the cost of prescription drugs.

In an effort to extend the life of Medicare’s hospital trust fund, the budget proposal would increase the number of drugs that can be negotiated, and allow those negotiations to begin sooner.

The plan builds off the Inflation Reduction Act (IRA), which granted Medicare the power to negotiate the prices of up to 20 drugs each year — though the drugs can only qualify after being on the market for at least nine years.

The IRA passed with only Democratic votes last year, and some in the GOP have already claimed they will try to repeal it.

Another IRA provision that would get a boost in the budget is the requirement that drug companies pay rebates to Medicare when they increase prices faster than inflation. Under the White House proposal, that requirement would extend to the commercial market as well.

The budget also seeks to extend the $35 insulin cap to the private sector. Under the IRA, Medicare beneficiaries won’t pay more than $35 out of pocket for insulin.

A proposal to cap the cost for all Americans was defeated by Senate Republicans.

The White House budget also includes proposals to expand ObamaCare programs.

It calls for permanently expanding enhanced subsidies for health plans on the exchanges, which currently expire at the end of 2025. The enhanced subsidies make insurance premiums free for most Americans with incomes just above the poverty line, and they lower the cost of premiums for Americans with higher incomes.

The budget also proposes “Medicaid-like” coverage for eligible people in states that haven’t expanded Medicaid coverage yet, paired with financial incentives to ensure states maintain their existing expansions.

Republicans began blasting elements of the budget before it was formally released, and are not likely to support the proposals.

The White House called the budget a “blueprint” to build on progress from the first two years of the administration. It claims that Republicans “have taken a very different approach” and want to add to the nation’s debt.

Senators Urge CMS To Close ‘Loopholes’ In Payer Price Transparency Rule

Senators urge CMS to close payer price transparency 'loopholes'

Two top senators are urging the Biden administration to address “loopholes” that they said allow insurers to skirt price transparency requirements.

Sens. Maggie Hassan, D-New Hampshire, and Mike Braun, R-Indiana, wrote in a letter (PDF) to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure that the agency should update its regulations to “ensure that there is true health plan transparency and compliance.”

The senators said some insurers have posted the required data in “an indecipherable structure” or made the files so large that they can only be processed by a supercomputer. This technically meets the requirement of posting the data but makes the information extremely difficult to use.

“As a result, employers and researchers have been unable to use the data to assess the drivers of high health care costs and target solutions,” they wrote.

The letter noted that public policy experts have suggested multiple avenues CMS could take to mitigate these loopholes, including setting file size limits, creating a standardized template for reporting, requiring a clear organization system with labels and reducing reporting frequency.

The senators said these changes would make the data more readily usable but would also streamline reporting requirements for insurers.

In addition, the agency should pair these reforms with stepped-up enforcement of requirements, holding plans that post low-quality data—or no data at all—more accountable.

“Randomly auditing the quality of plan data would result in better usability, and additional enforcement would help ensure that remaining noncompliant plans follow the law,” the senators wrote. “We urge CMS to consider these and other expert recommendations so we may continue improving price transparency for Americans and ultimately bring down health care costs.”

CMS Proposes Prior Authorization Rule Changes For Health Plans

CMS Prior Authorization Proposal Aims to Streamline the Process and Improve  Transparency | KFF

When Paula Chestnut needed hip replacement surgery last year, a pre-operative X-ray found irregularities in her chest.

As a smoker for 40 years, Chestnut was at high risk for lung cancer. A specialist in Los Angeles recommended the 67-year-old undergo an MRI, a high-resolution image that could help spot the disease.

But her MRI appointment kept getting canceled, Chestnut’s son, Jaron Roux, told KHN. First, it was scheduled at the wrong hospital. Next, the provider wasn’t available. The ultimate roadblock she faced, Roux said, arrived when Chestnut’s health insurer deemed the MRI medically unnecessary and would not authorize the visit.

“On at least four or five occasions, she called me up, hysterical,” Roux said.

Months later, Chestnut, struggling to breathe, was rushed to the emergency room. A tumor in her chest had become so large that it was pressing against her windpipe. Doctors started a regimen of chemotherapy, but it was too late. Despite treatment, she died in the hospital within six weeks of being admitted.

Though Roux doesn’t fully blame the health insurer for his mother’s death, “it was a contributing factor,” he said. “It limited her options.”

 

Few things about the American health care system infuriate patients and doctors more than prior authorization, a common tool whose use by insurers has exploded in recent years.

Prior authorization, or pre-certification, was designed decades ago to prevent doctors from ordering expensive tests or procedures that are not indicated or needed, with the aim of delivering cost-effective care.

Originally focused on the costliest types of care, such as cancer treatment, insurers now commonly require prior authorization for many mundane medical encounters, including basic imaging and prescription refills. In a 2021 survey conducted by the American Medical Association, 40% of physicians said they have staffers who work exclusively on prior authorization.

So today, instead of providing a guardrail against useless, expensive treatment, pre-authorization prevents patients from getting the vital care they need, researchers and doctors say.

“The prior authorization system should be completely done away with in physicians’ offices,” said Dr. Shikha Jain, a Chicago hematologist-oncologist. “It’s really devastating, these unnecessary delays.”

In December, the federal government proposed several changes that would force health plans, including Medicaid, Medicare Advantage, and federal Affordable Care Act marketplace plans, to speed up prior authorization decisions and provide more information about the reasons for denials. Starting in 2026, it would require plans to respond to a standard prior authorization request within seven days, typically, instead of the current 14, and within 72 hours for urgent requests. The proposed Centers for Medicare & Medicaid Services rule was scheduled to be open for public comment through March 13.

Although groups like AHIP, an industry trade group formerly called America’s Health Insurance Plans, and the American Medical Association, which represents more than 250,000 physicians in the United States, have expressed support for the proposed changes, some doctors feel they don’t go far enough.

“Seven days is still way too long,” said Dr. Julie Kanter, a hematologist in Birmingham, Alabama, whose sickle cell patients can’t delay care when they arrive at the hospital showing signs of stroke. “We need to move very quickly. We have to make decisions.”

Meanwhile, some states have passed their own laws governing the process. In Oregon, for example, health insurers must respond to nonemergency prior authorization requests within two business days. In Michigan, insurers must report annual prior authorization data, including the number of requests denied and appeals received. Other states have adopted or are considering similar legislation, while in many places insurers regularly take four to six weeks for non-urgent appeals.

Waiting for health insurers to authorize care comes with consequences for patients, various studies show. It has led to delays in cancer care in Pennsylvania, meant sick children in Colorado were more likely to be hospitalized, and blocked low-income patients across the country from getting treatment for opioid addiction.

In some cases, care has been denied and never obtained. In others, prior authorization proved a potent but indirect deterrent, as few patients have the fortitude, time, or resources to navigate what can be a labyrinthine process of denials and appeals. They simply gave up, because fighting denials often requires patients to spend hours on the phone and computer to submit multiple forms.

Erin Conlisk, a social science researcher for the University of California-Riverside, estimated she spent dozens of hours last summer trying to obtain prior authorization for a 6-mile round-trip ambulance ride to get her mother to a clinic in San Diego.

Her 81-year-old mother has rheumatoid arthritis and has had trouble sitting up, walking, or standing without help after she damaged a tendon in her pelvis last year.

Conlisk thought her mom’s case was clear-cut, especially since they had successfully scheduled an ambulance transport a few weeks earlier to the same clinic. But the ambulance didn’t show on the day Conlisk was told it would. No one notified them the ride hadn’t been pre-authorized.

The time it takes to juggle a prior authorization request can also perpetuate racial disparities and disproportionately affect those with lower-paying, hourly jobs, said Dr. Kathleen McManus, a physician-scientist at the University of Virginia.

“When people ask for an example of structural racism in medicine, this is one that I give them,” McManus said. “It’s baked into the system.”

Research that McManus and her colleagues published in 2020 found that federal Affordable Care Act marketplace insurance plans in the South were 16 times more likely to require prior authorization for HIV prevention drugs than those in the Northeast. The reason for these regional disparities is unknown. But she said that because more than half the nation’s Black population lives in the South, they’d be the patients more likely to face this barrier.

Many of the denied claims are reversed if a patient appeals, according to the federal government. New data specific to Medicare Advantage plans found 82% of appeals resulted in fully or partially overturning the initial prior authorization denial, according to KFF.

It’s not just patients who are confused and frustrated by the process. Doctors said they find the system convoluted and time-consuming, and feel as if their expertise is being challenged.

“I lose hours of time that I really don’t have to argue … with someone who doesn’t even really know what I’m talking about,” said Kanter, the hematologist in Birmingham. “The people who are making these decisions are rarely in your field of medicine.”

Occasionally, she said, it’s more efficient to send patients to the emergency room than it is to negotiate with their insurance plan to pre-authorize imaging or tests. But emergency care costs both the insurer and the patient more.

“It’s a terrible system,” she said.

KFF analysis of 2021 claims data found that 9% of all in-network denials by Affordable Care Act plans on the federal exchange, healthcare.gov, were attributed to lack of prior authorization or referrals, but some companies are more likely to deny a claim for these reasons than others. In Texas, for example, the analysis found 22% of all denials made by Blue Cross and Blue Shield of Texas and 24% of all denials made by Celtic Insurance Co. were based on lack of prior authorization.

Facing scrutiny, some insurers are revising their prior authorization policies. UnitedHealthcare has cut the number of prior authorizations in half in recent years by eliminating the need for patients to obtain permission for some diagnostic procedures, like MRIs and CT scans, said company spokesperson Heather Soules. Health insurers have also adopted artificial intelligence technology to speed up prior authorization decisions.

Meanwhile, most patients have no means of avoiding the burdensome process that has become a defining feature of American health care. But even those who have the time and energy to fight back may not get the outcome they hoped for.

When the ambulance never showed in July, Conlisk and her mother’s caregiver decided to drive the patient to the clinic in the caregiver’s car.

“She almost fell outside the office,” said Conlisk, who needed the assistance of five bystanders to move her mother safely into the clinic.

When her mother needed an ambulance for another appointment in September, Conlisk vowed to spend only one hour a day, for two weeks leading up to the clinic visit, working to get prior authorization. Her efforts were unsuccessful. Once again, her mother’s caregiver drove her to the clinic himself.

‘Keto-Like’ Diet May Be Associated With A Higher Risk Of Heart Disease, According To New Research

Can Keto Help Prevent or Manage Heart Disease? | Everyday HealthA low-carb, high-fat “keto-like” diet may be linked to higher levels of “bad” cholesterol and double the risk of cardiovascular events such as blocked arteries, heart attacks and strokes, according to new research.

“Our study found that regular consumption of a self-reported diet low in carbohydrates and high in fat was associated with increased levels of LDL cholesterol – or “bad” cholesterol – and a higher risk of heart disease,” lead study author Dr. Iulia Iatan with the Healthy Heart Program Prevention Clinic, St. Paul’s Hospital and University of British Columbia’s Centre for Heart Lung Innovation in Vancouver, Canada, said in a news release.

“This study provides an important contribution to the scientific literature, and suggests the harms outweigh the benefits,” said Christopher Gardner, a research professor of medicine at the Stanford Prevention Research Center who has conducted clinical trials on the keto diet. Gardner was not involved in the study.

“Elevated LDL cholesterol should not be dismissed as simply a negligible side effect of a VLCD (very-low-carb diet) or ketogenic diet,” Gardner said, pointing to the higher risk of cardiovascular events in individuals with higher ketone levels in the blood, when compared to those on a more standard diet.

In the study, researchers defined a low-carb, high-fat (LCHF) diet as 45% of total daily calories coming from fat and 25% coming from carbohydrates. The study, which has not been peer reviewed, was presented Sunday at the American College of Cardiology’s Annual Scientific Session Together With the World Congress of Cardiology.

“Our study rationale came from the fact that we would see patients in our cardiovascular prevention clinic with severe hypercholesterolemia following this diet,” Iatan said during a presentation at the session.

Hypercholesterolemia, or high cholesterol, increases a person’s risk of heart attack or other adverse cardiovascular events.

“This led us to wonder about the relationship between these low-carb, high-fat diets, lipid levels and cardiovascular disease. And so, despite this, there’s limited data on this relationship,” she said.

The researchers compared the diets of 305 people eating a LCHF diet with about 1,200 people eating a standard diet, using health information from the United Kingdom database UK Biobank, which followed people for at least a decade.

The researchers found that people on the LCHF diet had higher levels of low-density lipoprotein, also known as LDL, cholesterol and apolipoprotein B. Apolipoprotein B is a protein that coats LDL cholesterol proteins and can predict heart disease better than elevated levels of LDL cholesterol can.

The researchers also noticed that the LCHF diet participants’ total fat intake was higher in saturated fat and had double the consumption of animal sources (33%) compared to those in the control group (16%).

“After an average of 11.8 years of follow-up – and after adjustment for other risk factors for heart disease, such as diabetes, high blood pressure, obesity and smoking – people on an LCHF diet had more than two-times higher risk of having several major cardiovascular events, such as blockages in the arteries that needed to be opened with stenting procedures, heart attack, stroke and peripheral arterial disease,” researchers found, according to the news release.

The researchers said in the release that their study “can only show an association between the diet and an increased risk for major cardiac events, not a causal relationship,” because it was an observational study, but their findings are worth further study, “especially when approximately 1 in 5 Americans report being on a low-carb, keto-like or full keto diet.”

Iatan said the study’s limitations included measurement errors that occur when dietary assessments are self-reported, the study’s small sample size and that most of the participants were British and didn’t include other ethnic groups.

The study also looked at the longitudinal effect of following the diet, whereas most people who follow a keto-like diet tend to follow it intermittently for shorter periods of time.

Most of the participants – 73% – were women, which Iatan said is “quite interesting to see, but it also supports the literature that’s available that women in general tend to follow more dietary patterns, tend to be more interested in changing their lifestyles.”

When asked if there were any groups that were not harmed by following a LCHF diet, Iatan said how long people are on the diet and whether or not they lose weight “can counterbalance any LDL elevation.”

“What matters to remember is that each patient responds differently. And so, there’s really an inter-individual variability between the response. What we found is that, you know, on average, patients tend to increase their LDL cholesterol levels,” she said.

Dr. David Katz, a lifestyle medicine specialist who was not involved in the study, said that “there are various ways to put together a LCHF diet, and it is very unlikely they all have the same effects on serum lipids or cardiac events.”

However, he added, “That a LCHF diet is associated with adverse effects in this study is reality check for those adopting such diets just because they are in vogue.”

Most health experts say the trendy keto diet, which bans carbohydrates to make your body burn fat for fuel, cuts out healthy food such as fruit, beans and legumes, and whole grains. In the keto diet, you limit your intake of carbohydrates to only 20 to 50 a day – the lower, the better. To put that into perspective, a medium banana or apple is around 27 carbohydrates – the full day’s allowance.

“Those food groups that have to be eliminated to achieve ketosis are major sources of fiber in the diet, as well as many important nutrients, phytochemicals, and antioxidants. This is of concern to many health professionals who consider the VLCD or ketogenic diet to be harmful for long-term health,” Gardner said.

Keto is short for ketosis, a metabolic state that occurs when your liver begins to use stored fat to produce ketones for energy. The liver is programmed to do that when your body loses access to its preferred fuel – carbohydrates – and thinks it’s starving.

The keto diet has been around since the 1920s, when a doctor stumbled on it as a way of controlling seizures in children with epilepsy who didn’t respond to other treatment methods.

Low-carb diets like keto rely heavily on fats to fill you up. At least 70% of the keto diet will be made up of fat; some say it’s more like 90%.

While you can get all that fat from healthy unsaturated fats such as avocados, tofu, nuts, seeds and olive oil, the diet also allows saturated fats like lard, butter and coconut oil, as well as whole-fat milk, cheese and mayonnaise. Eating lots of foods high in saturated fat increases the body’s production of LDL cholesterol, which can build up inside the arteries and restrict blood flow to the heart and brain.

Virtual or In Person: Which Kind of Doctor’s Visit Is Better, And When It Matters

Virtual or In Person: Which Kind of Doctor's Visit Is Better, And When It  Matters | Kaiser Health NewsWhen the covid-19 pandemic swept the country in early 2020 and emptied doctors’ offices nationwide, telemedicine was suddenly thrust into the spotlight. Patients and their physicians turned to virtual visits by video or phone rather than risk meeting face-to-face.

During the early months of the pandemic, telehealth visits for care exploded.

“It was a dramatic shift in one or two weeks that we would expect to happen in a decade,” said Dr. Ateev Mehrotra, a professor at Harvard Medical School whose research focuses on telemedicine and other health care delivery innovations. “It’s great that we served patients, but we did not accumulate the norms and [research] papers that we would normally accumulate so that we can know what works and what doesn’t work.”

Now, three years after the start of the pandemic, we’re still figuring that out. Although telehealth use has moderated, it has found a role in many physician practices, and it is popular with patients.

More than any other field, behavioral health has embraced telehealth. Mental health conditions accounted for just under two-thirds of telehealth claims in November 2022, according to FairHealth, a nonprofit that manages a large database of private and Medicare insurance claims.

Telehealth appeals to a variety of patients because it allows them to simply log on to their computer and avoid the time and expense of driving, parking, and arranging child care that an in-person visit often requires.

But how do you gauge when to opt for a telehealth visit versus seeing your doctor in person? There are no hard-and-fast rules, but here’s some guidance about when it may make more sense to choose one or the other.

If It’s Your First Visit

“As a patient, you’re trying to evaluate the physician, to see if you can talk to them and trust them,” said Dr. Russell Kohl, a family physician and board member of the American Academy of Family Physicians. “It’s hard to do that on a telemedicine visit.”

Maybe your insurance has changed and you need a new primary care doctor or OB-GYN. Or perhaps you have a chronic condition and your doctor has suggested adding a specialist to the team. A face-to-face visit can help you feel comfortable and confident with their participation.

Sometimes an in-person first visit can help doctors evaluate their patients in nontangible ways, too. After a cancer diagnosis, for example, an oncologist might want to examine the site of a biopsy. But just as important, he might want to assess a patient’s emotional state.

“A diagnosis of cancer is an emotional event; it’s a life-changing moment, and a doctor wants to respond to that,” said Dr. Arif Kamal, an oncologist and the chief patient officer at the American Cancer Society. “There are things you can miss unless you’re sitting a foot or two away from the person.”

Once it’s clearer how the patient is coping and responding to treatment, that’s a good time to discuss incorporating telemedicine visits.

If a Physical Exam Seems Necessary

This may seem like a no-brainer, but there are nuances. Increasingly, monitoring equipment that people can keep at home — a blood pressure cuff, a digital glucometer or stethoscope, a pulse oximeter to measure blood oxygen, or a Doppler monitor that checks a fetus’s heartbeat — may give doctors the information they need, reducing the number of in-person visits required.

Someone’s overall physical health may help tip the scales on whether an in-person exam is needed. A 25-year-old in generally good health is usually a better candidate for telehealth than a 75-year-old with multiple chronic conditions.

But some health complaints typically require an in-person examination, doctors said, such as abdominal pain, severe musculoskeletal pain, or problems related to the eyes and ears.

Abdominal pain could signal trouble with the gallbladder, liver, or appendix, among many other things.

“We wouldn’t know how to evaluate it without an exam,” said Dr. Ryan Mire, an internist who is president of the American College of Physicians.

Unless a doctor does a physical exam, too often children with ear infections receive prescriptions for antibiotics, said Mehrotra, pointing to a study he co-authored comparing prescribing differences between telemedicine visits, urgent care, and primary care visits.

In obstetrics, the pandemic accelerated a gradual shift to fewer in-person prenatal visits. Typically, pregnancy involves 14 in-person visits. Some models now recommend eight or fewer, said Dr. Nathaniel DeNicola, chair of telehealth for the American College of Obstetricians and Gynecologists. A study found no significant differences in rates of cesarean deliveries, preterm birth, birth weight, or admissions to the neonatal intensive care unit between women who received up to a dozen prenatal visits in person and those who received a mix of in-person and virtual visits.

Contraception is another area where less may be more, DeNicola said. Patients can discuss the pros and cons of different options virtually and may need to schedule a visit only if they want an IUD inserted.

If Something Is New, or Changes

When a new symptom crops up, patients should generally schedule an in-person visit. Even if the patient has a chronic condition like diabetes or heart disease that is under control and care is managed by a familiar physician, sometimes things change. That usually calls for a face-to-face meeting too.

“I tell my patients, ‘If it’s new symptoms or a worsening of existing symptoms, that probably warrants an in-person visit,’” said Dr. David Cho, a cardiologist who chairs the American College of Cardiology’s Health Care Innovation Council. Changes could include chest pain, losing consciousness, shortness of breath, or swollen legs.

When patients are sitting in front of him in the exam room, Cho can listen to their hearts and lungs and do an EKG if someone has chest pain or palpitations. He’ll check their blood pressure, examine their feet to see if they’re retaining fluid, and look at their neck veins to see if they are bulging.

But all that may not be necessary for a patient with heart failure, for example, whose condition is stable, he said. They can check their own weight and blood pressure at home, and a periodic video visit to check in may suffice.

Video check-ins are effective for many people whose chronic conditions are under control, experts said.

When someone is undergoing treatment for cancer, certain pivotal moments will require a face-to-face meeting, said Kamal, of the American Cancer Society.

“The cancer has changed or the treatment has changed,” he said. “If they’re going to stop chemotherapy, they need to be there in person.”

And one clear recommendation holds for almost all situations: Even if a physician or office scheduler suggests a virtual visit, you don’t have to agree to it.

“As a consumer, you should do what you feel comfortable doing,” said Dr. Joe Kvedar, a professor at Harvard Medical School and immediate past board chairman of the American Telemedicine Association. “And if you really want to be seen in the office, you should make that case.”

Can’t Take Statins? New Pill Cuts Cholesterol, Heart Attacks

Can't take statins? New pill cuts cholesterol, heart attacks|#shorts -  YouTube

Drugs known as statins are the first-choice treatment for high cholesterol but millions of people who can’t or won’t take those pills because of side effects may have another option.

In a major study, a different kind of cholesterol-lowering drug named Nexletol reduced the risk of heart attacks and some other cardiovascular problems in people who can’t tolerate statins, researchers reported Saturday.

Doctors already prescribe the drug, known chemically as bempedoic acid, to be used together with a statin to help certain high-risk patients further lower their cholesterol. The new study tested Nexletol without the statin combination — and offers the first evidence that it also reduces the risk of cholesterol-caused health problems.

Statins remain “the cornerstone of cholesterol-lowering therapies,” stressed Dr. Steven Nissen of the Cleveland Clinic, who led the study.

But people who can’t take those proven pills “are very needy patients, they’re extremely difficult to treat,” he said. This option “will have a huge impact on public health.”

Too much so-called LDL or “bad” cholesterol can clog arteries and lead to heart attacks and strokes. Statin pills like Lipitor and Crestor – or their cheap generic equivalents – are the mainstay for lowering LDL cholesterol and preventing heart disease or treating those who already have it. They work by blocking some of the liver’s cholesterol production.

But some people suffer serious muscle pain from statins. While it’s not clear exactly how often that occurs, by some estimates 10% of people who’d otherwise qualify for the pills can’t or won’t take them. They have limited options, including pricey cholesterol-lowering shots and another kind of pill sold as Zetia.

Nexletol also blocks cholesterol production in the liver but in a different way than statins and without that muscle side effect.

The new five-year study tracked nearly 14,000 people who were unable to tolerate more than a very low dose of a statin. Half got daily Nexletol and half a dummy pill.

The main finding: Nexletol-treated patients had a 13% lower risk of a group of major cardiac problems. Then researchers teased apart those different conditions and found a 23% reduced risk of a heart attack, the biggest impact. The drug also cut by 19% procedures to unclog arteries. There wasn’t a difference in deaths, which researchers couldn’t explain but said might require longer to detect.

The data was published in the New England Journal of Medicine and presented Saturday at a meeting of the American College of Cardiology. The study was funded by Nexletol maker Esperion Therapeutics.

The results are “compelling,” Dr. John H. Alexander of Duke University, who wasn’t involved with the study, wrote in the journal. They “will and should” spur use of the drug by patients unwilling or unable to take statins.

“It is premature, however, to consider bempedoic acid as an alternative to statins,” he cautioned. “Given the overwhelming evidence of the vascular benefits,” statins remain the top choice for most patients.

Last Updated 03/15/2023

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