Saint Joseph hospitals in Lexington, London and Mount Sterling seek applications for grants to improve well-being, health equity

By Melissa Patrick

Kentucky Health News

The CHI Saint Joseph Health hospitals in Kentucky are accepting applications for local nonprofit organizations to apply for grants aimed at supporting services to improve well-being and health equity in their service areas. 

The grants are part of the Community Health Improvement Grants program, which was created in 2019 when Catholic Health Initiatives and Dignity Health came together to create the national health system CommonSpirit Health.

Grants through Saint Joseph Hospital and Saint Joseph East in Lexington, and Saint Joseph London, can be as small as $20,000 and as large as $100,000. Grant opportunities are also available at Saint Joseph Mount Sterling to serve that area, ranging from $10,000 to $19,500.  Click here for the link to the application website. 

"Grant applications must include collaborating partner organizations helping to deliver services and not be solely about one agency’s work,” Michael Bilton, CommonSpirit Health's senior director for community health and benefit, said in a news release. 

The application period is open through Aug. 16. Grants are available to nonprofit organizations that address substance-use disorders, mental health, and issues involving weight, physical activity and nutrition. All projects must be planned for calendar year 2025. 

The priorities were identified in the hospitals' most recent community health needs assessment, which is conducted every three years. 

“We are deeply committed to the well-being of our community," Christy Spitser, interim market president of CHI Saint Joseph Health, said in the release. "Providing grants to local nonprofits is a vital part of our mission to give back and make a tangible difference in the lives of those we serve.” 

Interested organizations can learn more about the grant program, including eligibility criteria, how to apply, and a local contact for questions, by visiting https://www.commonspirit.org/communitygrants.

When it's hot, drink more water; here are ways to get that done

Photo illustration from CDC

Kentucky Health News

Staying hydrated is essential to maintaining health, especially during summer months. Aside from preventing dehydration, the Centers for Disease Control and Prevention reports that water helps your body maintain normal temperature, facilitate joint movement and protection, protect sensitive tissues like your spinal cord and remove waste through sweat, urination and bowel movements.

Here are tips for staying hydrated this summer, and there are more available at cdc.gov/healthy-weight-growth/water-healthy-drinks/index.html.

Upgrade your water bottle. Buying a reusable water bottle to refill throughout the day can help ensure you drink enough water. Freezing pre-filled plastic water bottles can be a great way to make sure you have access to cold water throughout the day, especially if you plan to spend an extended amount of time outside. Consider buying a flavor-infusing water bottle to add fruit flavors to your water if you dislike the taste of plain water.

Cut back on other drinks. Substitute water for sugary drinks like sodas or teas when you feel thirsty and consume alcohol, caffeine and energy drinks in moderation. Sports drinks can be a good way to restore electrolytes after prolonged periods of sweating and heavy physical activity, but avoid consuming them outside of regenerating electrolytes. Remember that choosing to drink water as often as possible will help keep you hydrated.

Make water part of your meals. Water is usually a drink option at restaurants, so choose to order water when given the opportunity. If you plan to host dinners or parties this summer, serve water and water-based drinks with your meals. Serve recipes with fruits and vegetables that contain water, like cucumbers and tomatoes. Whether you plan to eat indoors or outside, consider keeping a pitcher of ice water on the table during meals so guests can refill their glasses as they need to. Add a wedge of lime or lemon to your water.

Some other beverages can be part of healthy eating patterns: Plain coffee or teas, sparkling water, seltzers, and flavored waters are low-calorie choices. Low-fat or fat-free milk; unsweetened, fortified milk alternatives; and 100% fruit or vegetable juice contain important nutrients. Enjoy these drinks within recommended calorie limits. Milk contains important nutrients such as calcium, potassium, and vitamin D.

What about other beverages? Here's what the CDC says:

• Sugary drinks: Regular sodas, fruit drinks, sports drinks, energy drinks, sweetened waters, and sweetened coffee and tea contain calories but little nutritional value. Learn how to Rethink Your Drink.
• Alcoholic drinks: If you choose to drink alcohol, do so in moderation.
• Caffeinated drinks: Moderate caffeine consumption (up to 400 mg per day) can be a part of a healthy diet. That's about 3 to 5 cups of plain coffee.
• Drinks with sugar alternatives: Drinks that are labeled "sugar-free" or "diet" likely contain high-intensity sweeteners, such as sucralose, aspartame, or saccharine. These sweeteners may reduce caloric intake in the short term. However, there are many questions about the sweeteners' effectiveness for long-term weight management.
• Energy drinks: In addition to added sugar, these products may also contain large amounts of caffeine and other legal stimulants. Concerns have been raised about the potential health risks of these products, especially for young people. 

Regularly consuming water during the summer will help you stay hydrated and healthy. Find more resources about water and hydration at nutrition.gov/topics/basic-nutrition/water-hydration-and-health and heart.org/en/healthy-living/fitness/fitness-basics/staying-hydrated-staying-healthy.

Curious about new, popular weight-loss drugs? Here's a lowdown

Axios Visuals map adapted by Ky. Health News; click to enlarge

Editor's note: At the end of 2023 Kentucky led the nation in the percentage of state residents, 2.1%, who had received the new class of diabetes and weight-loss drugs.

By Katelyn Jetelina
Your Local Epidemiologist

You’ve probably heard of Ozempic by now. It is everywhere. Sales are up more than 300% and research studies are coming out like a firehose, but future population-level implications are unknown. Here, we catch you up on the science and what it may mean for you.

Ozempic (one brand name for the substance semaglutide) is one of many medications under the umbrella of “GLP-1 receptor agonists.” Others are Trulicity (dulaglutide), Wegovy (semaglutide) and Mounjaro (tirzepatide).

GLP stands for glucagon-like peptide 1. GLP-1 is a hormone produced in the intestinal system and released when you eat food. It is a natural signal saying you have eaten enough food. Naturally occurring GLP-1 comes and goes in a few minutes.

These medications mimic this natural process but for longer. Ozempic, for example, stays in our system for an entire week. It also slows down gastric emptying, thereby slowing down digestion.

How effective are these drugs? Very. The original clinical trials that supported initial FDA approval for patients with diabetes blew expectations out of the water. It improved:

• Blood sugar control (A1c reduction)
• Weight loss (average 15 pounds)
• Unexpected positives, like reduced kidney disease (24% less likely to experience kidney failure and death due to kidney complications)

Since the first clinical trials, studies have tested its use in non-diabetic individuals, and its is effective in weight loss. A meta-analysis of eight studies found a significant decrease (about 10% of body weight). None saw an increase. Also, it has protective effects on the heart, such as reduced blood pressure and triglycerides.

 
What happens if you stop taking it? Unfortunately, weight (and other outcomes) rebound. As shown below, after the original clinical trial (68 weeks), people who stopped taking it regained their weight.

The use of GLP-1’s as a motivating tool for sustained change has been less studied. Will these be lifetime drugs like other medications (e.g., statin drugs for heart disease) or a tool to titer up or down in times of need? This is a big unanswered question.

While obesity often involves an energy imbalance where calories consumed exceed those expended, it’s influenced by genetics, socioeconomic status, environmental factors, and mental health. These factors contribute to a complex web of challenges that may extend beyond individual choices alone.

What about kids? Ozempic isn’t officially approved by the FDA for children (but can be used off-label), but Wegovy is approved. In 2023 alone, about 31,000 children aged 12 to 17 and 162,000 aged 18 to 25 used these medications.

A recent meta-analysis found treatments led to modest reductions in body weight and improved glycemic control in children with insulin resistance.

Ozempic babies? The term refers to a recent phenomenon where women are reporting unplanned pregnancies. This has sparked discussions on social media and in the medical community about the potential impact of these drugs on fertility. Why could this be happening? Two hypothesized pathways:

• 1. These drugs delay gastric emptying, which can impact the effectiveness of oral birth control by slowing down the rate of absorption
• 2. Weight loss enhances fertility, making it easier for women to become pregnant. This is particularly true for women with Polycystic Ovarian Syndrome, in which weight loss is known to boost fertility significantly.

However, it’s recommended to stop the medication two months before trying to get pregnant (see more below).

 

Datawrapper graph by YLE; data from Ghusn et al., JAMA

Are there downsides to the meds?

Like any medication, there are side effects and risks, some known and some theoretical, and many with mixed study results. Individuals must weigh the risks of obesity with the small but meaningful risks of the medication.

 
Many people experience side effects, particularly nausea and diarrhea. A recent analysis from an insurance agency found that 6 in 10 people who start the drugs quit before they see benefits because of side effects. These tend to go away after a few weeks, but they can substantially impact the quality of life until then.

Muscle loss: Most (60-75%) weight loss is from fat, but some is from non-fat, including muscle. This could lead to a rare condition called sarcopenia—loss of muscle mass and strength where you can’t do much because you’re physically weak. Research is mixed, though, on how often this happens, and it may be minimal when combined with exercise and adequate protein intake.

 
Increased risk of thyroid cancer. A small French case-control study found an elevated risk of thyroid cancers (58% elevated relative risk) and medullary thyroid cancer (78% elevated relative risk) after GLP-1’s. However, another study in Scandinavia with more than 400,000 people found no risk of thyroid cancer after 3 years. Regardless, the potential increase in absolute risk is very small.

Mental health. There is a big debate on what is happening in the brain. GLP-1 is not only produced in the gut but in the brain as well. Some evidence has correlated the usage of GLP-1 medications with suicidal ideation. However, recent evaluations by regulatory agencies found no substantial evidence after extensive review. Some studies have even suggested a potential decrease in the likelihood of anxiety and depression.

Eating disorders. It is a growing concern that GLP-1s may increase the risk of disordered eating, particularly among those who are high-risk (e.g., prior history of eating disorders).

 
Pregnancy. Pre-clinical trials on rats found GLP-1s are more likely to have offspring with birth deformities, so it’s not recommended to take during pregnancy.

While these new drugs have a strong safety profile based on available data, human studies are only about 5 years old. This means the long-term effects are not yet fully understood. However, we do have data from drugs in the same class that started testing in 2006, showing a consistent safety profile. Continued monitoring and research are essential to determine whether theoretical risks are real in light of new data.

This means decisions today must be made based on what is available and in the context of individual risk factors. For example, if you have a history of eating disorders, the risks of taking the medication may outweigh the benefits.

What does the future look like? After a century of fad diets and weight loss gimmicks, people are tired: some from fighting stigma and others from trying to lose weight unsuccessfully. These medications have proven to work, and the market shows it: GLP-1 prescriptions have increased by over 300% since 2020. A recent poll indicates that nearly half of adults express interest. But there’s no sugarcoating it: It’s expensive, about $1,000 per month without insurance. The price should decrease dramatically in about 8 years once the patent expires and the generic version comes to market.

On a population level, these drugs will likely have widespread impacts, just like the iPhone, which can be good or bad, depending on who you ask. Given the massive impact obesity has had on health in the past two decades, this could be extraordinary for lifespan and quality of life. It could also have ripple effects on the fast-food industry and save millions of dollars in health care costs.

But it could further widen health disparities, given the cost, and hurt body positivity, losing much ground gained. We also cannot ignore that these drugs benefit a billion-dollar pharmaceutical industry when underlying societal causes should be addressed for prevention. And, the fact there are numerous other benefits to a healthy lifestyle.
Bottom line

GLP-1 drugs offer much-needed hope to individuals, and a flood of studies show their effectiveness. However, there are both demonstrated and theoretical risks to consider. Regardless, obesity deserves compassion, and perhaps 21st-century tools can help foster a supportive environment that promotes lasting progress.

Hospital association, state Department of Agriculture start 'Food is Medicine' effort to get more local food into Kentucky hospitals

Logo of the program

Kentucky Health News

The Kentucky Hospital Association and the state Department of Agriculture have started an effort to get more local food into Kentucky hospitals.

"A recent survey completed by representatives of 50 hospital systems across the state found that only about 2 percent of the hospital’s budget is spent on local food," a department news release said. "The overall average percentage of local food being served at these same hospitals was 15 percent."

In their “Food is Medicine” campaign, the department, KHA, eight health systems and other organizations "will study how hospitals can play a key role in prescribing food as medicine to patients by creating more access to healthier and local foods," the release said. They will:
· Look at the food a hospital is serving to patients;
· Create partnerships between hospitals and local farmers;
· Connect patients with resources to a consistent healthy food resource;

· Reach out to patients who need a special diet, such as diabetes patients, and who could benefit from having a resource to fresh food.

“Access to nutritious food is critical to maintain a healthy lifestyle,” Agriculture Commissioner Jonathan Commissioner Shell said. “Advocating that connection between food and health is essential to meeting the goal of less chronic disease and longer lifespans. But it’s more than a message about choosing the right foods, it’s also a message about expanding our food distribution networks within the agriculture industry.”

KHA President and CEO Nancy Galvangni said, "Kentucky’s hospitals work every day to improve the health of our citizens and this new collaboration between KHA and the Department of Agriculture will elevate ways in which hospitals throughout Kentucky can address the social drivers of health facing our commonwealth.”

Hollie Harris, president and CEO of Appalachian Regional Healthcare, said "As the largest provider of care in southeastern Kentucky, our responsibility goes beyond treating illness. We want to help people live healthier lives, and that starts with access to healthy foods. . . . We can create partnerships to address our state’s troubling health statistics and make fresh, locally grown foods more available in our communities."

Food-as-medicine effort at UK gets a boost from new endowment

Alison Gustafson (UK photo by Sabrina Hounshell)

By Christopher Carney

University of Kentucky

One of the first two Gatton Foundation endowed professors at the University of Kentucky is Alison Gustafson, who directs the Food as Health Alliance. The endowment, from a $100 million gift by the late Bill Gatton, will provide funds to developing and expanding food-as-medicine programs across the state.

The money will help build capacity for health-care providers to get key services for diet-sensitive patients who are at risk of food insecurity. Gustafson is also developing and expanding community partnerships, offering approved food-as-medicine programs to those who qualify, and building a referral and network hub that will give patients a connection to services regardless of location. 

“Our team will be conducting expansion efforts for screening and referral, capacity building among community groups, outreach, UK Cooperative Extension training and research projects to better serve Kentuckians experiencing food insecurity,” Gustafson said. 

Gustafson is a professor in the Department of Dietetics and Human Nutrition in the Martin-Gatton College of Agriculture, Food and Environment and the College of Nursing. Under terms of the gift from the Bill Gatton Foundation, distinguished faculty get resources to continue meaningful research, extension and instructional programs related to advancing UK’s land-grant mission. 

The Food as Health Alliance was launched at UK in 2023 to boost health and well-being in the state through the combined application of agricultural, medical, and nutritional resources. Gustafson works to bring together clinical and community research to address the dual challenges of food insecurity and diet-related chronic diseases that many Kentuckians face.

Gustafson earned a doctoral degree in nutrition epidemiology from the University of North Carolina and a master's degree in public health from Boston University. As a master's student, she spent a year in Zimbabwe working with AIDS orphans. She has worked in local and state health departments, focusing on community health for disadvantaged populations. 

The other Gatton endowed chair, Tiffany Messer, will get support for student training and success, water-quality needs assessments, and low-cost water-quality treatment options. She is an associate professor of biosystems and agricultural engineering in the college.

Stomach cancer: How to recognize the signs and reduce your risk

Illustration by peterschreiber.media via iStock/Getty Images Plus

By Dr. Joseph Kim

University of Kentucky

While stomach cancer was in the headlines not long ago with the sudden death of musician Toby Keith, the diagnosis is relatively rare. Stomach cancer now accounts for 1.4% of new cancer cases in the U.S., down from nearly 10% from 30 years ago.

With an average age at diagnosis of 68, stomach cancer is more common among older individuals. But it can happen to anyone, so it’s important to understand its symptoms, risk factors and steps you can take to lower your risk.

What are the signs and symptoms of stomach cancer? Early stage stomach cancer often has no symptoms. As the cancer progresses, patients may experience abdominal pain or discomfort, feeling bloated or full after eating small amounts, nausea or vomiting, unexplained weight loss, blood in the stool and difficulty swallowing.

What causes stomach cancer? There are not always clear risk factors for developing stomach cancer, but some factors tend to be associated with the onset of the disease. These include:

• Heavy consumption of smoked, salted and processed meats
• A diet low in fruits, vegetables and fiber rich foods
• Smoking tobacco
• Being overweight or obese

Other risk factors include gastroesophageal reflux disease (GERD), a family history of stomach cancer, Epstein-Barr virus and H. pylori bacterial infection.

What can I do to reduce my risk? While there is no guaranteed way to prevent stomach cancer, you can lower your risk by:

• Eating a balanced diet with plenty of fruits, vegetables and whole grains. Limit processed meats and smoked or salty foods.
• Maintaining a healthy weight through diet and exercise
• Quitting smoking and limiting alcohol consumption

Can I get screened for stomach cancer? Routine screening isn't currently recommended for everyone. But if you have certain risk factors, like H. pylori infection or a family history of stomach cancer, talk to your doctor about screening options like upper endoscopy or blood tests.

While treatments have progressed in recent years, the five-year relative survival rate for stomach cancer is 35.7%. Early detection can make all the difference for better treatment outcomes, so don't hesitate to reach out to your health care provider if you experience any symptoms or have risk factors that warrant screening.

Joseph Kim, M.D., is a surgeon at the UK Markey Cancer Center.

UK diabetes research featured in group's annual research report

Brittany Smalls, Ph.D., is at upper right.

By Hilary Smith
University of Kentucky

One of the cover stories in the annual reserach report from the American Diabetes Association is about a University of Kentucky researcher devoted to helping rural Kentuckians — specifically in Appalachia — better manage their diabetes.

highlighting investments in advancing diabetes research and clinical practice. ADA research grants focus on innovative projects with high impact and help researchers establish collaborative networks to move their innovations into the hands of people living with diabetes.

Brittany Smalls an associate professor and the Dr. Claire Louise Caudill Professor in Family Medicine in the UK’s Department of Family and Community Medicine. Her futire work in Appalachia will look at intergenerational households, where large extended families often live together in the same home or throughout shared pieces of land. These families share everything from living spaces, meals, household chores, caregiving and more.

Such househodls are common in Appalachia, and so is a disproportionately high risk for Type 2 diabetes. The prevalence of Type 2 diabetes reaches 23% in Kentucky’s most rural counties, more than twice the state average.

Throughout her career of helping older adults with type 2 diabetes, Smalls quickly noticed that the adult children and grandchildren of those she worked with could also benefit from her research.

Thanks to an award from the ADA, Smalls will expand her focus from older adults with type 2 diabetes to entire families living with or who are at risk for the disease.

“By tapping into tight-knit family units, we can start to shift how people think about their health and how they think about each other,” Smalls said.

The cover story from the ADA’s report details Smalls’ work resulting from the award:

“She is piloting a health intervention that leverages social support within family units to promote nutrition and physical activity, which are key to mitigating obesity and type 2 diabetes. Each participating family will receive a tailored six-month lifestyle plan. 

“Only one adult needs a type 2 diabetes diagnosis for a household to be eligible, and a dietitian will engage them in medical nutrition therapy based on available foods. Participating families will receive ADA-backed recommendations for physical activity based on family members’ physical ability.”

State health chief says measles risk stems from pandemic's anti-vaccine 'ideologies'; discusses how to lose weight, need for sleep

WKYT news anchor Bill Bryant, left, interviews state Health Commissioner Steven Stack, M.D.

This story has been updated.

By Al Cross
Kentucky Health News

In a wide-ranging TV interview, state Health Commissioner Steven Stack warned Kentuckians that not enough of them are vaccinated for measles, which he said is an outgrowth of reaction to the Covid-19 pandemic and the measures taken against it.

Stack reflected on his work in the pandemic and talked about other health concerns, including the opioid epidemic, weight-loss drugs and the need for Kentuckians to get more sleep, in an interview that aired Sunday, March 10, on WKYT's "Kentucky Newsmakers" with Bill Bryant.

As of March 7, the Centers for Disease Control and Prevention had recorded 45 cases of measles in 17 states: Arizona, California, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New York, Ohio, Pennsylvania, Virginia and Washington.

Stack said measles was declared elimiated in the U.S. in 2000, but it has returned because vaccination rates have dropped to 90 percent. The disease may be the most contagious, and epidemiologists say 95 percent of a population needs to be vaccinated to protect those who can't or won't get the shot.

Stack said the measles-mumps-rubella (German measles) vaccine has been used since 1971, and is very effective. "We’ve got to get the public I hope, to accept that these tools help to prevent us from having far worse problems, like little babies who can't get vaccinated getting seriously ill." Children younger than 6 months are ineligible for vaccination.

Pew Research Center graph, based on Pew polling by party

Why have vaccination rates for contagious diseases dropped? "It's all gotten caught up in the Covid pandemic, in the narrative, in the ideologies that have unfortunately become associated with public health and medical science," said Stack, a physician.

Asked if he and Gov. Andy Beshear made the right calls in the pandemic, he said "I think we did the best we could with what we knew at the time." He said Kentucky outperformed most other states, considering its lower health status, which made it more vulnerable.

Stack said he and Beshear "balanced saving the most poeple [with] other harms that are worse than what you're trying to prevent." He said Kentucky's death toll of 20,000 was "far from what it would have been had we not intervened," noting that an intiial estimate was it could lose 1 to 2 percent of its population: 45,000 to 90,000 people.

Looking ahead, Stack said people 65 and older and those with other risk factors should get a Covid-19 booster this spring, and everyone should get an annual booster, much like has long been done for influenza.

Other health issues

Kentucky leads the nation in the percentage (about 2.1%) of population that has received a prescription for one of the new drugs created to fight obesity and diabetes, which can also aid weight loss.

"Overweight and obesity is a big problem in Kentucky," Stack said, noting that 38% of Kentuckians weigh too much. "That leads to diabetes, it increased your risk of cancer and cardiovasculat disease, like stroke and heart disease. It's really a major issue for us to address."

As for the drugs, "People are understandably desperate to find ways to get it under control," he said. "It's really too early to say what the long-term outcome of those medications will be. Some people have had wonderful benefits from it, have lost a lot of weight and improved their overall performance. Some individuals have had a difficult time tolerating it: persistent nausea, vomiting, or an unlucky small number with pancreatitis, so time will tell on those.

"Right now I think what we really need to do is try to think about ways to improve our environment so it's easier to eat healthier -- fresh fruits and vegetables -- and do mild things, like just go for a walk three or four days a week for 35 to 45 minutes; if you could do simple things like that, most of us could actually lose the small weight that we have to avoid becoming diabetic."

Kentucky is also one of the states most affected by the opioid epidemic. Stack said it has evolved because "The criminals keep getting more creative in the cocktails they put together and they're becomeing more and more lethal for people."

Speaking on the weekend that the nation moved its clocks to daylight saving time, Stack said lack of sleep is also a major health issue, especially for teens, who need more of it.

He said teens and adults "disrupt our sleep" with big and small screens, on TVs and smartphones. "We’ve got to get better sleep hygiene," he said, "and set out the time we need to get that eight hours of sleep."

Top UK surgeon discusses diseases of the thyroid gland, which are common, more so in Kentucky than in the rest of the nation

A thyroid exam (Photo by Antonio Diaz, iStock/Getty Images Plus)

By Dr. William Inabnet III

University of Kentucky

Twenty million people in the United States suffer from thyroid disease, and Kentucky has a higher rate of thyroid cancer than the rest of the country, according to the National Cancer Institute.

The thyroid gland is an organ that sits in the neck and controls the body's metabolism. The metabolism processes the food you consume and turns it into energy. Around 50% of the population develops thyroid nodules, yet only 5% of these nodules are malignant.

There are two types of thyroid disease: overactive and underactive. With overactive thyroid disease (hyperthyroidism), there is an excess of the thyroid hormone in the body which leads to the metabolic rate rising. This can lead to panic attacks, anxiety, heat intolerance, hair loss and palpitations of the heart.

The metabolic rate lowers when there is too little thyroid hormone being released (hypothyroidism). Depression, weight gain and thinning of the hair are all symptoms of an underactive thyroid.

Types of thyroid disease have names: Hashimoto's is the most common thyroid disease, leading to hypothyroidism. Graves’ disease is more dangerous than Hashimoto’s because the excess amount of thyroid hormone being pumped into the body can lead to hyperthyroidism.

What to look for: To monitor your thyroid health at home, there is a self-examination you can perform called “check the neck.” In this process, you are feeling for a lump, or nodule, on the thyroid gland.

Touch the thyroid gland where it sits over your airway on the neck. If you feel a lump — don’t panic. You can check in with your primary care provider for further care. Typically, an ultrasound is the best way to diagnose thyroid disease or cancer, followed by a biopsy on the nodule.

One of the first ways to check for a problem with your thyroid is to go to your primary-care provider and get a blood test. This cannot diagnose thyroid cancer but can check your levels of thyroid-stimulating hormone. This blood test can rule out conditions like hypothyroidism or hyperthyroidism.

The prognosis of thyroid cancer is very favorable. There is a combination of surgical therapy and other therapies indicated for this cancer. If you have any questions or concerns, talk to your primary-care provider.

William B. Inabnet III, M.D., is UK HealthCare surgeon-in-chief and chair of the Department of Surgery in the UK College of Medicine.

Heart Association gives UK grant to spur 'food as medicine' effort

By Grace Sowards
University of Kentucky

The Food as Health Alliance at the University of Kentucky has received a grant from the American Heart Association. UK is among the first recipients of AHA’s Health Care by Food Initiative awards.

Alison Gustafson (UK photo by Sabrina Hounshell)

FAHA director Alison Gustafson is a faculty member in the University of Kentucky Martin-Gatton College of Agriculture, Food and Environment. She will use the $386,000 grant over the next year and a half to see how a user-centered design program can improve screening, referral enrollment and engagement in food-as-medicine programs for adults with food insecurity and high blood pressure or other diet-sensitive chronic diseases.

This grant also involves UK HealthCare and Appalachian Regional Healthcare, with key partnerships from Instacart, Kroger Health with Soda Health, Mom’s Meals and Food City.

“We are looking forward to working with our partners across the state to improve screening, referral and enrollment practices to improve patient outcomes,” said Gustafson, a professor in UK's Department of Dietetics and Human Nutrition.  She has partnered with Instacart, Mom’s Meals and Food City on current pilot projects across Kentucky to help develop the infrastructure for patients receiving food-as-medicine programs.

The grant team is developing a referral hub for health-related social needs with key organizations in Kentucky. FAHA is bringing together diverse health-care, managed-care, non-profit and industry collaborators to facilitate screening, referral and enrollment to identify the most suitable and effective model(s) in the short term, while considering design for long-term sustainability.

FAHA seeks to bring together clinical and community research spanning across agriculture, food, health care and nutrition to address food insecurity and diet-related chronic disease. Researchers, community partners, food commodity producers, health care partners and students will explore innovative strategies to improve patient clinical outcomes and Kentuckians’ health.

“This award is an acknowledgment of the tremendous work the Food as Health Alliance has already been doing to address inequities related to food insecurity and chronic disease across Kentucky,” said Carolyn Lauckner, assistant professor in the Department of Behavioral Science at the UK College of Medicine and co-principal investigator on the grant with Gustafson.

“The grant demonstrates an investment in our efforts to use food as medicine to improve individuals’ health by targeting the link between food insecurity and cardiovascular disease,” Lauckner said. “I am thrilled to be working with this outstanding group of scholars and practitioners committed to using innovative, community-engaged research methods to improve the health of all Kentuckians.”

For more information on FAHA, visit https://foodashealthalliance.ca.uky.edu. For more information about the American Heart Association’s Health Care by Food Initiative, visit https://healthcarexfood.org.

It's Heart Month, which confronts the leading killer in the U.S.; here are five ways to keep your heart healthy or make it healthier.

University of Florida illustration

Kentucky Health News

February is American Heart Month, which focuses on the fact that heart disease is the leading cause of death in the U.S., and ways to lower your risk for heart disease. Here are five ways to boost your heart health, from the Centers for Disease Control and Prevention:

Exercise regularly. Maintaining a healthy weight is an important part of heart disease prevention, and regular exercise is one way to achieve this. The surgeon general recommends that adults get two and a half hours of moderate physical activity like walking or biking weekly. Children and adolescents should aim for an hour of physical activity every day.

Eat healthy. Establishing healthy eating habits is another way to maintain a healthy weight. Avoid foods that are high in saturated fat and trans fat. Opt for foods that are high in fiber and low in saturated fat, trans fat and cholesterol to help prevent high cholesterol. Foods with lower sodium can help lower your blood pressure, and consuming foods with less sugar can help keep your blood sugar under control.

Set limits. Limiting your alcohol intake and avoiding smoking can also help you prevent heart disease. Knowing your limits and setting boundaries can help you stay disciplined, which is another vital part of lowering your risk for heart disease.

Monitor health conditions. If you struggle with high blood pressure or high cholesterol or have diabetes, managing these conditions is a key part of preventing and lowering your risk for heart disease. Consult with doctors and other members of your health team to see what their recommendations are for managing existing medical conditions. They may prescribe medicines to help manage your blood pressure, cholesterol or blood sugar, along with lifestyle changes to help.

Work with a team. It's important to work with your health care team if any of your conditions change, if your family has a history of any of these medical conditions or if you suspect you might be at risk for them. Consult your doctor if you’ve already had a heart attack or if you struggle with mental-health issues. Create a treatment plan that works for you and discuss it regularly, making adjustments when necessary. Don’t stop taking any prescribed medicines before talking to your doctor.

Prioritizing heart health is critical for preventing and lowering your risk for heart disease. For more tips to boost heart health, visit cdc.gov/heartdisease/prevention.htm.

'SMART' ways to make those New Year’s resolutions stick

SMART goals concept
(Wikipedia graphic)

By Shorus Minella

University of Kentucky

If you’re looking for ways to make those New Year’s resolutions stick, try finding something you are really motivated to do. You are more likely to want to work toward a goal if you enjoy the activity. 

For example, if you want to start exercising but hate exercise equipment at the gym, find a dance or aerobic class instead.

After you’ve identified something you want to work towards, be realistic and set a specific goal. 

Instead of a broad goal like “I want to eat healthy,” instead, try “I want to eat two cups of vegetables every day.” You’re more likely to accomplish and stick to a specific goal.

Following the SMART goals concept is a great guide to setting and sticking to goals. Here’s what to keep in mind when making your goals:

 

Specific – Giving yourself a very specific goal makes it easier to achieve. For example, instead of setting a goal to lose weight, aim for a specific number, such as five pounds. When you reach that goal, aim for another five pounds.
Measurable – Set yourself up for success by tracking your progress. Seeing how far you’ve come is an excellent motivator!
Achievable – If you’ve never run a step in your life, vowing to run a marathon might be a difficult goal to stick to. Start small by running around the block, then a mile, then try signing up for a community 5K.
Relevant – Your goals should be in line with your values and passions. You’re more likely to achieve your goal if you are enjoying it!
Time-Based – Give yourself a realistic time frame to complete your goal.

Most importantly, give yourself grace during your journey. Celebrate your successes but don’t get discouraged by any setbacks. Talk to your doctor or check in with the local health department for resources and programs to help you meet your goals.

Shorus Minella is a dietitian and patient education coordinator at UK HealthCare’s Gill Heart & Vascular Institute.

Meat-heavy diet raises risk for Alzheimer's disease, study finds, predicting U.S. cases of the disease will grow 50% by 2038

Researcher Steve Blake diagrammed how different foods create greater risk for Alzheimer's disease (AD). AGEs are compounds formed in the body when proteins react with sugar; they increase the risk of many diseases.

Kentucky Health News

Americans' meat-rich diets make them more vulnerable to Alzheimer's disease, according to a study published in the peer-reviewed Journal of Alzheimer's Disease. "Diets that are more plant-based, like the Mediterranean diet and traditional diets in China, Japan, and India, are shown to reduce risk, especially when compared to the Western diet," says a press release about the study by nutrition scientists.

"Alzheimer’s disease rates rise in these countries as they make the nutrition transition to the Western diet," the release notes. "This study identifies dementia risk factors including higher consumption of saturated fats, meat (especially red meat such as hamburgers and barbeque) as well as processed meats such as hot dogs, and ultra-processed foods high in sugar and refined grains.

The study also helps explain why certain foods increase or reduce the risk of Alzheimer’s. "Meat raised risk of dementia the most by increasing risk factors such as inflammation, insulin resistance, oxidative stress, saturated fat, advanced glycation end products, and trimethylamine N-oxide," the release says. The study identified several foods that protect against Alzheimer’s, such as nuts, omega-3 fatty acids, whole grains, green leafy vegetables, colorful fruits and vegetables, and beans and other legumes (plants that fix nitrogen).

Ultra-processed foods can increase the risk of obesity and diabetes because they lack the ingredients found in whole plant foods that deter dementia away, such as anti-inflammatory components and antioxidants. Ultra-processed foods make poverty is an important driver of Alzheimer’s disease, because they are usually cheaper sources of energy than fruits, vegetables, whole grains, and other more nutritious foods.

"The paper also suggests that Alzheimer’s disease rates in the U.S. are projected to increase by 50% from 2018 levels by 2038," the release saus. "This calculation is based on comparing trends of obesity in the U.S. with Alzheimer’s disease trends. This comparison shows a 20-year lag between obesity rates and Alzheimer’s disease rates. This estimate is very close to the estimate published by the Alzheimer’s Association in 2018, an estimate of a 56% increase."

The researchers said, "Our estimate suggests that the rising trend of obesity, due to consumption of meat and ultra-processed foods, is the force driving dementia. Although our personal risk of Alzheimer’s disease can be reduced with diet, it is expected that those who continue to eat the Western diet will continue to have a higher risk."

The study, a review of other published research, was conducted by Steven Blake of the Maui Memory Clinic in Hawaii and William Grant of San Francisco's Sunlight, Nutrition and Research Center. It was endorsed by other experts.

“Grant and Blake comprehensively review and synthesize the role of dietary factors in Alzheimer’s disease,” said Dr. Edward Giovannucci, a professor of utrition and epidemiology at Harvard University. “Evidence from diverse perspectives support that a diet that emphasizes fruits, vegetables, legumes, nuts, whole grains, and … de-emphasizes meat, especially red meat, saturated fats, and ultra-processed foods is associated with lower risk of Alzheimer’s disease. Physical inactivity and obesity also contribute to higher risk.”

Ky. ranks low in benefits for the poor; health secretary says he reminds legislators of the impact programs have on communities

Health Secretary Eric Friedlander

Update, Dec. 4: This story has been updated with additional information from state Health and Family Services Secretary Eric Friedlander's office. One number has been corrected.

By Melissa Patrick
Kentucky Health News

In a national webinar on safety-net programs, state Health and Family Services Secretary Eric Friedlander said he would mention the state's low ranking in assistance to needy families in his discussions with legislators who will soon write the state budget. 

The webinar was held Nov. 28 by the Brookings Institution, a leading think tank that does in-depth, nonpartisan research to improve policy and governance at local, national and global levels.

The webinar opened with an introduction to Brookings' new tool, State Safety Net Interactive, showing the evolution of safety-net benefits over 21 years for a hypothetical sample of non-disabled, non-immigrant, single-mother families if they had full access to major safety-net programs, based on each state's rules.

Screenshot of Brookings Institution interactive map

The interactive tool shows that in 2022, Kentucky ranked 49th in cash and food assistance for this theoretical family, providing $4,810 in assistance. That was lower than any state but Arkansas and Mississippi. Adjusted for the cost of living in each state, Kentucky ranked 44th.

Friedlander told the webinar audience that he looked forward to using this interactive tool in his policy discussions with the state's lawmakers: "I appreciate getting the additional data and support from the tool that Brookings is rolling out today and I think it will be helpful in my discussions with the General Assembly."

Friedlander said it's important to recognize that Kentucky has a "blue governor" and a "very red General Assembly" and that there are often differing narratives when it comes to safety-net benefits and policy.  

He said that when it comes to safety-net programs, his cabinet tries to recognize that whatever happens to an individual in any community impacts everyone in the community, and he tries to convey this to policymakers. One example he used is the Supplemental Nutrition Assistance Program, formerly food stamps.

"I've taken an approach with the General Assembly, which is, if it weren't for SNAP, we wouldn't have the amount of grocers that we have across the state. If it wasn't for Medicaid, we wouldn't have a health-care system at all. If it wasn't for child-care support, we wouldn't have child care," he said. "So I also take it from an angle of the economic support to communities . . . but what happens to communities when we're able to provide support for these individuals in their communities."

Kentucky increases benefits to the most needy families

Friedlander said his cabinet recently increased Temporary Assistance for Needy Families, a federal program that provides cash assistance to families with children and very low incomes.

In a follow-up email, Friedlnader spokeswoman Susan Dunlap said Kentucky's TANF program is called the Kentucky Transitional Assistance Program and stressed that the interactive Brookings tool does not yet reflect the changes made to Kentucky's program. 

"The funding level changed earlier this year, and adjustments do not yet show up in the interactive tool, which reflects data through 2022," Dunlap said in an email. "The tool, soon, should reflect the change in income eligibility level."

Dunlap said the benefit and income eligibility levels for this program had not changed since at least 1995, when the one and two-person household income categories were last increased, and the last increase for larger households was even earlier. 

She offered this example: "Accounting for inflation having risen 92 percent between 1995 and 2022, the maximum benefit level for a household of three would have been $503 had it just kept up with inflation. The current benefit reflected in the interactive tool is $262 for a household of that size. The recent increase in funding doubles the benefit level to $524 for a household of three – just above the inflation-adjusted equivalent for 1995."

Dunlap added that the income eligibility limit has been frozen for the past 27 years. "Had it kept up with inflation, it would have been $1,870 per month last year," she wrote. "The current limit for a household of this size reflected in the interactive tool is just $974 per month." 

Friedlander said Kentucky had not changed TANF in 20 27 years and that the recent changes increased payments and reduced some administrative barriers. When legislators asked why, the cabinet showed them the economic impact of SNAP, TANF and Medicaid for each county, beyond the numbers for individuals.

"And it actually made an impact," Friedlander said, adding later, "There are these dependence narratives that are out there, and I don't believe that they're backed up by evidence. But we have to be able to show the evidence that this is not the case within the Cabinet for Health and Family Services." 

He said it is possible to work across partisan lines "as long as we are being honest and evidence-based about what's happening." He added that such talks generally take place "off-stage" and require "relationship building." 

Friedlander pointed to the state's efforts to use the Kynect website to reduce the administrative burden of safety-net programs. "We have an integrated eligibility system, meaning you can go and you can sign up for different programs -- TANF, SNAP, Medicaid, child care -- under one umbrella."

Friedlander said Kentucky discovered this system could work really well during the pandemic. He said other lessons from the pandemic include learning that CHFS could be "nimble" and "can make changes quickly" and can deliver services in a different, but often "more effective and efficient way."

"As of December 2023, there were approximately 12,514 families participating in the KTAP program, made up of approximately 6,242 adults and 21,534 children. Since 2016 alone, the total number of Kentuckians receiving KTAP had fallen by 54 percent," according to the CHFS.

Over the holidays, encourage picky eaters to try something new

Photo illustration from PureWow.com

By Dr. Rhya Strifling
UK HealthCare

During the holiday season, there are all kinds of foods on the table. But for parents and caregivers, even the most joyous of family gatherings can be stressful when you're dealing with a picky eater.

Sometimes what parents think is picky eating isn't actually picky eating. Some parents might be under the impression that their kids are picky eaters if they don't eat much, but children ages 2 to 5 have a slower rate of growth and therefore have smaller appetites.

It's normal for children to eat small amounts of food at one meal — sometimes just a few bites — and then a larger amount at a later meal or the next morning. They learn to regulate how much to eat and won't starve themselves. If they are growing well on their growth curves, don't worry about how much they are eating.

Keep mealtimes relaxed. The best way to prevent a child from becoming a picky eater is to make mealtimes enjoyable with a variety of small portions of healthy foods. Mealtimes should be relatively short, and children should not be made to "clean their plates." Some children will exert their independence by refusing to eat if you force them, punish them or bargain with them. The more you make them eat, the more they might begin to refuse.

Provide your child with a variety of healthy food choices in small, tablespoon-sized portions, then relax and focus on your own meal. The less focus you put on what your kid eats, the better they will eat. If they say they don't like what you have prepared, tell them that's OK and give them the same food options as the rest of the family, then return to your own meal. They will either eat, or catch up at the next meal.

Encourage your child to try new foods. A child might try a new food 10 to 15 times before realizing they actually like it. Don't be afraid to try new foods, but don't get frustrated if your child rejects them. The best way to get children to try new foods is to eat them yourself. Be sure to give them lots of praise and encouragement for taking even the smallest bite of a new food.

To help children eat better at mealtimes, follow some of these tips:

• Try to limit beverages prior to meals.
• Schedule snack time instead of letting them "graze" throughout the day.
• Serve as a role model, because children learn to feed themselves by experimenting with new foods.
• Sit at the table as a family to demonstrate healthy eating choices and habits.

Rhya Strifling, M.D., is a physician at Kentucky Clinic South.

Website offers evidence-based data about nutrition, supplements

By Melissa Patrick

Kentucky Health News

If you are looking for detailed information about research on nutrition and food supplements, a website called Examine.com is a resource to provide that information. 

Examine is a "leading source for evidence-based information about nutrition and supplement research that is independent from advertisers," a news release said.

"We never start with an objective, like low-carb or high-carb, pro-supplement or anti-supplement," the Examine website says. "Rather, we simply report on all the evidence that’s been published."

Examine was founded in 2011. Its website says that neither it, nor any member of its research team, is affiliated with any supplement or food company and that it is funded through its 13,000 individual subscriptions -- with no ads, sponsorships or industry ties. Its email list numbers 200,000.

"This has allowed the team of researchers to operate independently and focus their energy on analyzing the latest research and studies about nutrition and supplements," the release says.

Examine.com is structured around 25 broad health categories and includes the latest research for nonmedical interventions for  hundreds of conditions.

For example, a search for "Ketogenic Diet" leads to a page that defines the term and includes information about what the research says about such a diet, whether it is safe or not, and links to studies that are related to specific health outcomes on this diet -- such as its impact on blood pressure or blood glucose. The page links to even more research analysis regarding related topics. 

'Toddler formulas' for infants and young children offer little nutritional benefit, writes a UK specialist in pediatric digestion

Photo by tun723, iStock/Getty Images Plus via UK

By George J. Fuchs III, M.D.

University of Kentucky

A recent report from the American Academy of Pediatrics as part of my work on the AAP Committee of Nutrition addresses the claims made by the manufacturers of so-called “toddler formulas," purporting to bolster the immune system and improve brain development. Simply put, a nutritionally complete super formula that gives your child a brain boost and protects them from diseases is too good to be true.

Nutrition is integral to a child’s cognitive and physical development, especially in the first years of their life. Additionally, these years represent a narrow window of time during which nutritional status and the right nutrients at the right time are primary determinants of health and risk of obesity, diabetes and other diseases in childhood and through adulthood.

While the benefits of breastfeeding in the first six months of life are well-documented, there are numerous reasons why some infants must subsist on iron-fortified formulas. The composition of infant formulas is standardized and regulated by the Food and Drug Administration per the Infant Formula Act of 1980 and the manufacturing facilities are regularly inspected.

Recently, liquid nutritional products referred to as “formulas” have been developed for the older infant and toddler and increasingly promoted by manufacturers. Older infant-young child formulas (OIYCF) are marketed under identities such as “transition formulas,” “toddler formulas” or “growing-up milks." These formulas are not to be confused with medical or therapeutic formulas for conditions such as chronic gastrointestinal diseases, metabolic disorders or food allergy, the use of which are prescribed and monitored by pediatric specialists.

Unlike infant formulas, there are no standard criteria for the composition of OIYCFs. Some of these formulas have been criticized as having elements considered to be unnecessary or potentially detrimental, including high or low protein, and higher sodium content relative to cow milk and added sweeteners. OIYCFs are considered by some to be “sugar-sweetened drinks” and have been associated with greater intakes of sweetened beverages as well as sweetened dairy products, such as fruit yogurts and cream cheese desserts.

Advertisement practices for OIYCFs often convey them as a necessary “next stage” or “next step” for optimal nutritional intake. Manufacturers of OIYCF make claims that are not required to be based on scientific evidence or be reviewed or approved by the FDA. Claims of improved brain development or immune function have incorrectly shown to influence parents’ belief that OIYCFs are healthier than breast milk or cow milk. OIYCFs are not nutritionally complete and are marketed to parents of healthy children as a replacement or substitute for cow’s milk.

The diets of young children are generally adequate for most micronutrients, although possible gaps exist, especially for vitamins D and E and fiber. Nearly all store-purchased cow milk in the United States is fortified with vitamin D, thus eliminating the need for a supplemental formula. Additionally, OIYCFs are considerably more expensive than cow milk and can represent a significant cost burden to families, especially when consumed daily. Parents and caregivers are advised to provide nutritionally balanced diets that include fortified foods; children consuming a diet of solid foods that provide sufficient iron and vitamin content have no need for supplemental formulas.

If you are concerned about your child’s nutritional intake, ask their pediatrician for recommendations for a balanced, nutrient-rich diet to help ensure proper cognitive and physical development during formative early years.

Dr. George Fuchs is a pediatric gastroenterologist at Kentucky Children’s Hospital and a professor in the UK Colleges of Medicine and Public Health.

Nonalcoholic fatty liver disease now common in children; experts at UK and elsewhere say causes include diet and lack of exercise

Dr. Samir Softic (Washington Post photo by Drea Cornejo)

Kentucky Health News

For uncertain reasons, nonalcoholic fatty liver disease has become more common in American children, especially in Kentucky, and “It’s the worst disease you’ve never heard of,” said Samir Softic, a pediatric gastroenterologist at the University of Kentucky Children’s Hospital, who specializes in the disease.

Softic is a main focus of a long story in The Washington Post about the disease, which is estimated to affect 5 to 10 percent of U.S. children, "making it about as common as asthma, Post reporter Ariana Eunjung Cha writes. A video with the story says Kentucky's rate "is believed to be among the highest."

Cha reports, "The crisis is especially acute in swatches of the Southeast, where rates of pediatric obesity are highest," including Appalachian Kentucky. "But obesity is only part of the puzzle. Scientists have been surprised to find that not all kids with obesity have fatty liver, and not all kids who have fatty liver disease struggle with weight."

Softic runs UK's pediatric fatty liver clinic, which this spring was "often fully booked two to six months in advance," Cha reports. The disease often has few symptoms until it becomes serious, at which point it can cause weakness, severe tiredness, weight loss, yellowing of the skin or eyes, spiderlike blood vessels on the skin and long-lasting itching," says Johns Hopkins Medicine.

"For Softic, the fatty liver crisis is as much about policy as science. He has collected a stack of letters from insurers refusing to cover some patients’ treatment with a new generation of weight-loss drugs known as semaglutides, sold under brand names including Ozempic and Wegovy. The companies say the medications are not yet proven to help with fatty liver.

"While Softic believes that fundamental changes in how we eat and exercise are needed in the long term, he said lives could be saved in the short term if these drugs were widely and cheaply available. He’s lobbying state and federal regulators to help pay for the treatments — which can cost upwards of $1,300 a month — for patients younger than 18, who arguably have the most to gain because they have more of their lives ahead of them.

Washington Post graphic frrom Trilliant Health analysis of claims

"Liver transplants in children diagnosed with fatty liver disease remain rare, but Softic recently referred a 6-year-old for a transplant evaluation. There has been a clear rise in transplants for fatty liver in people in their 20s and 30s, meaning if he can’t help his pediatric patients now, they may soon face a transplant."

Softic told Cha the disease “goes unnoticed and unrecognized, and over time it catches up. For a good number of these young transplant patients, the disease process started in childhood,” he said. “On so many levels, we are not prepared to deal with this disease in children.”

A seven-minute video with the story includes the case of Sydney Woods, a Kentucky 15-year-old with fatty liver disease who improved her liver function by "cutting out soda and making other changes to her diet . . . but it's not as easy for most families to buy less procesed food." That's especially true in rural areas, said her mother, Angela Woods, a physician's assistant.

Softic says in the video, "Eating healthy requires time, it requires money, and not everyone has those resources."

Cha reports, "Many doctors believe that our modern lifestyle — diet, the increase in sedentary activities related to technology and environmental exposures — is to blame. One of the liver’s jobs is to filter toxins, and when something in the body is out of balance, the organ can become damaged and fail. Some pediatric experts theorize there’s a mismatch between our genetics and the highly processed and sugary foods that have come to dominate childhood diets," including some types of infant formula. The video says 67% of children's diets consist of ultra-processed foods.

"It's a major problem, and it's been exacerbated by diet and inactivity," Simon Fisher, director of UK's Barnstable Brown Diabetes Center, says in the video.

Cha reports, "The escalation of pediatric fatty liver cases has unfolded in tandem with the presence among the young of other conditions once viewed as almost exclusively adult diseases: high blood pressure, high cholesterol, diabetes, even gallstones."