I have spent more than 30 years in healthcare with one consistent mission: helping people sustain and improve their lives. That mission has guided my work across large pharmaceutical companies, entrepreneurial startups, and academic institutions. It has shaped how I view innovation—not as a luxury, but as a necessity.

We often speak about healthcare innovation as if it exists in a vacuum. It does not. Innovation only matters if patients can access it, understand it, and afford it. Today’s system too often breaks that chain.

The U.S. healthcare system has evolved to prioritize risk management over prevention, short-term cost containment over long-term health, and utilization controls over patient outcomes. The consequences are real. Breakthrough therapies are delayed or denied. Preventive medicines are underused. Patients are left navigating complexity at the very moment they are most vulnerable.

However, innovation has repeatedly proven it can change the trajectory of disease—and lives—when it reaches patients.

Earlier in my career, I had the opportunity to help build Claritin into a household name. What made Claritin transformational was not just the molecule, but access. Non-sedating allergy relief allowed people to function—to work, learn, drive, and live daily life without compromise. We paired scientific innovation with brand-building, education, and emerging digital tools to enable patients to engage with their care in new ways. That experience taught me something enduring: innovation fails when it remains trapped behind complexity.

As digital channels emerged, I saw how virtual access could democratize care. Early online refill capabilities and digital front doors were not about marketing. They were about meeting patients where they were. Innovation is not only what happens in the lab; it is how solutions are delivered in the real world.

More recently, my work in cardiovascular and preventive medicine has reinforced this belief. Cardiovascular disease remains the leading cause of death globally, yet preventive innovation often struggles most to gain access. When therapies reduce future heart attacks, strokes, and hospitalizations—but do not show immediate cost offsets within narrow budget windows—they face resistance. This is actuarial logic colliding with human biology.

But prevention works. Inflammation matters. Long-term risk reduction matters. Helping people avoid catastrophic events enables them to remain productive, engaged, and present in their lives and with their families. The value of that outcome is difficult to capture on a quarterly balance sheet, but it is undeniable.

Innovation also matters because healthcare is not static. Populations are aging. Chronic disease is rising. Demand for care will only increase. Without continued pharmaceutical innovation—new mechanisms, better tolerability, improved adherence—we risk managing decline rather than enabling vitality.

Critics often frame innovation and affordability as opposing forces. They are not. The real tension lies between short-term system incentives and long-term societal benefit. When access to effective therapies is delayed or denied, costs do not disappear. They shift—reappearing as hospitalizations, disability, lost productivity, and diminished quality of life.

I have worked inside large organizations, small startups, and everything in between. I have seen how difficult it is to bring a medicine from concept to patient—and how fragile that final step of access can be. That is why innovation must be paired with thoughtful policy, modernized reimbursement, and a patient-centered view of value.

Healthcare should not be about simply surviving longer. It should be about living better for longer. Medical innovation, particularly in pharmaceuticals, plays a central role in making that possible. Even in a system burdened by complexity and constraints, innovation remains one of our strongest tools for advancing healthcare.

After three decades, my belief has not changed: when science, access, and mission align, lives improve. That is worth fighting to achieve.

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Obesity is a significant public health issue that affects people of all ages, genders, and socioeconomic backgrounds. The World Health Organization (WHO) states that over one billion people worldwide are obese. This estimate includes 650 million adults, 340 million adolescents, and 39 million children.

The World Health Organization explains that obesity impacts most body systems, including the heart, liver, kidneys, joints, and reproductive system. It can lead to various non-communicable diseases (NCDs), including type 2 diabetes, cardiovascular disease, hypertension, stroke, cancer, and mental health issues. Individuals with obesity are three times more likely to be hospitalized for COVID-19.

Now comes a brain imaging study that analyzed brain differences between females and males with a high body mass index (compared with those with a normal BMI).

Obesity — Men and women have different brains

The University of California, Los Angeles (USA) researchers analyzed data from magnetic resonance imaging (MRI) scans, clinical characteristics, and medical histories. They aimed to identify sex-specific brain processes that lead to obesity. Might men and women develop obesity for different reasons?

Historical studies examined brain images to see how obesity affects eating habits. Few studies have looked to see how the brains of obese individuals might differ in males and females.

Here are the current study results:

Specific brain parts differed between males and females with a high body mass index (BMI). The researchers offer that tailoring management to an individual’s sex may be essential to combating obesity.

In other words, investigating sex as a biological variable is key to determining obesity development and management response.

Obesity — Study details

The study involved a review of data from 183 participants. Of these, 78 had a high body mass index, and 105 had a normal BMI. The researchers used several brain scan forms. They also collected survey data on early life experiences, mood, and eating habits.

Using a method known as DIABLO, the scientists tried to accurately discern differences between those with a high versus a normal BMI. They also assessed differences between males and females with high BMI.

The analysis could effectively differentiate high BMI from normal BMI participants with 77 percent accuracy. Also, males with high body mass indexes could be distinguished from females with high BMI with 75 percent accuracy.

The study discovered differences in specific brain regions when comparing males and females. These variations appeared to be related to mental health, early life experiences, and touch sense.

Women with obesity exhibited changes in emotion-related brain centers associated with higher compulsive eating levels. On the other hand, in men, brain regions related to eating behavior and obesity were linked to gut sensations linked to abdominal discomfort and hunger.

Moreover, women with a high BMI had more significant brain signatures and lower mental health scores than men. Females may be more vulnerable to developing food cravings and addictions.

My take — Obesity and sex differences in the brain

This exploration of sex differences is unusual; of 199 studies found by the researchers, only 13 examined sex differences.

Key brain signatures are changed in obese individuals, affecting how an individual views food (and food cravings), eating patterns, and obesity. By looking at how these brain patterns differ by sex, the researchers open the door to a better understanding of the pathways by which women and men develop obesity.

In summary, there are gender differences in obesity. The reasons for the variation are unclear. By better understanding how the brains of those with obesity differ from those without it, we may develop better diagnostic and management tools.

Because the study was cross-sectional (comparing one group to another), the researchers cannot establish any causal relationships. We do not know if the brain MRI differences between men and women, based on body mass index, are due to gender or BMI. There may be some other factors.

Second, the researchers could have used more accurate measures of obesity, including waist-hip ratio or fat measurements (visceral adiposity).

Finally, I don’t think this provocative study has any implications for the current management of obesity. Given that those with a higher BMI report significantly greater childhood traumas, anxiety, depression, a tendency to notice body symptoms with hypervigilance, and other chronic stressors, we need to do a better job addressing these issues.

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High blood pressure.

High cholesterol.

Excess weight.

These are the risk factors for heart disease that your doctor typically talks to you about.  Yet, there is a risk factor that most doctors never discuss that can have as much impact as the ones I just listed — Depression.

Your mood plays a significant role in whether or not you get heart disease.  Study after study shows that the biological changes involved with depression– increased cortisol, elevated adrenaline, and decreased serotonin – causes changes in how well your heart functions.  It directly impacts how well your heart pumps as well as how much plaque develops in your arteries. Intense emotions and acute anxiety can literally change the shape of the heart. It’s a condition called Takotsubo cardiomyopathy and often referred to as “broken heart syndrome.”

Why is no one talking about this?

Even though we have made progress in recent years around the mind-body connection, we often don’t implement it in clinical practice. We create silos with physical health managed by physicians trained in internal and family medicine and mental health largely managed by psychiatry.  We need to be integrating and acknowledging there is no physical health without mental health, and there is no mental health without physical health.  It doesn’t make sense to only address risk factors such as blood pressure, cholesterol and weight – and then have mood as some time of afterthought.

If you follow some of my writing, you know I’m a big fan of risk calculators. Perhaps it’s time to update those that help calculate risk of cardiovascular disease and add depression/anxiety in the calculation of the risk score. That might force folks to be more explicit and proactive about managing mood as part of a primary prevention program.

Like many other aspects of heart disease, we wait until someone has a heart attack to adequately address it.  We talk about the need to reduce stress after patients experience chest pain – we should be talking about mood before they get to that point!

We have made amazing advances in the treatment of heart disease but sometime still dies of a heart attack every thirty- five seconds. Given the mental health challenges that many people have experienced during the past two years, I expect deaths from heart disease will increase unless we take proactive steps in reducing risk.  Addressing depression and other mental health conditions must be an important part of plan.

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There has been much controversy regarding the association between alcohol intake and cardiovascular disease, the leading global cause of death.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in 2019, 86 percent of adults in the United States reported consuming an alcoholic beverage.

Moreover, 14.5 million people in the U.S. aged 12 years or older live with alcohol use disorder (AUD). The NIAAA offers that Alcohol use disorder is marked by “an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.”

Approximately 95,000 Americans die annually from alcohol-related causes. This number makes alcohol the third largest preventable death cause.

It has long been recognized that the problems with alcohol relate not to the use of a bad thing but to the abuse of a good thing. — Abraham Lincoln

On the one hand, observational studies show a lower risk of cardiovascular disease with light to moderate alcohol intake than abstinence or heavy consumption. There appears to be a J- or U-shaped epidemiologic association.

On the other hand, these supposed heart benefits of alcohol may be secondary to confounding factors, including a favorable lifestyle (and behavioral and socioeconomic factors associated with modest alcohol drinking).

Today we try to get clarity by examining the pooled results of 107 studies involving nearly five million subjects. After analysis, study co-author Tim Stockwell offs this insight:

“We just need to be very skeptical of scientific evidence or scientific studies suggesting there are health benefits.”

Red wine — a traditional view

Moderate consumption of red wine has been associated with potential health benefits. Still, it’s important to note that these benefits are not a one-size-fits-all solution and may vary based on individual factors.

Red wine contains antioxidants, such as resveratrol, linked to cardiovascular health benefits. Resveratrol may improve cholesterol levels, lower blood pressure, and reduce the risk of blood clots.

Additionally, the polyphenols found in red wine have anti-inflammatory properties, which may help to reduce the risk of chronic diseases.

However, it’s important to remember that moderation might be a key to reaping the alleged health benefits of red wine. Excessive alcohol consumption increases the risk of several health issues, including liver disease, high blood pressure, and some types of cancer.

A new study raises questions about the traditional view that moderate alcohol consumption improves health and lengthens life.

Alcohol consumption, health, and longevity

In a new sweeping analysis, researchers discovered the following:

Despite a widespread belief that moderate alcohol consumption is good for you, the more you drink, the higher your risk of early death.

The review analyzed research on nearly five million individuals’ drinking and health habits. The study is one of the largest to undermine the belief that moderate drinking of wine (or other alcoholic beverages) is healthy.

The new study also discovered that drinking relatively low levels of alcohol — 25 grams daily for women (less than one ounce) and 45 grams (roughly 1.5 ounces) or more daily for men — increased the risk of death.

In the United States, a standard drink (5 ounces of wine, 12 ounces of beer, or 1.5 ounces of distilled spirits) typically has about 14 grams of alcohol.

Alcohol consumption study — context

The findings align with a British study from last year: Researchers examined the genetic and medical data of nearly 400,000 people. They concluded that even low alcohol intake was associated with increased disease risk.

In this cohort study of over 371,000 individuals, genetic evidence supported a non-linear, consistently risk-increasing link between all alcohol amounts, high blood pressure, and coronary artery disease.

The “J-curve might not exist when it comes to alcohol consumption level and disease risk. There were modest risk increases with light alcohol intake and exponentially greater risk increases at higher consumption levels.

In summary, alcohol intake at all levels appears to be associated with increased cardiovascular disease risk.

My take on alcohol consumption and health

This study shows that moderate alcohol consumption does not promote health. In general, less alcohol appears to be better regarding health.

You may have heard of the “French paradox,” suggesting that low cardiovascular disease rates (among men in France) appeared to be associated with daily wine consumption. Subsequent analyses revealed research flaws.

If you are keeping score, be careful: The alcohol industry funded much of the research examining the effects of alcohol on health. A recent report showed that the industry has directly or indirectly paid for 13,500 studies.

Moreover, historical research often failed to adjust for confounders such as lifestyle (for example, exercise, diet, and smoking), sex, age, and socioeconomic status. The current study attempted to remove such biases and discovered no significant reductions in the risk of death among moderate drinkers.

So why did previous research show a “J-shaped” curve — with lower heart attack rates among those consuming low or moderate alcohol amounts, with higher rates at the extremes — these studies were deeply flawed. The light-to-moderate drinkers were generally healthier than non-drinkers on physical activity, diet, weight, income, and dental hygiene measures.

In addition, abstainers from alcohol may avoid drinking because of health problems. Historical research did not control for such biases. Sometimes, being able to drink is a sign that you are still healthy, not the cause of it.

Let’s end with the words of researcher Professor Dr. Ulrich John:

“Our study is one of the very few that asked for details [about the] former life of the abstainers, details that may be known risk factors for early death. Our study is perhaps the only one so far that includes a standardized diagnosis of former alcohol or drug dependence, i.e., a severe health disorder that may explain short time to death.”

We might need to rethink the notion that daily drinking of moderate alcohol amounts promotes health. My takeaway is not that all should avoid alcohol; rather, it may not be the health potion many believe it to be.

What say you?

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Today, we explore the promise and the perils of iron — why too little (or too much) of it harms health. But first, a quote from Iron Man, speaking in the film Avengers: Earth’s Mightiest Heroes:

“J.A.R.V.I.S., make a note. Remind me not to wake up in the morning ever again.”

Iron Man is in for a rude awakening when a villain starts the day on the wrong side of the bed. And when Iron Man doesn’t get his beauty sleep, he’s not thrilled about it, either.

So, after finally defeating the villain of the week, Iron Man gets a little help from his artificial intelligence J.A.R.V.I.S. to make a note. There’s nothing better than a long night’s rest after saving the world again.

What is Iron?

Iron is an essential dietary mineral, one that is primarily used by our red blood cells (erythrocytes). Iron is central to hemoglobin, the substance that gives red blood cells their color. Hemoglobin delivers oxygen to all of the cells in our body.

The extraordinary French physiologist Claude Bernard elucidated the role of hemoglobin in the blood. He also originated the term milieu intérieur and the associated concept of homeostasis.

Hemoglobin is a word derived from heme plus globin. Each hemoglobin subunit is a globular protein with a heme group at its center. The heme group has one iron atom that can bind one oxygen molecule. Human hemoglobin has found such subunits.

Max Perutz, an Austrian-born British molecular biologist, shared the 1962 Nobel Prize for Chemistry with John Kendrew for their studies of the structures of hemoglobin and myoglobin.

Iron — Dietary types

There are two forms of dietary iron:

• Heme iron: Heme is found only in animal flesh like meat, seafood, and poultry. Heme iron is absorbed more easily than non-heme iron.
• Non-heme iron: Non-heme iron is found in plant foods like whole grains, nuts, seeds, legumes, and leafy greens. Non-heme iron is in animal flesh (given animals eat plant foods containing non-heme iron) and fortified foods.

Those who have too little dietary heme are at risk of iron deficiency. For example, vegetarians have a high risk of suffering from a deficiency of some nutrients, such as vitamin B12 and iron.

Women have a higher risk of being iron deficient. Did you know that iron deficiency is the world’s most common mineral deficiency?

In summary, iron is an essential dietary mineral that is critical to the transport of oxygen to all of our tissues. Certain populations, including vegetarians, women of childbearing age, and children five and younger, are at higher risk of iron deficiency.

Regulation of iron stores

Iron levels are closely regulated, as iron is an essential nutrient to many of our basic body functions. We need small amounts of the mineral for health. On the other hand, too much iron is potentially toxic.

Our body regulates iron levels by adjusting how much we absorb through our digestive tract. Hepcidin is an iron-regulating hormone that can suppress iron absorption.

When we have high levels of iron in storage, hepcidin levels rise, and iron absorption drops. On the other hand, if our iron stores are low, hepcidin levels decrease, and iron absorption increases.

Physiology, Hepcidin

Hepcidin is a peptide hormone produced in the liver that plays a crucial role in iron homeostasis. Iron is an essential…

www.ncbi.nlm.nih.gov.

Disorders that suppress hepcidin can lead to iron overload, while ones that stimulate hepcidin formation may cause iron deficiency.

In addition, our iron balance is influenced by how much iron is in our diet. If we chronically have a low iron intake, we may develop iron deficiency; too much dietary iron can lead to iron poisoning.

Iron deficiency

Our bodies need iron for several biological functions. We use iron to make hemoglobin and myoglobin. In addition, cell regulation and proliferation processes require iron, as does D.N.A. synthesis and electron transport in our cellular powerhouses, the mitochondria.

Nearly two-thirds of our iron is in the hemoglobin in our circulating red blood cells. We store the remaining third in our liver, bone marrow, spleen, and muscle tissue as ferritin. The iron is delivered, as needed, throughout the body via transferrin (a blood protein that binds to iron). A healthcare professional may evaluate blood levels of these two components if a low red blood cell count (anemia) is suspected.

A ferritin test measures your blood levels of ferritin, the blood protein containing iron. If your ferritin level is too low, it indicates that your iron stores are low and you have iron deficiency. You may have anemia because of this lack of sufficient iron.

On the other hand, if your blood levels of ferritin are higher than normal, you may have a condition that results in your body storing too much iron. Alternatively, you may have hyperthyroidism, liver disease, rheumatoid arthritis, or another inflammatory condition.

Sideropenia (iron deficiency) is a state in which total body iron stores are insufficient to support the body's metabolic activities.

It is easy to miss iron deficiency without anemia; the symptoms can be vague and easily missed. We clinicians must be vigilant when we suspect a chronic iron deficiency in a patient with normal blood counts but symptoms similar to anemia and low ferritin. Iron deficiency may be present, and we should ask about blood loss.

Here are some populations with a higher risk of suffering from iron deficiency:

• Individuals with cancer. Upwards of six out of ten individuals with colon cancer have iron deficiency at diagnosis, likely due to chronic blood loss. Approximately 30 to 45 percent of other cancer types will have iron deficiency. Primary causes are anemia of chronic disease and chemotherapy-induced anemia. Others suffer from chronic blood loss or nutritional deficits (for example, a cancer-induced lack of appetite).
• Frequent blood donors. In the United States, adults may give blood as often as every eight weeks, which can deplete iron stores. Approximately 25 to 35 percent of regular blood donors develop iron deficiency.
• Pregnant women.
• Infants and young children.
• Women with heavy menstrual periods. Women of reproductive age with abnormally heavy bleeding during menstrual periods are at increased risk of iron deficiency.
• Those with heart failure. About six in 10 patients with chronic heart failure have iron deficiency. Chronic iron deficiency is associated with increased early mortality for those with heart failure.
• Individuals with gastrointestinal disorders (such as ulcerative colitis, Crohn’s disease, or celiac disease) or gastrointestinal surgery have a higher risk of iron deficiency.
• Elderly — Those with poor nutrition or chronic inflammatory diseases can lead to anemia.
• Vegetarians — Individuals who have a diet without heme iron from meat, fish, or poultry may develop iron deficiency anemia if they don’t include adequate non-heme iron foods. Because non-heme iron is not well-absorbed, greater quantities of these foods may be needed, or attention given to how they are consumed to improve absorption (consuming vitamin C-rich foods while avoiding eating calcium-rich foods, calcium supplements, or tea).
• Endurance athletes — Running can cause trace amounts of gastrointestinal bleeding, leading to so-called “foot-strike” hemolysis that breaks down red blood cells faster. Female endurance athletes who are menstruating have the greatest risk for iron deficiency anemia.
• People with chronic kidney failure on dialysis

Untreated iron deficiency can lead to cognitive impairment, poor quality of life, fetal brain maturation problems, and low birth weight. Maternal problems can include depression, systemic infection (sepsis), and a higher risk of death.

Iron deficiency anemia can cause fatigue and weakness; gastrointestinal disturbances; impaired cognitive functioning; poorer immune function, impaired body temperature regulation, and exercise or work impairment.

Iron deficiency anemia can lead to psychomotor and cognitive abnormalities and (left untreated) learning difficulties in infants and children.

Iron deficiency treatment

Those with uncomplicated iron deficiency without other significant health problems should receive treatment with oral iron therapy. Oral iron is readily available, cheap, effective, safe, and convenient.

Gastrointestinal (GI) side effects can be reduced using chelated forms of iron. Enteric-coated tablets lead to poor absorption and are not viable options. Selected patients may need intravenous (through a vein) iron treatment.

Interactions with medicines

Iron can interact with certain medications, and some medications can lower iron levels. Here are some selected examples: Iron-containing dietary supplements may lower levels of levodopa (a treatment for Parkinson’s disease or restless leg syndrome).

Levothyroxine is used to treat thyroid cancer, hypothyroidism, and goiter. When taken at the same time as iron, the effectiveness of levothyroxine may drop in some patients. Some drug product labels advise against taking levothyroxine within four hours of iron supplementation.

Proton pump inhibitors (such as lansoprazole (Prevacid®) and omeprazole (Prilosec®)) can be associated with suboptimal responses to iron supplementation.

Fortunately, iron deficiency is typically easily managed, and an excellent prognosis for those with uncomplicated cases and no significant medical problems.

Too much iron

Adults with normal intestinal function have a very low probability of suffering from iron overload secondary to dietary sources. If you take high-dose iron supplements, you may get gastrointestinal side effects. These problems can include gastric upset, nausea and vomiting, constipation, abdominal pain, and diarrhea.

Taking iron with food may help minimize gastrointestinal toxicities. Some develop more serious problems, including gastritis. Gastritis is a general term for a group of conditions with one thing in common: Inflammation of the stomach lining.

Supplements with 25 milligrams (or more) of iron can reduce zinc absorption and blood zinc levels. Finally, acute intakes of over 20 milligrams per kilogram of iron (about 1,365 mg iron for someone weighing 150 pounds) can lead to fluid and blood loss, tissue damage, shock, and organ failure.

Poisoning can occur when people, typically young children, overdose on iron supplements.

Hemochromatosis, a disease caused by a mutation in the hemochromatosis (H.F.E.) gene, is linked to an excessive buildup of iron in the body. Without treatment by regular chelation or removing blood, those with hereditary hemochromatosis often develop signs of iron toxicity by their 30s.

If untreated, hemochromatosis can lead to liver cirrhosis, hepatocellular carcinoma, heart disease, and impaired pancreatic function. The American Association for the Study of Liver Diseases recommends that hemochromatosis management include avoiding iron and vitamin C supplements.

Iron — Recommended iron

As we discussed, meats, seafood, and poultry are rich in heme iron. Do you want non-heme iron? Try some nuts, seeds, vegetables, legumes, and fortified grains. Heme iron is absorbed better than non-heme iron.

Vitamin C and heme iron taken at the same mean can optimize non-heme iron absorption. On the other hand, bran fiber, large calcium intake (such as from supplements), and some plant substances such as phytates and tannins can inhibit non-heme iron absorption.

Here is a source for the recommended intake levels:

Office of Dietary Supplements – Iron

This fact sheet is for health professionals. For a reader-friendly overview of Iron, see our consumer fact…

ods.od.nih.gov.

The maximum daily intake (unlikely to cause harm) for iron is 45 milligrams daily for all males and females ages 14 years or older. For younger ages, the maximum is 40 milligrams.

Heme iron sources

The Harvard T.H. Chan School of Public Health offers these sources of dietary iron:

• Oysters, clams, mussels
• Beef or chicken liver
• Organ meats
• Canned sardines
• Beef
• Poultry
• Canned light tuna

Sources of non-heme iron:

• Fortified breakfast cereals
• Beans
• Dark chocolate (at least 45%)
• Lentils
• Spinach
• Potato with skin
• Nuts, seeds
• Enriched rice or bread

If you want more specifics on the amount of iron in given foods, please check out this nice overview:

Office of Dietary Supplements – Iron

This is a fact sheet intended for health professionals. For a reader-friendly overview of Iron, see our consumer fact…

ods.od.nih.gov

Iron can be dangerous in excess. Fortunately, unless you have an iron overload disorder, it is unlikely that dietary iron will hurt you.

On the other hand, please be careful with iron supplements — they benefit those with iron deficiency but may cause harm for those without iron deficiency. Avoid supplements unless a valued healthcare provider recommends them for you.

Finally, there is low-level evidence (in the form of observational trials) that a high intake of heme iron may increase colon cancer risk. The association between red meat and cancer is debatable. While some plausible mechanisms could explain this association, most of the evidence is based only on observational studies.

Thank you for joining me in this look at how too much iron (or too little) puts your health at risk.

The post How Too Much Iron (or Too Little) Puts Your Health at Risk appeared first on Medika Life.

One of the most blatant examples of ignorance and bias has been shown in political campaigns where stroke seems to be a central issue — it shouldn’t be. The inappropriateness of a medical professional in this area is startling.

A stroke comes in varying degrees of brain involvement, some fatal and many neither life-threatening nor totally incapacitating. Medical breakthroughs and physical and cognitive rehab today, offering new hope for stroke patients, are breaking through the wall of ignorance and bias. Even stroke patients with sight loss are now receiving further treatments. One program helps patients to retain or potentially restore stroke-vision loss.

What about the cognitive impairments of a stroke? The results here all depend on the stroke type, the damage’s extent, and where it occurred. Many have ischemic strokes caused by blood clots; an illustration can be found here. One type of stroke, a TIA, or transient ischemic attack, is a “warning stroke” that occurs when a blood clot blocks an artery for a short time. The only difference between a stroke and TIA is that with TIA, the blockage is transient (temporary).

Depending on the type of stroke, rehab can often aid the brain in accessing its extraordinary ability to utilize other areas to take over some actions. The treatments for a stroke are many and varied to address physical and cognitive difficulties. Currently, more than seven million persons in the US have had strokes, so the numbers are not minuscule. But one of the problems is that up to one-third of them don’t receive rehab. What might be the problem here?

One of the problems may be insurance coverage where services are denied because the insurance company doesn’t believe there is “medical necessity,” ask the doctor to get involved. If you believe you are being denied payment or access to a medical service that you are entitled to, you have the right to appeal the decision. If this should happen, appeal the decision or look for ways to take additional action to receive the needed services.

Disability consultants have told me that the usual rehab course is about one year, but insurance may only provide three months of coverage. If Social Security Disability benefits are received, and the consultant decides to limit benefits to three months, do not accept it. Appeal and provide yourself with a disability attorney.

What does Medicare pay for in terms of stroke rehab? Medicare reimbursement depends on the type of Medicare and co-insurance the individual has with Medicare.

The costs may vary, but one study found it can be expensive, especially if all of the stroke patient’s medical insurance isn’t sufficient. One-year costs after the start of medical specialist rehabilitation post-stroke from a societal perspective, were $70,601 and $27,473 for inpatients and outpatients, respectively. For both inpatients and outpatients, rehabilitation was the biggest contributor, yet to a larger extent in inpatients than in outpatients. Both the costs for staying in the rehabilitation facility and for all types of therapy were higher. These costs may not relate to the US since the study was conducted in Europe.

The many areas of cognitive rehab require specific interventions long enough to aid in remediation. Going back to work might be one of the things you can plan to do once recovery has begun. A few helpful hints are offered here to assist anyone recovering from a stroke.

Anyone who wants a high-profile example of a brain injury victim (and that is what a stroke can be considered) should follow former Congresswoman Gabby Gifford’s rehab after a gunshot head wound. The woman should inspire any stroke patient, whether they have had a major or minor stroke.

A stroke is not the end of everything, and one of the most potent factors working on a patient’s behalf is motivation to keep improving. The brain is a wonderful organ, so let it perform its wonders.

The post Stroke Patients Are Being Cast Aside by a Lack of Understanding and Bias appeared first on Medika Life.

Get regular physical activity, and you can reduce your risk of becoming obese, developing diabetes, suffering from cardiovascular disease, dodge particular cancers, and more. But how does exercise work its physiological magic?

First, we’ll review some of the health benefits of regular physical activity. Second, we’ll turn to a new study that sheds light on how moving affects our physiology at a basic level.

Physical activity and cardiovascular disease

Many of us lead sedentary lifestyles, at least in the United States. Unfortunately, not getting regular physical activity is an independent risk factor for the early development of coronary heart disease.

Unfortunately, much of the evidence supporting the risk-reducing properties of exercise comes from long-term observational studies that demonstrate this:

Those who get regular physical activity have much less coronary heart disease and a lower risk of experiencing cardiac arrest.

Let’s compare the least active among us with the most active. I live in King County, Washington (USA). There, researchers from the University of Washington performed a population-based case-control study to examine the associations between regular high-intensity and moderate-intensity leisure-time physical activity and primary cardiac arrest.

The investigators looked at 333 patients with primary cardiac arrest, aged 25 to 75, attended by paramedics. Controls were randomly selected from the same community and matched for age and sex. None of the subjects had a history of heart disease, major health problems, or self-reported poor health.

The researchers interviewed partners of patients and controls to assess participation in 15 high-intensity and six moderate-intensity physical activities during the previous year.

Here are the relative risk reductions by activity type:

• Gardening for more than 60 minutes per week appeared to be associated with a drop in risk by two-thirds.
• Walking for exercise for more than 60 minutes per week appeared to be associated with a nearly three-quarters risk reduction.
• Engaging in high-intensity activities appeared to be associated with a drop in risk by two-thirds.

Unfortunately, I did not see absolute risk reduction numbers. However, here is some context: Globally, cardiac arrest takes more lives than colorectal cancer, breast cancer, prostate cancer, influenza, pneumonia, auto accidents, HIV, firearms, and house fires combined. In one year alone, 350,000 Americans die from cardiac arrest.

A sedentary lifestyle is an independent risk factor for cardiac arrest. Of course, exercise is not completely free of potential perils. Physical activity can have rare adverse effects, including heart attack, heart rhythm problems, sudden death, and rhabdomyolysis.

Rhabdo happens when damaged muscle tissue releases its proteins and electrolytes into the blood. These substances can damage the kidneys and heart and lead to permanent disability or even death.

Physical activity and weight

Exercise is important to prevent obesity; sedentary behavior is associated with weight gain. For older or obese adults, higher activity levels (compared to young adults) appear necessary to prevent weight gain.

A study of 34,000 females (with an average age of 54) consuming a usual diet had an average weight gain of 2.6 kilograms (5.7 pounds) over 13 years.

Compared with females doing more than 420 minutes per week of exercise (an average of one hour daily), those engaging in less activity gained significantly more weight.

Physical activity appeared inversely related to weight gain only among normal-weight individuals. To maintain normal body weight in mid-life, the females in the study needed higher levels of physical activity (about 60 minutes daily).

Once overweight, physical activity alone (without controlling caloric intake) did not prevent weight gain.

The available research findings suggest that physical activity protects against obesity regardless of an individual’s genetic predisposition to it.

Physical activity and life expectancy

Physical inactivity is associated with a reduced life expectancy. A retrospective study published in JAMA addresses this issue. The study explores the link between long-term mortality and various levels of cardiorespiratory fitness.

Cardiorespiratory fitness measures how well your heart and lungs pump blood and oxygen during prolonged exercise. The more fit you are, the higher your cardiorespiratory fitness.

Over 122,000 patients at the Cleveland Clinic (USA) had exercise testing on a treadmill to measure cardiorespiratory fitness for the research investigation. The subjects ranged in age from 18 to over 80, with an average age of 53. The results?

Cardiorespiratory fitness appeared to be associated with living longer. The higher the fitness, the higher the survival rate, regardless of age. The connection appeared to be especially strong among older individuals and those with high blood pressure. Moreover, the survival benefit continued to increase with no upper limit.

Physical activity — How it works its magic

Physical activity is a wonderful way to help maintain and restore good health. Despite numerous studies demonstrating this relationship, the molecular mechanisms underlying the benefits remain incompletely elucidated.

A new paper by researchers at Harvard Medical School (USA) and Massachusetts Institute of Technology (USA) in Cell Metabolism illuminates the complex physiological response to exercise.

The Harvard/MIT team combined modern single-cell technologies with advanced computational biology and artificial intelligence to look at how three metabolic tissues respond to exercise and high-fat diet-induced obesity at a single-cell resolution. This project is a first-of-its-kind research investigation.

The researchers discovered opposite responses to exercise and obesity across all three tissues.

Goodyear and colleagues focused on three tissues, including two kinds of white adipose tissue (fat) and skeletal muscle taken from mice. The rodents were either trained or sedentary and consumed either a healthy or high-fat diet (the latter aiming to mimic a typical Western diet).

Here are the four mice groups:

• Regular diet/sedentary
• Regular diet/active
• High-fat diet/sedentary
• High-fat diet/active

The mice consumed the diet for six weeks. The active mice had free access to a running wheel for three weeks.

After three weeks of exercise, researchers used single-cell RNA sequencing. Here are the findings:

Genes regulating extracellular matrix* remodeling and circadian rhythm appeared to be regulated by exercise and obesity in all three tissue types. Obesity up-regulated extracellular modeling, while exercise down-regulated them. Conversely, exercise up-regulated circadian-related pathways, and obesity down-regulated them.

• The extracellular matrix is the “non-cellular portion of a tissue. It is a collection of extracellular material produced and secreted by cells into the surrounding medium. The extracellular matrix provides structural and biochemical support to the surrounding cells.”

Here is co-first author, Pasquale Nigro, Ph.D.:

“With respect to the circadian rhythm, we saw very quiet cells that weren’t metabolically active with the high-fat diet group. We discovered that exercise reversed this. It seemed that, when the circadian system is up-regulated, cells become re-activated.”

My take — Physical activity

Unless there is a medical contraindication, we should all try to achieve and maintain high fitness levels.

Current guidelines recommend 150 to 300 minutes per week of moderate aerobic activity (such as walking, running, swimming, or biking), 75 minutes of vigorous activity, or a mix of both. Experts also recommend twice-weekly resistance training to strengthen muscles.

Unfortunately, only about one in five adults and teens in the United States gets enough exercise to maintain good health. We can do better.

Thank you for joining me in this look at the effects of obesity and exercise on fat and muscle.

The post Obesity and Exercise Have Opposite Effects on Muscle and Fat appeared first on Medika Life.

Before you leap to chocoholic status (for hypertension risk reduction), you probably want evidence that previously reported laboratory results translate well into the real world.

Enter a new study from the University of Surrey that illustrates the power of cocoa to reduce high blood pressure. I want to wander a bit through the known health benefits of this nectar of the gods before exploring the provocative new study from the United Kingdom.

The new study has this unwieldy title: “Assessing Variability in Vascular Response to Cocoa With Personal Devices: A Series of Double-Blind Randomized Crossover n-of-1 Trials,” but I hope to analyze it with more accessible language.

Dark chocolate is chock full of nutrients that may benefit your health. Created from cacao tree seeds, it is a potent source of antioxidants. Let’s explore three science-based health benefits of dark chocolate or cocoa.

1. Chocolate can improve cholesterol.

Dark chocolate positively impacts cholesterol by lowering “bad” LDL and improving insulin sensitivity. Let’s look at the evidence, admittedly not high-level.

As reported in a small randomized study in 2014, dark chocolate consumption (supplemented with the flavanol lycopene) significantly reduced levels of total cholesterol, LDL (“bad”) cholesterol, and triglycerides.

The results seem logical. Some types of LDL cholesterol are more likely to oxidize (when contacting free radicals in our body). This oxidation renders the LDL particle reactive, damaging other tissues, including the heart’s artery lining.

Cocoa lowers oxidation-prone types of LDL. With its antioxidants, the food substance enters our bloodstream to protect lipoproteins. We need to be mindful that dark chocolate also contains health-harming sugar.

2. Chocolate might protect your skin from the sun.

You read that correctly: The bioactive substances in dark chocolate may reduce sun-induced skin damage.

One well-done 6-month study involved subjects who consumed a flavanol-rich cocoa beverage. The beverage consumers significantly improved facial wrinkles and skin elasticity compared with the control group.

Before we open a cocoa stand, we should note that not all studies have demonstrated such positive results. Still, when I recently traveled to Kauai (Hawaii), I got in daily dark chocolate, aiming for at least 70 percent cocoa solids with little added sugar.

Of course, I recognize that dark chocolate is no replacement for other forms of sun protection, including sunscreen.

3. Chocolate may boost your brain.

Did you know that dark chocolate may improve your brain functioning? Cocoa rich in flavanols improves brain blood flow, at least in young adults. Consume cocoa, and you may witness improvements in memory, attention, and verbal learning, according to a systematic review from Madrid (Spain).

What about older adults? Can cocoa flavonoids help us maintain cognitive function? The answer is maybe. Lower level evidence comes in the form of a retrospective study showing the substance helped older adults maintain cognitive function (and dropped the chances of progression to dementia). This research study is by no means definitive.

Here is what I previously wrote about the dark chocolate/brain connection:Dark Chocolate and CognitionDark chocolate is chock full of nutrients that can positively affect your health.medium..com.

In the short term, we may get a brain function bump through cocoas compatriots, theobromine, and caffeine. Perhaps these substances are the reason I get a jump-start in brain function.

In summary, cocoa and dark chocolate may improve brain function by increasing blood flow or through the stimulants in the food (such as caffeine and theobromine). Fortunately for me, compared with regular coffee, the caffeine content of dark chocolate is relatively low.

“The greatest tragedies were written by the Greeks and Shakespeare…neither knew chocolate.”
― Sandra Boynton

L’AMUSE-BOUCHE
Chocolate Parmesan Tapioca with a Pan-Seared Scallop

L’ENTREE
Salad with Chèvre Chaud, Honey, and Mint Dressing
Roasted Butternut Squash and Cacao Soup
Oysters with a Mignonette Sauce

LE PLAT PRINCIPAL
Armagnac-and-Chocolate-Infused Daube de Bœuf à la Gascogne
Sweet Potato Curry with Mussels
Chocolate Pasta with a Gorgonzola Cheese Sauce

LA SALADE ET LE FROMAGE
Moules à la Plancha with Chorizo served over a bed of Arugula

Selection of the Château’s Cheeses

LE DESSERT
Mousse au Chocolat spiced with Pimento Chili Peppers and Chocolate Flakes, garnished with Mint.

I spun around on one heel, excited to get prepping. Unbeknownst to me, the rest of the kitchen staff had arrived, their jaws agape as they stared at the menu. As usual, Phillipa was the first to speak up. “That menu looks wicked incredible.”
“I don’t know about adding hot peppers to the mousse au chocolat,” said Jane, and the granny brigade nodded in agreement.
I was so sick of her know-it-all attitude. I knew a thing or two, and I was going to stand by my decision. “The combination has Aztec roots. To honor the fertility goddess, they drank xocolāt, a chocolate concoction spiced with chili pepper and vanilla. It’s delicious and unexpected.”
Jane rolled her eyes. “You’re the chef.”
“I am,” I said, wanting to challenge her. “And this is the menu.”
― Samantha Verant, The Secret French Recipes of Sophie Valroux

Chocolate and the heart — New findings

Back to our original question: Can cocoa — or chocolate act as a medicine for high blood pressure? A new study from the United Kingdom provides real-world evidence that the answer is yes.

The study authors observe that cocoa flavanols can lower blood pressure and arterial stiffness as much as some prescribed medicines. But here’s the rub: The great results have been obtained only in tightly controlled experimental settings.

Commenting in Medscape UK, lead study author Christian Heiss, professor of cardiovascular medicine at the University of Surrey, explains that:

“High blood pressure and arterial stiffness increase a person’s risk of heart disease and strokes, so it is crucial that we investigate innovative ways to treat such conditions.”

“Before we even consider introducing cocoa into clinical practices, we need to test if the results reported in laboratory settings safely translate into real-world settings, with people going about their everyday lives.”

Here’s what the scientists did: The team randomized 11 healthy volunteers (under age 45 years) who consumed either cocoa flavanol capsules or placebo capsules (containing brown sugar) on alternate days. They did one of two randomized sequences over eight consecutive days, with capsules taken each morning before breakfast.

Here are the results of this novel double-blind, randomized cross-over trial, published in Frontiers in Nutrition:

• Both 12-hour systolic blood pressure and pulse wave velocity decreased, the former by an average of 1.4 mm Hg.
• There appeared to be much inter-individual variation in responses and considerable between-day variation in individual responses.
• Blood pressure and arterial stiffness dropped when they had been high at baseline. Those with a low blood pressure measurement in the morning had no benefit from cocoa flavanols.
• The effectiveness peaked within three hours of cocoa flavanol ingestion (with a second, smaller peak about eight hours after consumption).

My take — Chocolate and the new study results

This study showed a small drop in blood pressure and arterial stiffness in everyday life, but only for those with elevations within the normal range. At first, I thought the 1.4 mm Hg drop in blood pressure seemed remarkably small until I noted this observation of the study authors:

“The magnitude of effects, in particular within the first 3 hours, is similar to what standard antihypertensive medications achieve in clinical trials, highlighting the clinical relevance and potential of flavanols for use in clinical practice.”

According to the researchers, the amounts of cocoa flavanols in the study are high but achievable through a regular diet.

Regrettably, the researchers did not obtain blood samples that would have allowed for an analysis of flavanol metabolites. Finally, whether a regular dark chocolate consumption habit results in long-term blood pressure decreases is unknown.

I will close with the usual caveats: Chocolate is rich in calories, sugars, and fat. I consume it in small amounts to dodge extra calories. Of course, dark chocolate alone is not going to be enough.

Don’t forget to move, maintain a healthy weight, watch your salt intake, and check your blood pressure. Hopefully, you will not need medicines to keep your blood pressure healthy.

Do you eat dark chocolate? If yes, what is your favorite? Thank you for joining me today.

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Healthy weight maintenance is important to optimize our health. Maintaining a healthy weight can lower your risk of many cancer types, heart disease, stroke, diabetes, and high blood pressure.

The Harvard TH Chan School of Public Health Letter reminds us that your weight, waist size, and weight gain since your mid-20s greatly influence your health, helping to determine your chances of developing any of these conditions:

• Cardiovascular disease, heart attack, stroke
• Diabetes
• Cancer
• Arthritis
• Gallstones
• Asthma
• Cataracts
• Infertility
• Snoring
• Sleep apnea

American weight gain is on the rise

Brigham Young University (USA) researchers recently examined weight gain patterns among nearly 14,000 adults from 2011 to 2018. THe COVID-19 pandemic interfered with the ability to get 2019 to 2020 information.

Here are the disturbing findings:

The average 10-year weight gain was 4.2 kilograms (9.2 pounds), or nearly seven percent of initial body weight.

Getting more granular, we find that one-half of subjects gained at least five percent of body weight, over one-third put on at least ten pounds, and 16 percent gained at least 20 percent over a ten years.

Looking by sex, the 10-year weight gain appeared significantly greater among women (5.4 kilograms) versus men (2.6 kilograms). And by race? Non-Hispanic Blacks gained the most weight, while Asians gained the least amount.

American weight gain: My take

Ten-year weight gain is a serious health problem for American adults. So what’s the root cause of weight gain? In general, potential contributing factors include:

• Diet
• Genes. Some are genetically predisposed to gain weight more easily. Nevertheless, genes are not destiny: Maintaining a healthy lifestyle can prevent the genetic predisposition to obesity. I limit my sugar-sweetened beverages.
• Move. Physical activity can lower the risks of some cancer types, heart disease, and other chronic diseases. Movement can advance weight control, too.
• Sleep. In general, those who get too little sleep tend to weigh more than those who get adequate sleep.

The post We’re Gaining a Lot of Weight appeared first on Medika Life.

Let’s look at a myth about strokes before turning to the risk factors. We’ll end with some strategies to drop your risk of suffering from a stroke.

Myth: We can’t reduce stroke risk

This one hits close to home for me as my dad died of a heart attack and stroke in his 86th year. Friend to both Dr. Martin Luther King and Malcolm X and mentor to hundreds, his passing was a significant loss to many.

But there is this turn of events: Three weeks before his death, my father expressed that he had a full and wonderful life, that his grandchildren were on a path to success, and that he would die in three weeks. He died naturally, to the day.

Now, back to stroke risk-reduction. Here are the most common risk factors for stroke, according to Johns Hopkins Medicine (USA):

Stroke: Potentially modifiable risks

• High blood pressure (hypertension). A blood pressure of 140/90 or higher can damage blood vessels (arteries)providing your brain’s blood supply.
• Heart disease. Heart disease is the number two risk factor for stroke and the primary cause of death for stroke survivors. Stroke and heart disease share many risk factors.
• Diabetes
• Smoking
• Oral contraceptives (birth control pills)
• High blood cholesterol and lipids. High cholesterol levels can lead to thickening or hardening of the arteries (atherosclerosis) caused by plaque buildup. This buildup can decrease the amount of blood flow to the brain. A stroke occurs if there is a blockage of blood supply to the brain.
• Obesity
• Lack of exercise
• Excessive alcohol use. Consumption of more than two alcohol-containing drinks daily raises blood pressure. Binge drinking can lead to stroke.
• Illegal drugs. Intravenous drug abuse is associated with a high risk of stroke from blood clots. Cocaine and other drugs increase the risk of heart attacks, strokes, and many other cardiovascular problems.
• High red blood cell count. Blood thickening makes clots more likely. This thickening raises stroke risk.
• Abnormal heart rhythm. Some types of heart disease can raise your risk for stroke. Having an irregular heartbeat (atrial fibrillation) is the most powerful and treatable heart risk factor of stroke.
• Heart abnormalities. Damaged heart valves (valvular heart disease) can cause long-term heart damage. Over time, this can raise your risk for stroke.
• Mini-strokes (transient ischemic attacks or TIAs) have symptoms the same as with a stroke, but with a TIA, the symptoms are temporary. Here’s the problem: TIAs make it nearly 10-times more likely to have a stroke than someone of the same sex and age who has not experienced a TIA.

After a transient ischemic attack, the risk of stroke is somewhere between two and 17 percent within the first 90 days. Among patients with a transient ischemic attack, one in five will have a subsequent stroke, a heart attack, or die within one year.

There are many risk-reduction strategies for those who have suffered a TIA.

Stroke: Fixed risks

The risk of a stroke more than doubles for each decade after age 55. African-Americans have a significantly higher risk of stroke than whites, partly because African-Americans are more likely to suffer from high blood pressure.

While stroke occurs more commonly in men, more women than men die from the disease in the USA.

A history of a prior stroke increases the chances of having another one. Those with a family history of the condition have a higher risk, too. In the USA, strokes are more common in the country’s southeastern part.

Strokes occur more frequently during temperature extremes.

Stroke risk-reduction

I focus on modifiable risk factors. I avoid high blood pressure, tobacco, and work to tamp down my slightly high triglycerides. I am okay weight-wise and do not suffer from diabetes.

Physical activity and a healthy diet can go a long way to reducing these risk factors. Finally, I try to minimize stress. Hopefully, these lifestyle maneuvers will help me escape any genetics from my dad.

Get help FAST

FAST is an easy way to remember the signs of a stroke. When you see these signs, you will know that you need to get help fast. FAST stands for:

F — Face drooping. One side of the face is drooping or numb. When the person smiles, the smile is uneven.

A — Arm weakness. One arm is weak or numb. When the person lifts both arms simultaneously, one arm may drift downward.

S — Speech difficulty. You may see slurred speech or difficulty speaking. The person can’t repeat a simple sentence correctly when asked.

T — Time to call 911. If someone shows any of these symptoms, call 911 right away. Call even if the symptom goes away. Make a note of the time the symptoms first appeared.

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