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Evidence suggests that gut health may also belong on the list of heart disease risk factors. Here’s what to know about the link between heart health and gut health, including steps you can take to maintain a balanced gut microbiome.

What to Know About the Heart and Gut Health Connection

Different factors can increase your chance of developing heart disease, like age, family history, high cholesterol, and high blood pressure, among others. And now, evidence suggests that gut health may also belong on the list of heart disease risk factors.

There are trillions of bacteria, fungi, and other small, microscopic organisms called microbes housed in your digestive system. They are collectively referred to as the gut microbiome. In recent years, researchers have found that the gut microbiome affects more than your digestive health alone. Heart disease is one of several health conditions that may be at least partially fueled by an unhealthy balance of gut bacteria.

The good news? This is a heart disease risk factor you definitely have control over. Here’s what to know about the link between heart health and gut health, including steps you can take to maintain a balanced gut microbiome.

Metabolites and your cardiovascular system

During the digestive process, microbes produce substances called metabolites. One of these substances in particular, trimethylamine (TMA), is linked to your risk for cardiovascular disease and other chronic health conditions like diabetes.

TMA forms when the bacteria and other organisms within the gut microbiome consume choline, a nutrient contained in red meat, fish, poultry, and eggs. The liver then converts TMA into a substance called trimethylamine N-oxide (TMAO). 

The medical community has identified a connection between high levels of TMAO in your blood and deposits of cholesterol, blood-clotting material, and other substances in your arteries. These substances are collectively referred to as plaque, and its accumulation in your arteries is referred to as atherosclerosis, a leading cause of cardiovascular disease, heart attacks, and strokes.

A 2017 analysis of several studies on the connection between TMAO blood levels and cardiovascular health found a correlation between elevated TMAO levels and serious cardiovascular issues. In the studies, researchers looked at people from different categories of health conditions in multiple countries, like individuals with and without diabetes, and individuals with and without chronic heart failure. 

Each group included individuals with various TMAO levels. The results showed that people with the highest levels of TMAO were 62% more likely to experience serious cardiovascular issues like heart attacks and strokes. The link appeared to be independent of other key risk factors for heart disease like diabetes and obesity.

In addition to the findings about TMAO, researchers have also identified a link between gut health and inflammation (redness, warmth, and swelling around tissues and joints). Inflammation is part of the body’s natural response to an injury, but when it persists after the healing process and becomes chronic inflammation, it can lead to an ongoing high white blood cell count.  

Over time, this elevated level of white blood cells can affect other organs including your heart, lungs, and kidneys, which may influence your risk for heart disease and other chronic conditions like diabetes.

The majority of the body’s inflammatory cells are stored in tissues in your gut, and researchers have found that an inflamed gut can trigger inflammation elsewhere in your body. Certain gut bacteria produce substances that enter your bloodstream and create inflammation in every part of the body that they travel through. This inflammation in the walls of your blood vessels can eventually lead to atherosclerosis.

Researchers are still learning about the gut microbiome’s influence on your risk for various health conditions. One thing they do know for sure is that a healthy gut microbiome is an important component of your overall health, and there are simple steps you can take to maintain a balanced digestive system.

A balanced diet is a great starting point for better gut health. Start by limiting foods that are processed or high in sugar or fat — particularly cookies, sugary drinks, salty snacks, and frozen foods — as these can lead to increased inflammation. Opt for fiber-rich foods like beans, peas, bananas, and asparagus; fermented foods like kimchi, yogurt, miso, and kefir; and collagen-rich or collagen-boosting foods like salmon, mushrooms, and egg whites.

Staying physically active and avoiding unhealthy habits like smoking and heavy alcohol consumption can also improve your gut health. Looking for a fitness routine that fits your schedule and health needs? Aim for about 150 minutes a week or 30 minutes per day. Explore different activities until you find the one that’s right for you — whether virtually or in person.

Over the long term, stress can lead to many physical and mental health problems, including digestive issues. Staying physically active reduces stress, so you’re already tackling this risk factor simply by working out regularly.

Beyond exercise, check out Insight Timer, an app that offers free guided meditations or Moodfit, a free mood-tracking app. And since there’s an established link between stress and high blood pressure, heart disease, and stroke, these small actions can benefit several aspects of your health at once!

At Alto, we’re committed to making it as simple as possible to protect your heart health and stay on top of cholesterol-lowering or blood pressure management medications.  We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly

Reach out any time via text or phone at 1-800-874-5881 or in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Proactively managing COPD with medication and lifestyle changes can help prevent periods of intensified symptoms, referred to as exacerbations or flare-ups. Here’s more on how to recognize, treat, and prevent COPD flare-ups.

How to Manage and Prevent a COPD Flare-Up

Proactively managing chronic obstructive pulmonary disease (COPD) with medication and lifestyle changes can help slow the progression of the chronic lung disease and prevent periods of intensified COPD symptoms, commonly referred to as exacerbations or flare-ups. 

However, these flare-ups may occur even when closely following your doctor’s individualized treatment plan, especially during the more advanced stages of COPD, so it’s important to have a plan in place to quickly address symptoms. Here’s more on how to recognize, treat, and prevent COPD flare-ups.

Recognizing the symptoms of a COPD flare-up

During a COPD flare-up, symptoms like shortness of breath and wheezing quickly intensify and lung function significantly changes. (Lung function refers to how well your lungs work, specifically how much air they can hold and how easy it is for them to empty air.)

Individual experiences of a COPD flare-up may vary, but many people often notice greater amounts of mucus clogging the bronchial tubes in their lungs and sudden tightening of muscles around their airways. Here are key signs and symptoms to be aware of.

More frequent or more intense coughing, wheezing, or shortness of breath

Changes in the color, thickness, or amount of mucus

Using more oxygen than usual, if your treatment plan includes supplemental oxygen

If you experience any of the symptoms above, the best step is to call your doctor right away. Each COPD flare-up can affect your long-term lung function, so it’s important to address symptoms as quickly as possible.

To effectively manage a COPD flare-up, you’ll want to create a COPD action plan with your doctor. Then, if you experience the signs of a flare-up, you’ll have a specific outline of the actions and medications that can help restore your breathing. Here are some of the medications your doctor may include in your individualized COPD treatment plan.

Short-acting medications like bronchodilators relax your airway muscles and open your lungs to quickly reduce discomfort. Albuterol (branded options include ProAir® HFA, Proventil® HFA, Ventolin® HFA) is commonly used to treat COPD exacerbations. This medication is typically taken through an inhaler, but can also be taken as a liquid solution for nebulizer use. (A nebulizer is a device that turns a liquid medication into a mist that you can inhale through a face mask. It allows the medication to travel quickly to your lungs.)

Although not common, potential side effects of bronchodilators include nervousness or shakiness, headache, throat or nasal irritation, and muscle aches. Your doctor can explain more about the risks and benefits of using a bronchodilator to treat COPD exacerbations when building your treatment plan.

Your doctor may also recommend oral corticosteroids, which are fast-acting medications that reduce swelling in your lungs and open your airways so that more air can move in and out of your lungs. They are primarily prescribed for short-term use, typically five to seven days.

Oral corticosteroids commonly used to treat COPD exacerbations include:

Prednisone (Prednisone Intensol®, Rayos®)

Some people experience mild side effects from short-term corticosteroid use, including swollen hands and feet, elevated blood pressure, increased appetite, and shifts in mood.

Many people with more advanced COPD use supplemental oxygen to increase their tolerance for physical activities, while others use it only to relieve shortness of breath during an exacerbation.

If your flare-up is more mild, you may take oxygen at home. When writing your prescription for oxygen therapy, your doctor will explain how and when to use the oxygen. It is important to follow all of your doctor’s instructions, including the flow rate setting (how much oxygen you’ll need per minute). The American Lung Association has resources for anyone starting oxygen therapy.

If your COPD has progressed to a later stage, some flare-ups may require treatment in a hospital setting. This allows healthcare professionals to more closely observe your symptoms and monitor vital signs like your pulse, temperature, and blood pressure. Consult with your doctor about specific symptoms to look out for that may indicate a need for more intensive treatment or monitoring.

How to lower your risk of COPD exacerbations

There are many steps you can take to lower your risk of a COPD exacerbation and reduce the frequency of COPD-related hospitalizations.

First, it’s important to closely follow your doctor’s recommendations, including taking any maintenance medications exactly as prescribed. (We designed our app to make it as simple as possible to do so, with medication management tools like reminders and auto refills that help you stay on track.)

In addition, try to limit your exposure to leading triggers of COPD exacerbations, including cigarette smoke (this includes secondhand smoke), indoor and outdoor air pollution, cold air, and household dust.

To keep the air inside your home as clean as possible, avoid perfumes and cleaning and hygiene products with strong odors. Use air purifiers and vacuum cleaners with a high-efficiency particulate air (HEPA) filter.

Lastly, the flu and pneumonia can worsen COPD symptoms and potentially lead to a flare-up, so it’s important to get your yearly flu shot and ask your doctor or pharmacist if you are eligible for the pneumonia vaccine.

We’re here to support your COPD treatment

COPD flare-ups can cause discomfort, but we’re here every step of the way to help you manage symptoms and get the medications you need, with free same-day delivery and easy-to-use medication management reminders in our app.

And our team of pharmacists are always here to answer your questions by phone, text, or chat. Reach out any time via text or phone at 1-800-874-5881, or in-app messaging.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

October is American Pharmacist Month, a time to celebrate the critical role that pharmacists and pharmacy technicians play within healthcare.

Celebrating American Pharmacist Month At Alto

October just might be our favorite month of the year, and for a good reason: it’s American Pharmacist Month, a time to celebrate the critical role that pharmacists and pharmacy technicians play within healthcare.

Pharmacists are one of the most accessible healthcare professionals, seeing people 5 to 8 times more frequently per year than primary care providers. And as such, they are integral to your overall health and well-being. 

You may not realize all the responsibilities that a pharmacist’s role encompasses. In addition to filling your prescriptions, they also educate on medication usage, advocate for changes that improve care, and problem solve clinical, ethical, managerial, economic, and legal compliance issues, becoming a trusted resource to the individuals they care for. Extensive training and education are required to enter the profession: a pharmacist must earn a doctorate in Pharmacy and complete state-specific licensing requirements before becoming licensed to practice pharmacy.

At many traditional retail pharmacies, each pharmacist is expected to tackle a broad assortment of tasks that often leave them feeling overwhelmed and stressed, like managing transactions for customers, answering questions about where non-pharmacy items are stocked, and contacting insurance companies on top of ensuring prescriptions are dispensed properly and safely. At Alto, however, pharmacists align with one of several practice areas — fulfillment, customer care, and onboarding — so that they are able to focus on specific aspects of pharmacist practice and deliver exceptional care to Alto’s customers.

Fulfillment pharmacists are responsible for inventory management, medication preparation, physical quality checks, and dispensing, all to make sure the right medication arrives at your door, on schedule. Our customer care pharmacists review prescriptions for accuracy and for potential complications with other medications on file; provide individualized consultations on dosing, side effects and other concerns; and partner with healthcare providers on clinical recommendations. And our onboarding pharmacists — a relatively new role at Alto — are a bridge to an individual's broader team, supporting healthcare providers and ensuring continuity of care between prescriber and pharmacy.

“At Alto, we are proud of our customer-focused services and forward-thinking means of providing those services,” shares Ashley Lee, Onboarding Pharmacist. “Being a pharmacist at Alto gives me the unique opportunity to not only practice patient care, but also to design it to be meaningful to as many individuals in need as possible. The innovation never stops here at Alto.”

How Alto pharmacists serve our communities

There’s no shortage of opportunities for a pharmacist to support an individual with their medication needs or to be a partner in their health journey alongside their doctor’s office, family and other support networks. Here are just a few of the many roles that Alto pharmacists fulfill.

Literally. Our pharmacists are educators who mentor other pharmacists-in-training. Sandra Aziz, Pharmacy Compliance Program and Training Manager, is responsible for training new Pharmacy Managers and Supervisors at our dispensing sites, ensuring they have the resources needed to be effective managers and to oversee their pharmacy location’s compliance program and daily operations.

Sandra also manages our internship programs for pharmacy students. Alto offers an immersive 10-week Pharmacy Operations Management summer internship program for eligible students at Howard University’s School of Pharmacy (HUCOP). The program provides an opportunity to gain a breadth of experience across clinical pharmacy care, operations, and business development. Students also have the opportunity to actively influence Alto’s software development and implement ideas that further preventative healthcare and pharmacist involvement in community health.

Sandra also launched our Introductory Pharmacy Practice Experiences (IPPE) and Advanced Pharmacy Practice Experiences (APPE) programs, which allow students from pharmacy schools across the country to select Alto as a practice site. While at Alto, they are exposed to highly skilled and entrepreneurial pharmacists, engineers, and operations experts with whom they can partner to challenge, reinvent, and improve pharmacy. 

“It’s been really rewarding to see more pharmacy students expressing interest in our programs,” Sandra said. “We have a rare opportunity to give students an experiential learning experience that you won’t find at any other pharmacy. At Alto, our pharmacists work cross-functionally across operations, engineering, and design to build a better, more intuitive community pharmacy from the ground up. We focus on challenges faced by patients, providers, and payers, and find solutions that optimize experience, transparency, and health outcomes.”

Read our previous post, 'From Pharmacist to Professor: Sandra Aziz Spotlight'.

They’re also here to teach you! Our pharmacists are happy to chat on the phone for however long you need to offer individualized support. Many customers use these one-on-one consultations to learn how to give themselves injections as part of fertility treatment or diabetes management or to confirm special storage or dosing instructions, but our pharmacists are happy to share their expertise on any question related to your prescriptions or health needs.

For example, did you know that our pharmacists are experts on managing side effects? As a bridge between you and your doctor, our pharmacists review all of your current medications to identify any potential symptoms or medication interactions, and they’re available to talk through any questions or concerns.

Lawmakers in several states have recognized the accessibility of pharmacists and their potential to play an even larger role in healthcare, specifically in the HIV prevention space. California became the first state to allow pharmacists to prescribe HIV prevention medication like pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) in 2019, and Colorado became the second in November 2020. Pharmacists at Alto’s California locations are able to prescribe PrEP and PEP, and we’re currently working to bring the service to our Colorado location.

“As healthcare providers in the community, there is a big opportunity for us as pharmacists to play a critical role in HIV prevention and help increase accessibility to medications like PrEP and PEP,” explains Susan Sun, Specialty Pharmacist. “It’s been wonderful to see growing recognition of a pharmacist’s impact even outside of the healthcare community, and the recent legislation that allows pharmacists to prescribe in some states is just a start. It’s a privilege for pharmacists to be a part of these exciting changes and make HIV prevention easier for others.”

In honor of American Pharmacist Month, we’d like to say a big and heartfelt thank you to our incredible team of 175+ pharmacists. Each of you plays a critical role in the wellbeing of our customers, the strength of our provider relationships and the quality of our service — we’re grateful for your hard work all year long. 

Here are just a few of the faces responsible for providing exceptional pharmacist care at Alto!

October 11 marks National Coming Out Day, an opportunity to celebrate all those who have come out as LGBTQ+ and recognize the courage they’ve demonstrated by choosing to be their authentic selves.

Celebrating National Coming Out Day at Alto

October 11 marks National Coming Out Day, an opportunity to celebrate all those who have come out as LGBTQ+ and recognize the courage they’ve demonstrated by choosing to be their authentic selves. In honor of this annual celebration, we sat down with two Alto team members — Ben Romero (he/they), Business Operations Manager for Health Plans and Travis White (he/him), Senior Software Engineer — who generously shared their experiences of coming out as bisexual/queer. Here are their stories, in their own words.

Ben: Like a lot of folks, I avoided coming out for most of my life. I grew up knowing that I wasn’t exactly straight and later recognized that I’m bisexual. I remember my entire experience around my sexuality being wrapped in shame. I would reluctantly conform to heteronormativity just to avoid the fear of being outed or questioned. It wasn't until college that I first felt like I could open myself up to the experience and validation that I deserved. By the time I graduated from college, I had a refreshed sense of my place in the world, but I was still hiding my sexuality from my family.

Five years after college, I was finally ready to be open with my family about being bisexual, and it was the first time I felt as if I had to “come out.” At the time I was engaged to my non-binary/queer partner. My family knew my partner as a woman, but my partner was also beginning to validate their nonbinary gender experience. All I could think about was how much of a disservice it would be to our identities as a queer couple if we started our marriage having to assume more invalidating heteronormative assumptions. I first told my closest family members — my younger brother and parents — who supported me unconditionally and showed me so much love. Not every family member was as accepting of my sexuality, which was really disappointing, but I had more than enough support from my chosen family to finally overcome the fear that I had held on to for so long. 

Travis: I realized I wasn’t completely straight at some point in high school. Growing up Catholic, I was always taught that men are attracted to women and that being gay was a sin. So when I found myself attracted to both girls and guys during high school, I wondered what was wrong with me. I brushed it off and ignored that aspect of my sexuality for a long time, which I would later come to regret since it definitely fed into ongoing anxiety and depression in college.

I first came out to my closest friends during my junior year of college. By that point, I had fully accepted that I wasn’t straight, but I had never acted on my bisexuality. I had only dated girls, so my friends saw me as completely straight. I couldn’t quite figure out how to tell them, and it ended up happening organically while hanging out on a Friday night. We were playing a game around the table that required everyone to share something no one else knew about them. Something came over me and I decided to throw caution to the wind with a, “by the way… I’m bi.”  

I came out to my parents several years later when I was working my first engineering job out of college, living in Silicon Valley and loving life. I knew that if they chose not to accept me, it was going to be their loss. After a night out (and an amazing prime rib dinner) when they were in town, I told them that there was something I wanted to tell them about myself - that I am bisexual. My dad’s first response was, “What does that mean?” I informed them that it means I am attracted to both men and women, though more recently, I’ve come to think of myself as being attracted to interesting people regardless of the gender they identify as. My parents were very supportive, but truthfully I had reached a point where I could be accepting of the worst-case scenario. 

Ben: I was most grateful for the sense of relief I experienced. Despite facing criticism and homophobia from some of my siblings after coming out, I couldn’t shake the sense of pride I felt from allowing myself to be unapologetically queer and visible. I’m finally allowing this part of me to flourish and grow. It’s liberating to be radically honest with yourself and others, regardless of what anyone else may think. I’ve now come to identify with the term queer in addition to bisexual. Part of the growth I’ve experienced involves unlearning so much of what I’ve been socialized to believe about the gender binary, and I’m just now starting to understand where I exist outside of it.  

Travis: When I came out to my friends during college, we stayed up talking until very late into the night. I left feeling a huge weight lifted off of my shoulders — and so full of love and support from some of the people I was closest to.

And later when I came out to my parents, they accepted me with open loving arms, for which I’m grateful, but I was also prepared to move forward with my life even if they did not accept me as my true authentic self.

What resources, support groups, or communities did you rely on when coming out? 

Ben: The isolation of being in the closet can sometimes lead to stories or expectations of yourself that aren’t necessarily helpful, or true. For me, as a bisexual, some of those expectations sounded like “I’m not queer enough,” “I don’t fit into the queer community,” or “people won’t believe I’m bi/queer.” I looked to my queer friends and even to LGBTQ+ advocates on social media and was relieved to find that they had many of the same fears about coming out as I did. I found that learning from other people’s experiences could help validate my own feelings, even if we had a different orientation or gender. As a queer Latinx, I also sought validation from people who shared similar intersections around my identity, which helped me navigate the concerns I had about coming out to my family.

Travis: My friends were very supportive so I was really able to lean on them. It was also helpful to just search online for other people’s coming out stories. Before I could tell my family, I knew I had to reach a point where I would be secure in my identity regardless of the outcome of that conversation. Part of the reason it’s so important to share coming out stories is because hearing other people’s experiences helps inspire you to do the same.

What advice would you give to others considering coming out? 

Ben: Above all, put your safety first. Try your best to not take on the burden of guilt for not being your authentic self — that is not a reflection of you, but a reflection of how our environment can fail to provide the validation we deserve. Take your time and build your comfort with folks who will validate your experience. There’s a whole community of people who will back you up and care for you if someone you come out to is hurtful or invalidating. 

Travis: Do it if, and when, you’re ready. You can never control how others will react, so just accept that other people’s responses have nothing to do with you. It took me years to reach that point with my family. It can be incredibly tough, and you can never know in advance how anyone will respond, but if they cannot accept you for your true authentic self, there are plenty others out there who will.

Do you have any suggestions for allies? 

Ben: I would stress the importance of familiarizing yourself with queer history and how our struggle for acceptence has evolved over the years. The LGBTQ+ community and allies have so much to be proud of today, like the repeal of “Don’t ask, don’t tell” (a former U.S. policy that directed military applicants to not disclose their sexual orientation), the legalization of gay marriage, and more queer representation on our screens — just to name a few.

At the same time, while all of those are certainly celebratory milestones, I ask that allies also recognize that our pride comes from so much more than a handful of legislative victories over the last decade. Our pride comes from the queer folks who came before us and fought for our visibility by rallying voices to speak out against injustice. Allies can research events such as the Compton’s Cafeteria riot, the Stonewall uprising, or the works of the Combahee River Collective. Understanding this historical context is important for also understanding the intersectional nature of the LGBTQ+ struggle for acceptance and restorative justice. Even though we have much to celebrate, our struggle continues as we fight for those who are still excluded or marginalized. 

Travis: Listen. The number one thing you can do is to listen and accept what someone in the LGBTQ+ community is telling you as their truth. It may change in the future — and that’s okay! Sexuality and gender are not a binary, and both can be incredibly fluid.

For parents: how you discuss sexual orientations and gender identities at home can leave a lasting impact on your children. I remember asking my mother about her thoughts on gay marriage, and she shared a more traditional view of marriage as a union between a man and a woman. That stuck with me for a long time and is a key reason I waited so long to tell them who I truly am. Read your toddler a book about a gay couple that gets married, teach your teens about prominent members of the LGBTQ+ community (and why they’re important), and if your LGBTQ+ child asks you to drive them to gay prom, treat the scenario as completely normal — because it is.

Why is it important for you to work at a company that values diversity in all forms? 

Ben: For me it’s a requirement that a company I work for prioritizes diversity and inclusion. I appreciate that Alto provides visibility into the progress that we’ve made towards building a diverse team that reflects the diversity of the patients we build solutions for. We also hold space to identify the work that still needs to be done. It’s really validating to have your background recognized at company celebrations and events or in spaces like employee resource groups (ERGs)*. It’s also important that we do all we can in our everyday actions to foster a collaborative and inclusive environment — one where people feel comfortable enough to be their authentic selves and not like they have to mask their gender, race, neurodivergence, or any other part of their identity. 

Travis: The U.S. — and the world — is made up of so many different people. There’s diversity of thought and beliefs, educational experiences, socioeconomic status, gender, race, A homogenous company that doesn’t mirror that diversity  will never be able to serve the entire population, and will miss out on a lot of opportunities. Alto’s mission is to fulfill medicine's true purpose — to improve quality of life — for everyone who needs it. The key word to me is everyone, and to truly fulfill the promise of that mission, we need a company as diverse as our customers. I personally find it rewarding to work at a company that values diversity and has strong representation of many identities, because that’s how the best ideas come to fruition and ultimately how the most positive impact is achieved.

At Alto, we believe in a world where every perspective matters. Diversity fosters creativity and creates innovation, and we welcome candidates of all backgrounds, skill sets, and experiences. To learn more, read Why We Prioritize Diversity at Alto. 

For more information on how to make your workplace safe and equitable for LGBTQ+ team members, read 11 Simple Ways You (Yes, You!) Can Make Your Workplace More LGBTQ Inclusive. 

If you or someone you know is considering coming out, we encourage you to review these resources:

Parents, Families, and Friends of Lesbians and Gays (PFLAG) Recommended Reading: Coming Out

*ERGs are meant to empower community groups within an organization by directly linking decision makers and implementing policies that support the group’s specific needs. The groups often center around a shared identity or experience and focus on building community, providing support, and contributing to its members’ personal and professional well-being. By creating an open forum for employees to come together, discuss challenges and opportunities, and foster a sense of belonging, ERGs help both individuals and organizations thrive.

There are 1.6 million Americans living with type 1 diabetes, including about 200,000 young people under 20 and 1.4 million adults aged 20 years old and older. Here is a high-level guide to living with type 1 diabetes at any age.

How to Live with Type 1 Diabetes at Any Age

There are 1.6 million Americans living with type 1 diabetes, including about 200,000 young people under 20 and 1.4 million adults aged 20 years old and older. While type 1 diabetes is typically diagnosed during childhood or adolescence (it was once referred to as juvenile diabetes), a diagnosis can come at any age 

Living with type 1 diabetes is a lifelong journey, and insulin therapy and blood glucose monitoring will remain constant. Some aspects of diabetes management, though, apply only to certain age groups, like coordinating with school staff about a child’s type 1 diabetes care plan or prioritizing heart disease prevention as you get older (more about that later).

Below, we’ve highlighted  things to be mindful of with type 1 diabetes treatment for various age groups. This is intended to be a high-level guide to living with type 1 diabetes at any age, and your diabetes care team (or your child’s) will help you develop an individualized treatment plan with recommendations for insulin dosage, blood sugar targets, and blood sugar monitoring frequency.

Type 1 diabetes and children: blood sugar monitoring at school

Individuals with type 1 diabetes are unable to produce any insulin, a hormone produced in the pancreas which helps convert sugar, or glucose, into energy. Getting started with insulin therapy is one of the first steps after a type 1 diagnosis, and is an important part of living with type 1 diabetes at any age. Daily insulin therapy, along with blood sugar monitoring and meal planning, allows people with type 1 diabetes to maintain healthy and consistent blood sugar levels.

While the goal of insulin therapy is to keep your blood sugar levels as steady as possible throughout the day, fluctuations are natural. Checking blood sugar levels several times each day allows you to stay within a healthy range. Younger children with type 1 diabetes will need help with both insulin administration and blood sugar monitoring, and during the school day you may need teachers and other school staff to provide support. It’s also important that someone at the school understands how to administer glucagon if your child’s blood sugar falls too low (known as hypoglycemia).

Here are some steps you can take to simplify your child’s treatment needs and make sure you’re prepared for an emergency.

Communicate with your child’s teacher and/or other school staff before classes begin to make sure they’re aware of your child’s type 1 diabetes diagnosis. 

Discuss daily treatment needs like blood sugar monitoring and insulin therapy as well as potential complications that may arise, like low blood sugar, and how to spot the signs and symptoms.

You may also want to consider an insulin pump. They have become increasingly common in diabetes treatment, especially with children, due to their convenience, ease of use, and automated timing of insulin injections 

The American Diabetes Association has resources that you can share with school staff to help them understand how to support your child’s diabetes care plan. And the JDRF has a back to school checklist, which includes all the information your child’s teachers should know.

Read our previous blog to learn more about managing your child’s type 1 diabetes.

Teens and young adults: managing diabetes away from home

Learning how to navigate life with greater independence and less structure as you enter your late teens and twenties often takes on additional importance if you have type 1 diabetes. You may now be responsible for aspects of your own diabetes treatment that parents or other adults previously helped with.

For many young adults living with type 1 diabetes, this transitional period requires learning about the logistical aspects of diabetes care, like filling prescriptions, ordering supplies, and scheduling appointments. And whether you’re living far from home or nearby, it may be time to find a new doctor, as many young adults switch from seeing a pediatrician to an adult healthcare provider around the ages of 18 - 21.

To avoid any gaps in your diabetes treatment, plan ahead and work with your pediatrician and your support system, including your parents or other relatives, to create a plan for finding an adult healthcare provider. Make sure that you also have the information you need to stay on track with your diabetes management, like how to navigate health insurance, or how to use diabetes supplies like a continuous glucose monitoring device (CGM)  or insulin pump. 

It’s understandable if other challenges related to your diabetes care needs arise for the first time during this stage of life. For many young adults, there’s a learning curve with handling other illnesses when you’re away from home. For example, the flu can become more complicated if you have diabetes, since it may affect your calorie intake, which in turn may affect your blood sugar levels. Once you’ve found a primary care provider, ask them about additional steps to take when you’re sick, like checking your blood sugar levels more frequently or consuming carbohydrate-rich soft food and liquids .

It’s also important to understand how alcohol use can interact with insulin therapy and affect your blood sugar levels. Ask your doctor for recommendations about drinking safely when living with type 1 diabetes, and be honest with them about your alcohol consumption so that they can best address your individual health needs.

You may also benefit from working with a certified diabetes educator during the transition from your teens to adulthood. A diabetes educator is a healthcare professional with extensive knowledge of diabetes who has been certified to coach individuals living with the condition. They can make sure you have all the necessary information to successfully manage your diabetes.

Maintaining a balanced life with type 1 diabetes

It may feel like life has only gotten faster during your late twenties and into your thirties and forties. However, staying on track with your diabetes management is as important as ever — and for some individuals, you may be first learning of your type 1 diabetes diagnosis during this busy time.

A common challenge of living with type 1 diabetes in adulthood is fitting daily treatment needs into a busy schedule. If you work long days in a physical setting, it may feel inconvenient to take insulin and check your blood sugar while on the job. You may find that an insulin pump is a good option for you since you won’t have to worry about remembering the timing of your injections.

Ultimately, deciding how much of your health situation to share with an employer is a personal choice, but at least one person should be prepared to offer support in the event of an emergency if you work on site. Make sure they know the signs of low blood sugar, how to administer emergency glucagon, and where you keep your supplies.

If you are a woman living with type 1 diabetes and considering starting a family, sharing your family planning goals with your primary care physician can help you have a healthy pregnancy. Your A1C levels — your average blood sugar levels over a period of two to three months, which your doctor will check periodically during your regular visits — are even more important in the months before pregnancy. This is because your blood sugar levels can impact the development of your baby’s organs during the first 8 to 12 weeks of your pregnancy.

Ask your doctor to clarify your A1C goals and how long to maintain them before pregnancy. And once you find out you are pregnant, contact your healthcare provider as soon as possible to find out if you need to make any changes to your treatment.

Your risk for many conditions like heart disease, high blood pressure, high cholesterol, and dementia all increase as you age. When living with type 1 diabetes, preventative care and healthy lifestyle choices are even more important, as many aging-related health risks intersect with potential diabetes-related complications.

Men and women living with type 1 diabetes have a higher risk of developing heart disease than those without the condition. High blood pressure is common in older adults with diabetes, which can lead to a greater risk for strokes and heart attacks and may also affect your vision and kidney function.

It’s important to keep track of your blood pressure and cholesterol levels and follow your doctor’s recommendations for treatment, which may include lifestyle changes and medications. And depending on your overall health, you may need a loved one’s support with managing certain aspects of your diabetes care, like administering insulin and recording blood sugar readings.

Living with diabetes at any age is easier with a reliable pharmacy partner. At Alto, we’re committed to making it as simple as possible to manage your diabetes, with free same-day delivery and medication management tools like reminders and auto refills in our app. And our dedicated diabetes support team is here to ensure that you have all the information you need to follow through on your individualized treatment plan.

Reach out any time via text or phone at 1-800-874-5881, or in-app messaging.

We’re excited to welcome Christopher Tidball to the Alto team as Director of Product Management, Supply Chain & Fulfillment. Learn more about his passions both in and outside of work and what drew him to Alto.

Introducing Christopher Tidball, Director of Product Management - Supply Chain & Fulfillment

We’re excited to welcome Christopher Tidball to the Alto team as Director of Product Management, Supply Chain & Fulfillment. Most recently, Christopher led a large team of product managers, engineers and program managers at Amazon to power the company’s most complex fulfillment operations. 

As Alto continues to expand our geographic footprint and customer base, Christopher’s nearly 20 years of industry experience will support us in scaling our systems, so that we can continue to deliver the same high standards of care and service to even more communities.

We recently sat down with Christopher to learn more about his passions both in and outside of work, what drew him to Alto, and the operational opportunities he’s most excited about. 

Welcome to Alto! What inspired you to join the team?

Before a recruiter ever reached out to me about a role at Alto, my wife and I were very satisfied customers. We had been on a long journey of trying to start a family, and that ultimately led us to a fertility clinic that recommended Alto. We had a great experience from day one: the app was easy to use, the same-day deliveries from couriers were always on time, and Alto’s pharmacists walked us through the various medications in our delivery and answered all of our questions. 

Alto’s focus on the customer experience was immediately clear, and I made a mental note that this was the type of company I’d like to work for. Fast forward a few months later, a recruiter reached out and introduced me to the leadership team whose passion and experience sold me on leaving Amazon to come here.

As the Director of Product Management - Supply Chain and Fulfillment, I'll focus on the technology investments that can help us continue to grow and offer exceptional service to our customers. “Supply chain” covers a lot of ground: procurement, inventory, pharmacy operations, delivery, and more. There are tons of opportunities to automate processes to make it easier for Altoids to run the business, especially as we grow and expand. 

What areas of the business are you most excited about?

The operations side has always been exciting to me—it's where the magic happens. At the end of the day, if we don't have sustainable, efficient ways to fulfill the promises we make to our customers, we won't survive. 

Alto has a great business model, and many happy customers to show for it, but there’s always room to continue to innovate and improve the delivery experience. It's one of the few in-person interactions we have with the customer and we want to make it exceptional.

Tell us about life outside of Alto. Are you doing anything interesting at the moment?

I'm a pilot in training — I'm about 75% of the way to getting my single-engine license. I live in Seattle so the aerial views of the city, Puget Sound, and the Cascade Mountains are absolutely breathtaking. Flying gives you a sense of freedom that reminds me of when I first got my driver's license.

You can find more information about Christopher or connect with him directly on LinkedIn. If you have any questions about Alto, or are interested in joining our team, please visit alto.com/careers.

Infertility is often thought of as exclusively a women’s health issue, but the truth is that it can affect anyone regardless of gender. We explain more including male infertility causes, symptoms, and treatment options.

Male Infertility: Causes, Symptoms, and Treatment

Infertility is often thought of as exclusively a women’s health issue, but the truth is that it can affect anyone regardless of gender. About one-third of infertility cases include factors related to male reproductive function.

If you’ve experienced infertility, you’re not alone: about 9% of men and about 11% of women in the U.S. have experienced fertility challenges. And while these challenges may feel overwhelming, they do not necessarily mean that you won’t be able to start a family one day — there are a variety of fertility treatment options for both men and women to support your family building journey.

Below, we explain more about male infertility, including causes, symptoms, and treatment options that can help you build or add to your family.

Male infertility most often stems from issues with sperm production. In some cases, it may be a problem with the quality of your sperm, like how fast or how well your sperm move. In other instances, it’s a matter of sperm quantity: you may not be able to produce any sperm, or you may have a low sperm count (the threshold is typically a sperm count under 15 million sperm per milliliter of semen.)

Sperm production problems may also occur as the result of other health conditions, including hormone, pituitary gland, or immune system problems or genetic conditions like cystic fibrosis, a progressive disease that makes it difficult to breathe, and hemochromatosis, a condition in which you have an excess of iron in your system.

Lifestyle and environmental factors can also play a role: heavy smoking (20 or more cigarettes per day), consistent heavy drinking or binge drinking (for men, five or more drinks in a two-hour timeframe), drug use, and exposure to toxins like endocrine disruptors contained in plastics and pesticides have been linked to male infertility.

Beyond issues with sperm production, anything that blocks a reproductive organ can interfere with the flow of semen, including inflammation from a sexually transmitted infection, scar tissue from surgery, or swollen veins in any of your reproductive organs. Additional factors in male infertility include erectile dysfunction, premature ejaculation, liver or kidney disease, and treatment for seizure disorders.

You may have a greater chance of experiencing fertility issues if you have had any of the following:

Inflammation of your prostate or genital infections

Certain prescription medications may also increase your risk of infertility, including:

5-alpha-reductase inhibitors, a medication class used to treat prostate enlargement and hair loss, which includes finasteride (Propecia®) and dutasteride (Avodart®)

Alpha blockers like silodosin (Rapaflo®), tamsulosin (Flomax®), alfuzosin (Uroxatral®), terazosin (Hytrin®), doxazosin (Cardura®), which are used to treat prostate enlargement

Some selective serotonin reuptake inhibitors (SSRIs) used to treat depression and anxiety, including sertraline (Zoloft®) and paroxetine (Paxil®)

Spironolactone, which may be used to treat high blood pressure or acne

Cimetidine, which is used to treat acid reflux and Gastroesophageal reflux disease (GERD) 

If you and your partner are unable to conceive after trying for at least a year, one or both of you may be experiencing infertility. If you have experienced any of the following symptoms, you may wish to consult with your doctor about a potential diagnosis of male infertility:

Problems with ejaculation, including delayed ejaculation

If you have previously had surgery in your genital area, you should also consult with a doctor about potential infertility issues.

To evaluate you for an infertility diagnosis, your doctor will first ask questions about your medical history, including your sexual history and any other factors that may affect your reproductive health and fertility. They may also do a physical exam to check your genitals for any abnormalities.

The next step is typically a semen test, sometimes called a sperm count. Your doctor will ask you for a sample of semen. During their evaluation, they will look at how many sperm you produce and whether the sperm are normal in shape and movement — healthy sperm have an oval head and long tail.

Your doctor may recommend additional tests, including blood tests to evaluate your hormone levels and to rule out other health conditions and genital ultrasounds to identify potential reproductive health issues.

Thanks to the medical community’s advances in fertility treatment and technology, infertility issues do not mean that you won’t be able to build a family. There are a range of treatment options that can help increase your chances of conception. Your doctor will make recommendations for the best course of treatment based on the underlying cause of your fertility issues.

In some cases, hormone imbalances or problems with how your body uses hormones may impact your sperm production. If that’s the case, your doctor may recommend hormone treatments or medications such as gonadotropin therapy or antibiotics to increase the number of sperm in your semen.

Gonadotropin therapy may be used to treat both male and female infertility and is typically administered via injections. Common side effects of gonadotropin therapy for men may include pain, redness, and swelling at the injection site, stomach pain, nausea, and vomiting. In some cases, it may lead to the enlargement of male breast tissue.

Since lifestyle habits like heavy smoking or alcohol use can affect sperm production, you may be able to increase your sperm count with healthy choices like exercising regularly and abstaining from cigarettes, alcohol, and drugs.

There are several fertility treatment options that can increase your chances of conceiving a child, including in vitro fertilization (IVF) using a technique called intracytoplasmic sperm injection (ICSI) and different forms of artificial insemination like intrauterine insemination (IUI).

In intracytoplasmic sperm injection (ICSI) a single sperm can be injected directly into an egg. This procedure is often incorporated into an IVF cycle for many couples affected by male infertility. IVF is a process in which eggs and sperm are fertilized in a laboratory and then placed into the uterus with the potential outcome of a pregnancy. Women trying to conceive may undergo IVF treatment if their partner is experiencing male infertility to increase their chances of conceiving. ICSI can be the fertilization method used in IVF.

In IUI, sperm that have been washed and concentrated are placed directly into your partner’s uterus around the time that they are ovulating, helping your sperm reach an egg more easily.

A fertility pharmacy partner you can rely on

At Alto, we understand that there are many paths to parenthood, and that each individual or couple’s needs are different. Our team of pharmacists is experienced in male infertility treatment options, and we’ll be here at every step of the way if fertility medications become part of your plan. 

The Next Evolution of Our Company Values

A lot has changed at Alto since Matt and I first set out to transform the pharmacy experience back in 2015. (For one thing, we no longer work out of a storage closet.) In the past two years alone, we’ve quadrupled our team to more than 1,000 Altoids and opened new locations in Denver, Las Vegas, Seattle, New York City, Houston, Dallas, San Jose and San Diego.

Our mission — improving the quality of life for everyone who needs medicine — will never change, but a team of 1,000 needs a different recipe for success than one of 100. And as our team continues to grow, along with our geographic footprint, we’ve revisited our core values so that we can move forward with intention and clarity during this next phase of Alto’s journey.

Here are the values that guide our work today.

This was at the top of our founding values, and it’s still here. In fact, our resolve to put patients first has only gotten stronger — not because it’s what is best for the business, but because it is our only reason for being in business. Each member of our team strives to build a world where healthcare companies truly prioritize the needs of their patients, and we’ll do everything in our power to make that a reality.

My personal favorite of all our new values, dancing in the storm is about embracing the bumps in the road — and there are many when you’re taking on challenges within healthcare — and recognizing that you can always choose joy. We strive to help our teammates do the same by infusing a little bit of levity and laughter into the workday. It only takes one person to start a dance party!

Humility is not thinking less of yourself, but thinking of yourself less. Nor is it the absence of strong opinions, but the willingness to learn and change our minds. Sometimes our ego takes over — that’s only human. But we try to be mindful of it, and willing to let go of our ego and instead put our mission, customers, and teammates ahead of ourselves.

We view ourselves as creators of our circumstances, responsible for our actions and our own well-being. When we don’t like an outcome, we don’t project blame onto others or ourselves, but rather take radical responsibility for how we created the situation. More than any other value, this is an opportunity for deep internal reflection, and by practicing it consistently, we can maximize our own individual growth.

We say what is true for us in the moment, even when it is uncomfortable. We support our teammates to do the same by recognizing the validity of their experience and not taking it personally. Leading with candor isn’t always easy, but it feels much better to live authentically and honestly and to work with others who do as well. Candor doesn't have to be angry or hurtful - it can be kind and binding, compassionate and respectful.

Blog

What to Know About the Heart and Gut Health Connection

How to Manage and Prevent a COPD Flare-Up

Celebrating American Pharmacist Month At Alto

Celebrating National Coming Out Day at Alto

How to Live with Type 1 Diabetes at Any Age

Introducing Christopher Tidball, Director of Product Management - Supply Chain & Fulfillment

Male Infertility: Causes, Symptoms, and Treatment

The Next Evolution of Our Company Values

What Does a Diabetes Educator Do and How Can They Help You?

The Role of Insulin Pumps in Diabetes Treatment

National Gay Men's HIV/AIDS Awareness Day

Medications Commonly Used to Treat Arrhythmias

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