Life with Chronic Conditions: Public Opinion

The Kaiser Family Foundation published an article this week “Public Opinion on Chronic Illness in America.”  The survey was conducted April 20th–30th 2018, among a nationally representative random digit dial telephone sample of 2,000 adults ages 18 and older, living in the United States.  Key findings include:

• Six in ten say they or someone in their immediate family have a chronic health condition that requires ongoing medical treatment. Compared to those without chronic conditions, these individuals are more likely to report having a hard time paying medical bills. One-third (35 percent) of those dealing with a chronic condition requiring ongoing medical care say they or their household have had problems paying medical bills in the past 12 months, compared to one-fourth (27 percent) of the overall public.

• The majority of the public are aware that heart disease, diabetes, asthma, mental health illness, cancer, and arthritis are all illnesses that are considered “chronic diseases,” but less than three in ten are aware of the prevalence of chronic diseases in this country nor how much of health spending is spent treating chronic diseases. Note that 2/3 of adults living in the US have at least one chronic condition and ¾ of all health care costs are for chronic conditions.

• Seven in ten Americans say chronic diseases are usually due to factors and circumstances beyond a person’s control, while fewer say people who have chronic diseases mostly have themselves to blame for their condition. Despite this, half of the public (including half of those dealing with a chronic illness) say individuals themselves should play the largest role in helping to prevent individuals in this country from getting chronic diseases. This is larger than the share who say the same about health care providers, the government, or employers and businesses.

• Among those dealing with a chronic health condition (either themselves or an immediate family member) the majority (55 percent) say they are or their family member are doing “everything” they can to prevent the condition from getting worse while an additional one-third (35 percent) say they are doing “many but not all the things” they could do to prevent the condition from getting worse. Fewer (9 percent of those dealing with a chronic health condition) say they are doing “just a few things” or “none of the things” to prevent the condition from getting worse.

• When asked whether they favor or oppose various policy proposals aimed at preventing or managing chronic diseases, a majority of the public say they favor proposals aimed at promoting healthy behaviors but fewer say they favor other proposals that either ban or tax unhealthy choices. There are some partisan differences with larger shares of Democrats and independents favoring all of the policy proposals compared to Republicans. 

Does public opinion matter? Yes, because it is voters who elect politicians  who make the decisions about whether to fund and set policy about prevention programs, health insurance and more.  Health care, particularly chronic care, shouldn’t be a political party decision but it is. Public opinion absolutely shapes the ideas that spread across America and it starts with your home state.

This strategies mapped out in Living With Chronic Conditions:What to Do Now that Trump is Elected  are as relevant today as when I wrote that post in Nov. 2016. Basically, if you want things to change:

-       become part of a condition specific organization

-        be an activist

-       be an e patient and share your data

-       boost your social capital

-       reduce your carbon footprint

-       support organizations (locally whenever possible) that are working with vulnerable communities and are seeking equality for all

Take a Break: It’s National Canoe Day

 June 26^th is National Canoe Day. If possible celebrate with a paddle in a nearby lake, stream, pond, harbor, bay or, if you are lucky the ocean. However if that’s not an option, try a virtual canoe trip. 

 

Not interested in today’s activities, try the Take a Break Pinterest Board.

Life With Chronic Conditions: What I learned From Caring for My Brain Injured Dog

Less than a month ago a car hit our dog Ida. Bred to be a cattle dog, her agility may have lessened the blow, as she evidently tried to jump away from the car. She  also may have a thicker skull (these dogs get hit in the head in their line of work) but not having been home at the time of the accident, I’m not sure exactly what happened. Regardless, she survived her injury without a fracture. Our vet did an incredible job, as did the special hospital where she spent three days.

Ida learning to catch a ball again.

When it was time for Ida to go home, a nurse brought out our dog, who didn’t know us, could barely walk, didn’t wag her tail, had lost considerable weight and looked ancient. They gave us a discharge summary along with a variety of pills for possible pain, heartburn and anti anxiety and off we went. It was a little bit like, "good luck with your dog."

Fortunately, I’ve worked a lot with head injured adults so figuring it’s a mammalian brain, I was only too happy to get her in the car and start rehab. She promptly went to sleep so there was little I could do until we arrived home.

 I took her off all meds to see just what we were dealing with. Turns out she no longer needed any of them. Since she would circle, both an issue with blindness and neuro involvement, I started walking with her on a short lead outside. We walked a lot figuring it was better to walk her in a straight line instead of letting her pace in a circle-take advantage of neuroplasticity and re program the brain.

 I decided that regardless of whether her sight was coming back or not, I would use a combination of treats and tapping on the steps to teach her how to walk up and down stairs. A day and a half of training and she was a champ.

Incontinence was a major issue initially so we used modified toddler diapers and took her outside every hour. Rewarding her with treats quickly helped to resolve that issue.

Besides food, she loved to play catch, so I let her mouth some of her favorite toys she liked to catch and her response was immediate. You could see the synapses firing. Within a matter of a few days she could get around and seven days after the injury she was playing a very modified version of fetch, wagging her tail, knew who we were and was on a good path to recovery. As my friend, who had a dog who would have seizures, it's a bit like starting over with a brand new dog.

Sleep was critical for her so she slept as much as she wanted. We were careful not to wake her as sleep helps to heal the brain. Because her sleep cycle was erratic, I’d try and nap as well since caring for her was a 24 hour job.

It has been a lot of trial and error, but we are so fortunate to see so much of Ida’s pre injury behavior return. It consumes a lot of my time. However, it’s been an incredible learning experience, which you can see from my observations below:

• Vets are very cost conscious and before they do anything they go over price breakdowns and possible outcomes. In fact, we had to pay up front for the vet hospital. Our vet sent records of everything they had done initially and the hospitals said there was no need to re do, x-rays as they would go with the referring vet’s results. Doctors and hospitals re do tests all the time justifying it with different labs and equipment can yield different results.

Because many people can’t afford MRIs for their pets, vets do a lot of observing and working to understand how an animal’s behavior relates to what are underlying issues. Sadly, the medical profession has moved more and more away from basic understanding of patients and relies very heavily on “what the tests say.”

• When you are talking to a several people about a patient, address them both. My husband felt left out of the conversations as the entire team caring for Ida was female. They only looked at him if he asked a question.

• It is very scary being a caregiver when you aren’t sure what to do. It’s very helpful to give families and caregivers websites and materials to help them. Found some excellent sites on training a dog that has suddenly lost their vision. It would have been nice to join a support group where I could talk to others who were rehabbing pets with traumatic brain injury.

• One of my friends that runs a farm with lots of animals, including border collies, said not to baby her. Protect her from getting injured but don’t over protect her. In short, don’t label her as a cripple.

• Sleep is critical for both patients and caregivers. Sleep when they sleep.

• In an effort to find the right items to help your charge you can spend a lot of money needlessly.  Keep receipts and return items when it becomes obvious they don’t work. On-line research can help make better choices.

• Life definitely changes when you are thrust into a caregiving role. However, there are opportunities. I’m now taking long walks first thing in the morning. While I’d rather be sleeping, once we’re out and moving, I can’t help but enjoy the rising sun, dew on the grass and other things that I normally don’t see.

• I so appreciate my friends that have sent treats for Ida and asked about her. It means a lot.

• While Ida is incredible, I find some days I wonder how she’s going to do in the snow, which hopefully wont be here for another four months. We had plans to go away but it’s no longer simply leaving her with friends. What if she develops seizures, a complication of TBI?  In short, I can become very overwhelmed by things that aren’t a problem at the moment. I’m having to remind myself to be in the present.

• Keeping a journal helped me note progress as well as reminded me of what I had tried, what worked, what didn’t etc.

• Accepting a lower standard of housekeeping definitely helped reduce stress in the first two weeks. I reminded myself that Ida was the priority and it was not a big deal if there were dust bunnies under the couch or dishes in the sink.

• Taking care of my own needs-like going to the bathroom before I take Ida for a walk-is very important. Just as she needs healthy foods to heal, so do I.

Take a Break: Try Breathwalking

Breathwalk is the science of combining specific patterns of breathing with your walking steps, enhanced with the art of directed, meditative attention. Try it and see if helps to relax you. While it’s great to do it outside, it’s okay to walk around the house breathwalking. 
 

 Not interested in today’s activities, try the Take a Break Pinterest Board.

Journal Watch June 2018

 CHRONIC PAIN

Early physical therapy benefits low-back pain patients: Patients with low-back pain are better off seeing a physical therapist first, according to a study of 150,000 insurance claims. Those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit -- but a 19 percent higher probability of hospitalization. Health Services Research

Galcanezumab Beats Placebo for Episodic Migraine: For patients with episodic migraine, galcanezumab is better than placebo for reducing migraine headache days, according to a study published online May 29 in JAMA Neurology.

Do arthritis treatments provide mental health benefits? Drugs used to treat rheumatoid arthritis may impact mental health by improving pain and stiffness and by targeting inflammatory processes common to arthritis and depression; however, a recent review demonstrates that relying on rheumatoid arthritis therapies alone may not meaningfully improve patients' mental health. Arthritis & Rheumatology

COMPLEMENTARY & ALTERNATIVE MEDICINE

Parkinson’s Disease and Complementary Health Approaches: Several complementary health approaches have been studied for Parkinson’s disease, and some have shown a positive benefit for the symptoms associated with the disease. There is some limited evidence that tai chi may improve some symptoms of Parkinson’s, but study results are mixed. Some systematic reviews and meta-analyses have found positive effects of acupuncture in people with Parkinson’s disease, but many of the studies have been of low quality so conclusive evidence is still lacking. No dietary supplements have been shown to be beneficial for symptoms of Parkinson’s disease. The American Academy of Neurology issued a practice parameter in April 2006 on neuroprotective strategies and alternative therapies for Parkinson’s disease and made evidence-based treatment recommendations that address the needs of specialists and caregivers for people with Parkinson’s disease. This issue of the digest provides a summary of evidence for several complementary health approaches that have been studied for Parkinson’s disease, including natural products and mind and body practices. NCCIH Clinical Digest May 2018

Yoga Can Reduce Urinary Incontinence in Older Women: A three-month yoga intervention can reduce urinary incontinence (UI) frequency in ambulatory women aged 50 years or older, according to a study presented at the annual meeting of the American Urological Association, held from May 18 to 23 in San Francisco. 

Mindfulness Program May Help Increase Physical Activity Levels: A meditation and stress reduction program may be as effective as structured exercise programs for increasing physical activity, according to a study published in Medicine & Science in Sports & Exercise. 

Herb List App: The National Center for Complementary and Integrative Health has a herb database app now available for free. It provides research based information about the safety and effectiveness of herbal products.

FDA ACTION

• Approved Palyniq for adults with phenylketonuria (PKU)

• Permitted marketing of Imagen OsteoDetect, a type of computer-aided detection and diagnosis software designed to detect wrist fractures in adult patients.

• Approved Doptelet (avatrombopag) tablets to treat low blood platelet count (thrombocytopenia) in adults with chronic liver disease who are scheduled to undergo a medical or dental procedure.

• Approved first artificial iris

• Approved Tofacitinib for moderate to severely active ulcerative colitis

• Warns Websites Marketing Unapproved Opioids

PREVENTION

Depression speeds up brain aging, find psychologists: Psychologists have found a link between depression and an acceleration of the rate at which the brain ages. Psychological Medicine

Review IDs Exercise 'Dose' That May Improve Cognition in Seniors: For older adults, exercise is associated with improved cognition, with exercising for at least 52 hours over a six month period for about an hour each session associated with improved cognitive skills, according to a review published online May 30 in Neurology: Clinical Practice.

ACS Updates Colorectal Cancer Screening to Start at Age 45: Colorectal cancer (CRC) screening should begin at age 45 for people at average risk, according to updated guidelines from the American Cancer Society published online May 30 in CA: A Cancer Journal for Clinicians. 

Social Isolation Tied to Worse Heart Failure Outcomes: Greater perceived social isolation is associated with an increased risk of death and health care use among patients with heart failure, according to a study published online May 23 in the Journal of the American Heart Association.

Loneliness is bad for the heart: Loneliness is bad for the heart and a strong predictor of premature death, according to a new study. The study found that feeling lonely was a stronger predictor of poor outcomes than living alone, in both men and women. European Society of Cardiology.

Suicide Prevention Should Be a Public Health Priority: Suicide prevention needs to be a public health priority, according to the American Psychological Association (APA). The APA calls for a multifaceted approach that includes increasing access to mental health screenings and ensuring that insurance covers both prevention services and treatment. 

Higher Blood Pressure at Mid-Life Increases Dementia Risk:The risk of dementia is increased in 50-year-olds with blood pressure ≥130 mm Hg, which is below the current threshold for hypertension, according to a study published online June 13 in the European Heart Journal 

Work Stress May Increase Risk of Developing Atrial Fibrillation: Job strain is associated with an increased risk of incident atrial fibrillation, according to a study published online May 30 in the European Journal of Preventive Cardiology. 

Job Strain May Raise Death Risk in Men with Cardiometabolic Disease: Job strain is associated with an increased risk of death among men with cardiometabolic disease, according to research published online June 5 in The Lancet Diabetes & Endocrinology.

Exercise May Lower Mortality in Adult Survivors of Childhood CA:For adult survivors of childhood cancer, vigorous exercise in early adulthood is associated with reduced risk of mortality, according to a study published online June 3 in JAMA Oncology. 

No to ECG Screening to Prevent CVD in Low-Risk Adults:The U.S. Preventive Services Task Force (USPSTF) recommends against screening with resting or exercise electrocardiography (ECG) to prevent cardiovascular disease (CVD) events in low-risk asymptomatic adults. This final recommendation statement has been published in the June 12 issue of the Journal of the American Medical Association. 

Long-Term Type 1 Diabetes Associated With Cognitive Decline:Both patients with type 1 and patients with type 2 diabetes show overall worse cognition than people without diabetes, according to a study published online June 5 in Diabetes Care.

Intellectual Activities in Later Life May Cut Dementia Risk: Active participation in intellectual activities among adults aged 65 years or older is associated with reduced risk of dementia, according to a study published online May 30 in JAMA Psychiatry.

Tonsil, Adenoid Removal Associated With Long-Term Risks of Respiratory, Allergic, Infectious Diseases: Both tonsillectomies and adenoidectomies are associated with higher levels of allergic, respiratory and infectious diseases later in life, according to a study published in JAMA Otolaryngology - Head & Neck Surgery.

Erectile Dysfunction Associated With Increased Risk for Heart Disease: Erectile dysfunction (ED) indicates greater cardiovascular risk, regardless of other risk factors, such as cholesterol, smoking, and hypertension, according to a study published in Circulation.

NUTRITION/SUPPLEMENTS/VITAMINS

Most popular vitamin and mineral supplements provide no health benefit, study finds: The systematic review of existing data and single randomized control trials published in English from January 2012 to October 2017 found that multivitamins, vitamin D, calcium and vitamin C -- the most common supplements -- showed no advantage or added risk in the prevention of cardiovascular disease, heart attack, stroke or premature death. Generally, vitamin and mineral supplements are taken to add to nutrients that are found in food. The study found folic acid alone and B-vitamins with folic acid may reduce cardiovascular disease and stroke. Meanwhile, niacin and antioxidants showed a very small effect that might signify an increased risk of death from any cause. Journal of the American College of Cardiology

Mediterranean Diet May Lessen Adverse Impact of Air Pollution: Adherence to a Mediterranean diet is associated with an attenuation in the effects of air pollution, according to a study presented at the American Thoracic Society's 2018 International Conference, held from May 18 to 23 in San Diego.

Higher Protein Intake Up Heart Failure Risk in Men: Higher dietary protein intake is associated with a trend toward increased heart failure risk among middle-aged men, according to a study published online May 29 in Circulation: Heart Failure.

Non-Nutritive Sweeteners Don't Up Blood Glucose Levels: Consumption of non-nutritive sweeteners (NNSs) does not increase blood glucose levels, according to a review published online May 15 in the European Journal of Clinical Nutrition.

Lentils significantly reduce blood glucose levels: Replacing potatoes or rice with pulses can lower your blood glucose levels by more than 20 per cent, according to a new study. Researchers found that swapping out half of a portion of these starchy side dishes for lentils can significantly improve your body's response to the carbohydrates. Replacing half a serving of rice with lentils caused blood glucose to drop by up to 20 per cent. Replacing potatoes with lentils led to a 35-per-cent drop. The Journal of Nutrition

Pregnant smokers may reduce harm done to baby's lungs by taking vitamin C: Women who are unable to quit smoking during their pregnancy may reduce the harm smoking does to their baby's lungs by taking vitamin C, according to a new randomized, controlled trial. American Thoracic Society 

High Quality Diet May Decrease Mortality in Cancer Survivors: High-quality diets are associated with decreased risks of overall and cancer-specific mortality among cancer survivors, according to a study published online June 5 in JNCI Cancer Spectrum.

 TREATMENT

Certolizumab Looks Promising for Moderate-to-Severe Psoriasis: Twice-weekly certolizumab biologic appears to be both safe and effective for the treatment of moderate-to-severe chronic plaque psoriasis, according to a study published online April 13 in the Journal of the American Academy of Dermatology.

CPAP Use May Improve Sexual QOL in Those With Sleep Apnea: Successful continuous positive airway pressure (CPAP) use for obstructive sleep apnea may be associated with improved sexual quality of life (QOL), according to a study published online May 24 in JAMA Otolaryngology-Head & Neck Surgery.

Antidepressant Prescribing Linked to Lasting Weight Gain: Antidepressant prescribing is associated with long-term increased risk of weight gain, according to a study published online May 23 in The BMJ.

New treatment for severe asthma: Two new studies of patients with difficult-to-control asthma show that the eczema drug dupilumab alleviates asthma symptoms and improves patients' ability to breathe better than standard therapies. Dupilumab, an injectable anti-inflammatory drug, was approved in 2017 by the Food and Drug Administration as a treatment for eczema, a chronic skin disease. NEJM

Nilvadipine Lowers BP, Without Increasing Risk of Orthostatic Hypotension in Patients With Alzheimer’s Disease: Nilvadipine lowers blood pressure (BP) without increasing the risk of orthostatic hypotension in patients with mild to moderate Alzheimer’s disease, according to a study presented here at 28th Scientific Meeting of the European Society of Hypertension (ESH).

 OTHER

To Lower Your Medicare Drug Costs, Ask Your Pharmacist for the Cash Price: A simple question at the pharmacy could unlock savings for millions of Medicare beneficiaries. Under a little-known Medicare rule, they can pay a lower cash price for prescriptions instead of using their insurance and doling out the amount the policy requires. But only if they ask. That's because pharmacists say their contracts with drug plans often contain "gag orders" forbidding them from volunteering this information. Researchers analyzing 9.5 million Part D prescription claims reported in a research letter to JAMA in March that a patient's copayment was higher than the cash price for nearly one in four drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent. VPR

One-third of US adults may unknowingly use medications that can cause depression: A new study suggests that more than one-third of U.S. adults may be using prescription medications that have the potential to cause depression or increase the risk of suicide. JAMA 

Federal Government Must Tackle Rising Insulin Prices: U.S. officials need to take action to control spiking insulin prices, the American Medical Association (AMA) says. The Federal Trade Commission and the Justice Department should monitor insulin pricing and market competition and take any necessary enforcement measures, AMA members agreed at the group's annual meeting. The nation's largest physicians group said the rising cost of insulin is causing big financial problems for patients, Medicare and Medicaid. 

Online Consumer Ratings of Physicians Tend to be Skewed: Online physician reviews tend to be skewed positively, according to a study published in the May issue of the Journal of Medical Internet Research.

Take a Break: Five Ways to De Stress in Five Minutes

-->

Some days are crazier than others and it’s nice to have some quick ways to remind your body to slow down in order to reduce stress and anxiety. Try one of the following:

• Chew gum: Whatever the flavor, make sure it has the ADA (American Dental Association) approval that way you not only reduce anxiety and lower cortisol levels while you chew, you’re also giving your teeth a “brush” that reduces the risk of cavities.

• Eat a handful of trail mix, carrots or celery sticks: It’s all about the crunch when you’re stressed.

• Lay your head on a cushion or pillow: Don’t have time for a nap? Lay your head on a pillow and take five minutes to let the pillow soak up your fears and anxieties.

• Count: Stopping and counting is a great way to break from stressful thinking and make you more mindful. Whether it’s counting backwards from 100 by 2s, or counting all the cars on a given street, whichever way you do gives the brain a much-needed break

• Acupressure: Acupressure is an ancient Chinese healing method that involves putting pressure with the fingers or the hand on certain points of the body. Unblocking the flow of Qi can release tension. You can do this on your own to promote health and relieve stress.

Not interested in today’s activities, try the Take a Break Pinterest Board.

Life With Chronic Conditions: Feeling suicidal

People affected by chronic conditions are more apt to feel suicidal, and to that end, I wrote the post Understanding the Connection Between Chronic Conditions and Suicide in June 2017. The celebrity deaths this past week of  Chef Anthony Bourdain and fashion designer Kate Spade, coupled with the Centers for Disease Control’s report, Trends in State Suicide Rates have brought this issue to the forefront.

Suicide is preventable. If you are concerned about a family member, friend, neighbor or someone else, know the top risk factors for suicide:

•  prior suicide attempt; family history of suicide; exposure to suicide, including loss of a loved one or graphic portrayal in media

•  mood disorder like depression, bipolar disorder, schizophrenia, conduct disorder, anxiety disorder

• chronic pain or other serious health condition, including traumatic brain injury

•  substance abuse or alcohol abuse disorder.

•  access to lethal means

• prolonged stress; stressful life events or major life changes

• childhood abuse, neglect or trauma

According to the CDC report, 54 percent of the people who killed themselves didn't have a previously known mental health issue. "Instead, these folks were suffering from other issues, such as relationship problems, substance misuse, physical health problems, job or financial problems, and recent crises or things that were coming up in their lives that they were anticipating."

The Mighty asked people with chronic conditions to share their “red flags” that let them know they might be suicidal. Among the comments shared were:

• Thinking the world would be better off without me; I’m a burden

• Withdrawing. Talking less and less. Feeling detached

• Feeling nothing

• Stuck in a though loop of feeling out of control, anxious

• Wanting to stop the pain

• Selling off possessions

• Stopping eating and/or taking medications

If you find yourself thinking such thoughts, or acting in this manner, or if you suspect someone is suicidal, get help. Let someone know. Call 800-273-TALK. If you prefer use the Crisis Text Line  text to 741741 for free, 24/7.

People do want to know how you feel and they want to help. You are not alone. If the feelings are strong, consider it like having severe chest pains and go directly to an emergency room.

If you are concerned about someone, in addition to the resources listed above, contact #Bethe1to.

For more information on this topic read Understanding the Connection Between Chronic Conditions and Suicide.

Take a Break: Try Painting with Watercolors

So if you don’t have a handy set of watercolors lying around, start by making your own.

Martha Stewarts How to Make Watercolor Paint:  Note that she says to use an egg carton. Be sure it’s the plastic variety. You can also use a muffin tin, ice cube tray or whatever else you have on hand.

If you prefer the video format

Check out Call Yourself a Painter: 14 Ways to use Watercolors for tips on painting with water colors.

Not interested in today’s activities, try the Take a Break Pinterest Board.

Life with Chronic Conditions: Ethnicity, Ancestry, Sex and Gender Makes a Difference

Recently Geisinger Health System announced that it will be offering DNA sequencing to its patients, looking for gene mutations in at least 77 genes. Using this information, clinicians can tell whether a patient is more at risk for heart disease, a particular type of cancer or another condition. Routine DNA Screening Moves Into Primary Care 

23andMe  has been offering genetic testing since 2006  but have re branded their services to focus on ancestry services with the health information as a combined package.

The idea of knowing you have genetic markers for a specific condition can be very unsettling, since just having a gene doesn’t mean you’ll go on to develop it. So is Geisinger and 23andMe helping or making people unnecessarily alarmed? Geisinger has stated they will only provide information for genetic markers that patients can do something about.

Ancestry alone can offer some genetic clues. For example Asheknai Jews are genetically at higher risk for Tay-Sachs Disease; Asians and Hispanics are at greater risk for thalassemia; Caucasians have a higher incidence of cystic fibrosis; and African Americans have a higher risk of sickle cell anemia. Systemic lupus erythematosus (SLE) is an autoimmune disease that predominantly affects women during their childbearing years, and is more common in African-American, Native American and Hispanic patients.

In the United States, race and ancestry are often confused, as skin color is used in place of a genetic understanding of what a person’s actual genetic ancestry might be. For example, many identify as “black,” but their genetic profile may have more European ancestry than African. Interestingly, among Americans of African descent, even though 95% will be of West African origin, within that population there is far greater genetic variation than among Europeans. Untangling Race and Health Risks Through Genetics

Ethnicity is another important variable. While ancestry relates to your actual genetic make up, ethnicity refers to  culture, customs and often lifestyle choices. Diet can vary drastically among cultures, which can have a marked impact on health. For example, many Hindus and Buddhists are vegetarians while fasting is part of various religious groups including Muslims who do not eat food during the day light hours of Ramadan. How one dresses can even have an impact. In Northern hemisphere climates, cultures that require full coverage dress can result in vitamin D deficiency.

For centuries, health research has been heavily male focused. Even in health research male animals can outnumber the females nearly sixfold. Needless to say, this is a problem as men and women can present differently with the same diagnosis, and respond differently to medications and treatments.

Not only does weight differ between men and women, but other factors such as body fat and hormones makes a difference. Certain drugs, such as antidepressants, are “fat soluble,” meaning that they dissolve in fat before going to the brain. Given women’s naturally higher level of body fat then men, the drug is distributed differently in women then men.

Heart medications affect women differently than men. Women tend to have a greater potential for bleeding so the recommendation for low dose aspirin to reduce the risk of a heart attack is not necessarily recommended. The blood thinner warfarin, used to prevent strokes and blood clots is one example where smaller doses are recommended for women than men. In 2013, the FDA issued new dosage requirements based on sex, for Ambien and Sublinox since women metabolize the drug much slower then men.

Interestingly gender is linked to sex, but not defined by it. Yet, it affects health.

For example, a 2016 study from a group of Canadian researchers suggested that successful recovery from acute coronary syndrome (a term describing a blockage of blood flow to the heart, as happens during a heart attack) was dependent not on whether the patient was male or female, but rather, on each person’s gender characteristics: Patients with more traditionally feminine traits, such as responsibility for caregiving, were more likely than those with more traditionally masculine traits, such as being the primary income earner for their households, to suffer another coronary episode or die within the following year, regardless of their biological sex. Of Mice,Men and Women 

Understanding that ancestry, ethnicity, gender and sex can all make a difference in your medical condition is important. Consider the Following:

• Genes can be turned on and off by our environment (e.g. food, supplements, geography, exercise). Just because you carry a gene doesn’t mean you’ll develop a condition.

• Develop your family health history, which includes ancestry and ethnicity.  It may not be apparent to your provider what your ancestry or ethnicity might be so be sure to let them know.

• If you’re part of a group with a higher genetic risk, you often can reduce that risk by making better lifestyle choices.

• Pharmacogenetics is a new field of understanding how genetics impacts your reaction to medication. Based on your DNA, it’s possible to know what your body can tolerate. If you are having problems with medication, it might be worth having this test. Talked to your provider about whether this testing would be beneficial for you.

•  When reading health studies, understand the make up of the study population. It may not be as relevant as you first think.

• Precision Medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person." This approach will allow doctors and researchers to predict more accurately which treatment and prevention strategies for a particular disease will work in which groups of people.