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PIKSEL / Getty ImagesNew guidelines for stroke prevention from the American Stroke Association emphasize the benefits of GLP-1 drugs, a balanced diet, regular physical activity, and maintaining a healthy weight.PIKSEL / Getty Images
The American Stroke Association has updated its guidelines on stroke risk reduction for the first time since 2014.
In their recommendations, the ASA urges healthcare professionals to carefully screen patients for risk factors such as high blood pressure, elevated cholesterol levels, obesity, and high blood sugar.
The new stroke guidelines highlight unique risk factors for females and transgender women and how social determinants of health impact stroke risk.
The guidelines also emphasize the benefits of GLP-1 drugs for cardiovascular health, and encourage a balanced diet, regular physical activity, maintaining a healthy weight, and getting adequate sleep.
The Centers for Disease Control and Prevention (CDC) estimates nearly 800,000 people have a stroke every year in the United States. Of these, more than 600,000 will be a first-time stroke.
For the first time in 10 years, the American Stroke Association (ASA) has updated its guidelines for reducing stroke risk. According to an ASA news release, up to 80% of strokes may be preventable through diet and lifestyle changes and other modifications.
Many of the new stroke guidelines coincide with the American Heart Association’s Life’s Essential 8, which promotes cardiovascular and brain health. The lifestyle factors in the ASA’s new stroke guidelines include a healthy diet, regular exercise, better sleep, and smoking cessation.
“Patients looking to reduce their stroke risk (and cardiovascular disease risk in general) should strive to follow the American Heart Association’s Essential 8 recommendations for healthy living,” said Cheng-Han Chen, MD, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California. Chen wasn’t involved in the new guidelines.
“We recommend that people eat a healthy balanced diet, engage in regular physical activity, get an adequate amount of sleep, maintain a healthy weight, avoid tobacco and alcohol, reduce stress, and control their blood pressure and cholesterol numbers,” Chen told Healthline.
Overall, the guidelines provide a clear pathway for medical professionals and their patients. The guidelines also call for more public awareness and education about how people can lower their risk of stroke.
Women face unique stroke risk factors
The updated stroke guidelines recommend that medical professionals screen for conditions that can increase the risk of stroke in females.
Stroke risk factors affecting females include the use of oral hormonal contraceptives, developing high blood pressure during pregnancy, and pregnancy complications, such as:
The guidelines also note that transgender women and gender-diverse individuals taking estrogen may also be at an increased risk of stroke.
Social determinants of health and stroke risk
The new stroke recommendations emphasize “social drivers of health.” These non-medical factors include inequities in healthcare, education, economic stability, and structural racism.
The ASA adds that neighborhood factors such as a lack of walkability and access to healthy food also play a role. The guidelines urge medical professionals to advocate for patients in these circumstances.
“Some populations have an elevated risk of stroke, whether it be due to genetics, lifestyle, biological factors and/or social determinants of health, and in some cases, people do not receive appropriate screening to identify their risk,” said Cheryl Bushnell, MD, a professor and vice chair of research in the Department of Neurology at Wake Forest University School of Medicine in North Carolina, in a news release. Bushnell is chair of the group that wrote the new guidelines.
“This guideline is important because new discoveries have been made since the last update 10 years ago,” she continued. “Understanding which people are at increased risk of a first stroke and providing support to preserve heart and brain health can help prevent a first stroke.”
José Morales, MD, a vascular neurologist and neurointerventional surgeon at Providence Saint John’s Health Center in California Morales echoed the importance of primary stroke prevention and said the guidelines were long overdue. Morales wasn’t involved in developing the new guidelines.
“The focus on equitable access to healthcare, social determinants of health, and gender-specific recommendations are important additions to guiding clinical practice in an evidence-driven matter,” he told Healthline.
The medications, which have been approved by federal regulators as treatments for obesity or type 2 diabetes, have shown promise in clinical trials in improving cardiovascular health and reducing the risk of stroke.
Chen said the inclusion of newer topics such as weight-loss drugs into the new guidelines is an important step.
“These updated guidelines also incorporate the important new class of drug (GLP-1 agonists) that we are finding to be extremely effective in treating those same risk factors for stroke,” Chen noted.
Healthy diet for stroke prevention
One of the most important things you can do to prevent a stroke is to maintain a healthy, balanced diet.
The new guidelines urge people to stick closely to a Mediterranean diet. This diet focuses on the eating habits of people who live along the Mediterranean Sea.
That plan encourages people to consume more fruits and vegetables as well as legumes, nuts, seeds, and heart-healthy fats. It discourages the consumption of processed foods, added sugars, refined grains. It also recommends limiting the consumption of alcohol.
“Risk factors for stroke vary by age, gender, genetics, comorbidities, and even medications. Therefore, I think the suggestion of screening for not only the basic risk factors but also secondary factors is essential to prescribe the right lifestyle interventions,” said Kristin Kirkpatrick, MS RDN, a dietitian at the Cleveland Clinic Department of Wellness & Preventive Medicine in Ohio. Kirkpatrick wasn’t involved in the new guidelines.
“For my patients, I will often also recommend a Mediterranean pattern, but then work with the patient to assess tweaks to that pattern,” she told Healthline.
“For example, with someone who has insulin resistance or type 2 diabetes, I may focus on a more moderate carbohydrate version of the Med diet. For patients with high blood pressure, I may counsel more on a low sodium perspective. The most important component, however, may be to focus as a whole on a more plant-forward approach that limits ultra-processed foods, sugar, refined grains, and excess amounts of alcohol,” Kirkpatrick continued.
“I also recommend nutrigenomics testing for my patients as well to be able to get a truly personalized approach to prevention based on genetics,” she said.
Exercise and stroke prevention
The guidelines recommend that healthcare professionals screen patients for sedentary behavior and counsel them to engage in regular exercise.
As noted by the ASA’s news release, physical activity is “essential for stroke risk reduction and overall heart health.”
The CDC recommends that adults get at least 150 minutes a week of moderate-intensity aerobic activity or 75 minutes a week of vigorous aerobic activity. That exercise should be spread throughout the week.
Regular exercise can help improve metrics such as blood pressure, cholesterol levels, inflammatory markers, insulin resistance, and overall weight.
“A combination of both aerobic and anaerobic is essential to focus on both muscle retention (and growth) as well as cardiovascular health. Flexibility is also an important factor,” Kirkpatrick said.
Untreated high blood pressure, also known as hypertension, can cause damage to arteries that can eventually lead to a higher risk of stroke, heart attack, and other cardiovascular issues.
The typical way to diagnose hypertension is by having your blood pressure checked.
Causes of high blood pressure include family history, smoking, and a high intake of caffeine, alcohol, and salt. A lack of physical activity and obesity can also be factors.
In addition to regular screenings, the guidelines urge healthcare professionals to make sure patients at risk for high blood pressure are eating a heathy diet and getting regular exercise.
“Over the past decade, we have gained a better appreciation for the need to manage lifestyle-related cardiometabolic risk factors such as hypertension, overweight/obesity, cholesterol, and blood sugar control,” Chen said.
Sleep quality and stroke prevention
Healthy sleep is listed in both the new guidelines and the Life’s Essential 8 as an important component of reducing stroke risk and promoting heart health.
The CDC estimates that more than 30% of U.S. adults get insufficient sleep.
The CDC recommends that adults obtain a minimum of 7 hours of sleep per night. It’s also not recommended that you get more than 9 hours of sleep per night.
“Adequate and consistent sleep, mindfulness, and taking steps to reduce exposure to pollution would be other factors,” Kirkpatrick said.
What to know about stroke
Stroke is the fifth leading cause of death with nearly 160,000 related deaths annually. The CDC notes that stroke is also a leading cause of long-term disability.
CDC officials add that stroke-related costs in the U.S. were $56 billion between 2019 and 2020. Those costs included healthcare services, medications, and missed days of work.
A stroke occurs when there is a blockage in the blood supply to the brain or when a blood vessel in the brain ruptures. The blockage or rupture prevents blood and oxygen from reaching the brain’s tissues.
Symptoms of a stroke include:
paralysis
numbness or weakness in the arm, face, or leg.
trouble speaking or understanding others
vision problems
dizziness
sudden headache
Medical professionals say the quicker someone is diagnosed with a stroke and receives treatment, the better their chances for survival and recovery.
They recommend a person attending to a person who is suspected of having a stroke to adhere to a checking system with the acronym BE-FAST. That stands for:
Balance: Does the person have trouble standing?
Eyes: Are they experiencing vision difficulties?
Face: Does one side of their face droop?
Arms: Can they lift both arms?
Speech: Is their speech slurred or difficult to understand?
Time: If any of the above symptoms are present, call 911
Takeaway
The American Stroke Association has updated its guidelines on stroke risk reduction for the first time since 2014.
In their recommendations, the association urge healthcare professionals to more carefully screen patients for risk factors such as high blood pressure, elevated cholesterol levels, obesity, and high blood sugar.
The new stroke guidelines also highlight unique stroke factors for females and transgender women.
The ASA also emphasizes the benefits of GLP-1 drugs for heart health and urges more awareness of the health dangers of poor diet, sedentary behavior, obesity, and lack of adequate sleep.
An initial toxicology report revealed that former One Direction member Liam Payne had several drugs, including “pink cocaine,” in his system when he died after falling from a hotel balcony in Argentina. Mike Marsland/Mike Marsland/WireImage/Getty Images
Liam Payne, a former member of pop group One Direction, passed away on October 16.
His death is still under investigation, but authorities believe that drug use was a potential contributing factor.
Over the years, Payne had been outspoken about his mental health journey and living with substance misuse.
The death of Liam Payne on October 16th is a tragic reminder of the complexities of navigating mental health and drug misuse, even for those with the resources to do so.
Payne, a singer and former member of the pop group One Direction, fell to his death from the balcony of a hotel in Argentina on October 16, 2024. He was 31 years old.
The incident is still under investigation, and police have yet to determine if the death was caused by accident or suicide.
In the months leading up to his death, Payne had apparently told those in his inner circle that he was sober.
But the scene in his hotel room told a different story, where suspected drug paraphernalia, unknown powder, and anti-anxiety medication were littered around.
Reports indicate that an individual at the hotel had been acting erratically before the incident. Police have suggested that a drug-induced hallucination may have led to the fall, but that has not been confirmed at this time.
Nicola Payne, Liam’s sister, wrote a tribute to her brother after the news of his death.
“You led your life with a motto of why bother doing something unless you are brilliant at it, and Liam you were certainly brilliant at everything you did!! … I hope you have finally found peace up there and that you’ll continue to look after us all as you have done in life,” she wrote.
Payne had shared details about his mental health journey and substance use before his death
The former One Direction member had been outspoken over the years about his mental health journey and drug misuse, exacerbated by the pressures of fame and celebrity.
The singer, who was only 16 when he joined One Direction, was catapulted to fame after the group took off on the television show “The X Factor” in 2010. Payne left the band in 2015, and the group disbanded in 2016.
Payne later revealed some of his experiences with alcohol and suicidal ideation on the Diary of a CEO podcast, describing going through a “pills and booze phase” while touring with One Direction.
“Where’s rock bottom for me? And you would never have seen it. I’m very good at hiding it. No one would ever have seen it… There is some stuff that I have definitely never, never spoken about. It was really, really, really severe. And it was a problem,” he said.
He also described some of his time with the group as boring and unfulfilling, referring to getting up on stage as “putting the Disney costume on.”
Rachel Goldman, PhD, a licensed psychologist in private practice in NYC and clinical assistant professor in the Department of Psychiatry at New York University, told Healthline that those kinds of negative feelings are all too common.
“Mental health concerns and mental health illnesses don’t discriminate. Celebrities have a lot of pressure; they often have a different persona on stage or on camera than in real life, and that isnt easy to manage. Mental health resources need to be more readily available, accessible, encouraged, and normalized — even for celebrities,” she told Healthline.
Goldman also points out that discussing mental health is still heavily stigmatized, especially for men.
“We can do better regarding raising awareness around men’s mental health and continuing to break the stigma regarding asking for help and seeking help,” she said.
Signs of drug misuse and emotional distress
It can be difficult to identify the signs of drug misuse and emotional distress.
Payne’s story highlights how even when an individual is adamant about their sobriety, they can still relapse. But if you’re worried about someone and suspect they are struggling somehow, there are still things to look out for.
“In general, I like to ask people if they have noticed changes in mood, sleep, energy, focus/concentration, appetite, or motivation,” said Goldman.
Quickly changing emotions (e.g. feeling very sad followed by very happy)
Not caring for oneself (e.g. not showering or brushing teeth)
Sleeping strange hours
Changing friends frequently
Having interpersonal and familial problems
Drug misuse and mental health are complex issues, but Goldman suggests that beginning by validating someone’s feelings is a good place to start addressing them.
“Oftentimes, people need to know their feelings are valid and want to be heard. Many times people aren’t looking for advice or others to solve their problems (although sometimes that is what people want). Just simply listening and offering a listening ear can show that you care and you are concerned,” she said.
“Making the connection, validating their feelings, and showing that you care and are concerned is often the first step as it gives them a safe space,” added Goldman.
The bottom line
Liam Payne, a former member of the pop group One Direction, died on October 16 in Argentina after falling from his hotel balcony.
His death is still under investigation by police, but early reports indicate that drug use was a potential contributing factor.
Payne was outspoken about his struggles with mental health and drug misuse over the years.
Identifying the signs of drug misuse and emotional distress can be difficult. They often include changes to sleep, mood, social life, and performance at work.
If you or someone you know is struggling or in crisis, help is available. In the United States, call or text the suicide and crisis lifeline at 988.
Eating a diet high in sugar is linked with several increased risks, including depression, type 2 diabetes, and stroke. Oscar Wong/Getty Images
In a recent study, having a sweet tooth was linked with a greater risk of depression compared to those who favor healthier foods.
Preferring sweets was also associated with greater metabolic disease risk.
People who strongly prefer sweets had higher inflammation, blood sugar, and lipids.
Small, sustainable changes will make it easier to reduce your sugar intake.
You may even find that you feel better in just a few weeks, giving you an incentive to continue.
Do you have a sweet tooth? According to Statista, many people in the U.S. do. In fact, when they surveyed Americans in 2022 and 2023, 41% said they ate sweets regularly.
However, if you consume a lot of sugary foods, research indicates that you may want to reconsider your choices.
In the October 2024 study, which was published in the Journal of Translational Medicine, the researchers found that people who favored sweets had a higher risk of depression than those who preferred healthier foods.
These individuals also had higher levels of inflammation, blood sugar, and lipids, which can indicate a risk of metabolic disease.
On the other hand, those people who had a more health-conscious eating pattern had reduced risk of heart disease and stroke, per the authors.
How having a sweet tooth affects metabolic disease risk
The researchers examined data from blood samples taken from the UK Biobank, a large database containing health and genetic information for half a million volunteers in the U.K.
The data contained information about 2,923 proteins and 168 metabolites that had been measured to look for changes.
The research team used unsupervised machine learning to look for patterns in this data, finding three distinct groups based on people’s food preferences: Health-conscious (preferring vegetables and fresh fruit to animal-based foods and sweets), Omnivore (preferring all foods), and Sweet-tooth (having a high preference for sweet foods and beverages).
Looking at the various proteins and metabolites, they found those in the sweet tooth group had higher C-reactive protein, a marker for inflammation.
They also had higher blood sugar and worse lipids, elevating their risk of metabolic conditions like diabetes and heart disease.
The team further found that having a preference for sweets was linked with a greater likelihood of having depression, diabetes, and cardiovascular disease compared with the other two groups.
On the other hand, the Health-conscious group had a reduced risk of heart failure, chronic kidney disease, and stroke; and the Omnivore group had only moderate health risks.
While they did not directly observe what people ate, the researchers noted that food preferences alone could potentially be used to predict people’s risk for metabolic diseases.
However, more research is required to confirm their findings.
Why having a sweet tooth might increase health risks
Dr. Michael O. McKinney, a physician and nutritionist with Healthy Outlook, said that the risks to physical and mental health increase when we eat a lot of sugar because of how sugar affects the body’s functioning.
He said that when you consume sugar, your blood sugar rises, which in turn increases the amount of insulin produced to cope with the added sugar.
“The consumption of food items containing excessively high glucose levels in the long course can result in insulin resistance,” said McKinney, “which is a root cause of metabolic illnesses such as Type II diabetes.”
Ingesting excess sugar and carbohydrates can also lead to high levels of inflammation, he said, which is linked with heart disease, stroke, and mental health conditions like depression and anxiety.
“Inflammation can damage the brain and impair the body’s capacity to govern emotions, increasing mental illness susceptibilities,” explained McKinney.
How you can reduce your sugar consumption
Dr. Ramit Singh Sambyal, an MD/General Physician associated with ClinicSpots, said that reducing your sugar consumption doesn’t have to be overwhelming.
“Small, gradual changes can make a huge difference,” he said.
The first step is becoming aware of all the places that sugar can hide.
“Many everyday foods, even ones marketed as ‘healthy,’ contain hidden sugars,” said Sambyal.
He suggests taking a closer look at labels, especially those of products like sauces, salad dressings, and flavored yogurts.
Sambyal also advised learning to look for sugar’s different names, such as glucose or maltose.
Another step in reducing your sugar consumption is to reach for whole fruits like apples and berries rather than grabbing a candy bar or other sugary snack.
“They provide natural sweetness while also offering fiber, which helps stabilize blood sugar,” he said.
However, you don’t need to make any drastic changes right away.
“Start by making small adjustments — like using less sugar in your coffee or choosing whole grains over sugary cereals,” suggested Sambyal. “This makes the change more manageable and sustainable in the long term.”
Finally, he advises looking at any sugary drinks that you regularly indulge in. “Sodas, fruit juices, and energy drinks are some of the biggest sources of added sugar in our diets,” said Sambyal. “Switching to water, sparkling water, or herbal tea can make a big difference.”
While cutting out sugar can result in some temporary sugar detox symptoms, you may find that you feel better within just a few short weeks.
In fact, Sambyal mentioned that those with depression may experience changes in their well-being relatively quickly.
“Patients who reduce their sugar intake often notice improvements in their energy levels and mood,” said Sambyal. “They feel less sluggish and experience fewer mood swings.”
And, of course, in the long term, you reduce your risk of not only depression but also conditions like heart disease and diabetes.
“Reducing sugar is one of the best steps you can take for your health,” said Sambyal. “Even small changes can significantly improve your physical and mental well-being over time.”
Takeaway
According to a new study, having a sweet tooth may be linked with a greater risk for depression.
These people also had higher inflammation, blood sugar, and lipids, which may indicate a greater risk for metabolic diseases like diabetes and heart disease.
To eat less sugar, you can start slowly by reading labels and making better choices, like having whole fruits when you crave sweetness and putting less sugar in your coffee.
Small changes will add up over time to a happier, healthier you.
New research examined several key factors to determine which states rank the highest and lowest for mental health care. Alexander Spatari/Getty Images
New research analyzed seven data points to reveal the worst states for mental health care.
Texas topped the list as the worst state for mental health care for a second time in two years, while Vermont was ranked as the best state for mental healthcare.
Experts offer advice on what to look for in health insurance plans regarding mental health coverage and how to access mental healthcare without insurance.
Where you live may determine the kind of mental health care you can access.
For instance, if you’re in Vermont, you’re in good shape, but if you’re in Texas, not so much, according to Forbes Advisor Health Insurance, which analyzed seven data points to reveal the worst states for mental health care.
For the second year in a row, Texas tops the list of worst states due to having a large population of uninsured adults with mental illness and having significant barriers to mental health resources. Vermont ranks as the best.
Six of the top 10 worst states for mental health care are located in the South, whereas five of the top 10 best states for mental health care are in the Northeast.
“Research reports that mental health care is significantly influenced by a person’s beliefs and their place of residence, with urban and northern states having more positive overall mental health,” Deborah Serani, PsyD, psychologist and professor at Adelphi University, told Healthline.
The top 5 states for the worst and best mental healthcare
Below are the top rankings, according to Forbes Advisor Health Insurance.
Worst States for Mental Health Care
Texas
Georgia
Alabama
Florida
Mississippi
Best States for Mental Health Care
Vermont
Connecticut
Rhode Island
Pennsylvania
Massachusetts
The disparity between the South and the Northeast underscores the need for more investment and attention to mental health infrastructure in the most underserved states, said Jason Metz, lead insurance editor at Forbes Advisor.
“It’s a positive federal policy that health insurance plans cover mental health, but the study emphasizes significant gaps still exist when it comes to regional access to care,” he told Healthline.
Why Texas ranks the lowest for mental health care
Texas tops the list as the worst state for mental health care for the second time in two years due to a combination of factors that create significant barriers to accessing treatment, said Metz.
“The state has a high rate of uninsured adults with mental health illness, 21.4%, the second highest in the U.S. Additionally, nearly 75% of youth with depression do not receive mental health services, and 19.4% of youth with private insurance lack coverage for mental health problems,” he told Healthline.
Financial barriers also factor into the ranking, with nearly one-third of those with a mental illness unable to afford a doctor’s visit.
“Texas has a limited mental health infrastructure, ranking the third lowest in the number of treatment centers, with only 8.4 per 10,000 businesses,” said Metz. “Overall, two-thirds (62.3%) of adults with mental illness in Texas go untreated, highlighting the state’s challenges in mental health care.”
Serani noted that socio-cultural beliefs with regard to mental health care also play a part. Statistically speaking, she said people who live in the South tend to have beliefs that seeking help for mental health suggests personal weakness and would harm their reputations.
“Clinically called public stigma and self-stigma, these assumptions prevent others from getting the help they need,” she said.
Why Vermont ranks highest for mental health care
Vermont has great access to services, comprehensive insurance coverage, and strong support for mental health initiatives, said Metz.
“The state has a well-developed mental health care system, with 34 treatment centers per 10,000 businesses—only bettered by 4 states,” he said. “Vermont also has lower rates of uninsured individuals with a mental illness (6%), with more residents having health insurance that covers mental health services, reducing financial barriers to care.”
The state also has one of the lowest percentages of untreated mental illnesses (43%), demonstrating its healthcare system’s ability to meet the mental health needs of its population.
Reduced stigma around mental health may also have influence, noted Serani.
“People in the Northeast are socialized in ways that asking for help is not viewed as a vulnerability, so mental health care and treatment are accessed more,” she said.
Does stigma affect how well states treat mental health care?
Sarah Davis, senior managing editor at Forbes Health, said while the stigma traditionally associated with mental health conditions is beginning to dissipate, it still exists and can impact insurance coverage.
She pointed to a 2024 study in The Lancet that found structural stigma of mental health disease refers to the “inequitable deprioritization, devaluation, and othering of mental health and substance misuse health (compared with physical health)” in healthcare systems.
“The study notes an example of this as a hospital emergency department having a patient-to-nurse ratio of 3:1 for physical health patients but a 6:1 ratio for mental health patients,” Davis told Healthline.
The 2008 Mental Health Parity and Addiction Equity Act requires certain health plans to provide physical and mental health benefits equally.
“[But] the National Alliance of Mental Health points out parity laws mean nothing if there are factors like inadequate provider network coverage in certain geographical areas, which you can see in our survey findings,” said Davis.
What to consider when choosing a mental health insurance plan
To ensure proper coverage, Metz said consider the following.
Confirm the health plan covers local mental health providers
If you have a provider in mind, it’s always best to confirm it’s in-network with the plan you’re considering.
“In-network versus out-of-network providers will make a difference on how much you pay for care,” Metz said.
Consider all the associated costs of the plan
Health insurance costs include both your monthly premium and all of your out-of-pocket costs.
“So when comparing health insurance quotes, review all costs like copays, deductibles, coinsurance, and out-of-pocket maximums,” said Metz.
“If you’re already taking medication, confirm its coverage with the potential plan,” said Metz.
Consider virtual healthcare coverage
While treatment for mental health services is generally preferred to occur in person, Serani said the pandemic proved that virtual therapy can be effective too.
“So, if you’re homebound, live too far from mental health resources, or can’t find a mental health practitioner that has a specialty in your concerns, the option to get treatment virtually opens many more possibilities,” she said.
Know if you need a referral for mental health care
Some health insurance plans require a referral from a primary care provider for mental health services.
“For example, an HMO usually requires referrals for most types of specialized coverage, while a PPO and EPO do not,” said Metz.
What mental health coverage typically includes
When choosing an insurance plan for mental health care, Serani said to choose a plan with an out-of-network benefit so you can go to a specialist.
“You really want to find someone who has training in the issues with which you are struggling,” she said.
If you must stay in-network, Serani said there are ways to access expert mental health care if there isn’t a specialist in your network.
“The insurance term called a single case agreement can help you work with a trained mental health specialist that you may not be able to find in your HMO network,” she said.
Below are some of the services that the best insurance plans for mental health cover, said Metz.
Talk therapy includes specific therapy modalities like general counseling, cognitive behavioral therapy, and dialectical behavioral therapy. “If you’re meeting one-on-one with a therapist or psychologist, the session is typically covered by insurance, less out-of-pocket costs,” said Metz.
Inpatient hospitalization involves intensive mental health treatment, which can be voluntary or involuntary. “You stay in a hospital or facility for a short period and receive continuous care through individual and group therapy, medication management, and coping strategies,” Metz said.
Partial hospitalization includes a structured program of psychiatric treatments during the day only.
Substance misuse treatment addresses drug and alcohol addiction. “Health insurance plans may cover talk therapy, medication management, 12-step programs, or medical detox for people going through substance abuse treatment,” said Metz.
Emergency psychiatric care or crisis intervention might include self-harm or overdose treatment, however coverage varies by plan.
Medication coverage usually includes at least partial coverage of pharmaceutical treatment for mental health disorders, with some plans requiring a copay or other out-of-pocket costs for these medications.
How to access mental health services without insurance
In Serani’s book, “Living with Depression,” she included the below options for accessing mental healthcare if you don’t have insurance.
Sliding scale and pro-bono services
Many psychotherapists make accommodations to see children and adults at low fees or pro-bono fees.
“Check with local mental health organizations to discover which professionals offer low or no-fee sessions,” said Serani.
University programs
Frequently, university and college programs will offer psychotherapy to children and adults at low fees.
“Generally staffed by graduate students earning degrees in related psychotherapy fields, the treatment takes place in the university setting,” she said.
Postdoctoral or postgraduate psychotherapy centers
Consider working with an already licensed mental health expert who is pursuing a postgraduate degree in psychotherapy. Similar to university centers, they offer low-fee treatment, yet the sessions commonly occur in the therapist’s office.
“By and large, these professionals have a desire to become even more specialized in the field of psychotherapy, and they seek training programs to hone their skills,” Serani said.
State and county clinics
There are over 1,500 free clinics in the United States, providing health services to children and adults who have no health care coverage.
“As a rule, you go through a clinic screening where your overall health is evaluated. With regard to mental health, a case manager helps you get to a therapist,” said Serani.
Standing more isn’t enough to offset the negative health effects of a sedentary lifestyle and may raise the risk of circulatory diseases. Kristine Weilert/Stocksy United
Sitting and sedentary behavior are linked to a higher risk of many health conditions, including cardiovascular disease.
Standing isn’t enough to offset the negative health effects of a sedentary lifestyle, according to a new study.
Prolonged standing may increase the risk of circulatory diseases, such as varicose veins, the authors suggest.
Doctors recommend brief bursts of exercise or activity throughout the day to offset the health risks of sedentary behavior.
Many people are familiar with the modern-day sedentary routine: you sit all day at your work computer, and then you decompress by sitting at home watching television. All that sitting has serious negative effects on health.
Standing desks and other innovations have made standing a popular antidote to extended periods of sitting. Unfortunately, standing may not be enough to offset those risks, according to new research.
A new study published in International Journal of Epidemiology suggests that prolonged standing may not offer much in the way of health benefits and raise the risk of orthostatic circulatory disease.
Australian researchers cast doubt on the benefits of standing and underscored the necessity for daily activity to combat sedentary behavior.
“Standing, although not associated with higher risk for heart disease, was also not associated with lower risk. More time spent standing was associated with higher risk for circulatory conditions,” Matthew Ahmadi, MD, first author of the study, research fellow, and deputy director of the Mackenzie Wearables Research Hub at the University of Sydney, told Healthline.
Sitting and ‘stationary’ behavior linked to circulatory disease
Using accelerometer data from more than 83,000 adults in the United Kingdom, researchers investigated the outcomes of sedentary behavior on cardiovascular disease and orthostatic circulatory disease outcomes.
The findings were confirmatory of the risks related to sitting.
Sitting for more than 10 hours per day increased both cardiovascular and orthostatic disease risk. For every hour of sitting above 10 hours, cardiovascular disease risk increased by 15%, and orthostatic disease risk increased by 26%.
“Stationary behavior,” which includes both standing and sitting without movement, showed similar risks when performed more than 12 hours per day: for every additional hour CVD risk increased by 13% and orthostatic disease risk jumped by 22%.
Standing time was not associated with increased risk of cardiovascular disease, but was positively associated with orthostatic disease risk.
After 2 hours of standing per day, every additional 30 minutes was associated with an 11% increased risk.
“It’s not sitting or standing, it’s the lack of movement or continuous uninterrupted sedentary behavior that’s problematic and you can still do that when you’re standing. You can be sedentary while standing,” Scott Lear, PhD, a professor of health sciences and Chair in Cardiovascular Prevention Research at Simon Fraser University, told Healthline.
Is standing better than sitting?
Despite the findings, other experts maintained that standing is still likely a better option than sitting, although the health benefits may be limited.
“For the same amount of sedentary time, standing was better than sitting,” Michael McConnell, MD, a clinical professor of cardiovascular medicine at Stanford Medicine told Healthline. “But more standing is not a panacea in that it doesn’t decrease CVD risk — you need to move for that,” he added.
Evan L. Brittain, MD, MsC, an associate professor of cardiovascular medicine at Vanderbilt University Medical Center, agreed that standing still has health benefits.
“I disagree with the idea that standing isn’t ever a valuable replacement for sitting. If you’ve got to be in one place and you’ve got to be stationary, then I think these data do support standing,” he told Healthline.
Although standing may not be protective against CVD or orthostatic disease risk, it was still associated with a lower risk overall than sitting.
“Less harmful is the same as being beneficial. If you’ve got to be in one place in front of your computer, then compared to sitting, standing is beneficial. That’s another way of interpreting these data,” said Brittain.
There’s no clear solution on how to solve the sedentary behavior problem in America, but the experts interviewed by Healthline offered a variety of strategies, including:
using a treadmill desk
changing your position at regular intervals using a convertible sit-to-standing desk
being active at work (i.e., taking phone calls while walking or walking meetings)
incidental activity like getting up for coffee
incorporating chores like laundry throughout the day if you work from home
“To optimize cardiovascular health and lower the risk for circulatory conditions, standing should be mixed with periods spent walking or doing other forms of activity that gets the body moving. Such as taking the stairs or a short walk around the block mixed in with standing,” said Ahmadi.
Takeaway
A new study of more than 83,000 individuals investigated the effects of sitting and standing on cardiovascular disease risk and circulatory disease risk.
Contrary to popular belief, standing was not shown to be protective against cardiovascular disease risk. And, like sitting, extended periods of standing may increase the risk of circulatory diseases, such as varicose veins.
To offset the deleterious health effects of sedentary behavior, doctors recommend periodic exercise and activity throughout the day. This could include set periods of walking or light activity, or incorporating activity into work itself, such as through walking meetings or phone calls.
Naltrexone (referred to as the “Ozempic of alcohol”) is a drug that can help reduce alcohol and opioid cravings for people living with substance misuse disorder. vitapix/Getty Images
Prescription medication naltrexone is used to treat alcohol use disorder and opioid use disorder.
The drug works by reducing cravings and the “buzz” associated with the use of alcohol.
Naltrexone can help people cut back on how much alcohol they drink but is best used alongside behavioral and psychosocial support programs.
A pill that costs less than a dollar has been called the “Ozempic for drinking” after helping people cut back on how much alcohol they consume.
This prescription medication, known as naltrexone, is used to treat alcohol use disorder and opioid use disorder by reducing cravings and feelings of euphoria associated with the use of alcohol or opioids.
Here’s what to know about naltrexone.
What is naltrexone?
Naltrexone is a prescription medication approved by the Food and Drug Administration to treat alcohol use disorder and opioid use disorder. Naltrexone can be prescribed by any health care practitioner licensed to prescribe medications.
“Of the medications that are available [to treat alcohol use disorder], naltrexone is the one with the most clinical research and evidence to support its safety and effectiveness,” said Keith Heinzerling, MD, addiction medicine specialist, and director of Pacific Neuroscience Institute’s Treatment & Research in Psychedelics Program at Providence Saint John’s Health Center in Santa Monica, Calif.
However, “naltrexone works best in combination with significant behavioral support, internal motivation by the patient and psychosocial support,” he told Healthline.
According to the National Institute on Alcohol Abuse and Alcoholism, alcohol use disorder is a “medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational or health consequences.” Alcohol use disorder can range from mild or moderate to severe or even life threatening, said Heinzerling.
Treatment with naltrexone lasts three to four months. For alcohol use disorder, it is available in pill form or as an extended-release injection, which is given every four weeks.
How naltrexone works
Naltrexone works by binding to opioid receptors in the body. This “helps decrease cravings for alcohol,” which helps them consume less alcohol, said Natalie Klag, MD, assistant professor of psychiatry in the Department of Psychiatry & Behavioral Health at The Ohio State University Wexner Medical Center and College of Medicine.
It “also makes it easier to put the brakes on and stop drinking if there is a return to use,” she told Healthline.
Some people take naltrexone regularly to abstain from alcohol use.
Others take it in pill form an hour before drinking alcohol to reduce the risk of alcohol overuse. This is known as the Sinclair Method. When done this way consistently over several months, a person may lose the desire to drink entirely.
Is naltrexone effective?
“Naltrexone is an incredibly safe and effective medication,” said Klag. However, “with any medications, but particularly for those used to treat any substance use disorder, the most important factor is working with a provider that you trust and who will work with you in a collaborative relationship.”
The World Health Organization recommends the use of naltrexone and acamprosate for the treatment of alcohol use disorder in adults.
Clinical studies from 2001 found that 78% of people who took naltrexone in pill form one hour before drinking were able to stop drinking altogether or drink very infrequently. This has helped people stay sober for longer periods.
In addition, “if people do return to drinking [while using naltrexone], they drink less, which can be important,” said Heinzerling, “because they might be more likely, if they have a slip-up and begin drinking, to be able to get back on track and not go into a full-blown relapse.”
Klag pointed out that naltrexone does not make you sick if you drink while taking it. “This means that if someone taking it has a return to [alcohol] use, it is helpful to continue taking naltrexone,” she said.
However, the effects of naltrexone can wear off after several hours. In addition, people who continue to drink after taking naltrexone can undo the protective effects of the medication. When that happens, people may feel the alcohol “buzz” again, which can lead to increased alcohol use.
In spite of the studies showing that naltrexone and other medications help people reduce or stop drinking, these drugs are not prescribed very often. In 2023, of the estimated 28.9 million people 12 years of age and older in the United States with alcohol-use disorder over the past year, only 554,000—or 1.9%—received medication-assisted treatment.
Heinzerling recommends that people who are looking for help to stop drinking or reduce their overall intake consider naltrexone as part of a comprehensive treatment approach.
“That should also involve counseling, psychological counseling, and behavioral support,” he said.
Support groups such as Alcoholics Anonymous and others can also help people stay sober.
“Self-help groups are not a professional treatment, but [they can] provide people with ongoing support and accountability,” said Heinzerling.
Naltrexone may also cause serious side effects such as liver damage, severe reactions at the injection site, severe allergic reactions, pneumonia, or depressed mood.
Klag emphasized that while naltrexone is suitable for many people who live with alcohol use disorder, it’s not recommended for everyone.
People with existing liver impairment need to be monitored closely while taking naltrexone, she said. If their liver impairment is severe enough, they may not be able to take naltrexone.
Also, because naltrexone is an opioid blocker, it can cause problems for people who are using opioids, either prescription medicines or illegal drugs, she said. So people taking naltrexone would not be able to use opioid pain medications if they needed them for surgery or other pain.
And people with a history of depression may find that naltrexone can worsen their mood, she added.
How much does naltrexone cost?
Your cost for naltrexone will depend on your treatment plan and insurance coverage. You may also have to pay for an office visit with a doctor to receive an injection of naltrexone or a prescription for the pill form.
Optum Perks lists the cost of 30 tablets of naltrexone as low as $11.99 with a coupon from the site. This coupon can be presented to the pharmacist when filling or refilling your prescription.
The cost for a naltrexone injection is around $1,738 for a one-month supply, according to Drugs.com.
Takeaway
Prescription medication naltrexone is used to treat alcohol use disorder and opioid use disorder. It works by reducing cravings for alcohol and the “buzz” associated with alcohol use. This can help people stop or control their alcohol use.
Naltrexone is available in pill form or as an extended-release injection, which is given every four weeks. Some people take naltrexone regularly. Others take it in pill form an hour before drinking alcohol to reduce their risk of overusing alcohol.
Naltrexone has been shown to help people reduce or stop drinking. However, doctors recommend that it be used in combination with behavior support and psychosocial support programs. This may include support groups such as Alcoholics Anonymous.
The number of mpox-related deaths in Africa has surpassed 1,000, prompting health officials to call for increased international support to combat the ongoing outbreak. The Africa Centers for Disease Control and Prevention (Africa CDC) reported that 50 deaths occurred in just the past week, raising the total to 1,100. This alarming surge highlights the significant …
Whooping cough cases are on the rise in the United States. Experts say routine immunization is the best way to prevent infection. ozgurcankaya/Getty Images
New CDC data shows a resurgence in whooping cough, with cases returning to “pre-pandemic levels.”
Experts believe that missed routine vaccinations during the COVID-19 pandemic may be partially driving the increase in whooping cough cases.
Symptoms of whooping cough include cough seizures and difficulty breathing, which may be life threatening for infants.
Following the recommended routine immunization schedules is the best way to protect yourself against this bacterial infection.
A preventable illness that causes cough, seizures, and difficulty breathing is rising in the United States.
As of October 5, around 17,579 whooping cough cases have been reported, with the highest numbers in the Middle Atlantic states. By comparison, there were only 3,962 whooping cough cases around this time last year.
In June, the CDC warned that whooping cough cases were increasing, “returning to its more typical pre-pandemic cyclic patterns of more than 10,000 cases a year.”
According to experts, the five-fold increase in pertussis cases over the past year is partially linked to missed routine immunizations during the COVID-19 pandemic.
Infants are most at risk for severe illness and death, but whooping cough can affect older children and young adults. Vaccination against whooping cough with the DTaP or Tdap vaccine (depending on age) reduces the risk, but protection can wane over time, leading to outbreaks.
As the current whooping cough surge dovetails with winter respiratory virus season, cases are relatively low compared to influenza, RSV, or COVID-19. Still, the rising cases of whooping cough remain a public health concern.
“The numbers are smaller, but they’re not trivial because we don’t wish whooping cough on anyone,” said William Schaffner, MD, professor of preventive medicine and infectious diseases in the Department of Health Policy at Vanderbilt University Medical Center in Nashville.
Healthline spoke with Schaffner to learn more about what’s driving the surge in whooping cough cases and why following routine vaccination schedules is crucial for preventing infectious diseases.
This interview has been edited and condensed for clarityand length.
What is whooping cough?
Schaffner: We have substantially reduced whooping cough over the years, and it has that overtone of an infection from the history books because we don’t hear it talked about very often.
Pertussis, or whooping cough, is a bacterial infection transmitted through close contact via respiratory droplets. The infection can lead to inflammation of the throat and the bronchial tubes, and because the patient’s airways are so tiny, they can get swollen and have difficulty breathing.
What happens in the body is that the bacteria, as it multiplies, produces a series of proteins that then go out into the body, and it’s these toxins that produce the illness. The persistence of those toxins in the body is what produces these long-term cough seizures.
The Tdap vaccine protects us against the effects of those toxins. We routinely include vaccination against whooping cough among the shots that children start to receive very early in life, but what happens is the protection can wane over time, so you have to keep up your protection. Even mild whooping cough is still a very nasty, troubling infection.
What are the symptoms of whooping cough?
Schaffner: Whooping cough produces cough seizures, not the conventional kind of cough, but a whole series of coughs together, such that you may have difficulty breathing during the cough seizures. When they stop, you inhale, and that’s the ‘whoop.’
The illness is called the ‘cough of 100 days’ because these cough seizures can last for a long period of time.
During the cough seizure, sometimes they are so severe you can faint, and if you fall, you can injure yourself.
Furthermore, these cough seizures can occur at any time and are very disruptive to your life. If they interrupt your sleep, you’re not going to feel good the next day, and you’re not functioning optimally. So, these are very troubling infections.
Why are whooping cough cases surging?
Schaffner: I think the major reason is that during COVID, we began to get a lot of medical care through telemedicine because we were staying at home and not going to the doctor for fear of acquiring COVID.
As a consequence, both children and adults fell behind in their vaccination schedules, and in order to keep up your protection against whooping cough, you have to keep up your routine vaccinations.
The current surge is affecting children who have not had a complete Tdap series or missed the Tdap vaccine completely. Younger adults who also missed the series may also be affected.
Who should get vaccinated against whooping cough?
Schaffner: Whooping cough can be life threatening for infants. However, this bacterial infection can also impact older adolescents and young adults who don’t keep up with their vaccinations.
The vaccination routine for children starts when they are very young. They get a series of doses of diphtheria, tetanus, and acellular pertussis (DTdap) vaccine at 2, 4, and 6 months of age, then their fourth dose at 15 months, and another dose at 4 to 6 years of age.
Adults should get Tdap updates every 10 years. Whooping cough doesn’t affect older adults as much, because now we use a different vaccine that works very well in the relatively short term, and it has many fewer side effects than the previous Tdap vaccine. However, the duration of protection is not as prolonged as the older vaccine.
Another group of people who should be vaccinated is pregnant people. The recommendation is that you get a dose of Tdap during every pregnancy. That’s not so much for the mother’s benefit because that protection goes across the placenta and begins to protect newborns and young infants before we start vaccinating them.
Once the baby is born, anyone who wants to visit that baby should be up to date with their Tdap vaccinations because we want to create a cocoon of protection around those vulnerable babies.
Is vaccine hesitancy contributing to the whooping cough surge?
Schaffner: Vaccine hesitancy and skepticism are undoubtedly contributing to the current increase in whooping cough cases.
We hope that if people keep up with their vaccination schedules, we will see the number of whooping cough cases reduce to virtually zero.
While the greatest problem is the risk of death in infants, this is a very troublesome, nasty infection.
Takeaway
New CDC data shows whooping cough cases have increased five-fold over the past year, returning to pre-pandemic levels.
Experts say missed routine immunizations during the COVID-19 pandemic may be partially responsible for the increase. Ongoing vaccine hesitancy may also be driving rising whooping cough cases.
Following routine immunization schedules offers the best protection against whooping cough, which can be deadly for infants.
Recent research indicates that popular weight loss medications, specifically semaglutide (found in drugs like Ozempic and Wegovy), may have significant benefits in treating alcohol and opioid addiction. A study published in the journal Addiction highlights how these drugs could potentially reduce cravings and lower the rates of substance use disorders. Key findings from the study …
