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• New research shows adding a few minutes of vigorous “everyday” physical activity to your daily exercise routine could help control blood pressure. 
• Heart-pumping activities like cycling, running, and stair climbing were linked to lower blood pressure readings among study participants.
• An extra 5 minutes of exercise led to mild improvements in blood pressure, with clinically meaningful results at an additional 10 and 20 minutes of physical activity.
• Experts recommend aiming for 30 minutes of aerobic exercise daily to control blood pressure and maintain a healthy heart.

Exercise is universally linked with positive outcomes, like maintaining healthy blood pressure.

Short bursts of physical activity can help get your heart pumping, but regular exercise is key for overall health.

A new study published November 6 in the journal Circulation suggests that adding a few minutes of vigorous physical activity to your daily exercise routine can help lower blood pressure. 

The researchers found that an extra 5 minutes of stair climbing, cycling, and running was linked to slight reductions in systolic and diastolic blood pressure, while clinically meaningful improvements were seen at an additional 10 and 20 minutes of daily exercise. 

Less strenuous forms of movement, such as standing or walking, had minimal effects on blood pressure.

“Our findings suggest that, for most people, exercise is key to reducing blood pressure,” first author Jo Blodgett, PhD, a senior research fellow at UCL Surgery & Interventional Science and the Institute of Sport, Exercise & Health, said in a statement.  

“The good news is that whatever your physical ability, it doesn’t take long to have a positive effect on blood pressure. But if you want to change your blood pressure, putting more demand on the cardiovascular system through exercise will have the greatest effect,” Blodgett continued.

Everyday activities help control hypertension

Researchers from University College London and the University of Sydney conducted this study with support from the British Heart Foundation (BHF).

The research team analyzed health data and blood pressure measurements from 14,761 participants with an average age of 54 from six cohorts in the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS).

They tracked blood pressure changes over 24-hour periods comprising six different activities with the following average durations: 

1. sleeping — 7.1 hours 
2. sedentary behavior (i.e., sitting) —  10.7 hours
3. slow walking (fewer than 100 steps per minute) — 1.6 hours
4. fast walking (more than 100 steps per minute) — 1.1 hours
5. standing — 3.2 hours
6. exercise (i.e., running, cycling) — 16 minutes

They estimated the impact of replacing one type of activity with an additional 5, 10, and 20 minutes of exercise.

They found that replacing less active behaviors with 5 minutes of exercise lowered systolic blood pressure (SBP) by 0.68 millimeters of mercury (mmHg) and diastolic blood pressure (DBP) by 0.54 mmHg.

They note that a 2mmHg reduction in SBP and a 1mmHg reduction in DPB equates to a 10% reduction in heart disease risk.

They also estimate that 20 additional minutes of daily exercise could lead to clinically meaningful improvements in SBP, and 10 extra minutes of exercise per day could improve DBP.

The researchers emphasize that everyday activities that get the heart pumping may promote healthy blood pressure.

“What’s unique about our exercise variable is that it includes all exercise-like activities, from climbing the stairs to a short cycling errand, many of which can be integrated into daily routines. For those who don’t do a lot of exercise, walking did still have some positive benefits for blood pressure,” Blodgett continued. 

Exercise lowers blood pressure, benefits heart health

Cheng-Han Chen, MD, board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, told Healthline the study reinforces physician-backed recommendations for regular daily exercise.

“It is encouraging to see measurable changes in blood pressure with just a few minutes of exercise, something that can be incorporated into even a busy schedule,” Chen said.

“We know that physical activity directs our organs and tissue to undergo changes that improve their performance and efficiency, which can then lead to improved blood pressure control. By increasing the intensity of exercise, you are accelerating the physiological changes that are providing the benefits to heart health,” he explained.

How much physical activity do you need?

The findings of this study do not suggest that 5 minutes of exercise a day is enough but rather encourage people already getting regular exercise to increase their output, particularly those with high blood pressure.

Current CDC guidelines for physical activity recommend 150 minutes of moderate-intensity exercise each week for adults, 75 minutes of vigorous exercise, or a combination of moderate and vigorous exercise.

For heart health, Chen said he typically recommends 30 minutes of moderate-intensity aerobic activity daily on most days of the week.

To effectively lower blood pressure, Chen echoed the findings from this study and recommended aerobic forms of exercise, such as: 

• walking
• jogging
• cycling
• swimming or water aerobics

“It is also helpful to incorporate some strength training, as this also helps to improve the function of blood vessels and improve blood pressure,” Chen said. 

“Patients who do not have their blood pressure under control should avoid very high intensity exercises such as sprinting or heavy weights, as these activities can lead to a spike in blood pressure,” he advised.

Other ways to lower blood pressure 

Chen noted that many people may not realize the health benefits of adding a little exercise to their daily routine. 

“There are many easy ways to incorporate physical activity throughout the course of the day,” he noted. Some examples may include: 

• short 5-minute brisk walks while at work  
• taking the stairs instead of the elevator
• parking farther from the store and walking

Chen noted that if you live with high blood pressure, you should talk with your doctor about lifestyle factors that can help control it.

Regular physical activity aside, other ways to lower blood pressure may include: 

• following a healthy, balanced diet low in sodium 
• getting enough quality sleep
• maintaining a healthy weight
• avoiding tobacco and alcohol
• managing stress

Takeaway

A new study showed improvements in blood pressure with an additional 5 minutes of daily exercise. The findings became more significant with an extra 10 and 20 minutes of heart-pumping physical activity each day. 

Aim for around 30 minutes of aerobic daily exercise to control blood pressure and maintain a healthy heart. If you have high blood pressure or live with another chronic health condition, check with your doctor before starting a new exercise routine.

• Bruce Willis’ wife has stated that an early sign of his dementia was first dismissed as stuttering.
• Experts say frontotemporal dementia itself does not cause stuttering.
• However, its associated language issues can make an existing stutter worse.
• Early warning signs can also include changes in personality, behavior, or motor function.
• If you spot the warning signs, it’s a good idea to speak with your primary care provider.

According to Emma Heming Willis, wife of action hero Bruce Willis, her husband’s frontotemporal dementia (FTD) was initially dismissed as a return of childhood stuttering.

Speaking in an interview with Katie Couric for Town & Country, she explained: “He had a severe stutter as a child. He went to college, and there was a theater teacher who said, ‘I’ve got something that’s going to help you.’”

Heming Willis said this is where Bruce got his start in acting since he realized that he could memorize a script and say his lines without stuttering.

“Bruce has always had a stutter, but he has been good at covering it up,” she said. So, when he began to experience difficulties with language, it seemed like it was just a part of his stutter.

“Never in a million years would I think it would be a form of dementia for someone so young,” said Heming Willis.

How common is stuttering as a warning sign of FTD?

Stephanie Jeret, who is a speech-language pathologist and the founder of Speak with Stephanie, said stuttering is not commonly associated with FTD.

This condition mainly impacts people’s ability to understand and use language, she said.

“For instance, Bruce Willis had developmental stuttering that likely persisted into adulthood,” said Jeret.

“He may have developed coping strategies to manage it, but with the onset of FTD, he could have experienced a regression in his language skills, leading to overt stuttering as a symptom of this decline rather than a direct symptom of FTD.”

Jason Krellman, PhD, a Neuropsychologist and Assistant Professor of Neuropsychology at Columbia University Irving Medical Center, agreed with Jeret.

“Stuttering is itself not considered a typical first symptom,” he said. “But stuttering could be caused by more common early symptoms such as changes in word finding and sentence construction or changes in the person’s ability to physically articulate words.”

According to Krellman, changes in personality and behavior, language, or motor functioning are usually seen early in the development of FTD.

“People can become withdrawn or impulsive, rigid, and socially inappropriate,” he said. “They can have difficulty finding words or understanding language. They can have spasms, tremors, or weakness.”

How to get help when you spot FTD warning signs

Krellman added that it can be challenging for patients and healthcare providers alike to tease out whether what’s being seen is indeed FTD symptoms or just a natural part of aging, stress, psychological problems, or, as in the case of Willis, another medical condition.

“For example, word-finding difficulty is a common feature of normal cognitive aging, motor changes can be due to musculoskeletal problems like arthritis, and people can tend to socially isolate themselves or become irritable, more easily agitated, and therefore appear socially inappropriate when they’re depressed,” he said.

Additionally, FTD can come on slowly and progress so gradually that you might not notice the differences right away, said Krellman, comparing it to noticing the hands of a clock moving.

However, Krellman says people should contact a primary care provider any time they have concerns, keeping in mind that the person themself may not notice the changes.

“A PCP can do an initial evaluation to decide whether to refer the person to a neurologist for further evaluation,” he said.

Krellman went on to offer reassurance, stating that “FTD is pretty uncommon, and it is much more likely than not that any concerning symptoms are due to normal aging or a more common and potentially treatable condition.”

He noted, however, that if symptoms are getting worse over time and having a negative impact on a person’s daily functioning, it’s always a good idea to get a checkup.

He added that in addition to seeing your primary care physician, organizations like the Association for Frontotemporal Degeneration and the Alzheimer’s Association can provide support and educational resources.

Takeaway

In a recent interview with Town & Country, Emma Heming Willis, wife of actor Bruce Willis, discussed her husband’s frontotemporal dementia diagnosis, revealing that they first thought his worsening stuttering was simply a part of a condition that he had had since his youth.

Experts say that stuttering itself is not a symptom of FTD.

However, the language difficulties associated with FTD can make it more difficult for a person to control their existing stuttering.

People can also experience changes in personality, behavior, and motor functioning.

If you or someone you know is showing early warning signs — especially if they are growing worse or negatively affecting daily functioning — you should seek an evaluation with a primary care provider.

• Teacher Krista Figari is opening up about how she experienced a “wake-up” stroke at the age of 39.
• This includes sharing video clips of the event that were captured as it happened.
• Figari is sharing her story to help others recognize the symptoms of stroke and raise awareness.
• Early intervention of stroke can help save lives.

Krista Figari went to sleep on April 18, like any other night. However, around 4:45 a.m., her life changed.

“I remember waking up and doing my normal routine. I made my bed, and all the sudden, I kind of stumbled over to the left and was on the ground,” she told Healthline. “I couldn’t stand up. I literally couldn’t move, lift, feel my leg, my arm, my hand. That whole left side was just not working.”

As Figari tried to understand what was happening, she crawled over to her nightstand and reached for her cell phone with her right hand. She tried calling her cousin, who lives nearby, and the super of her building, but neither answered.

Her super called her back and immediately went to her apartment, yet he couldn’t get in through her front door.

“That’s when I used Siri to call 911,” said Figari.

When the police arrived, they also couldn’t get through her front door, so her super crawled through a window.

“Once he came through, he opened the door, and the EMS people came in and brought me to the hospital,” Figari said.

When Figari arrived at New York-Presbyterian/Weill Cornell Medical Center, doctors quickly diagnosed her with a stroke. The type of stroke she experienced is called a wake-up stroke.

What is a wake-up stroke?

A wake-up stroke is a type of ischemic stroke that occurs when symptoms are discovered as a person wakes up from sleep.

While strokes are unpredictable and can happen at any time, about 20% of strokes are wake-up strokes.

How wake-up strokes are diagnosed and treated

“If a patient comes in with witnessed stroke onset within 4.5 hours of [having their first symptoms], they can be treated with a clot-busting medication or thrombolysis, TPA or TNK are the medication names,” Nicholas Janocko, MD, a neurologist at NewYork Presbyterian Hospital, told Healthline.

Janocko, who treated Figari, explained that the 2018 WAKE-UP trial demonstrated that in selected patients who experienced a stroke with unknown onset or a wake-up stroke, a hyperacute MRI can be used to determine if the stroke happened within a few hours, and if so, whether they are eligible for thrombolysis treatment.

“Our stroke team was able to obtain an emergent MRI for her…we were able to use the imaging features to support that her stroke was recent in onset, and we were safely able to give her thrombolysis,” said Janocko.

After treatment, Figari stayed in the hospital for four days to be monitored.

While stroke recovery usually involves physical therapy, occupational therapy, and speech therapy, she did not require any of these.

“Within three days, most of my movement came back, and the numbness [was gone], and I was basically fully recovered. I didn’t need any rehab,” she said.

Congenital conditions can increase stroke risk

Doctors determined that her stroke was caused by a large patent foramen ovale (PFO), a hole in the heart between the two atria.

“A PFO is a remnant from fetal circulation, which closes in most people after birth. However, it remains open or patent in about 25% of the population,” said Janocko.

In most people, PFO doesn’t cause issues, but it is associated with migraine and an increased risk of stroke.

A few months after her stroke, at the age of 39, Figari underwent heart surgery to close the hole in her heart. She also had follow-ups with her neurologist and cardiologist.

Stroke risk is increasing among younger people

While Figari’s stroke was caused by a congenital condition, stroke in people younger than 50 makes up about 10% of all strokes.

Janocko said the incidence and prevalence of stroke in young people is increasing over time, mainly due to an increase in vascular risk factors like:

• Obesity
• High blood pressure
• High cholesterol
• Diabetes
• Sleep apnea
• Smoking
• Substance misuse

“There is also increased awareness of stroke and utilization of MRI to confirm the diagnosis in atypical stroke presentations,” he said.

Why Figari is sharing video footage of her experiencing stroke symptoms

Figari has a nanny cam in her apartment because she likes to monitor her dog while she is at her teaching job.

When she got home from the hospital, she discovered that the camera caught footage of her stroke.

“I was glad I had it because I was able to see it and know that what I thought happened actually did. Since I was alone, it validated my story for me and anyone I shared it with,” said Figari.

She is sharing her story because she wants others to know that a stroke can happen to anyone and that it might affect them differently.

“Even if you feel one little thing…if you feel something’s wrong, get help,” she said. “I think we often think we’re invincible and that just because we’re not a certain age, that something can’t happen to us. But you never know what’s going to happen.”

Footage of Figari experiencing wake-up stroke symptoms can be viewed in the following two video clips.

Common stroke symptoms

To remember the symptoms of stroke, he said to keep in mind the mnemonic BE-FAST:

• Balance loss
• Eye-sight changes
• Facial droop
• Arm weakness
• Speech difficulty
• Time (time to call 911)

The Spanish version is RAPIDO. 

“Stroke treatment is a team effort. It starts with community recognition of the signs and symptoms of stroke,” said Janocko.

Ways to reduce your risk of stroke

Hera Kamdar, MBBS, a neurologist at Ohio State University Wexner Medical Center, said practicing the following can help reduce your risk of stroke.

• Improve your blood pressure
• Normalize your cholesterol levels
• Eat healthy foods and follow a Mediterranean diet which is rich in vegetables, whole grains, legumes, fruits, nuts, seeds, and olive oil
• Exercise regularly 
• Maintain a healthy weight 
• Ensure quality sleep and treat sleep apnea if you have it 
• Manage diabetes 
• Drink in moderation
• Avoid smoking

In addition to the above, Kamdar said the American Heart Association is focused on new recommendations for women, including screening for conditions that can increase their risk of stroke, such as the use of oral contraceptives, high blood pressure during pregnancy, and early onset menopause.

“There is also more focus put on a person’s social determinants of health and how that may impact their ability to receive optimal screening and care to prevent stroke,” Kamdar told Healthline.

• A phase 3 clinical trial suggests a new standard of care for treating people with advanced cervical cancer.
• The recommendation includes a combination of induction chemotherapy followed by chemoradiotherapy.
• The researchers are interested in how future studies can investigate the use of immunotherapies to further improve survival rates.
• Clinicians are hopeful the new approach will give people with aggressive cervical cancer additional options for treatment, particularly those who face barriers to healthcare.

Cervical cancer affects approximately 11,500 people in the United States each year and 660,000 people worldwide.

A phase 3 clinical trial recently published in The Lancet proposes a new standard of care for people with cervical cancer who aren’t candidates for surgery. The recommendation includes a combination of induction chemotherapy followed by chemoradiotherapy instead of chemoradiotherapy alone.

Compared to participants who received only chemoradiotherapy, those who received both induction chemotherapy and chemoradiotherapy saw an increase from 64% to 72% in their 5-year progression-free survival rates.

The INTERLACE trial included 500 participants from medical centers in Brazil, India, Italy, Mexico, and the United Kingdom, all of whom had locally advanced cervical cancer.

“Prior to this study, doing chemotherapy before chemotherapy and radiation in combination had not really demonstrated benefit,” said Joshua G. Cohen, MD, medical director of the gynecologic cancer program at City of Hope Orange County, CA, told Healthline. Cohen wasn’t involved in the study.

“This was a large trial, an international trial [that] took over 10 years to complete, but certainly a study that gives us another option to offer patients, which is fabulous,” Cohen told Healthline.

A promising development in cervical cancer treatment

The INTERLACE trial reduced the wait time between the initial course of induction chemotherapy and chemoradiotherapy, yielding promising results.

Study co-author and clinical oncologist Mary McCormack, PhD, told Healthline that while this updated approach has the support of many healthcare professionals, including those in the U.S., not everyone is on board with the new standard-of-care recommendation.

“I think some [concerns] lark back to the ’90s, when the older trials were published and demonstrated a detrimental effect of this approach by giving the chemotherapy,” McCormack said.

“There were a number of issues and potential flaws with those studies when they were all generally small studies and they all used different drug combinations and different schedules. They didn’t control for this interval between finishing the treatment, the chemo, and starting the radiation,” she explained.

The INTERLACE trial study was much broader, with participants spanning five different countries. Those who received both induction chemotherapy and chemoradiotherapy received 6 weeks of chemotherapy, with treatments occurring once a week. 

Diana Pearre, MD, a gynecologic oncologist at The Roy and Patricia Disney Family Cancer Center at Providence Saint Joseph Medical Center in California, shared she is optimistic about the new treatment pathway. Pearre wasn’t involved in the clinical trial.

“I suspect many will read this study and think that this is a great way to start our patients on something,” she told Healthline. 

“As clinicians, we are often made keenly aware of how different insurances, referrals, and other issues prevent our patients from starting radiotherapy on time. With over 70% of gynecologists also administrating chemotherapy, induction chemotherapy seems like something within our realm of control,” Pearre noted.

What’s next for cervical cancer treatment?

The drugs used in the INTERLACE trial are already broadly available, as are many of the quality-of-life treatments. Scalp cooling, for instance, can be used to combat the side effects of induction chemotherapy. 

McCormack hopes to see clinicians make changes to improve cervical cancer treatment outcomes. She is also hopeful that ongoing research — like studies into the use of immunotherapies — could hold the key to even better treatment outcomes. 

“I think the next step should be to look at incorporating and adding in immunotherapy with this induction treatment, because there’s good scientific rationale why this might work, and it’s an opportune moment to look at that now. And I do believe there are some groups in the US that are planning to do just that,” McCormack said.

Cohen agreed: “We’ve been looking for years in ways we can incorporate immunotherapy into the use of cervical cancer [treatments] because we all believe that cervical cancer should have an immune therapy treatment, given it’s largely driven by a virus, HPV,” he said, noting around 80% to 90% of cervical cancer is driven by HPV.

As with most medical treatments, access to the proposed standard of care and having it covered by health insurance is a key focus for the future.

While HPV vaccination and cancer screening efforts have increased over the decades, cervical cancer poses a higher risk to those in low-income countries and low-income areas.

While vaccination against HPV is vital to ongoing prevention and treatment efforts, Cohen said the findings of the study could lead to more options for those facing barriers to quality healthcare.

“If you’re in a place where you’re having a tough time getting a radiation oncologist to see you, or you’re getting delays in care, it’s a good option to start with chemotherapy,” he said.

“You have 6 weeks, you can get chemotherapy started, then maybe you get plugged in with the radiation oncologist. This is a good option now that we have data that says it works.”

Takeaway

A new phase 3 clinical trial suggests a new standard of care for people with advanced cervical cancer who aren’t a candidate for surgery.

The promising new recommendation involves a combination of induction chemotherapy followed by chemoradiotherapy instead of just chemoradiotherapy by itself.

Experts are optimistic this approach will give people additional treatment options, particularly those with barriers to healthcare.

• Fewer Medicare Advantage plans will be available in 2025.
• Some health care providers will stop accepting certain Medicare Advantage plans.
• There will also be a drop in the number of Medicare Part D prescription drug plans.

With the Medicare Open Enrollment Period for 2025 running from October 15 to December 7, consumers should be aware of several major changes in the availability of plans and pricing.

But some of the biggest changes to Medicare will be seen in Medicare Advantage and Part D prescription drug plans.

Here are three key changes you should know as you consider your Medicare coverage for 2025.

Fewer Medicare Advantage plans available

In 2025 there will be an average of 34 Medicare Advantage plans offered in each county in the United States, reported Forbes, falling from 43 this year.

In addition, 6.6% fewer Medicare Advantage plans with prescription drug coverage will be available next year compared to this year. This includes 5.4% fewer plans offered by UnitedHealth Group, and 2.5% fewer plans by Humana.

On the bright side, the average monthly premium on Medicare Advantage plans will be $17.00 in 2025, a drop from $18.23 in 2024, said the Centers for Medicare & Medicaid Services (CMS). This is an average, so some plan premiums may increase.

In addition, benefit options will remain stable, CMS said, including Medicare Advantage supplemental benefit offerings such as hearing, dental, and vision.

However, “a lot of [Medicare Advantage] plans … are adjusting their core benefits or reducing or eliminating supplemental benefits like gym memberships,” said Whitney Stidom, VP of Medicare Operations at eHealth Insurance.

Robert Griffith, senior director at L.A. Care Health Plan, said his group is closely monitoring regulatory changes by CMS, including ones “with an emphasis on addressing health equity, encouraging Medicare Advantage plans to incorporate benefits and outreach efforts tailored to vulnerable populations.”

”These changes, combined with ongoing competition between Medicare Advantage plans in L.A. County, mean beneficiaries are likely to see a broader range of plan choices with expanded supplemental benefits,” he told Healthline.

Some providers won’t accept certain Medicare Advantage plans

Even if your Medicare Advantage plan is still available in 2025, you may find that your health care provider no longer accepts or participates in the plan.

For example, Essentia Health announced that it would no longer accept Medicare Advantage plans from Humana and UnitedHealthcare. Sanford Health, a major medical provider in the Midwest, said it had ended its contract with Humana Medicare Advantage.

In a recent survey by HFMA, about 16% of health systems expect to stop accepting one or more Medicare Advantage plans over the next two years. They cite onerous authorization requirements and high denial rates of these plans.

If you are on a Medicare Advantage plan, your medical care is only fully covered when the provider is in the plan’s network. You will pay all or most of the cost for out-of-network care.

During Open Enrollment, check to be sure your doctors, hospitals and other providers are on your plan’s list for 2025.

Stidom said it’s also important to read the Annual Notice of Change letter sent by your Medicare insurer and to review your options for 2025. Only three in 10 enrollees reviewed their Change letter, a recent survey by eHealth found.

“This year, more than any in recent memory, it is important for beneficiaries to review their plan’s annual notice of change letter and make sure the benefits their plan offers meets their needs,” she told Healthline.

Forbes also reports that in 2025, Medicare Advantage plans will be able to deny coverage of procedures and services recommended by your doctor. When this happens, you either have to skip the treatment or appeal the decision.

Changes to Part D prescription drug plans

There will be about 25% fewer Medicare Part D policies available in 2025, reports CMS. This is the lowest number of policies offered since the start of Part D coverage.

Many of the plans still being offered in 2025 will have higher premiums, deductibles and other out-of-pocket costs, reported Forbes. There may also be fewer drugs covered by a plan, or drugs may be moved to a different tier, which can affect the cost you pay for it.

If you are regularly taking medications, or expect to be in 2025, study the details of your coverage options during Open Enrollment.

Griffith highlighted that “Part D out-of-pocket spending will be capped at $2,000 [annually], as part of continuous efforts to close the Part D ‘donut hole,’ or coverage gap.” This change is due to the Inflation Reduction Act.

“Perhaps one of the biggest fundamental changes to Medicare Advantage is the new Medicare Prescription Payment Plan, which is designed to help the most vulnerable enrollees lower monthly expenses and improve prescription drug affordability,” he said.

This allows enrollees to pay for their prescription drug costs in monthly installments rather than all at once when they pick up their prescriptions. All Part D plans are required to offer this option, but participation by enrollees is voluntary.

Takeaway

Medicare Open Enrollment in 2025 will see several key changes that may affect your coverage. One major change is that there will be a drop in the number of Medicare Advantage plans. However, the average monthly premium on Medicare Advantage plans will decrease in 2025 to $17.00, down from $18.23 in 2024.

Some health care providers will no longer accept or participate in certain Medicare Advantage plans. Medical care is only fully covered if a doctor, hospital, or other provider is in your plan’s network, so check your plan’s list for 2025 to make sure your providers are listed.

In addition to a drop in the number of Medicare Part D prescription drug plans in 2025, many of the plans will have higher out-of-pocket costs including premiums and deductibles. There may be also be fewer drugs covered by a plan, or certain drugs may be moved to a higher-priced tier.

• A new study reports that people in their 40s who have difficulty sleeping have a brain age 1.6 to 2.6 years older by the time they’re in their 50s compared to people who consistently get quality sleep.
• Experts say quality sleep can improve brain health and lower dementia risk and also decrease inflammation in the body and boost the immune system.
• You can promote a good night’s sleep by exercising during the day, putting away electronic devices before bedtime, going to sleep around the same time every night, and sleeping in a cool, darkened room.

Poor sleep quality in your 40s can affect your brain health later in life.

That’s the conclusion of a study published on October 23 in Neurology, the journal of the American Academy of Neurology.

In their findings, researchers from the University of California San Francisco (UCSF) and other institutions reported that people who have poor sleep quality around the age of 40 can have a brain age from 1.6 years to 2.6 years older than people who regularly get quality sleep.

“Our findings highlight the importance of addressing sleep problems earlier in life to preserve brain health, including maintaining a consistent sleep schedule, exercising, avoiding caffeine and alcohol before going to bed and using relaxation techniques,” Kristine Yaffe, MD, a study author and professor of psychiatry at UCSF as well as a member of the American Academy of Neurology, said in a news release.

“Future research should focus on finding new ways to improve sleep quality and investigating the long-term impact of sleep on brain health in younger people,” Yaffe continued.

Examining the link between sleep and brain health

In their study, researchers looked at 589 people with a mean age of 40. About 53% of participants were female and 39% were Black.

At the start of the research, participants were asked to fill out a survey with questions such as:

• Do you usually have trouble falling asleep?
• Do you usually wake up several times at night?
• Do you usually wake up far too early?

The researchers recorded the number of six poor sleep characteristics reported by each individual. The sleep habits included:

• short sleep duration
• bad sleep quality
• difficulty falling asleep
• difficulty staying asleep
• early morning awakening
• daytime sleepiness

Based on the responses, the researchers assigned participants into three groups:

• 0-1 poor sleep characteristics
• 2-3 poor sleep characteristics
• More than 3 poor sleep characteristics

At this initial phase, 70% of participants had no more than one poor sleep habit. Another 22% had 2 to 3 characteristics while 8% had more than 3 characteristics.

The researchers then sent the same survey to participants 5 years later. After another 10 years, they used MRI scans and machine learning tests to estimate the participants’ brain age.

The researchers reported that people with more than 3 poor sleep characteristics had an average brain age of 2.6 years older than people in the group with 1 or less characteristic. People with 2 to 3 characteristics had an average brain age of 1.6 years older than people in the lowest group.

“This study is impactful, since it demonstrates the relationship between poor sleep and accelerated brain aging in middle-aged adults, and offers promise that early treatment to manage sleep problems could prevent neurocognitive dysfunction in the future,” Clete Kushida, MD, a neurologist and a professor of psychiatry and behavioral sciences at Stanford University in California, told Healthline. Kushida wasn’t involved in the study.

Scott Kaiser, MD, a geriatrician and the director of Geriatric Cognitive Health for the Pacific Neuroscience Institute at Providence Saint John’s Health Center in California, not involved in the study, agreed.

“This is a highly compelling study — finding clear associations between poor sleep quality in midlife and accelerated brain aging — that contributes important insights into a critical body of research investigating connections between sleep and brain health.” Kaiser told Healthline. 

Quality sleep is crucial for brain health

The researchers acknowledged a limitation of their study was the self-reporting by participants of their sleep habits. They also said the study was observational so it only produced an association between poor sleep and brain aging instead of a causation.

Nonetheless, the researchers said their findings emphasize the importance of quality sleep. Experts agreed.

“Sleep is without question important to brain health,” Kushida told Healthline. “We know that some sleep disorders, such as obstructive sleep apnea, can have effects on neurocognitive function and risk of cerebrovascular disease. Additionally, the relationship of poor sleep with brain aging is an important one as shown in the study.”

“There is an increasingly robust body of research demonstrating the critical importance of a good night’s sleep for brain health,” Kaiser said.

“Whether through the clearing of debris, ‘resetting’ of neural networks, or providing down-time to various systems, the quantity and quality of sleep [although in this particular study the accelerated brain aging findings were limited to those with poor sleep quality] have profound physiologic impacts that impact our day to day thinking, memory, and mood as well as our long-term risk of cognitive decline and dementia,” Kaiser noted.

Quality sleep essential for overall health

Sleep is now listed among the top lifestyle factors for maintaining good health.

Researchers have reported that quality sleep can:

• maintain critical body functions
• restore energy
• repair muscle tissue
• allow the brain to process new information

Past research has indicated that consistent quality sleep can lower a person’s risk of dementia.

Other research has concluded that quality sleep can also help a person lose or maintain weight, strengthen the heart, lower type 2 diabetes risk, boost the immune system, and decrease inflammation in the body.

Experts say it’s important to have good sleep hygiene at any age.

“Sleep is important in all ages,” Kushida said. “We know that in children and adolescents, sleep problems can lead to delayed growth and behavioral issues. Middle age is when many sleep disorders and medical disorders that impact sleep become more prevalent and increase further with age, and as demonstrated in this study, poor sleep in this age group is associated with advanced brain age,” he added.

How to get quality sleep

The Centers for Disease Control and Prevention (CDC) recommends differentl daily amounts of sleep at certain ages:

• Infants 4 to 12 months old: 12-16 hours (including naps)
• Toddlers 1-2 years old: 11-14 hours (including naps)
• Preschoolers 3-5 years old: 10-13 hours (including naps)
• School-age children 6-12 years old: 9-12 hours
• Teenagers 13 to 18 years old: 8-10 hours
• Adults: 7 hours or more

Getting a consistent amount of sleep isn’t always easy. The CDC offers tips to achieve quality sleep:

• spend time in bright light during the daytime
• exercise regularly, aiming for 30 minutes per day five days a week
• eat meals at consistent times
• avoid heavy meals, nicotine, caffeine, and alcohol before bedtime
• use a consistent routine to wind down at night
• put away electronic devices an hour before bedtime and sleep in a quiet, cool, and dark environment

Kushida added a few more items to this list.

• Go to sleep and wake up at approximately the same time every day.
• Avoid irregular long daytime naps.
• Avoid staying in bed longer than 20 minutes if you can’t go to sleep or can’t fall back asleep after awaking in the middle of the night.

Kaiser urged anyone with sleep difficulties to seek professional guidance.

“There are healthcare professionals with expertise in this domain who can further evaluate your issues and may offer effective solutions to improve sleep quality, including addressing the specific poor sleep characteristics —difficulty initiating or maintaining sleep, early morning awakening, and daytime sleepiness — assessed in this study and associated with accelerated brain aging,” Kaiser said.

Takeaway

Poor sleeping habits during your 40s may affect brain health in later years.

In a new study, researchers reported that a group of people with a mean age of 40 who experienced poor sleep hygiene showed brain ages 1.6 years to 2.6 years older than people the same age who practiced healthy sleep patterns.

Experts say quality sleep provides a number of health benefits from repairing muscle tissue to allowing the brain to process new information to lowering the risk of inflammation, and boosting the immune system.

They say you can improve your chances of getting a good night’s sleep by going to bed approximately the same time every night, putting away electronic devices an hour before retiring, and sleeping in a cool and darkened room.

• Country music star Jelly Roll recently revealed that he’s now dropped 100 lbs on his weight loss journey.
• In an Instagram video, the singer shared his weight loss milestone and said, “Next year, when y’all see me, you won’t recognize me.” 
• Jelly Roll used a combination of weight loss strategies to lose 100 lbs, including getting help for food addiction, eating a high protein diet, and running.
• Experts say he has taken a well-balanced and sustainable approach to weight loss.

Country music star Jelly Roll revealed that he’s dropped 100 lbs on his weight loss journey. At one point, the singer weighed more than 500 lbs. 

The 39-year-old shared a video of his progress on Instagram earlier his month, saying, “Next year, when y’all see me, you won’t recognize me.”

In the same video, Jelly Roll’s nutrition coach, Ian Larios, shared what the star has been doing to lose weight. 

“We’re either walking [around] the arena, playing basketball, boxing,” Larios said. He also shared that the star has been on a high protein diet. 

On October 14th, Jelly Roll appeared on Jay Shetty’s On Purpose podcast, where he revealed he has struggled with food addiction. 

“The weight for me right now is the mountain in front of me, and I’m taking it, I’m learning. I’m being very diligent with it. I’m taking it really serious, I’m drinking a lot of water, I’m cold plunging, I’m eating right, I’m doing good,” he shared.  “I just have to fight the pirate on my shoulder, you know them late nights, I’m a food addict, man. I’ve probably never said it this honestly, but this is the podcast to be that real about it.” 

Here, two nutritionists offer their thoughts on the strategies Jelly Roll is using to lose weight and their effectiveness.

Jelly Roll sought help for food addiction

“Food addiction is when someone may become addicted to certain foods, usually those that are high in fat, sugar, and salt, because of the feel-good brain chemicals that are released when consumed,” explains registered nutritionist and functional medicine practitioner Nicola Shubrook. 

While Shubrook points out that some researchers consider food addiction to be more about behavior than the food itself, she says there is an important link between food addiction and obesity, metabolic syndrome, and binge-eating disorder. 

She believes seeking help for food addiction can be very beneficial. 

“By addressing the root cause behind your food addiction, be it behavioral, genetic, or both, you can begin to create a healthier relationship with food which ultimately leads to not only eating less but also making better food choices,” she explains   

“Physiologically, this can create more stable blood sugars and brain chemistry, improving satiety and therefore leading to gradual weight loss.” 

Running and walking

Putting one foot in front of the other can be a great weight-loss tool. 

“Walking is a fantastic way of increasing your NEAT (Non-exercise activity thermogenesis),” explains nutritionist and behavior change specialist Lisa Monger.

“This term refers to the energy you use doing anything other than exercise, and including more of it makes it easier to lose weight and keep it off,” she notes. 

Beyond the physical benefits, Monger points out that these activities release endorphins, reducing stress and helping you feel more energized. 

“Feeling less stressed and tired means you’re less likely to reach for food or drinks to cope with emotions,” Monger reasons. 

“In this sense, running or walking becomes a healthy, sustainable way to manage both weight and emotional wellness, making it easier to stick to your goals in the long run.” 

Shubrook agrees, but points out that diet may play a bigger role in weight loss than exercise. 

“The food we eat is one of the biggest contributing factors to weight loss, but research has shown that when both diet and physical activity are combined, longer-term weight loss is achieved,” she explains. 

Cold plunges 

Cold plunges might not be the first weight loss technique that springs to mind, but they can be beneficial. 

“When you expose your body to extreme temperatures such as the intense heat of a sauna, or the extreme cold of a cold-water plunge, it must work a lot harder to function,” explains Shubrook. “Cold plunges encourage the body to release adiponectin, a hormone that is made in adipose tissue or body fat.”

How?

“It activates brown fat, a type of adipose tissue, that needs to burn calories to produce heat and keep the body warm and so regular use of cold-water exposure may help with weight loss over time, but more research is needed,” Shubrook adds. 

She also points to a study that found repeated exposure to cold water can lower and/or transform body adipose tissue. It can also reduce insulin resistance and improve insulin sensitivity.

Worked with a nutrition coach

Weight loss can be a long, lonely road, and often, better results may be achieved with the support of a nutrition coach. 

“A good coach will combine personalized guidance with accountability and education and work with you not only on changing habits but the feelings, experiences, and beliefs that you have that drive those behaviors,” says Monger. 

A nutrition coach may make your weight loss plan easier to stick to long-term. Monger says this is because coaches typically tailor plans according to your lifestyle, preferences, and health goals. 

Eating a high protein diet  

If you’re on a weight loss journey, you may have heard that increasing your protein intake is key. 

“Research has often found that consuming a high protein diet not only helps with weight loss, but it also enhances body composition by decreasing body fat while maintaining lean body mass and muscle,” says Shubrook. 

She adds that some long-term clinical trials have also demonstrated that a high protein diet can help protect against weight gain after weight loss, and with no real adverse effects on bone density or kidney function. 

High-protein diets aid weight loss by promoting greater satiety. Protein raises levels of hormones that reduce appetite, including the hunger hormone ghrelin, helping you feel fuller for longer. 

Takeaway 

Country music star Jelly Roll appears to have a very balanced and sustainable approach to weight loss.

He has balanced dietary changes, exercise, and professional support to lose 100 pounds, with the goal of losing more.

Shubrook says it’s great to see that he is approaching weight loss from all angles – physically, physiologically, and psychologically.

• Actor Kat Dennings is opening up about her journey living with migraine headaches.
• She is speaking out to spread awareness and advocate for treatment reform.
• Dennings hopes others living with migraine attacks will join her in advocating for change.

Since she was 12 years old, Marvel and “2 Broke Girls” actor Kat Dennings has lived with migraine headaches.

Sometimes the pain she experienced was so intense and frightening that she slept near her mom.

“She actually had a cot in her closet that she would pull out when I had an attack,” Dennings told Healthline. “When she first took me to the doctor, we were told I would grow out of it, but news flash — I didn’t.”

In her 20s, Dennings finally connected with a doctor who officially diagnosed her with migraine.

She is one of over 40 million Americans (85% of who are female) who live with chronic migraine headaches.

To raise awareness about the seriousness of migraine headaches, Dennings is participating in the Migraine Blackout campaign by going dark for several days on social media.

In October, Dennings archived all posts on her Instagram account and has refrained from posting on any other forms of social media for five consecutive days as a symbolic stance to raise awareness of the toll migraine attacks can have on a person living with the condition.

She also hopes to rally the migraine community to push for care reform.

Pfizer and advocacy organizations, including the American Headache Society, National Headache Foundation, Alliance for Headache Disorders Advocacy, and The Headache & Migraine Policy Forum, are leading the campaign.

“The program is focused on some of the systematic issues that those with migraine face when trying to access treatment,” said Dennings. “We’re providing resources to help people navigate challenges when working with their insurance companies or in getting the treatments that they are prescribed while also advocating for step therapy reform.”

Step therapy requires people with migraine and other chronic diseases to try and fail insurer-preferred treatments before advancing to another therapy.

Patient advocacy groups, including the Alliance for Headache Disorders Advocacy and the Headache and Migraine Policy Reform, support step therapy reform. This aims to eliminate step therapy and help alleviate treatment delays so people can access treatments sooner.

“This push for federal change…is one of the most powerful ways we can spark change for people with migraine,” Dennings said.

To join in on her efforts, you can electronically sign an open letter that will be sent to your congressional representation asking them to support step therapy reform and emphasizing the urgency of improved patient access to migraine care.

“I’m an example of how long it can take to find the right doctor and treatment, so I know a lot of people may be frustrated that they can’t find help,” said Dennings. “I hope to help rally people to advocate for better access to care. I think we can help bring real change and increase access to medications for many people impacted by migraine.”

Below, Dennings shared more with Healthline about living with migraine headaches and speaking out for all those with the condition.

How debilitating are migraine headaches?

Dennings: I cancel personal plans all the time due to my migraine attacks, and that’s the worst because I feel like the ultimate flake. But the truth is, when I have a migraine, I struggle to do anything. That is why I blacked out my social content as part of the Migraine Blackout campaign. I’ve pushed through my pain for years, but this is my way of saying, “I’m done.” By going dark on social media, I’m showing that, really, people with migraine should check out and take care of themselves but also get the care that works for them.

Has a migraine attack ever interfered with your work?

I have never and would never cancel work because of my migraine attacks. I’ve always pushed through the pain because I don’t want to let people down and wasn’t sure if people would understand if I took time off because of it. But that says something, doesn’t it? There was a part of me that felt like having a migraine attack wasn’t a legitimate reason to rest up.

How have you learned to manage migraine headaches over the years?

When things are bad, my go-to solution is lying in a dark room with ice on my neck. Sometimes I’ll use this migraine helmet that helps apply pressure to my head, or I drink a cold slushy. It doesn’t get rid of the pain, but it helps. But the thing with migraine is that it affects everyone differently, so what works for me might not be right for someone else. If you’re experiencing migraine you should talk to your doctor to see what treatment approach is right for you. 

Have you had to go through any obstacles to get treatment?

Unfortunately, there were many times where I sought medical help and was met with a sort of  “well, being a woman is tough.” And as a woman, you feel like you are being a nuisance and that your experience is not legitimate, or someone thinks you are exaggerating. My current doctor is great, but it was hard to find him. It’s a lot of trial and error and asking friends and family who they go to. I’m glad I was able to find someone I like, but it’s a tedious journey.

How have you advocated for yourself when it comes to living with migraine headaches?

It’s sometimes hard to advocate for yourself, and I have to remind myself to speak up and be honest about what I’m feeling and what treatments are or aren’t working. Raising awareness about the real burden of migraine and helping improve access to care is why I wanted to join Migraine Blackout.

Many people don’t know about step therapy, it is a requirement by some states where people with migraine have to try three medicines without sufficient relief before getting to a newer one, even if your doctor prescribes the newer option. I am advocating for step therapy reform, and believe it is one of the most powerful ways we can spark change for people with migraine—and people can do that by signing the open letter at migraineblackout.com.

What do you think people misunderstand most about living with migraine headaches?

Everyone’s migraine pain is different. I have a friend whose migraines are so bad she has to go to the ER. But just because I don’t experience that doesn’t mean mine aren’t valid and painful. Having a migraine isn’t just an excuse to bail on plans—it’s a legitimate disease and should be taken seriously. It’s hard enough to navigate the world when you’re living with migraine, and the stigma just adds onto that.

• Recalls of multiple food products in recent weeks have alarmed consumers and health officials.
• This is due to the risk of food-borne bacteria like E. coli, listeria, and salmonella in the broader U.S. food supply chain.
• Deli meat, frozen waffles, McDonald’s hamburgers, and ready-to-eat poultry meals sold at stores have all been recalled after routine testing showed traces of bacteria.
• Experts say the global food chain makes a number of products more vulnerable to such contamination, but the fact that we know about all the recent recalls means the safety protocols in place are working.

Recalls of multiple food products in recent weeks have alarmed consumers and health officials, as the risk of food-borne bacteria like E. coli, listeria, and salmonella in the broader U.S. food supply chain has increased.

Deli meat, frozen waffles, McDonald’s hamburgers, and ready-to-eat poultry meals sold at stores like Walmart, Trader Joe’s, and Costco have all been recalled after routine testing showed traces of bacteria.

• The popular Boar’s Head company had to pull 7.1 million pounds of deli meat after E. coli was detected at a facility in Virginia responsible for producing ready-to-eat liverwurst; 59 infections were reported in 19 states and at least 10 people died, according to the Centers for Disease Control and Prevention.
• At least 75 people in 10 states were sickened by E. coli that has been linked to McDonald’s Quarter Pounders. The company’s subsequent testing of the beef involved showed no E. coli, but federal investigators suspect that the bacteria was present in the raw slivered onions that were on the burgers.
• Frozen waffles and pancake products sold at stores like Target, Dollar General, and Publix were recalled by the company that produces them after listeria was found through routine testing at a manufacturing factory in Canada. No infections were reported.
• Green onions, eggs, and ready-to-eat poultry meals have all been recalled this fall due to concerns about potential salmonella outbreaks.

Why food recalls are increasing, and how they’re identified

With so many highly processed foods in the supply chain, there are more chances for contamination and infection and, in the case of the Boar’s Head listeria outbreak, sometimes poor oversight at the source of production.

However, there are also more backstops in place than there used to be and coordination between federal, state, and local public health officials.

Richard Martinello, MD, Yale Medicine infectious diseases doctor and professor of medicine at Yale School of Medicine, told Healthline that the CDC’s ability to identify and coordinate has made it possible for us to know about multistate outbreaks like the ones recently identified. In this way, the fact that so many have been publicized is a sign of success, he says.

“We have an increasingly industrialized food industry producing products at a large scale for lower cost. When potential contamination is not prevented, identified, and controlled, it can lead to large-scale, multistate outbreaks of disease,” Martinello said.

He further explained that foodborne diseases such as Listeria and E.coli 0157: H7 are notifiable to public health authorities, and this timely reporting allows a rapid response.

“Local and state public health authorities work closely with the CDC to both identify and respond when these events occur. As many foodborne outbreaks involve multiple states, CDC’s efforts are critical to identify and respond to these matters in a timely manner,” Martinello said.

He explained that the CDC has a deep bench of experts in a wide array of communicable diseases, allowing it to supplement state and local public health expertise. The CDC is also a lead agency for FoodNet.

“This collaborative federal effort helps to ensure timely identification of foodborne illnesses and an effective response. Both the Boar’s Head and McDonald’s issues are great examples of success. The outbreaks and their cause were quickly identified, communicated to the public, and measures taken to prevent further disease,” Martinello said.

Melanie Murphy Richter, MS, RDN, a registered dietitian nutritionist and the director of communications for the nutrition company Prolon, told Healthline that the vast network of supply and shipping involved in many products in stores can make them that much more susceptible to such contaminations, but the bad headlines in the news mean that the system’s safeguards are working.

“Our food now often has a global journey — from different farms, facilities, and countries — which opens up more chances for contamination. One event, like a salmonella issue in a farm’s onion supply, for instance, can impact salsa across multiple brands. This interconnected supply chain means a problem at any one point can trigger a far-reaching recall,” Richter said.

“With advanced DNA testing and data-sharing between agencies, we’re catching contamination faster and more precisely than ever. This technology means recalls happen sooner and are often larger because we’re better at detecting patterns across states and tracing them back to their source. This is definitely a good thing, and also, we hear about these outbreaks more, too,” Richter added.

How consumers can protect themselves from food-borne bacteria

Many experts have suggested that eating highly processed foods — which includes processed meats, ready-to-eat meals, and deli meat — should be avoided in general. But with the higher costs of groceries across the country, not everyone has the option of avoiding products that could carry these risks.

Richter suggested staying informed, reading labels carefully, and thoroughly washing fresh produce or purchasing frozen or canned produce along with shelf-stable proteins like beans, chickpeas, and canned fish.

Dry goods, in particular, are also a good meal option, she said.

“Foods like rice, pasta, quinoa, and whole grains are processed with minimal handling, making them generally low risk for contamination. They also store well and can form a safe, healthy base for many meals,” Richter said. “Pairing these with canned or frozen veggies, beans, or lentils can help create balanced, filling meals that don’t compromise on safety.”

However, it’s important to read food labels as some canned foods can be packed with high amounts of sodium and additives, which can also negatively impact your health.

As far as deli meats go, Richter suggested the following three specific ways to consume them safely if you’re concerned about potential contamination:

Eat prepackaged over “house-cured” meats

“Prepackaged deli meats generally have fewer handling points, so they tend to be a safer bet than those sliced in-store. Standardized processing and controlled packaging help reduce the likelihood of contamination,” Richter said.

Keep cold and eat fresh

“Listeria thrives even in cool temperatures, so store deli meats in the coldest part of the fridge and try to consume them within a few days of purchase,” Richter said.

Choose low sodium and nitrate-free options

“While often a healthier choice, these options tend to come from brands with more transparent processing and safety standards, which can add an extra layer of quality control,” Richter said.

Takeaway

Recalls of multiple food products in recent weeks have alarmed consumers and health officials, as the risk of food-borne bacteria like E. coli, listeria, and salmonella in the broader U.S. food supply chain have increased.

Deli meat, frozen waffles, McDonald’s hamburgers, and ready-to-eat poultry meals sold at stores like Walmart, Trader Joe’s, and Costco have all been recalled after routine testing showed traces of bacteria.

Experts say the global food chain makes a number of products more vulnerable to such contamination, but the fact that we know about all the recent recalls means the safety protocols in place are working.

• The American Stroke Association has updated its guidelines on stroke risk reduction for the first time since 2014.
• In their recommendations, the ASA urges healthcare professionals to carefully screen patients for risk factors such as high blood pressure, elevated cholesterol levels, obesity, and high blood sugar.
• The new stroke guidelines highlight unique risk factors for females and transgender women and how social determinants of health impact stroke risk.
• The guidelines also emphasize the benefits of GLP-1 drugs for cardiovascular health, and encourage a balanced diet, regular physical activity, maintaining a healthy weight, and getting adequate sleep.

The Centers for Disease Control and Prevention (CDC) estimates nearly 800,000 people have a stroke every year in the United States. Of these, more than 600,000 will be a first-time stroke.

For the first time in 10 years, the American Stroke Association (ASA) has updated its guidelines for reducing stroke risk. According to an ASA news release, up to 80% of strokes may be preventable through diet and lifestyle changes and other modifications.

The 2024 Guideline for the Primary Prevention of Stroke also urges healthcare professionals to carefully screen individuals for stroke risk factors, including: 

• high blood pressure
• elevated cholesterol levels
• high blood sugar
• obesity

Many of the new stroke guidelines coincide with the American Heart Association’s Life’s Essential 8, which promotes cardiovascular and brain health. The lifestyle factors in the ASA’s new stroke guidelines include a healthy diet, regular exercise, better sleep, and smoking cessation.

“Patients looking to reduce their stroke risk (and cardiovascular disease risk in general) should strive to follow the American Heart Association’s Essential 8 recommendations for healthy living,” said Cheng-Han Chen, MD, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California. Chen wasn’t involved in the new guidelines.

“We recommend that people eat a healthy balanced diet, engage in regular physical activity, get an adequate amount of sleep, maintain a healthy weight, avoid tobacco and alcohol, reduce stress, and control their blood pressure and cholesterol numbers,” Chen told Healthline.

Overall, the guidelines provide a clear pathway for medical professionals and their patients. The guidelines also call for more public awareness and education about how people can lower their risk of stroke.

Women face unique stroke risk factors

The updated stroke guidelines recommend that medical professionals screen for conditions that can increase the risk of stroke in females.

Stroke risk factors affecting females include the use of oral hormonal contraceptives, developing high blood pressure during pregnancy, and pregnancy complications, such as:

• premature birth
• endometriosis
• premature ovarian failure
• early-onset menopause

The guidelines also note that transgender women and gender-diverse individuals taking estrogen may also be at an increased risk of stroke.

Social determinants of health and stroke risk

The new stroke recommendations emphasize “social drivers of health.” These non-medical factors include inequities in healthcare, education, economic stability, and structural racism.

The ASA adds that neighborhood factors such as a lack of walkability and access to healthy food also play a role. The guidelines urge medical professionals to advocate for patients in these circumstances.

“Some populations have an elevated risk of stroke, whether it be due to genetics, lifestyle, biological factors and/or social determinants of health, and in some cases, people do not receive appropriate screening to identify their risk,” said Cheryl Bushnell, MD, a professor and vice chair of research in the Department of Neurology at Wake Forest University School of Medicine in North Carolina, in a news release. Bushnell is chair of the group that wrote the new guidelines.

“This guideline is important because new discoveries have been made since the last update 10 years ago,” she continued. “Understanding which people are at increased risk of a first stroke and providing support to preserve heart and brain health can help prevent a first stroke.”

José Morales, MD, a vascular neurologist and neurointerventional surgeon at Providence Saint John’s Health Center in California Morales echoed the importance of primary stroke prevention and said the guidelines were long overdue. Morales wasn’t involved in developing the new guidelines.

“The focus on equitable access to healthcare, social determinants of health, and gender-specific recommendations are important additions to guiding clinical practice in an evidence-driven matter,” he told Healthline.

GLP-1 drugs may reduce stroke risk

The ASA’s guidelines include a new recommendation for healthcare professionals to consider prescribing GLP-1 weight loss drugs, such as Ozempic, Mounjaro, Zepbound, and Wegovy.

The medications, which have been approved by federal regulators as treatments for obesity or type 2 diabetes, have shown promise in clinical trials in improving cardiovascular health and reducing the risk of stroke.

Chen said the inclusion of newer topics such as weight-loss drugs into the new guidelines is an important step.

“These updated guidelines also incorporate the important new class of drug (GLP-1 agonists) that we are finding to be extremely effective in treating those same risk factors for stroke,” Chen noted.

Healthy diet for stroke prevention

One of the most important things you can do to prevent a stroke is to maintain a healthy, balanced diet.

The new guidelines urge people to stick closely to a Mediterranean diet. This diet focuses on the eating habits of people who live along the Mediterranean Sea.

That plan encourages people to consume more fruits and vegetables as well as legumes, nuts, seeds, and heart-healthy fats. It discourages the consumption of processed foods, added sugars, refined grains. It also recommends limiting the consumption of alcohol.

“Risk factors for stroke vary by age, gender, genetics, comorbidities, and even medications. Therefore, I think the suggestion of screening for not only the basic risk factors but also secondary factors is essential to prescribe the right lifestyle interventions,” said Kristin Kirkpatrick, MS RDN, a dietitian at the Cleveland Clinic Department of Wellness & Preventive Medicine in Ohio. Kirkpatrick wasn’t involved in the new guidelines.

“For my patients, I will often also recommend a Mediterranean pattern, but then work with the patient to assess tweaks to that pattern,” she told Healthline.

“For example, with someone who has insulin resistance or type 2 diabetes, I may focus on a more moderate carbohydrate version of the Med diet. For patients with high blood pressure, I may counsel more on a low sodium perspective. The most important component, however, may be to focus as a whole on a more plant-forward approach that limits ultra-processed foods, sugar, refined grains, and excess amounts of alcohol,” Kirkpatrick continued.

“I also recommend nutrigenomics testing for my patients as well to be able to get a truly personalized approach to prevention based on genetics,” she said.

Exercise and stroke prevention

The guidelines recommend that healthcare professionals screen patients for sedentary behavior and counsel them to engage in regular exercise.

As noted by the ASA’s news release, physical activity is “essential for stroke risk reduction and overall heart health.”

The CDC recommends that adults get at least 150 minutes a week of moderate-intensity aerobic activity or 75 minutes a week of vigorous aerobic activity. That exercise should be spread throughout the week.

Regular exercise can help improve metrics such as blood pressure, cholesterol levels, inflammatory markers, insulin resistance, and overall weight.

“A combination of both aerobic and anaerobic is essential to focus on both muscle retention (and growth) as well as cardiovascular health. Flexibility is also an important factor,” Kirkpatrick said.

High blood pressure and stroke risk

A person may develop high blood pressure for years without any symptoms.

Untreated high blood pressure, also known as hypertension, can cause damage to arteries that can eventually lead to a higher risk of stroke, heart attack, and other cardiovascular issues.

The typical way to diagnose hypertension is by having your blood pressure checked.

Causes of high blood pressure include family history, smoking, and a high intake of caffeine, alcohol, and salt. A lack of physical activity and obesity can also be factors.

In addition to regular screenings, the guidelines urge healthcare professionals to make sure patients at risk for high blood pressure are eating a heathy diet and getting regular exercise.

“Over the past decade, we have gained a better appreciation for the need to manage lifestyle-related cardiometabolic risk factors such as hypertension, overweight/obesity, cholesterol, and blood sugar control,” Chen said.

Sleep quality and stroke prevention

Healthy sleep is listed in both the new guidelines and the Life’s Essential 8 as an important component of reducing stroke risk and promoting heart health.

The CDC estimates that more than 30% of U.S. adults get insufficient sleep.

The CDC recommends that adults obtain a minimum of 7 hours of sleep per night. It’s also not recommended that you get more than 9 hours of sleep per night.

“Adequate and consistent sleep, mindfulness, and taking steps to reduce exposure to pollution would be other factors,” Kirkpatrick said.

What to know about stroke

Stroke is the fifth leading cause of death with nearly 160,000 related deaths annually. The CDC notes that stroke is also a leading cause of long-term disability.

CDC officials add that stroke-related costs in the U.S. were $56 billion between 2019 and 2020. Those costs included healthcare services, medications, and missed days of work.

A stroke occurs when there is a blockage in the blood supply to the brain or when a blood vessel in the brain ruptures. The blockage or rupture prevents blood and oxygen from reaching the brain’s tissues.

Symptoms of a stroke include:

• paralysis
• numbness or weakness in the arm, face, or leg.
• trouble speaking or understanding others
• vision problems
• dizziness
• sudden headache

Medical professionals say the quicker someone is diagnosed with a stroke and receives treatment, the better their chances for survival and recovery.

They recommend a person attending to a person who is suspected of having a stroke to adhere to a checking system with the acronym BE-FAST. That stands for:

• Balance: Does the person have trouble standing?
• Eyes: Are they experiencing vision difficulties?
• Face: Does one side of their face droop?
• Arms: Can they lift both arms?
• Speech: Is their speech slurred or difficult to understand?
• Time: If any of the above symptoms are present, call 911

Takeaway

The American Stroke Association has updated its guidelines on stroke risk reduction for the first time since 2014.

In their recommendations, the association urge healthcare professionals to more carefully screen patients for risk factors such as high blood pressure, elevated cholesterol levels, obesity, and high blood sugar.

The new stroke guidelines also highlight unique stroke factors for females and transgender women.

The ASA also emphasizes the benefits of GLP-1 drugs for heart health and urges more awareness of the health dangers of poor diet, sedentary behavior, obesity, and lack of adequate sleep.