Geriatrician, Hospitalist, Patient Advocate, Healthcare Educator

People Cannot Afford Prescription Medications

Researchers from the National Center for Health Statistics analyzed responses to the 2021 National Health Interview Survey of US households. The report by the US Centers for Disease Control and Prevention found that millions of adults in the United States were not taking medications prescribed to them due to cost.

About 60% of adults aged 18 to 64 years reported taking one prescription medication in 2021. Among those that took prescription medications, 8.2%(about 9.2 million people) did not take medications as prescribed due to cost. Women were more likely than men to not take medication.

The United States is one of the richest countries but the cost of medications, healthcare insurance industry, pharmaceutical companies, all have made it difficult for patients to afford lifesaving medications. It harms the patient to skip medications, ration, delay a prescription refill, or take a lower dose than prescribed and they may eventually end up with other health consequences.

If you are not taking your prescription medication as prescribed, please speak to your healthcare provider, often times there are alternatives available which will cost less or resources available to offset some of the cost.

Changes to Expect With Regular Exercise

Photo by Lucas van Oort

So you’ve been consistently getting in your exercise for the past month and are wondering when you will start to see some results. Don’t stop what you are doing if you don’t see the results. Like anything, this will take time but here is what to expect:

Decrease in heart rate

Like the other muscles in your body, the heart which is also a muscle will get stronger and your heart will pump more blood per beat which will decrease your resting heart rate. You can expect to see this change in a few weeks of consistent work-outs.

Change in blood pressure

  • Going from being relatively sedentary to increasing your step count and getting in some aerobic exercise can decrease both systolic and diastolic blood pressure.
  • After a few weeks, there will also be an improvement in blood pressure for those individuals with borderline elevated blood pressure and those who have hypertension(known elevated blood pressure). However, those with normal blood pressure, will see little overall change.

Muscle fitness

You may notice a little bit of muscle toning in about a month or two, but it may take about 3-6 months to see significant improvement in your muscle fitness when you incorporate regular resistance training in your work-outs. This is because the neruromuscular connetions learn how to more efficiently contract your muscles. Although the results of resistance training are variable from person to person, you will eventually see improvement in strength, muscle tone, and overall fitness.

Weight loss

This again varies from person to person but to really see some significant result, you need to get in 60 minutes or more of activity time.

Improvement in mood

Exercise will lead to an improvement of mood, reduce stress, and help energy levels. It has been found that even a quick 10 minute walk can have these results.

Improved endurance

With continued exercise, endurance will improve. It takes about 8-12 weeks to see improvement in endurance and overall cardiovascular health. There will be more oxygen delivered to the working muscles which will allow for longer work-outs and reduced effort.

Losing That Extra Fat Will Take Some Time

Photo by Siora Photography

It’s been several weeks since you started working out and actually sticking to the schedule but are just not seeing the results. Where and when can you expect to see the results? Each person carries fat differently with genetics, hormones, environment, and lifestyle all playing a role.

Fat is the extra carbohydrate or protein from food that we eat that gets converted into triglycerides and stored in adipocytes in the body. There are 2 types of fat.

  1. Visceral or “hard” fat-this is a dangerous type of white fat that is between, around, and inside organs.
  2. Subcutaneous or “soft” fat-this is located under the skin and is not as dangerous as visceral fat, you can pinch this fat through your skin

When a calorie deficit is created either by reducing oral intake or increasing physical activity, your body draws on the stored triglyceride for fuel but stores are tapped evenly throughout the body so we cannot choose where the body will tap into this.

  • You will first lose the bad visceral fat that surrounds your organs, then you will start burning the soft fat
  • As to where you will lose that soft fat- some say that you lose weight where you last gained it and the first place you gained that fat will be the last to go
  • Spot-training or targeting one body area such as your abdomen does not really work, work on full body work-outs
  • It may be diffcult for women to lose in their hips, butts, and thighs because the fat there is important for child-bearing and related to higher levels of estrogen

How to burn fat effectively

  • Create a calorie deficit(work out and practice intentional eating)
  • Build muscle to increase your basal metabolic rate
  • You need to be consistent and do regular physical activity at least 30 minutes on most days of the week. However to notice significant changes in terms of weight loss, goal will be to be physically active for 60 minutes or more.
  • In about 3-6 months, you will start seeing 25-100% improvement in muscular fitness if you are also doing regular resistance exercise

Remember, it took a long time to build up the fat. It will take some time to get where you want to, but keep with it. You will eventually see that stubborn fat budge away be it in your belly or elsewhere. Your body will look and feel more toned and it will be worth it.

Find That Sense of Purpose

A study published in the journal Preventive Medicine looked at 13,000 US adults aged 50 years and older who self-reported sense of purpose and looked at 8 year mortality risk beginning between 2006 to 2008. It was found that having a higher purpose was associated with lower all-cause mortality. The benefit was evident across gender, race, and ethnicity but was felt to be stronger for women as compared to men.

It has also been found that a sense of purpose in life helps in learning and growth and has been linked to less memory impairment and less functional decline. A sense of purpose not only gives you something to look forward to… be it a goal to achieve, a milestone to reach…. but also indirectly promotes a healthier lifestyle…you will eat better, get more activity in, impart positivity, and laugh more!

What Is Sarcopenia?

Photo by Alexandra Tran

As we age, we lose muscle mass which leads to a decline in muscle strength and function, in medical terms, a condition called sarcopenia. Muscle mass decreases about 5% per decade starting in our 30s. Sarcopenia has been linked to a decreased ability to function in everyday life, to travel, and enjoy activities. It has also been linked to chronic medical illnesses such as hypertension, obesity, type 2 diabetes mellitus, heart disease, and stroke. To help counter these changes, it is important to eat protein as well as work on strength/resistance training, the earlier in life, the better.

The importance of strength/resistance training

  • stimulates muscle growth, function, and enhances muscle tissue quality
  • improves connective tissues strength
  • improves bone mineral density
  • resistance training requires our muscles to contract to lift a heavy object against the pull of gravity. Aim to do this 2 to 3 times a week.
    • weight lifting
    • resistance bands
    • body weight-bearing exercises such as pushups, squats, yoga

How much protein should you eat?

  • The recommended daily allowance for protein is 0.8 to 1 gram/kg of body weight or 0.36 gram/pound of body weight. The protein need depends on activity level, age, muscle mass, and overall health. Those who exercise regularly and the elderly require more protein.
  • Most elderly adults require about 1.0 – 1.2 grams of protein/kg body weight

How Much Sugar Is Too Much?

Photo by Alexander Grey

We all love our sugar, whether it be in our morning cups of tea/coffee, cookies, pastries, chocolates, etc. But really, how much is too much?

Sucrose is a carbohydrate and is the chemical name for sugar which is made of two sugars(glucose and fructose)bound together and naturally made and found in all green plants. Therefore, sugars are naturally found in all foods that contain carbohydrates such as fruits, vegetables, dairy, and grains. Our bodies tend to digest these foods slowly and this natural sugar in them offers a steady source of energy to body cells.

Then we have “added sugar” which is sugar that food manufactures add to products to enhance flavor and also shelf life. This includes things like flavored yogurts, soft drinks, cakes, candies, cookies, soups, breads, ketchup, and most processed foods. Added sugar in foods is also what we add while cooking or baking.

There was a recent study published in The BMJ which analyzed several studies of different types and concluded “High dietary sugar consumption is generally more harmful than beneficial for health, especially in cardiometabolic disease. Reducing the consumption of free sugars or added sugars to below 25 g/day (approximately 6 teaspoons/day) and limiting the consumption of sugar sweetened beverages to less than one serving/week (approximately 200-355 mL/week) are recommended to reduce the adverse effect of sugars on health.”

It was found that high consumption of added sugar was associated with negative health effects such as obesity, diabetes, heart disease, stroke, gout, high blood pressure, dental caries, high cholesterol just to name a few.

The American Heart Association suggests that women consume no more than 100 calories (about 6 teaspoons or 24 grams) and men no more than 150 calories (about 9 teaspoons or 36 grams) of added sugar per day.

What can you do to limit added sugar?

  • read food labels to be aware of how much added sugar is in foods you are buying
  • try to decrease your sugar intake in beverages such as tea and coffee
  • for those of you with a sweet tooth-smaller portions of your beloved desserts and less often, start incorporating more fruit in your diet which has natural sugar
  • swap out the soda with unsweetened drinks(a 12 oz soda can has about 36 grams of sugar)
  • avoid or reduce intake of sauces like ketchup or sweet chili sauce(look into using alternatives for flavoring such as herbs or lemon)
  • change sugary cereals to healthier ones and start adding fruit and nuts to your cereal
  • cook at home so you know what is in your food

Vaccines May Change the Future of Healthcare

Per Linda Geddes in an article published in The Guardian, “Cancer and heart disease vaccines ‘ready by end of the decade’”

“Millions of lives could be saved by a groundbreaking set of new vaccines for a range of conditions including cancer, experts have said. A leading pharmaceutical firm said it is confident that jabs for cancer, cardiovascular and autoimmune diseases, and other conditions will be ready by 2030. Studies into these vaccinations are also showing “tremendous promise”, with some researchers saying 15 years’ worth of progress has been “unspooled” in 12 to 18 months thanks to the success of the Covid jab. Dr Paul Burton, the chief medical officer of pharmaceutical company Moderna, said he believes the firm will be able to offer such treatments for “all sorts of disease areas” in as little as five years. The firm, which created a leading coronavirus vaccine, is developing cancer vaccines that target different tumour types. Burton said: “We will have that vaccine and it will be highly effective, and it will save many hundreds of thousands, if not millions of lives. I think we will be able to offer personalised cancer vaccines against multiple different tumour types to people around the world.” .”

This is something to watch for in the future. Something good that may have come out of COVID-19 pandemic is the role vaccines will play in the future of healthcare in management of cancer and prevention of chronic health conditions.

Practice Intentional Eating

Photo by Jonas Kakaroto

Spring is right around the corner, getting our bodies whipped back into shape and working on feeling and looking better is also. Other than working out, intentional eating can help get us where we want to be. Intentional eating makes us cognizant of what we are putting in our bodies and accountable. Keeping track of what we eat and doing better each day should be the goal.

  • eat more organic if possible, no pesticides
  • eat less sugar
  • avoid processed foods
  • cook at home-you know what is in your food and you can make it healthier and feel better about eating
  • cook extra, you can freeze another meal for another day when you may not have time to cook(this will prevent unhealthy meals such as fast food those days)
  • eat more fruits and vegetables-you can get your vitamins and anitioxidants in them, increase the fruits and vegetable ratio so you get more of them on a plate then the carbs and fat, it will also make you plate more colorful and enticing
  • eat together-this will create time for bonding. It will also teach kids sharing, taking turns, and manners. You will tend to eat slower and not just gulp down your meal as you will enjoy conversation.
  • eat smaller portions-listen to your body regarding satiety and hunger

Tips to Get Better Sleep

Photo by Mpho Mojapelo

Getting that good night’s sleep is so very important, if can affect you and all your activities and interactions the next day. It is recommended that we get about 7 to 9 hours of good quality sleep a night but it may not always be an easy feat. Here are some tips to ensure a better night’s sleep.

Keep it cool

  • it is easier to fall asleep if your bedroom is cooler than warmer
  • set your bedroom temperature to about 67°F, the brain and body need to drop a core temperature of about 1 degree Celcius or 2-3 degrees Fahrenheit for you to fall asleep and stay asleep

Set a regular time to sleep at night for the weekdays and weekends

  • you may like to stay up later on weekends and sleep in but your internal body clock and brain responds best when you keep it regular
  • this helps with sleep quantity and quality.

Identify and implement a bedtime routine or wind-down routine that works for you

  • examples include shower, stretching, meditation, reading a book, journaling

Adjust the light

  • we need darkness at night to trigger melatonin so we need to be mindful about the last 30 to 60 minutes before bed
  • stay away from screens(laptops, phones) about the last hour before sleep, or dim the screens
  • blue light has damaging affect
  • use black out curtains in bedroom to avoid excessive light
  • in the morning, we should have the most exposure to indoor and outdoor light as we need brightness during morning hours to keep circadian rhythm regular

Room atmosphere

  • On top of a quiet, dark, and relaxing room atmosphere, where you sleep and what you sleep in matters
  • comfortable pajamas and bedding can make a big difference
  • invest in a comfortable mattress for you
  • work on a pleasant bedroom environment(furniture, acessories,etc) where you feel safe and at ease

Get recommended exercise

  • physical activity during the daytime helps you fall asleep easier but no intense activity 2 hours before sleep

Things to avoid

  • stay away from caffeine at least 6 hours before going to bed
  • avoid large meals, spicy food, and alcohol hours before bedtime
  • it is best to not eat anything 3 hours before bedtime
  • avoid drinking lots of fluids before bedtime, getting up to use the bathroom at night will interrupt your sleep cycle, especially the later stages
  • avoid loud noise
  • limit bed to sleep
  • be cautious with sleeping pills, sedatives hypnotics do not produce naturalistic sleep and can cause issues with learning and memory including forgetfulness

Consider tracking your sleep

  • We all know that everyone is different but it may be worthwhile every once in a while to track your sleep.
  • there are smart rings, smart mattresses, smart watches that can help
  • You can see how changes are affecting your sleep such as exercise, eating at a certain time, etc and can make changes to help with better sleep quality and quantitiy.

Prioritize a Heart Healthy Lifestyle

Photo by jesse orrico

February is all matters related to the heart, it not only marks Valentine’s Day, but also American Heart Month. February was declared American Heart Month in 1964 by President Lyndon B. Johnson. To understand how we can make our hearts healthy and prevent heart disease, we need to understand what heart disease is, risk factors of heart disease, and how to adopt a heart healthy lifestyle in an attempt to prevent heart disease.

Heart disease or cardiovascular disease is a general term which means disease of the heart and blood vessels. Coronary artery disease occurs when there is narrowed or blocked blood vessels that can affect blood flow to the heart. A heart attack can occur when blood flow is severely reduced or blocked. Symptoms of heart attack may not be clear cut and may range from chest pain, sometimes an “elephant” sitting on your chest, shortness of breath, jaw pain, dizziness, sweating, nausea, heartburn, stomach pain, or flu like symptoms.

Risk factors of heart disease include high blood pressure, high cholesterol, lack of exercise, diabetes mellitus, blood clots, stress, unhealthy diet, obesity, smoking, second hand smoke, genetic risk factors, and age over 65 years.

80% of heart disease is preventable so we all can all do a little something to improve our chances, it does not have to be all at once, but pick one or two things to work at and then pick another, you will be moving in the direction to love your heart.

Tips to lead a heart healthy lifestyle

Get active and stay active

  • American Heart Association recommends 150 minutes a week of moderate intensity exercise. This may not always be possible, but exercise in any form, even as simple as going for a walk helps
  • Sit less(don’t forget about sitting disease)
  • Spending time outside in nature can be a plus and can reduce stress and lower cortisol level

Evaluate your risk factors with the help of your doctor

Going to the doctor helps take care of preventive measures, you can get checked for elevated cholesterol, diabetes, high blood pressure and come up with a game plan.

  • High cholesterol
    • extra cholesterol enters your body when you eat foods high in trans-fat and saturated fat. Too much bad cholesterol(LDL or low-density lipoprotein) causes plaque to form on artery walls(leading to a term called atherosclerosis)
    • Goal: Total cholesterol should be less than 200 mg/dl, work on increasing your good cholesterol(HDL or high density lipoprotein)
  • High blood pressure
    • can strain the heart
    • Goal: blood pressure should be less than 120/80 mmHg
    • lower blood pressure will decrease the force/strain on the heart and arteries and can prevent heart attacks and strokes
  • Diabetes mellitus
    • high blood sugars damage blood vessels and nerves
  • Maintain a healthy weight
    • Obesity leads to major risk factors for heart disease and more
    • Goal: maintain a waist circumference less than 35 inches for women and 40 inches for men

Eat healthy

  • reduce trans-fat highly processed fats that clog arteries and raise LDL and lower HDL
  • avoid processed foods-margerine, fried food, snack foods
  • eat lots of fresh fruit and vegetables, nuts, high fiber diet, olive oil(good fat)

Good dental hygiene

  • bacteria in mouth can cause gum disease and move to blood stream
  • floss daily and brush twice daily
  • eating leafy greens and fiber can also give better oral hygiene

Manage stress

  • chronic stress increases inflammation and increases potential of cardiovascular disease
  • things you can do: meditation, yoga, breathing exercises, laughter, physical contact

Sleep better

  • people who sleep fewer than 6-8 hours a night are twice as likely to have a stroke or heart attack

Quit smoking and avoid second hand smoke

Educate your family and friends and know your family history