Health tips from Dr. Mike Roizen for 4-25-23

Understanding the change (for the better) in insulin prices

An article in JAMA Network says that insulin prices have skyrocketed over the past 20 years — in some cases to over $360 a day — even though a vial costs roughly $3 to $6 to produce. This has caused people who depend on insulin to ration their daily dose — or worse, skip it all together. Luckily the federal government has now put a cap on costs for Medicare patients — $35 a month. And pharma companies, feeling the public outrage, have announced they will reduce prices, too.

Eli Lilly is capping what patients pay out-of-pocket for insulin at $35. In May, unbranded Insulin Lispro Injection will cost $25 per 100 units/10 mL vials, instead of $82.41.

Novo Nordisk says reduced insulin prices are coming in January 2024. Vials and pens of Novolin and Levemir will be 65 percent of current list prices, and NovoLog and NovoLog Mix 70/30 will be 75 percent cheaper. Folks without insurance can download a savings card that provides a $35 out-of-pocket cap on monthly insulin prescriptions.

Sanofi says that by the beginning of next year, it will cut the price of Lantus by 78 percent and short-acting Apidra by 70 percent.

This is great news, but to ease the burden of over-the-top prices for all meds: Review your insurance coverage; try generic medicines (some non-profit hospitals have banded together to support producing at least 20 of the drugs that have become generic); investigate prescription discount cards; check out drug companies' patient assistance programs; investigate buying medicines on the internet (clear it with your doctor first!).

How to avoid amputation due to diabetes-related wounds

Over 154,000 amputations occur every year in the U.S. — one every four minutes! Shockingly, the majority of them could be prevented if there were greater awareness of the risk factors, such as diabetes, and use of prevention tactics, such as early intervention, and more timely treatment of non-healing wounds and neuropathy, according to the American Diabetes Association.

As the ADA works to make those changes possible through a new initiative, the Amputation Prevention Alliance, the estimated 2 million folks in this country with chronic limb-threatening ischemia now may have a minimally invasive, limb-saving alternative to amputation. A study of a new way of restoring blood flow to the foot and leg using transcatheter arterialization of the deep vein system was recently published in NEJM.

Researchers from Vanderbilt University treated 105 patients facing amputation who had non-healing wounds on their feet. They found that at six months after the procedure, 76 percent of participants were able to keep their legs and had completely healed or healing wounds, and 86 percent had freedom from all-cause mortality.

That's great news — but back to the fact that most amputations are preventable. What it takes is early, aggressive treatment or reversal of Type 2 diabetes, prevention of diabetic complications such as neuropathy, heart and circulatory issues, and careful monitoring by your doctor. You see your doctor every six months, or more frequently if recommended, don't you? And to take charge of your diabetes, "The Great Age Reboot" offers a life-long plan that will help you live younger longer.

Exercising your gut

Mia Hamm, a former professional soccer player, two-time Olympic gold medalist and two-time FIFA Women's World Cup champion, says, "True athletes aren't always the ones who win, but the one with the most guts." Researchers looking into the composition of high-level athletes' intestinal microbiome agree: Their gut's mix of bacteria is something special.

But it turns out, according to a new study in the FASEB Journal (Federation of American Societies for Experimental Biology), exercise — even for overweight folks 40 to 65 years old — can do a lot to improve the gut biome. And when your gut biome is more diverse and has more health-promoting bacteria that boost your immune function, mood, behavioral health status, gastrointestinal health and blood sugar regulation and can help control your weight and prevent chronic metabolic disease.

Researchers from the University of Calgary looked at 350 middle-age overweight and normal-weight folks and found that 150 to 500 minutes a week of moderate exercise gave the best boost to diversity of their gut bacteria. Moderate exercise included brisk walking, cleaning, mowing the lawn and other yard work, bicycling (for most folks), and playing sports such as badminton and doubles tennis.

Normal weight folks' guts benefited the most, but that's because overweight causes additional health challenges that affect the gut and they take time — and weight loss — to reduce or resolve. One additional finding: Increased intensity of exercise did not improve gut health, but increased time spent on physical activity did. So aim for 30 to 90 minutes of moderate activity daily.

Big biceps can interfere with an accurate BP reading

Arnold Schwarzenegger's flexed bicep was said to be 22 inches in circumference; Mike Tyson's — 18.5 inches; and Venus Williams's, 15 inches. That's a lot of muscle. But chances are your arms are that big, too! Because more than 70 percent of adults are overweight or obese, a majority of folks have biceps (unflexed) that are between 13 inches to more than 17 inches in circumference.

That makes getting an accurate blood pressure reading — so important to protect your heart and brain health — iffy, if the cuff that wraps around your upper arm is too small. A study in the American Journal of Hypertension found that 53 percent of men and 34 percent of women need a large or extra-large cuff. The large cuff accommodates biceps that are 13 to 17 inches; the extra-large works for over 17 inches (XXL is also available.). I suggest you measure both your arms to make sure your pressure is taken accurately.

At the doctor's office, don't let the staff use any ol' cuff. Insist that it be the right size for your arm … and ask for a check on both arms, since the readings may vary and the highest reading of the two should be the one of record.

For at-home monitoring, standard cuffs go up to around 16 inches — you may need to a larger one. Also, be aware some home blood pressure monitors don't correlate with the monitor in your doc's office. Find out which home monitors are rated "good to use" by the American Medical Association at www.validatebp.org.

Avoiding walking-related aches and pains

Jennifer Lawrence is "terrible at walking," according to her "Hunger Games" costar Liam Hemsworth. She once broke a heel and tumbled while walking with him. She also fell on her way up to the stage at the 2013 Oscars, and the same year, she was tripped up by a curb while walking with Bradley Cooper during the BAFTA awards.

Your missteps while aiming to walk 10,000 steps a day might not be so high profile, but they can keep you from exercising regularly — and cause real pain. The most common walking-related injuries come from poor posture. It can cause pain from your neck to your toes. To prevent that, no staring at your phone screen while doing your paces! Keep your shoulders back; your torso open and elongated; the crown of your head pulled straight up, centered over your shoulders. Aim your gaze about 10 to 20 feet in front of you. If the surface you're walking on is too irregular to do that, walk somewhere else!

You may also experience shin splints, sprains, and tissue inflammation, from walking in the wrong shoes (too tight, too heavy, too worn down, not well-cushioned or too cushy), from carrying hand weights or walking on ankle-twisting surfaces.

Your goal is to feel great getting 10,000 steps a day — the minimal amount for maximum heart, brain, and immune system health — but a new study shows 8,000 steps, one or two days a week, deliver real rewards (healthier heart, longer life) as you build endurance. The next step is up to you!

Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic.

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