During the Recipe for Heart Health study, 40 participants at risk for cardiovascular disease were randomly assigned to consume either a “low” amount (less than a teaspoon) of extra virgin olive oil or a “high” amount (4 tablespoons) each day. After a one-week “washout” period, the participants switched and followed the other olive oil regimen for four weeks. Participants also adhered to whole-food, plant-based or vegan diets that were not low in fat.

UF’s researchers found that no matter the amount, consuming Extra Virgin Olive Oil decreased LDL, or “bad,” cholesterol, which has been linked to heart disease. They also learned that while consuming olive oil daily helps, other elements of someone’s diet may play a more significant role in achieving health benefits. For example, people who consumed low amounts of olive oil, but also limited foods such as red and processed meats, added sugars, and saturated fats  and ate plant-based fats such as avocados, nuts, seeds and olives had more significant reductions in LDL cholesterol than participants who just consumed high amounts of olive oil.

Overall, the study’s researchers concluded that where participants received their dietary fat from mattered and that getting it from whole-plant-based fats was more beneficial for reducing cholesterol than getting it from olive oil alone. The UF team plans to use data to produce additional research articles on cooking, diet quality, mood and quality of life.

Florida health officials did not release the name of the city or store where the deli meat was purchased. Along with the death, three people in Florida have been hospitalized from eating contaminated deli meat.

Overall,  57 people have been hospitalized and eight have died from what federal officials call the largest listeriosis outbreak since 2011. The CDC reported that, as of Aug. 8, the Boar’s Head deli meat outbreak had sickened people in 18 states.

An investigation into cases of Listeria linked to deli meat began in July when health officials found Boar’s Head brand liverwurst was making people sick. Boar’s Head has since recalled 71 products produced between May 10, 2024, and July 29, 2024, under the Boar’s Head and Old Country brand names. The recall list includes hams, bologna, bacon, sausage, salami and frankfurters. Turkey has not been recalled.

The CDC now is recommending everyone check their homes for any remaining recalled Boar’s Head products, since they can have long a shelf-life. Look for “EST. 12612” or “P-12612” inside the USDA mark of inspection on the product labels. Some of the products have “sell by” dates into October 2024.

It can take up to 10 weeks for some people to have symptoms of listeriosis. Listeria can cause severe illness (known as invasive listeriosis) when the bacteria spread beyond the gut to other parts of the body. Symptoms of severe illness usually start one to four weeks after eating food contaminated with Listeria but may start as early as the same day or as late as 70 days after.

Listeriosis can cause fever, muscle aches, headache, stiff neck, confusion, loss of balance, diarrhea, or other gastrointestinal symptoms. It is particularly dangerous for anyone pregnant.  The infection can cause miscarriages, stillbirths, premature delivery or life-threatening infection of the newborn. Older people or anyone with weakened immune systems also are at higher risk. Listeriosis typically is treated with antibiotics.

Health officials encourage consumers to check their fridges, discard any recalled products listed on the Boar’s Head website, or return them to the store where they purchased them for a full refund.  Anyone with contaminated meats should thoroughly clean and sanitize their refrigerators to prevent contamination of other foods. The CDC notes that Listeria is a hardy germ that can remain on surfaces, like meat slicers, and foods, even at refrigerated temperatures.

In July, a Publix spokesperson said the grocery chain had removed all products from the impacted Boar’s Head facility from every Publix location. The company did not break out which locations sold the potentially contaminated meats.

South Florida Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.

Strieter’s mother had Alzheimer’s, and now that Strieter has entered her 70s, she wants to keep her own risk as low as possible.

“My doctor told me I should eat healthy, so that’s what I am doing,” she said.

A study released Wednesday shows that Strieter is on the right track in monitoring what she eats. Research presented at the Alzheimer’s Association International Conference in Philadelphia shows that eating a couple of servings per week of processed red meat, such as bologna, hot dogs, or bacon, raises the risk of dementia. More specifically, researchers found that consuming about two servings per week of processed red meat raises the risk of dementia by 14% compared to those who eat less than three servings a month.

The newest research looks at how what we eat affects the aging brain’s ability to think and remember. As many as 580,000 Floridians ages 65 and older are living with the disease and more than 6.7 million Americans.  The increasing prevalence has triggered more research on the factors that raise risk.

The study followed more than 130,000 people for up to 43 years and discovered that each additional daily serving of processed red meat was linked to an extra 1.6 years of brain aging. Yuhan Li, the study’s lead author, said processed meat may affect the brain because it contains high levels of harmful substances such as nitrites (preservatives) and sodium.

“The Alzheimer’s Association has long encouraged eating a healthier diet — including foods that are less processed — because they’ve been associated with lower the risk of cognitive decline,” Heather M. Snyder, Alzheimer’s Association vice president of medical and scientific relations, said in a prepared statement.

Studying processed meats adds to earlier research on food and brain health, linking diet to disease risk. The results have led experts to recommend seniors eat whole, fresh foods as much as possible.

“It’s important for people to know that there is not a single food or ingredient that causes dementia or Alzheimer’s,” said Dr. Christian Camargo, associate professor of neurology and a memory specialist with the University of Miami Health System. “There also is not a single food that will cure it.”

Here are other findings on diet and Alzheimer’s risk:

Pre-packaged and highly processed foods increase risk

In 2022, UK researchers found that for every 10% increase in daily intake of highly processed foods, the risk of dementia increased by 25%.  Examples of highly processed foods include packaged bread, crackers, soft drinks, breakfast cereals, sweetened yogurts, snack bars, ice cream, and chips. Researchers studied 72,083 men and women who were 55 or older. The participants kept detailed logs of what they ate and drank.

Researchers concluded: “Increasing unprocessed or minimally processed foods by only 50 grams a day, which is equivalent to half an apple, a serving of corn, or a bowl of bran cereal, and simultaneously decreasing ultra-processed foods by 50 grams a day, equivalent to a chocolate bar or a serving of fish sticks, is associated with 3 percent decreased risk of dementia.”

A high-sugar diet can increase risk 

Studies have linked high sugar consumption to insulin resistance in the brain and increased risk of dementia. In particular, some researchers have examined the overconsumption of sugar-sweetened drinks like sodas and fruit juices. The findings indicate it may be possible to keep brain cells healthy by reducing sugar intake.

“Just about anything with added sugar is not going to be great for you,” said Julia Sheffler, assistant professor in the Department of Behavioral Sciences and Social Medicine at the Florida State University College of Medicine. “Whether you have sugar in your drinks or food, it spikes your insulin and over time that can lead to your body becoming insulin resistant. That increases your risk for type 2 diabetes, but it also has negative impacts on the brain.”

Foods like fish, nuts, seeds and berries can lower risk

Previous research has found that diets rich in green leafy vegetables, fruits, whole grains, beans, and fish are associated with fewer signs of Alzheimer’s disease. These diets also tend to include olive oil, whole grains,  small amounts of wine, and limited red meat.  This type of diet aims to increase the nutrients that protect the brain and inhibit beta-amyloid deposits found in the brains of people with Alzheimer’s.

“There’s really robust evidence that a Mediterranean diet, in particular, has benefits for brain health and heart health and that it can actually slow the rate of cognitive decline and reduce the risk for Alzheimer’s and other dementias,” Sheffler said.

At FSU, Sheffler is looking at how to help seniors adopt those diets and overcome reluctance or obstacles.

“If you can’t stick with it, you just kind of occasionally eat the right foods here and there, it’s not going to be as effective as if you’re really consistently following the Mediterranean or a Mediterranean-ketogenic diet,” she said.

Olive oil lowers risk

People who incorporate olive oil into their everyday diet may decrease their risk of dementia-related death, according to a  Harvard T.H. Chan School of Public Health study.

The Harvard study analyzed the diets and health outcomes of 92,383 American adults. It found that regardless of genetic predisposition or diet, participants who consumed at least 7 grams of olive oil per day had a 28% lower risk of dementia-related death compared to participants who never or rarely consumed olive oil.

“Foods like olive oil that have heart benefits also have brain benefits,” Camargo said.

Supplements may not lower risk

Advertisements often tout the benefits of supplements such as Lion’s Mane, Vitamin D, and Ginkgo biloba for lowering your risk of Alzheimer’s disease and dementia.

But Florida Alzheimer’s experts are skeptical.

Camargo points out supplements are unregulated in the United States.

“They are not well studied because they are not pharmaceuticals,” he said. “You don’t know what you are getting and they were not studied for the purpose of learning whether they reduce Alzheimer’s risk.”

He said all the new research on diet helps people understand that there are ways to reduce their risk of Alzheimer’s. “The point is we have some control.”

Sheffler advises gaining that control regardless of age. “The earlier the better, but it’s never too late. You are still going to see benefits.”

Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.

New research shows anxiety and poor diet may be a factor in the early onset of hair loss in millennials and 20-somethings.

At the same time, men and women older than 50 are experiencing hair loss and hair thinning, either due to genetics, hormone changes or the aging process.

Together, these have triggered a skyrocketing demand for therapies and drugs to prevent and treat hair loss. So far, the FDA has approved only topical minoxidil and finasteride as pharmacological treatments. No other drug has been FDA-approved for the most common form of hair loss in almost 30 years. But that soon may change.

A least a half dozen medications and cell-based therapies are advancing in clinical trials, and Florida dermatologists see hope on the horizon.

“It’s an exciting time,” said Dr. Joshua Berlin, a Boynton Beach dermatologist who treats patients for hair loss. “We are seeing a resurgence of companies looking at solutions for this condition. Although it’s nothing life-threatening, it affects a significant part of the population, and it’s upsetting for them.”

Berlin said the increased advertising for hair loss products has created more awareness — and interest in solutions. “I am definitely seeing more people coming to my office specifically for hair loss.”

Dr. Brett King, an associate professor of dermatology at Yale School of Medicine, specializes in hair loss. He is jazzed about the advancements and attention on the most common form of hair loss called androgenetic alopecia, also known as female and male pattern hair loss. He recently discovered something for his patients that is working.

King is getting great results by prescribing oral minoxidil, a well-known hair-loss treatment drug typically applied to the scalp. Minoxidil is the active ingredient in Rogaine, a lotion or foam that is rubbed on the scalp, and is now generic. It has not been approved by the Food and Drug Administration for oral use for hair loss. However, a rising number of hair-loss dermatologists recently have been giving the low-dose pills to patients, and like King, they report success.

“Oral minoxidil is so much better for many reasons,” he said. “Topical only works where you put it, while oral treats all the parts of your scalp.”

Two new medications approved in the last year and a half also show results in people who have alopecia areata, an autoimmune condition that attacks hair follicles and causes hair loss. Alopecia areata is the second most common type of hair loss. The medications allow users to regrow their hair again.

“Now hair loss is something that when someone walks into a dermatology office, the doctor doesn’t just throw up their hands and say ‘I don’t know, go get Rogaine,’” King said. “Now we have new treatments for the two most common forms of hair loss.”

Those advancements are just the start, he believes.

Some drugs in clinical trials show promise for the early stages of hair loss and hair shedding, while others exhibit the potential to stimulate existing hair folicles and create new hair growth. In addition, progress also is coming unintentionally in some cases as medications intended for other health conditions are repurposed as hair growth stimulators. Another field of research and development is cell-based therapies that stimulate hair growth by injecting stem cells into the scalp.

“I think in the next decade we will see the new development of medicines that truly grow hair … medicines that do not just do a reasonably good job, but doing a great job of treating severe hair loss at younger and younger ages,” King said.

Biotech researchers believe that people with hair loss will turn to convenient, direct-to-consumer, treatments — pills, lotions, injections — they can use in their homes.

Of course, hair transplants remain popular, too.

Berlin says the best way to know the right choice is to see a dermatologist. They can examine your scalp and order blood work to check for possible underlying causes.

If a nutrient deficiency is an issue, taking specific supplements may remedy the situation. Berlin is a fan of a biotin as well as a nutritional supplement called Nutrafol — a blend of vitamins, minerals, and botanical ingredients. One study found Nutrafol decreases hair shedding in women before during and after menopause. “They work to some degree, no question,” he said.

“Hair loss is a condition where we have had nothing new for many years and all of a sudden there are breakthroughs,” he said. “The goal is more novel threatments, and I know many people would like see that.”

Sourh Florida Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.

Recently, though, Kirtley went almost all day without eating, a noticeable behavior change coming only 3½ months after starting Wegovy, a popular weight-loss medication. “It’s mind-blowing that I have to remember to eat,” said Kirtley of Lake Worth Beach. “But when I am eating less amount of food, I know that I have to pay attention to what I am eating and make sure I am getting nutrients.”

Kirtley started at 328 pounds on April 1 and has lost 38 by taking the weight-loss medication under a doctor’s supervision. She follows a carefully researched diet heavy on lean protein, vegetables and lots of water.

“To avoid losing muscle mass, I focus on the protein, not on calories,” she said.

GLP-1 drugs such as Wegovy, Ozempic and Mounjaro have emerged as a game-changer for weight loss, slowing digestion and increasing how satiated you feel after eating. But South Florida dietitians caution that taking weight-loss drugs can be risky if you don’t have the right diet. Everything from your bones to your muscles can atrophy as you shed pounds too quickly. They guide patients on how to eat while on medications without causing their body harm.

“If someone does not know how to eat on these medications, they may be exchanging one problem for another,” said Lillian Craggs-Dino, a licensed dietician and support group coordinator for the Bariatric and Metabolic Institute at Cleveland Clinic Florida. “It’s easy to become vitamin deficient.”

The side effects are challenging

Ten GLP-1 drugs, including a class of medications called semaglutides, are FDA-approved to treat either type 2 diabetes or weight loss. Most are given by self-injection and work by regulating insulin production and lowering blood sugar levels. The most common side effects are gastrointestinal symptoms including nausea, vomiting, diarrhea, and constipation. Dietitians say the symptoms often can be managed: Diarrhea by drinking plenty of water and avoiding dairy products and high-fiber foods, and constipation by eating more fiber and drinking plenty of water.

“It may not be the drugs, it may be your diet causing the nausea or constipation. Maybe somone is eating too fast or picking the wrong foods,” Craggs-Dino said.

At Cleveland Clinic Weston, Craggs-Dino does a full assessment before someone starts weight-loss drugs to discover whether a patient has vitamin deficiencies, to learn their lifestyle habits and to find out their food allergies, likes and dislikes. She then creates an eating plan

“Medications will help with behavior because you will feel full, but you still have to eat balanced meals with lean protein, fat, whole grains and vitamins,” she said. “Some people are not hungry and don’t eat. If you don’t eat, you are not nourishing your body and you are losing muscle mass along with fat.”

Some people need vitamin supplements, and others need a higher amount of “good fat,” she said.

Losing weight rapidly without a proper diet and exercise can decrease bone density, and lower your resting metabolic rate which can lead to sarcopenia — the gradual loss of muscle mass, strength, and function that makes it hard to do daily activities like walking up stairs. Dietitians say ideally anyone on these medications should consume about 25-30 grams of protein per meal to preserve muscle.

Kirtley says she has tried all kinds of diets and watched her weight fluctuate, while she remained obese. Her eating habits had included regular trips to Dunkin Donuts and Popeye’s. But that’s in the past. She started on a low dose of Wegovy in April and plans to modify her diet further as she ramps up. She tracks her water intake and her protein consumption with an app on her phone, and allows herself protein shakes and bars.

“I knew going in I wanted to change my diet,” she said. “My hope going in was that this will help me make better choices about what I am eating, and it has.”

What to know before you self-inject

Although the internet is filled with photos of people shedding pounds on semaglutide medication, taking weight-loss drugs without any education is a mistake, dietitians say. The medications are designed to be used in combination with a healthy diet and exercise.

“Education is a critical piece that many people are missing,” said Amy Kimberlain, registered dietitian with the Miami Cardiac & Vascular Institute Cardiometabolic Clinic at Baptist Health.

“You have to understand how the medications work, what’s happening to your digestion and how to modify what and when you eat,” she said.  “You want to mitigate the side effects that could be caused by what you are eating.”

Since you are not counting calories, you should stack your plate  with nurtrient-rich foods, even when you are in maintence mode, she said. She recommends high-quality protein sources such as fish, chicken, eggs, tofu, tempeh, yogurt, cheese, and seafood. Food that should be avoided include pastries, sodas, processed foods, fatty cuts of meat, and foods high in sodium like pickles and deli meats. Fats and carbohydrates can be added into your diet eventually.

Surgical weight loss expert Dr. Christopher Thompson said some people aren’t a good candidate for weight-loss medications, even with the right diet. Thompson, a Harvard medical professor and founder of Bariendo, recommends having your bone and muscle density checked before starting on them. If your numbers are low, weight-loss surgery may be a better option, he said. Thompson performs a unique endoscopic stomach-tightening procedure for weight loss. However, he also prescribes medications, noting that patients who take them need a game plan that includes resistence training and long-term eating modifcations.

“If you start this medication, intend to be on it the rest of your life,” he said. Even after reaching a weight-loss goal, research shows that most people will need to stay on the medication indefinitely, likely at low doses. “Those who get off find weight regain is typically faster than the time it takes people to lose the weight in the first place,” he said. “It will come back with a vengence, and quickly.”

Navigating the popularity and cost

Ozempic, originally intended for Type 2 diabetes, caught on for weight loss in 2023. With its popularity, the U.S. Food and Drug Administration approved a similar medication, Wegovy, for chronic weight management. The insatiable demand saw Mounjaro (tirzepatide) arrive at the end of 2023, and now a newer, reportedly more effective drug called retatrutide is in the pipeline. The challenges with these medications in South Florida and nationwide are cost and availabiity. In South Florida, everyone from chiropracters to MedSpas to virtual doctors are prescribing them. The cost can be prohibitive — as much as $1,000 or more a month — and finding needed doses can be difficult.

But compounding pharmacies are stepping in, making their own versions of semaglutide and tirzepatide drugs at lower costs and varied dosages.

That’s the path Martin Katz, 78, is taking. He said he is using a compounding pharmacy to make doses of tirzepatide at lower prices because Medicare doesn’t cover it for obesity. He relies on dietitian Craggs-Dino from Cleveland Clinic Weston to guide his diet. Five years ago, the Coral Springs tax accountant had bariatric surgery for weight loss, and dropped 85 pounds. But by January 2024, he had gained back what he lost and wanted to try Wegovy. In the last six months on the medication, Katz has gone from 270 lbs to 230 lbs, dropping 40 pounds and two pants sizes.

Breakfast is a cottage cheese cup and cheese stick, he says. Lunch or dinner might be a small piece of chicken or fish and vegetables. “My appetite is gone so I don’t eat four slices of pizza anymore,” he said. Katz says he also lost his desire for snacking and cut out his daily six cups of coffee. “I changed my drinking and eating habits.”

Katz said he manages his own dosing, having increased in small amounts four times already.

This time around, he thinks he can maintain the weight loss.

“People have to realize this isn’t a quick fix,” he said. “It takes a commitment on your part to change your ways.”

Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.

When a man’s level falls below normal, his sex drive, energy levels, body hair, and muscle size are affected. Low testosterone also can be a trigger for depression.

A simple blood test  — at home or in a lab — can reveal whether testosterone levels are low.

South Florida doctors say they now have many options to raise testosterone levels: shots, gels, patches, and more recently, pills.

Pembroke Pines urologist Maury A. Jayson says he treats many patients for low testosterone. “It’s a huge health issue,” he said. Jayson advises against patches (they tear up the skin) and topical gels (they run off as men sweat in hot South Florida).

“I use mostly injections or self-injections,” he said. “There have been new formulas.”

Another newer option is pellets. “I insert testosterone pellets under the skin twice a year,” he said. Jayson said with the pellets the dosage is customizable, and the effects are long-lasting. “It’s convenient for men who are busy, and the levels stay elevated consistently over four to six months,”

Treatments for low testosterone typically have side effects: One side effect can be infertility. For older men, this may be less of a concern than for younger men who are still planning to have children.

At the University of Miami, researchers studied a nasal testosterone gel in a clinical trial. The results proved promising for younger men looking for a method to raise their testosterone levels without infertility.

The nasal gel is short-acting and doesn’t cause the body to maintain high testosterone levels throughout the day. Because it’s short-acting, it preserves the production of hormones from the pituitary gland responsible for sperm production.

“We did a trial to see whether nasal gel would maintain sperm production, and it did,” said Dr. Thomas Masterson, assistant professor of clinical urology at UM. “There was still some sperm production decline, but the overwhelming majority maintained sperm count while on that drug.”

In the last few years, the U.S. Food and Drug Administration has approved oral medications to boost testosterone — Jatenzo, Kyzatrex and Tlando. However, they have side effects that include an increase in blood pressure, and possible liver injury. “Because they are so new, our experience with these drugs is still somewhat limited,” Jayson said.

“I don’t prescribe those as much because of insurance issues,” Masterson said.

Doctors say supplements such as vitamin D, zinc and magnesium may also help to boost testosterone.

“When there is a sea of options, we want to tailor these medications to the patient,” Masterson said. “I pick and choose what may work better for each patient.”

Urologists advise looking at your health as a whole, rather than rushing to take testosterone boosters. “Low levels can be caused by other factors, including medication side effects, obstructive sleep apnea, thyroid problems or diabetes,” Masterson said.

It is 2 a.m. when Brianca Spence slips behind the wheel of her car. The drive to the nearest hospital can stretch as long as an hour, and feel like an eternity when she’s rushing to guide an expecting mother through childbirth.

As labor unfolds, Spence will translate the harsh demands of a nurse on duty into calming guidance. She will encourage the woman to ask for pain medication when she needs it or suggest a position change to speed up labor. And, when the mother eventually returns home with a new baby, Spence will be her pillar of support, encouraging her to stick with breastfeeding, or go for her postpartum doctor’s visit.

Babies born early, ill, or dead: Florida spends millions on prevention. Why isn’t it getting better?

In this maternity care desert on the western fringes of Palm Beach County, Spence’s mission as a doula is to advocate for mother and baby before, during and after childbirth. If she does her job well, she will play a vital role in keeping more Black mothers and babies alive.

With Florida’s infant mortality rate stubbornly higher than the national average and Black babies in the state dying at more than double the rate of white non-Hispanic babies, doulas represent a potential pathway to address the problem.

Doula training has ramped up in the state, the result of a confluence of factors that are making the option more available to women — particularly women of color — who may benefit most from having an advocate through the process. Doulas are non-medical, trained labor assistants or coaches who provide physical and emotional support during pregnancy, childbirth and recovery. A doula will speak up for a mother when a doctor dismisses her concerns. She will ensure a woman’s birth plan is followed as much as possible. And, she will pick up on signs of complications or postpartum depression that could have been overlooked.

There’s no legal training requirement for doulas in Florida, although most have completed certification programs.

To become a doula, Spence participated in the first cohort in 2022 to graduate from a training program through Healthy Mothers, Healthy Babies Palm Beach County. The program was specifically designed to drive down death rates for Black mothers and babies. Spence then joined Florida’s Doula Network, an Orlando-headquartered company that provides health plans with credentialed doulas. In Florida, The Doula Network contracts with Medicaid plans to cover doula services and typically pays the doulas a flat fee for prenatal, childbirth and postpartum support. “Each plan has a different amount that they pay,” Spence said. A private-pay client typically pays a doula a higher rate, she said.

Spence balances her doula role with a full time job at Lake Okeechobee Rural Health Network and her responsibilities as a mother of three young children. She gave birth to her children in a birthing center using a midwife and wants other mothers to have a good birth experience, too.

“I just want to be that support for women in my community,” she said. “The most important thing I do is teach them to speak up and what to speak up for. You don’t get that with a traditional prenatal provider.”

Steep cost of long-term preemie care takes heavy toll on overburdened families

In the past, doula care often has been unaffordable to low-income Black women who have higher risk of birth-related complications. If self-paid, a birth doula can cost $1,200 to $4,000, depending on whether pre- and post-birth visits are included.

As of 2019, many Medicaid enrollees in Florida’s managed care plans have access to the doula benefit. Florida is one of only 13 states that allows Medicaid plans to cover doula services, as an optional benefit. Some Florida plans offer it only to high-risk mothers while others make it more widely available.

For national insurer Elevance Health, Florida is one of the biggest markets for doula services in its Medicaid plans.

“We recognize that the Black community is really embracing doulas as an opportunity for change, and so we’re trying to put ourselves in that space to be able to help support that,” said Dr. Tiffany Inglis, national medical director at Elevance Health.

Inglis said her company began its foray into doula coverage by educating doctors, nurses and midwives in its network on the value they bring to the care team.

“We made it clear we don’t want doulas to replace doctors, nurses and midwives. We want them to be part of the care team so that we can sort of remove that burden to find social support (for a mother) from a clinical team that’s not trained for it,” Inglis said.

Spence, for example, not only accompanies mothers to prenatal and postpartum visits, but she also connects them to community resources for food, diapers, transportation, or mental health counseling.

Inglis said Elevance looks to its doctors to promote doula usage among patients and tracking results.  “The plans are putting doulas in communities where they know we have larger populations of Black moms because we are seeing such a good impact from it and we are seeing such a good uptake of it,” Inglis said.

Rebekah Antoine, a doula and community programs director with Miami’s Southern Birth Justice Network, said the doula benefit through Medicaid is a public health intervention and has the potential to reduce not only Florida’s infant mortality rate but also its maternal mortality and morbidity rates.

She wants to see Florida take the next step.

“There needs to be more funding going to community-based organizations to train new doulas to serve within their communities.” Antoine said. “There needs to be more education to let Medicaid recipients know the benefit is available. Midwives and doulas should be an option suggested to a pregnant person when they enroll.”

Just because you have a benefit doesn’t mean that you know how to sign up and how it works. Connecting the patients to the doulas is a missing link, she said.

Antoine would like to see state health officials foster more partnerships between doulas and providers such as Federally Qualified Health Clinics located in communities of color, particularly the underserved Haitian community.

“Doulas and midwives are an important part of the collaboration for making quality maternal care more accessible,” she said.

In Tallahassee, the services that doulas provide to the minority communities have caught the attention of Florida Sen. Rosalind Osgood, D-Tamarac.

Osgood wants to propose doula legislation similar to a law recently passed in Virginia, which mandates that health insurers who cover obstetrical services also provide coverage for state-certified doulas. She wants plans to set a higher rate for reimbursement. Doulas often complain of low reimbursement rates.

“I would like to see doulas paid consistently by healthcare providers for their advocacy and support of babies and mothers doing childbearing,” Osgood said. “Once we get some kind of criteria for certification, it makes it easier to allocate government dollars for those services and ensure doulas get paid fairly for their services.”

The state of Florida now connects pregnant women with doulas as a new initiative of the Florida Association of Healthy Start Coalitions.

Medicaid plans have provided funding to Healthy Start to train doulas using the G.R.O.W. Doula model. Sixteen of the 32 Healthy Start offices in Florida are working to complete the certification of the trained doulas and connect them with pregnant women.

Healthy Start’s Cathy Timuta asked the state in its 2024 session for more money to expand the Florida Health Start doula program to improve the disparities in birth outcomes for women of color.

“Healthy Start is launching a doula program through contracts with some of the health plans for the Medicaid population. However, we are in need of funding for the pregnant mothers who are not eligible for Medicaid which represent about 50% of births in Florida,” she wrote in a funding request for 2024-25.

Steep cost of long-term preemie care takes heavy toll on overburdened families

So far, the state has not approved the funding request.

However, in Miami, a Black Maternal and Infant Health Equity Collaborative has formed to train and certify 65 doulas and incorporate them into the obstetric care teams at Jackson Health, Miami-Dade’s large public hospital system.

“We have trained 29 doulas so far as well as training hospital staff to create a more doula-friendly environment,” said Loreen Chant, executive director of the Health Foundation of South Florida, which has provided funding for the Jackson Doula Pilot Project.

But doulas aren’t medical providers and won’t solve the problem of dwindling maternal care in some neighborhoods. About 19% of Florida’s counties are maternal care deserts, particularly concerning for Black women who face death rates related to pregnancy that are over three times those for white women.

Midwives are stepping in to fill the gaps and provide what they call “more culturally sensitive care.”

In a small office building in North Miami, Jamarah Amani runs a midwife clinic through a nonprofit called Southern Birth Justice Network. The space is calming, as is Amani’s voice as she sees Ashly Hinds for her first visit after giving birth. She asks the new mother about her success with breastfeeding, her mental health, her sex life.

Amani explains that midwives play a vital role in obstetric care.

“There’s different reasons that people come to us,” Amani said. “Sometimes it’s because they don’t trust the hospital. Sometimes it is because of previous birth trauma, or maybe they’re undocumented and they don’t want to be caught up in the system. But they do know when they come, that they’re going to get a more individualized, holistic, family-centered approach.”

Hinds, 30, of Coconut Grove said she is aware of the disparities facing mothers of color and didn’t feel comfortable with a hospital birth. She sought Amani to deliver her baby in her home. “For me it’s cultural,” Hinds said. “My grandmother was born at home with a midwife. What’s my normal might not be everyone else’s, and that’s OK.”

A recent analysis highlighted by The Commonwealth Fund found that a midwife workforce, integrated into health care delivery systems, could potentially avert as much as 39% of neonatal deaths and 26% of stillbirths.

In Florida, midwives need a license to practice but they typically don’t see high-risk patients.

Community midwives work outside of hospitals, delivering babies in birthing centers or at homes. Some Florida hospitals like Jackson Health in Miami or UF Health in North Florida offer team-based care that includes nurse midwives as part of their staff.

Florida’s new Live Healthy bill championed by Kathleen Passidomo eases the restrictions on independent midwives, making it easier for them to practice at birthing centers. The bill also allows “advanced birth centers” to provide cesarean section deliveries for women considered low-risk pregnancies. Until now, birth centers have been prohibited from providing cesarean sections, surgical procedures previously done only in hospitals.

Some insurers including Medicaid cover the cost of midwives, but reimbursement rates vary, and often are low. Typical midwives spend at least 45 minutes with a patient each visit, a different approach than most obstetricians..

“Many traditional providers will spend very little time with their patients because they just need the volume,” Amani said.

Florida has 853 certified nurse midwives, according to the national certification board, and 169 student midwives.

One of those student midwives is 32-year-old Johanne Ulysse. The Coral Springs mom is studying to become a midwife after a bad birth experience. Ulysse said when her baby went into distress at 41 weeks, she had an emergency C-section. “I thought, there has to be a better way.” The baby survived, but Ulysee knows the statistics — about 1,300 babies a year in Florida do not survive their first year.

“Midwives will talk about the patient’s personal life, health, diet … a lot of things that culminate and make a healthy pregnant person,” Ulysse said. “I think that if more Black women knew you don’t have to go to a doctor. You can have a midwife who will listen to you and give you more in-depth care. I think that it would be revolutionary.”

Jennie Joseph, founder of Orlando’s Commonsense Childbirth, became the first Black person in the U.S. in 2020 to privately own a nationally accredited midwifery school. She says Florida should offer universal healthcare to cover all women who want access to midwifery care, or doula care, or other maternal health providers.

As opposed to an OB-GYN she will take anyone who needs maternal care, regardless of their insurance status, and help them through the difficult process of applying to Medicaid, which few physicians in Florida want to accept, she said.

“Once you get to our clinic or make a phone call to our clinic, the answer is always going to be ‘Yes, we will see you.’”

After years of feeling dismissed in hospitals or provider offices, many Florida women are working to find prenatal caregivers who look like them, speak their language and listen to their concerns.

Belle Glade, a town with a significant population of women who are Hispanic, Black and Haitian, has only two prenatal care providers, and the nearest hospital with labor and delivery is 30 to 45 minutes away.

In her doula role, Spence feels like she is the safety net in her diverse community.

“When I looked at the stats and numbers and the community here, I saw mothers and babies in rural areas are dying more and the people who could make a difference don’t know or understand why,” Spence said. “Doulas might not be the end-all-be-all, but it’s a step in the right direction.”

Cindy Krischer Goodman, health reporter for the South Florida Sun Sentinel, reported this article while participating in the USC Annenberg Center for Health Journalism’s 2023 Data Fellowship, which provided training, mentoring, and funding to support this project. She can be reached at cgoodman@sunsentinel.com.

BORN TO DIE: FLORIDA’S INFANT MORTALITY CRISIS

PART 1: Babies are dying in Florida at a rate higher than the national average. Despite a declining birth rate, and millions of dollars spent on maternity programs, research, and outreach, the rate of babies who die before their first birthday remains unchanged. Florida’s tightening restrictions on access to abortion raise the risk even more, with the increasing likelihood that unhealthy and disadvantaged mothers will have no choice but to give birth to children who might die in their first year. So far, little the state is doing is leading to significant improvement in infant mortality, even while many of these deaths may be preventable. SunSentinel.com/InfantMortality

PART 2: For the last five years, Florida has seen an increase in premature births, a product of our poor health system and an increase in the number of women with health complications because of that system. The result is millions of dollars of public money are being spent to keep the premature babies alive in NICUs and support their ongoing medical issues. Not only does this drain public funds, but it keeps the families at near-poverty levels. The final segment in the “Born to Die” series looks at the families coping with a generation of children in need of costly medical care, education and development support. SunSentinel.com/LongtermCare

PART 3: Where does Florida spend its money when it comes to ensuring the health of babies, whether unborn or newly born? Data shows that despite funding and resources, the rate of babies dying before the age of 1 remains above the national average and hasn’t improved much in a decade. Florida spends $150 million a year on this issue. We examine where the money goes, how results are measured, and where money could be better spent to keep more babies alive and healthy.

Florida is now blanketed with med spas, weight management clinics, and online pharmacies that sell Ozempic, Wegovy and drugs that contain the compound, semaglutide, that squelches hunger and food cravings. In 2024, new weight loss drugs are on their way to the Sunshine State as are new diets and more ways to get medications for dropping pounds with minimal effort.

“I think we are going to see more of these drugs and more side effects,” said Dr. Eneida Roldan, an obesity specialist, professor and associate dean of Florida International University’s Herbert Wertheim College of Medicine.

The hype over weight loss drugs took hold in 2023, fueled by celebrities posting their before and after Ozempic photos on social media. Comedian Tracy Morgan had this to say: “I went and got a prescription, and I got Ozempic. And I ain’t letting it go … It cuts my appetite in half. Now I only eat half a bag of Doritos.”

Ozempic, a drug used to treat diabetes, and Wegovy, a drug for obesity, are being used off-label to help people drop pounds fast — whether 10 pounds or 100. These drugs work by reducing the appetite and allowing users to feel full sooner.

Floridians have joined the national craze, even forming Ozempic support groups on Facebook where they swap tales of their weight-loss journeys.  Mounjaro also has joined the drugs intended for diabetes but being used by Americans for weight loss. Its active ingredient is tirzepatide and like Ozempic, it is given as a once-weekly injection in the stomach, thigh or arm.

Mounjaro sells for a list price of about $1,023 per fill, which is equal to a month’s supply or four injector pens, according to Eli Lilly. Wegovy is slightly more costly with a list price of $1,349 for a month’s supply. Many private health insurance plans still do not cover obesity medications and shortages of the drugs have limited supply for consumers. For now,  Medicare is forbidden to cover such medications, but efforts by lawmakers are underway to change that.

A look ahead for weight loss

In 2024 more weight loss drugs are on the way.

In November, the Food and Drug Administration (FDA) approved Zepbound, a new drug for chronic weight management that contains the same compound as Mounjaro. Similar weight-loss medications are in the pipeline with a half-dozen or so candidates in this same drug class now making their way through clinical trials. There also are pill versions of  existing weight loss drugs in the works.

“Having more medications that are slightly different is a good thing, because some people may respond better to one and some may respond better to another,” Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medicine and NewYork-Presbyterian, told TODAY.com.

As the new year rings in, health experts expect more Floridians to turn to weight-loss drugs. Already, Florida ranks fourth for residents searching online for Ozempic, according to Kaly.com. Floridians are conducting 1,310 average monthly searches per 100,000 residents, Google data shows.

While these drugs grow in popularity, researchers only now are studying how healthy these weight-loss methods are for the general population, how they may affect certain populations, and whether they are sustainable. People have to keep taking the drugs for them to work, otherwise they eventually regain most of the weight that was lost.

Reported side effects include nausea, constipation, diarrhea, vomiting, indigestion and stomach pain, according to the manufacturers and posts on social media. There are also less common but more severe side effects such as allergic reactions, changes in vision and pancreatitis, and Ozempic includes a warning for the risk of thyroid C-cell tumors.

Specialists, like FIU’s Roldan, say although the medications are being prescribed off-label for weight loss rather than severe obesity or diabetes, there isn’t enough evidence yet to know whether they might be beneficial or harmful for people who fall outside of the FDA’s criteria.

Start with a doctor’s visit

Experts say too many people rely on the weight-loss drugs rather than learning healthy eating habits that will keep off the pounds over the long term.

“Medications are tools. Bariatric surgery is a tool. But there is no quick fix,” Roldan said “Like everything else it’s a game of numbers. The more individuals start using these drugs, the more complications we will see.”

People who resolve to lose weight in 2024 should start with a physician consultation, Roldan says.  She says the popular diet, intermittent fasting — fasting daily for a set amount of time — could be helpful for some people if they are not in danger of hypoglycemia. So could reducing sugar and fatty foods.

“Anything you want to try should be done in consultation with a professional who can give you a baseline of your physical and mental condition,” she said. “The bottom line is what makes you lose weight is getting to know yourself, your habits, your lifestyle, how you react to stress.”

Exercise-mimicking drug sheds weight

In North Florida, Thomas Burris, a University of Florida professor of pharmacy, may have discovered another weight loss breakthrough.

He is working on a new weight-loss drug tested in mice that mimics aerobic exercise and increases endurance. Known as SLU-PP-332, the drug boosts a natural metabolic pathway that gets activated when someone exercises. In effect, the drug makes the body act like it is training for a marathon, leading to increased energy expenditure and faster metabolism of fat in the body.

So far, the drug has been tested in mice and hasn’t shown any severe side effects. Burris says the greatest hope for the new drug might be in maintaining muscle mass during weight loss. He believes pairing it with one of the new weight-loss drugs could be beneficial.

“When you reduce food intake, you reduce protein intake, and you lose muscle mass and muscle function unless you increase exercise at the same time,” he said. “A combination of these drugs could be the next step for anti-obesity drugs.”

For now, Burris warns Floridians to scrutinize any weight-loss medications that aren’t brand name, noting that all kinds of businesses are advertising their own versions of drugs with semiglutide at discounted prices and in various doses (often marketed as Ozempic alternatives).  “I worry when you see compounding,” he said. “You don’t know if it’s the real thing or a modification. These drugs are expensive to manufacture, so when people are offering what they say are the same drugs at substantial discounts, you have to think how can they do that?”

Bariatric surgery is still an option

Before this new class of weight-loss drugs drew attention, bariatric surgery had been embraced as an option for the obese. Dr. Raul Rosenthal, a bariatric surgeon at Cleveland Clinic Weston, says the surgery continues to be performed on the severely obese. However, he says it can be costly and not everyone who is obese is a candidate. For some patients, he prescribes the new weight-loss drugs. “They are welcome by bariatric surgeons as another tool in our toolbox. I think we still need to define who will get it, who will not, and define who will prescribe this medication,” he said.

Rosenthal said the drugs represent a medical revolution, a less costly, more universal way to address the disease of obesity.

“So far these medications are injectable. I foresee in the near future either oral medications or dermapatches. and they will be cheaper, so more patients can be treated,” Rosenthal said.

Along with stories of rapid weight loss from Ozempic, there are people who have expressed on Facebook and Tik Tok how they “wished they had never touched it,” claiming the drug has led to stomach paralysis, loss of muscle, and excessive vomiting.

Another way to lose weight

Dr. Terri DeNeui, founder and Chief Medical Officer of EVEXIAS Health Solutions, says anyone who wants to lose weight in the new year should look into the root cause of why they have gained pounds — and that may be a hormonal imbalance.

“These medications are a game-changer in the weight-loss world,” she said. “But trying to address weight loss without addressing hormone deficiency is futile. You can jump start weight loss with the medications, but keeping it off is different.”

After 40, she says, hormone imbalances are more common.

“Adjusting hormone levels can be the cornerstone for weight loss, but you also need to look at dietary changes,” she said. “With these medications, people aren’t changing their lifestyle, just eating less. After awhile they report the drugs are not working anymore. They can get desensitized and they haven’t made the lifestyle changes.”

Some scientists also are looking into fermentable fiber as the “magic” behind the drugs that have triggered weight loss. They believe that particular types of fibers trigger GLP-1 release (the same receptor that Mounjaro targets). By eating more of this fiber, their theory is that it will create a feeling of fullness similar to the medications. So far, the fiber in barley, oats and rye have shown promise.

Change your mindset to lose weight

Dr. Adedapo Iluyomade, a preventative cardiologist at Baptist Health Miami Cardiac & Vascular Institute, believes weight loss needs to be seen as a chronic condition that should be addressed in an ongoing manner — through food choices and daily exercise.

“Targeting weight loss is a very important goal for someone headed into the new year if they are overweight or obese,” he said. “Being overweight can affect their health in a multitude of ways.”

In recent years, high-fat, low-carb diets have become popular.

Lluyomade advises against them: They have been shown to elevate cholesterol to unsafe levels and increase a person’s cardiovascular risk.

Although he has prescribed weight-loss drugs to some patients, he believes the best way to lose weight is to reduce calorie intake and increase physical activity.

“Just get up and move and do something,” he said. “It will build momentum.”

Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.

As of Friday, 17 states are reporting “high” or “very high” levels of respiratory illness activity, federal health data shows. The states where illness activity is highest are scattered throughout the U.S. but most of the Southeastern states are seeing high levels, along with Western states like California, Nevada and Colorado. New Jersey and New York City also are seeing high levels, based on percentage of visits to outpatient healthcare providers or emergency departments for fever and cough or sore throat.

States with the lowest levels of respiratory illness are Minnesota and West Virginia. To check the level of respiratory activity in the area where you are traveling, visit the Centers for Disease Control and Prevention respiratory illness dashboard.

“Every individual has a different risk tolerance and a different medical history,” said Alicia Budd, lead of domestic surveillance division of CDC. “It’s important to look at the surveillance, know the situation where you are going and be aware of what your risk will be.”

This year, as people board airplanes and cruise ships and load into their cars to celebrate with friends or family, fewer Americans are vaccinated against flu and COVID-19.  Only about 20% of U.S. adults say they have received the updated COVID-19 vaccine with most of the recipients ages 65 and older, according to the KFF COVID-19 Vaccine Monitor. Also, as of Dec. 2, only 40.8% of U.S. adults have received the flu vaccine, which is about  2 percentage points lower than flu vaccine coverage at the same time a year ago.

Last week, the CDC sent an alert to healthcare providers, encouraging them to administer COVID-19, flu and RSV vaccines as soon as possible.

“The flu strains now are well matched to the strains circulating,” Budd said. “It may not prevent you from getting the flu, but it reduces severity … it helps prime your immune system so you are  better able to respond and fight off infection or you don’t get as severely ill.”

Overall, in most areas of the U.S. the amount of respiratory illness (fever plus cough or sore throat) causing people to seek healthcare is elevated and ER visits are on the rise, according to data updated Dec. 15 from the CDC.

“This year we are seeing full-blown everything,” Budd said. “The timing of when one virus is surging and others are not can vary, but in some states you do see all three at same time.”

Flu is hitting hard

Flu, in particular, is on the increase across the country, just as airports are expecting more travelers.  Up to 5.4 million people in the United States already have been sick with the flu this fall with symptoms that include headache, fatigue and a lingering coughing, the CDC estimates.

If you’re traveling to cold climates, beware:  Health experts believe the flu virus survives better in cold weather, and cold, dry air weakens people’s resistance.

“I think we will see flu activity continuing to increase … I expect that to be the case for several more weeks,” Budd said.

The southeast, south-central, and west coast areas of the country are reporting the highest levels of flu activity.

In Florida, flu activity leading to emergency department visits is stable or decreasing  in most parts of the state as of Dec. 2, the most current data reported by the Florida’s Department of Health. Still flu activity in Florida is above the previous three-year average in all regions of the state.

COVID-19 is still out there

COVID-19 also is circulating at high levels in some parts of the country. The new COVID variant JN.1, a descendent of Omicron, has become an increasing share of cases, the CDC’s tracking shows.  The variant will be responsible for at least half of new infections in the U.S. before December ends, the CDC experts say. Although highly contagious, there is no evidence JN.1 causes more severe disease. The federal agency advisory says COVID-19 tests and treatments are expected to be effective against JN.1.

Francesca Ceddia, senior vice president of  respiratory vaccines at Moderna, said the updated shot will work against the JN.1 strain. “We keep calling them boosters but really they are updated vaccines and were changed for a purpose. They are made to be more specific for the sublineages circulating now.”

Ceddia said Moderna, at this time, feels confident the updated vaccine will cover existing strains. “At this stage, we have not started on a new booster.”

Ceddia says Americans are now facing the most critical part of respiratory illness season as people travel and gather. “If you get the updated vaccine, your protection against infection should be high, but most importantly you get  protection against hospitalizations and deaths. They are on the rise week over week, and you want to avoid that.”

The CDC data tracker shows COVID-19 hospitalizations have been increasing following relatively low levels throughout the summer and early fall. Miami-Dade and Broward County hospitals  report a 16.9% rise in new COVID-19 admissions during the past week, while Palm Beach County hospitals report only a 3.8% increase.

Test positivity rates are rising too, with some areas of the country seeing higher increases. To check COVID test positivity levels where you are traveling, visit the CDC COVID-19 data tracker.  You can also check to see the change in positivity from the prior week.

The CDC also uses wastewater surveillance data to monitor COVID levels. As of Dec. 11, the data suggests there’s a lot of COVID-19 going around, particularly in states such as Wisconsin, Illinois, Michigan and Ohio. In South Florida, however, the data shows minimal levels of COVID-19.

RSV surge may be subsiding

Another respiratory virus circulating this season is Respiratory Syncytial Virus, known as RSV. Health experts believe it may have peaked in November and report the virus appears to be receding nationwide. Nationally, visits to emergency departments for RSV declined slightly in the last week, the new federal data shows. The decline was driven mainly by decreases in Southeastern states.

Overall, it has been a harsh respiratory illness season thus far. CDC estimates that there have been at least 3.7 million illnesses, 38,000 hospitalizations, and 2,300 deaths from flu and  COVID.

Health experts expect the numbers for illnesses, hospitalizations and deaths to rise in late December and early January due to travel and holiday gatherings.

Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.

Most fitness trackers and wearable devices are programmed with a daily goal of 10,000 steps, which amounts to about 5 miles. But some experts say that goal can be too high or too low, depending on the amount of exercise a person needs to be healthy.

For the average person,10,000 steps a day can be a great goal, for others it’s a starting place, and for some it could be too lofty, says Michael C Zourdos, professor in the Department of Exercise Science and Health Promotion at Florida Atlantic University.

“Ten thousand is not a magic number,” Zourdos said. “There are very few things in health and fitness that have a magic number.”

Zourdos emphasizes that a fitness goal should consider age and current activity level. Beginners should start slow to avoid muscle strain and experienced walkers should refrain from overdoing it to the point of chronic fatigue.

For most healthy persons, walking is less about the number of steps and more about intensity and increasing heart rate for a continuous period of time. You need at least 150 minutes a week of moderate aerobic activity, such as brisk walking, to lower your risk of cardiac metabolic disease. .

“If you are fit and do 10,000 low intensity steps and replace that with 8,000 vigorous steps, it probably will be better for you,” Zourdos said.

In South Florida, a hardy beach walk can double the exercise benefits of your typical outdoor walk. Studies show that walking on sand increases the amount of energy you use.

According to research, walking on sand actually requires over two times more energy than walking on a traditional surface at the same speed. That means your body is working twice as hard at your normal pace, therefore doubling the activity and burn of your usual walk.

Movement should be a primary goal, regardless of the number of steps. Studies have shown that sitting for long periods is in itself unhealthy.

Zourdos adds, “If 10,000 steps is a benchmark to keep you motivated, go for it.”

Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.