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Here are seven unconventional ways to support your heart that have sparked the interest of leading health experts. 

7 Unusual Heart Health Risk Factors

What Science is Revealing About Heart Health

Researchers are working hard to curb the impact of heart disease, which is currently the leading cause of death in the United States. These efforts to develop new prevention strategies have led them to some surprising heart health hypotheses. You probably know that you should eat well and stay active, but these lesser-known risk factors may not be on your radar. Here are seven unconventional ways to support your heart that have sparked the interest of leading health experts. 

It turns out, brushing your teeth may have more benefits than just sparkly whites and fresh breath. Numerous studies have documented a link between poor dental health and heart disease. The verdict is still out as to why, but the prevailing theories point to inflammation. It could be that the bacteria which infect gums enter the bloodstream and cause blood vessel inflammation or that the body’s immune response is to blame. While more research is needed, it’s one more reason to brush your teeth for the recommended two minutes twice a day and get regular dental checkups. 

There have been some interesting studies exploring the connection between workplace stress and heart health. A decade-long study in Sweden found that having a bad boss increases your risk of a heart attack. Additional research has suggested that working long hours may increase your risk of cardiovascular disease and stroke. 

A key takeaway here is that stress, in general, isn’t great for your overall health. Stress causes your cortisol levels to spike, which can lead to high blood pressure, weight gain, sleep disruption, and reduced energy over time. Not to mention, your diet, exercise routine, and other healthy habits often suffer when you’re stressed out. Make sure to find ways to unwind at the end of your workday, whether that means listening to a relaxing soundtrack on your drive home or a brief meditation before you make dinner. Sometimes you can’t avoid challenging coworkers or chaotic days, but you can put strategies in place to help you feel calmer and more resilient. 

Not that you needed another reason to love your pets, but several studies have shown that pet ownership, especially having a dog, can improve heart health. According to Harvard Health, researchers have found that dog owners have lower blood pressure and cholesterol than non-owners, probably because dogs require daily walks and tend to have a calming effect on their humans. 

If you’re not a dog owner, we don’t advise adding pets to your life purely as a health strategy. Instead, you might consider stopping to meet some of your four-legged neighbors. A few studies have found that just petting a dog can lower your blood pressure. 

Sleep is the unsung hero of the health world. It allows your whole body to rest and replenish. Although your heart never stops beating, it does slow down and recover during sleep. According to John Hopkins Medicine, by depriving your heart of this crucial recovery time, lack of sleep increases your risk of heart attack and heart disease.

If you have trouble sleeping, creating a nightly ritual can help. Try to wind down at the same time every evening and create a calm, dark, and quiet environment in your bedroom. You should turn off your electronic devices at least thirty minutes before bedtime to help your body prepare for restful sleep. 

If you find yourself tossing and turning on the regular, it’s best to talk with your doctor. Various underlying and unsuspecting conditions could be causing your lack of sleep and there are many different therapies that can help.  

For more sleep-enhancing tips, read, “Too Stressed to Sleep? These Strategies Can Help.”

Bring on the oatmeal and scrambled eggs! When a panel of experts from the American Heart Association reviewed studies on eating habits and heart health, they formed an intriguing conclusion: breakfast-eaters tended to have lower instances of heart disease and were less likely to have high cholesterol and high blood pressure.

If you struggle to make time to eat in the morning, the American Heart Association suggests these breakfast hacks for some quick and easy meal ideas. Harvard Health recommends including whole grains in your morning meal to further reduce your risk for heart attack, stroke, and heart failure. They offer this menu of options full of whole grains, protein, and fruit. 

We all love a good movie marathon, but regularly sitting for hours at a stretch could be putting your heart at risk. And yes, that includes long workdays at the computer. 

The American Heart Association and the American College of Cardiology have both warned that regularly sitting for long periods is a significant contributor to heart disease. It’s not an issue of laziness—in a world full of deskjobs, car trips, and the all-important need to unwind, many of us struggle to find time to get the consistent movement our bodies need.

If you’re stuck sitting for long periods, the American Heart Association suggests finding ways to sneak movement into your day. You might try setting a timer and taking a five-minute stretch break every hour or using your lunch break to go for a walk. Every extra minute on your feet will help you get to the recommended 150 minutes of activity per week. Exercise also helps you reduce stress and sleep better, making it a true heart-health allstar. 

Several studies suggest an association between optimism and a lower risk of cardiovascular disease. A 2015 study found that those with a more positive outlook were more likely to make healthy lifestyle changes after a heart attack. And a researcher at the University of California, San Diego, found that patients with a greater sense of gratitude had lower levels of inflammation and better heart health overall.

Robert A. Emmons, Ph.D., a professor of psychology at the University of California, Davis, told the American Heart Association, “Clinical trials indicate that the practice of gratitude can have dramatic and lasting effects in a person’s life. It can lower blood pressure and improve immune function...grateful people engage in more exercise, have better dietary behaviors, are less likely to smoke and abuse alcohol and have higher rates of medication adherence.”

If optimism doesn’t always come easy to you, you’re not alone. Psychologists believe we have a natural tendency to fixate on negative information as a way to avoid it in the future. It’s a phenomenon known as “negativity bias.” Practicing gratitude is a powerful way to counteract this inclination. Best of all, it’s easy to get started. Your new habit can be as simple as writing down what you’re grateful for every day. 

When you look closely, these unconventional risk factors aren’t really that surprising. They each relate to foundational heart-healthy lifestyle choices such as managing stress, eating healthy foods, and staying active. This advice aligns with the CDC’s guidance, which outlines six essential strategies for living a heart-healthy lifestyle. 

If you’re concerned about your heart, the CDC recommends learning about your family’s health history and talking to your healthcare provider about your risk. Together you can create an action plan that’s best for you. If your doctor prescribes medication to treat high cholesterol, high blood pressure, or diabetes, the CDC stresses the importance of taking it as directed. 

Alto’s expert pharmacists will always be available via in-app message or phone to answer questions about dosage instructions or side effects, and we’d be happy to bring your medications to your doorstep for free. Your heart-healthy lifestyle does not have to include standing in line at the pharmacy or worrying about refills. We’ll take care of the details so you can focus on cooking a healthy breakfast or walking your dog. 

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.

We were honored to sit down with Dr. Hildreth to discuss the challenges and opportunities we are facing at this pivotal moment in history. In addition to recounting his inspiring personal story, he shared many profound insights about the COVID-19 pandemic and the state of American healthcare. 

The COVID-19 Vaccine & Racial Disparities in Healthcare: A Q&A with Dr. James Hildreth

In August, we announced that Dr. James Hildreth had joined our newly formed Advisory Board as one of its first two anchor members. Dr. Hildreth’s extensive healthcare expertise has been invaluable as we’ve sought to guide Alto into the future and continue reimagining the pharmacy experience. 

A Fascinating Chat with Dr. James Hildreth

Dr. Hildreth is the President and Chief Executive Officer of Meharry Medical College—one of the nation’s oldest and largest historically Black academic health sciences centers. He is internationally renowned for his decades of influential HIV research and is deeply entrenched in our current global health challenge as a member of the FDA’s COVID-19 Vaccine Review Committee.

Can you tell us about your background and professional journey?

I grew up in a small town in Arkansas. It was one of those towns where if the two traffic signals were synchronized, you could drive right through and not even notice it. My father passed away when I was eleven years old. Quite honestly, because we were poor and Black, my father received very little medical attention. That was what prompted me to become interested in medicine.

I had no role models to look to, so I went to the library and read books about medicine. At age thirteen, I read a series of books that ranked your chances of getting into various medical schools. One of the universities was head and shoulders above all the rest, so my life’s work became getting into Harvard University.

To make a long story short, I got scholarships to Harvard, Princeton, Brown, Yale, Stanford, and many other places. But because my research had shown that Harvard was the place to go, that’s where I went. I got a job at the medical school, and the professor who ran the lab was also from Arkansas. He took me under his wing, and suddenly I wanted to be an immunologist. 

It was too late to change my major, but I was hooked. I applied for and was awarded a Rhodes scholarship in 1978, becoming the first Rhodes scholar from Arkansas who was Black. I got my Ph.D. in Immunology then went to Johns Hopkins School of Medicine. 

I planned to become a transplant surgeon until I met my very first patient. She was an African American woman with HIV who had just given birth to a baby who also tested positive. At the time, all we could do was watch them die, and that impacted me deeply enough to change my trajectory. I became an HIV researcher, and I have been studying HIV for the last thirty-eight years. 

I have been President of Meharry Medical College for five years. I feel that my life has come full circle because Meharry’s mission is to give opportunities to individuals who otherwise wouldn’t have them. 

Can you tell us more about Meharry’s mission?

Meharry was founded in 1876, but the story is that in 1826, a young, white teenage boy named Samuel Meharry was driving his salt wagon in the backwoods of Tennessee. His wagon got stuck in the mud, so he knocked on the door of a nearby cabin. An African American family greeted him, gave him a place to stay for the night, and helped him on his way. He promised them that if he ever had any resources, he would do something for Black people. 

Sure enough, fifty years later, he and his four brothers made a gift to a central Tennessee college to start a medical department for African Americans. That department evolved into Meharry Medical College.

To be leading an organization whose purpose is to give opportunities to people who look like me makes me feel that my life has come full circle. Meharry is one of four Black medical schools in the country, and without us, the face of medicine in this country would look very different. We are very proud of our mission and I’m so happy to be leading the organization at this time. 

Given that you’re on the FDA’s Vaccine Review Committee for COVID-19, what is your perspective on how we’ve handled the pandemic to date?

It’s hard to avoid acknowledging how politics have devastated our response to this pandemic. Viruses don’t respect borders, especially when you’re dealing with a pandemic virus. We should have had a nationwide response from the very beginning. Ideally, the whole country should have shut down for several weeks. That would have saved tens of thousands of lives.

What are your thoughts on how the pandemic might unfold going forward?

In my opinion, we’re entering a frightening period because we’re at the base of an exponential rise in cases. It’s essential to understand that for every case we diagnose, there are probably four, if not eight, cases that go undiagnosed. Many people don’t know they have the virus and are spreading it. 

Our country represents four percent of the global population but twenty percent of the people who are dying. That’s unimaginable to me. When you’re dealing with an airborne pathogen that can be transmitted so easily, it is unacceptable and unethical not to have stronger leadership and mandates in place. 

Can you share any insights on potential vaccines and vaccine distribution?

I’m on the FDA committee that will review the data from the drug companies and make recommendations about approval. In a couple of weeks, we will review the Pfizer vaccine. I can tell you that the data from both Moderna and Pfizer are very compelling. Both vaccines appear to be highly effective.

Neither of these vaccines is what we’d call a “sterilizing vaccine,” They will not prevent a person from getting infected, but they will limit the amount of disease that occurs after infection. The other exciting aspect of these vaccines is that they represent a new type: messenger RNA vaccines. Rather than using a protein for the vaccine, we’re using a message that encodes for the protein. There was some doubt if this new type of vaccine would work in humans, but it does. This development will facilitate future vaccines quite nicely. 

By the spring of next year, there will likely be two vaccines approved for use. The question is: who will get those first forty million doses that become available? Healthcare workers will probably get them first, then people in nursing homes and assisted living facilities. Many experts, myself included, are trying to make the case that those most vulnerable to disease and death should be next in line. The CDC has already worked with the states to develop distribution plans, but they are not in line with that thinking. There are going to be a lot of intense discussions in the coming weeks. 

What are the healthcare topics that get you most excited—or keep you up at night—right now?

The pandemic has revealed something that minority healthcare professionals have known for a long time: there is a wide gap in the health status of Americans. If you are African American or Latinx and live in certain communities, you are much more likely to have certain chronic conditions. This increased risk is related to your zip code, educational attainment, where you work, and what your job might be, but running through all of this is an underlying current of racism. 

We can’t solve the problem until this country has a necessary conversation about the role of racism in every domain of American life. I like the way that Martin Luther King put it. He said that when you have centuries of neglect, suppression, oppression, or denial, there is an interest that accumulates. The answers to these problems are going to be much more expensive and time-consuming than if we had been dealing with them all along. 

No matter what industry we’re in, all of us need to have tough conversations about what race really means. Take, for example, the sequencing of human genomes. African genomes are the ancestral genomes—all of us can link our humanism back to Africa. But of all the hundreds and thousands of genomes that have been sequenced, very few of them come from folks who look like me. 

It’s the same as my experience in medical school in the 1980s. We learned to treat the average, middle-aged white male because that’s who the studies were centered on. The exclusion of certain groups from clinical trials, programs, and conversations has created a wide gap that we now have to close. We need to have every healthcare institution at the table trying to work on it.

On a positive note, as the pandemic reveals these disparities, many organizations are awakening to the fact that there is work to be done. I’m encouraged by what happened after we witnessed the senseless murder of George Floyd. It was a really painful time for me because that could have been me, my son, or my brother. It could have been any one of us. But the response that we witnessed wasn’t just from African Americans and liberals. It seemed to me that people of all different backgrounds and races came together to say that this is unacceptable. It gave me some hope that we can change this and become a better nation.

What opportunities do you see for Alto in the world of healthcare?

I think Alto has a great opportunity to improve people’s quality of life who need to take medications to improve their health status. Before she passed, my mother would complain about how difficult it was to get her prescription medications. The ability to simplify and improve the process for everyone will positively impact a significant population of people. 

I was humbled that you asked me to be in your advisory group. I’m excited about what you’re doing, and I think it’s going to make a big difference for many people. 

As we approach the holidays, I’d like to share something I’ve told my students. The last thing you want to do is create a situation where this is the last holiday you’ll spend with some of your older relatives. Please be mindful that there is a lot of the virus out there, wherever you are in the United States. Please take steps to protect yourselves and your families. Have a wonderful holiday, but if you can, make it virtual.

Note: This interview was conducted in early December 2020. 

Blood pressure is one critical way the heart maintains its happy, healthy medium. In this article we'll explore how to manage high blood pressure and what you can do to maintain healthy blood pressure.

The Lowdown on Healthy Blood Pressure

Blood is constantly flowing through every part of your body, propelled by the beating of your heart. Though this hardworking muscle is only about the size of your fist, it contracts sixty to eighty times per minute, sending oxygen-rich blood to the farthest reaches of your body and back. 

Like any finely-tuned machine, the heart requires balance to remain in optimal condition. If it doesn’t pump hard enough, its vital job doesn’t get done. But if it starts working too hard, it runs the risk of tiring and eventually giving out. Blood pressure is one critical way the heart maintains its happy, healthy medium.

Blood pressure is the force of the blood as it moves through the body. It’s important because we need blood to deliver the oxygen and nutrients that nourish our tissues along with antibodies and white blood cells for immunity. Blood pressure also helps us remove the waste products of our metabolism, like carbon dioxide and toxins from the liver and kidneys. 

The heart creates blood pressure with every contraction, but there are other forces at work as well. Blood keeps moving through the network of blood vessels in our bodies because of differences in pressure in our continuously narrowing arteries, veins, and capillaries. It’s similar to what occurs with multi-function showerheads. The amount of water flowing through your pipes remains the same, but a more narrow flow exerts more pressure while a widened spray feels more gentle.  

The initial, most substantial pressure comes from the heart, and the arteries’ structure helps maintain it as the blood continues to flow. 

A blood pressure reading measures two forces. Systolic pressure is the force that occurs as blood flows out of the heart and into the arteries. Diastolic pressure is the force created when the heart fills with blood as it rests between beats. 

These forces are measured using a sphygmomanometer, or what many of us know as the inflatable arm cuff that healthcare providers use during checkups. 

The cuff is inflated enough to stop the pulse, and a reading is taken. When the pulse returns, the cuff is allowed to deflate slowly, and another reading is taken. The numbers are expressed in terms of the pressure it takes to move mercury around a tube against gravity, a unit called millimeters of mercury (mm Hg). Your healthcare provider will give your reading as two figures—systolic pressure first and the diastolic pressure second—such as “140 over 80 mm Hg.” 

The National Institutes of Health advises that normal blood pressure for most adults is below 120 mm Hg systolic and 80 mm Hg diastolic. While both readings provide important information, “high blood pressure” typically refers to systolic pressure, the first number in your blood pressure reading. 

High blood pressure, also known as hypertension, is a condition that occurs when the force of the blood flowing through a person’s arteries is consistently above 130 over 80. The added pressure forces the heart to work harder and can stretch or injure the blood vessels. It also speeds the build-up of harmful plaque that can block blood flow, increasing blood pressure even further.

Over time, high blood pressure can lead to life-threatening issues like heart disease, heart attack, and stroke. It can also damage major organs such as your heart, brain, kidneys, and eyes. According to the CDC, high blood pressure usually has no early warning signs or symptoms. Getting your blood pressure checked regularly by your healthcare provider is the only way to determine whether your blood pressure is too high. 

It’s critical to detect high blood pressure early because it can be treated, usually through heart-healthy lifestyle changes with or without prescription blood pressure medications. Your healthcare provider can determine the right treatment plan for you. 

The American Heart Association encourages everyone to know their blood pressure numbers and adopt a more heart-healthy lifestyle. Impactful changes include eating a well-balanced diet that limits salt, staying physically active, taking steps to manage stress, reducing alcohol, and eliminating smoking. 

Even if you don’t have high blood pressure, eating less salt is one of the best choices you can make for your heart. Though sodium is essential for life, consuming too much salt pulls water into the bloodstream, increasing the volume of your blood. More blood flowing through your blood vessels exerts greater pressure on your heart. 	

The American Heart Association recommends that everyone limit their sodium intake to 1,500 mg/day. The biggest sodium culprits in the average American diet often don’t emerge from the salt shaker on the table. Processed or prepackaged foods like soups, cold cuts, bread, and frozen meals are major sources of excess salt because they often contain sodium-based preservatives and additives to enrich their flavor. It’s not always easy to determine by looking at their labels, however, there are several sodium-containing compounds to watch out for in the ingredient list, such as sodium benzoate, sodium tripolyphosphate, and monosodium glutamate (MSG). 

Start to make a habit of looking at labels while you grocery shop and choosing low-sodium options when possible. The American Heart Association created this sodium fact sheet to help you make heart-healthy choices. 

If your doctor determines that your blood pressure is too high, you’re certainly not alone. According to the CDC, nearly half of American adults have hypertension. If blood pressure medications become part of your treatment plan, we’d be happy to connect you with one of our pharmacists, who are specialists in heart medications. Plus, our free hand-delivery means you’ll never have to plan an extra trip to the pharmacy. With a few healthy lifestyle changes and the support of your doctor and pharmacy, your life doesn’t have to miss a beat. 

Your thyroid makes the hormones that regulate your metabolism. In this article we'll share tips for supporting your thyroid health as well as what to do when your thyroid is out of balance.

All About the Thyroid

The thyroid is a small butterfly-shaped gland located at the base of your throat. It’s part of the endocrine system—a series of glands that produce and regulate hormones. Hormones are chemical messengers that “tell” certain cells and organs what to do, influencing nearly all of the body’s functions. 

Your thyroid makes the hormones that regulate your metabolism: thyroxine (T4) and triiodothyronine (T3). Metabolism is the process by which your body converts food into energy,  facilitating vital functions such as blood circulation, breathing, and cell repair. Without the thyroid, the body could not break down protein, fats, and carbohydrates for fuel. 

The thyroid gland does not simply act on its own. It receives signals from the pituitary gland, the body’s “master gland,” which is located at the base of the brain and regulates vital body functions. The pea-sized pituitary gland sends its instructions through a hormone called thyroid-stimulating hormone (TSH). TSH levels rise and fall in the blood, telling the thyroid the exact amount of each hormone to secrete. Hormone levels within the body are a delicate balancing act, and several disorders can arise if the thyroid overproduces (hyperthyroidism) or underproduces (hypothyroidism) T4 and T3. 

With hyperthyroidism, the thyroid gland makes too many hormones, accelerating the body's metabolism, which can cause unintentional weight loss and a rapid or irregular heartbeat. According to the Mayo Clinic, other symptoms may include increased appetite, nervousness or anxiety, sweating, fatigue, and difficulty sleeping. Without treatment, hyperthyroidism can lead to serious complications, including heart conditions like congenital heart failure, eye problems, and osteoporosis. 

Hypothyroidism occurs when the thyroid isn’t making enough hormones, and symptoms may not be noticeable at first. Common symptoms of hypothyroidism may include increased sensitivity to cold, fatigue, constipation, weight gain, and dry skin. If left unchecked, the condition can eventually lead to obesity, joint pain, infertility, and heart disease.

Both conditions can be treated, often through the use of synthetic hormones or anti-thyroid medications. If you’re concerned about thyroid health, your healthcare provider can administer a blood test to check your thyroid hormone levels and recommend the appropriate treatment. 

Eating a nutritious, well-rounded diet is essential for thyroid health. Many vitamins and minerals support the thyroid, and iodine is chief among them. This trace mineral is an essential building block of thyroid hormones, but our bodies don’t produce it. Therefore, we need to consume iodine in foods such as iodized salt, seafood, seaweeds, egg yolks, dairy products, and lima beans.

It’s important not to go overboard, however. Consuming iodine in excess can negatively affect hormone levels in some individuals. Iodine deficiency is rare in the United States, so if you’re eating a varied diet, you’re likely within the range of the recommended 150 micrograms per day. 

Selenium is another critical mineral for thyroid function that can be found in brazil nuts, fish, meat, poultry, and fortified cereals and grains. Just like with iodine, selenium deficiency in the U.S. is rare, and it can be detrimental to go too far over the recommended 200 micrograms per day. 

Both the Mayo Clinic and Harvard Health recommend eating a variety of healthy foods rather than focusing too heavily on specific foods or supplements for thyroid health. If you have any concerns about your intake of essential nutrients, talk with your doctor about taking a multivitamin with minerals.

A Word of Caution about Thyroid Supplements

Your endocrine system maintains a very precise balance of hormone levels. For that reason, it’s not a good idea to experiment with your hormone health on your own. According to Cleveland Clinic endocrinologist Christian Nasr, MD, taking over-the-counter iodine supplements could result in getting more than the recommended daily value, which may leave you worse off than before. “The effect of iodine supplements can vary by person, causing the thyroid to produce either too much or too little hormone,” he cautioned.

Consumer Reports also issued a warning about thyroid supplements, reporting that many have been found to contain thyroid hormones derived from animal glands—and there’s often no indication on the labels. When researchers randomly tested ten “thyroid support” supplements, they found that nine contained “clinically relevant” levels of thyroid hormones, in some cases at levels that rivaled prescription thyroid medications. Researchers concluded that these supplements posed a “potential danger to public health.” 

Keep in mind that dietary supplements are not reviewed for safety or effectiveness by the FDA, so it’s best to talk with your healthcare provider before beginning a new over-the-counter supplement. Taking “thyroid support” supplements could alter your hormone levels in unpredictable ways and have undesirable health consequences. If you’re at all concerned about your thyroid health, consult your doctor so you can have your hormone levels tested and begin a prescribed treatment plan. 

A healthy thyroid contributes to feeling energized and ready to live life to the fullest. If your doctor determines that your hormone levels are out of balance, taking medication can restore your vitality. Once you develop a treatment plan, we’d be happy to take over the details of managing your medications. We’ll drop them off at your doorstep for free, and your prescription information will always be at your fingertips through our desktop and mobile apps. Plus, our pharmacists will only be a phone call, text message, or in-app chat away if you have questions about side effects or which foods to avoid eating around dosage time. 

Want to learn more about a better pharmacy experience with Alto? Our care team and endocrinology specialists are available to answer your questions from 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends; reach out by in-app secure messaging or phone.

Following prevention guidelines like mask-wearing, social distancing, and handwashing is still the surest way to stay safe. In addition, here are seven strategies to follow during the COVID-19 pandemic if you have asthma.

Seven Strategies for People with Asthma During COVID-19

As COVID-19 infection rates surge across the country, asthma is making its way into news headlines. Research published in the Journal of Allergy and Clinical Immunology at the end of November suggests that people with asthma may be at reduced risk of contracting the coronavirus. 

The researchers stressed that further study is needed, and possible explanations are still being explored. But the news may be welcome for people with asthma—a chronic lung condition that causes inflammation in the airways—who are facing an additional threat to their lungs from COVID-19, which primarily affects the respiratory system.  

This singular study is no reason to relax on preventative measures, however. The CDC has warned that those with moderate-to-severe asthma who do contract COVID-19 may be at a higher risk of serious complications, including asthma attacks, pneumonia, and acute respiratory distress.

Following prevention guidelines like mask-wearing, social distancing, and handwashing is still the surest way to stay safe. However, in addition to doubling down on these efforts, here are seven strategies to follow during the COVID-19 pandemic if you have asthma:

Right now, prevention is still our best defense against serious illness from COVID-19. Though rising infection rates may mean that restrictions will tighten in the short term, eventually, the gradual phases of reopening will begin again. Remember that most reopening guidelines center on those who are not at a higher risk of COVID-19 complications. Anyone who is considered high risk due to age or an underlying medical condition, including moderate-to-severe asthma, should continue to take extra precautions as reopening in their area unfolds and adhere to the CDC’s recommendations for their specific condition. 

The coronavirus can survive on some surfaces for hours or even days; however, surface transmission does not seem to pose nearly as significant a risk as person-to-person contact. Nevertheless, the CDC advises cleaning high-touch surfaces regularly. 

This recommendation can present an issue for people with asthma. Many chemical sprays used to clean indoor spaces can trigger an asthma attack—a sudden onset of inflammation in the airways that can cause difficulty breathing, coughing, wheezing, and chest tightness.  

If possible, ask someone else in your household to disinfect surfaces and objects for you. If you need to take care of it yourself, be sure to choose disinfectants that are less likely to trigger an asthma attack. The Environmental Working Group (EWG) provides recommendations for green cleaning products and includes asthma safety ratings. 

When using cleaners or disinfectants inside, open as many doors and windows as possible. Use only the amount of product recommended on the label and follow the instructions carefully. It can also help to use wipes or a dampened towel rather than a spray to avoid inhaling aerosols while cleaning. 

The CDC recommends keeping an emergency supply (30 days’ worth) of your asthma medications on hand so you don’t risk running out if you need to quarantine, become sick, or otherwise can’t make it to the pharmacy. 

If you fill your prescription with Alto, we want to assure you that we are fully prepared to deliver your asthma medications throughout the COVID-19 pandemic. We offer free, contactless drop-offs with every single prescription, so you’ll receive your refills on time from the comfort and safety of home. 

There has been misleading information circulating online about inhaled corticosteroids (i.e. Flovent, Qvar, Pulmicort, and Asmanex)—a standard asthma treatment—possibly increasing the risk of contracting COVID-19. At the same time, other articles suggest ICS as a potential treatment for COVID-19. 

Experts are clear: there is not enough evidence to prove these assertions, and discontinuing treatment or misusing medications poses a real danger to people with asthma. If you have any concerns about your medications, continue to use them as prescribed, and reach out to your healthcare provider. Alto’s pharmacists are also on call to answer your questions by phone or in-app secure messaging.

The symptoms of an asthma attack (wheezing, shortness of breath, chest tightness, and coughing) bear some similarities to the emergency warning signs of COVID-19 (trouble breathing, pain or pressure in the chest, confusion, and bluish lips or face)

If you’re experiencing asthma symptoms that do not respond to your treatment plan or symptoms that could indicate COVID-19 infection, seek immediate medical attention. For more information on the common symptoms of COVID-19 and other seasonal respiratory illnesses, read “Cold, Flu, or COVID-19? Your Seasonal Symptom Guide.” 

Find Ways to Cope with Stress and Anxiety

We are living in undoubtedly stressful times. Stress and strong emotions can be asthma triggers, so it’s essential to find ways to cope with anxiety during the pandemic and beyond. 

It’s impossible to avoid stress altogether, so don’t fall into a pattern of stressing about your stress. It’s much more helpful to regularly check-in with your emotional state and take steps to course-correct when you begin to become overwhelmed. 

Meditation, movement, healthy sleep habits, and social connection are effective ways to become more resilient during stressful situations. You might also consider practicing mindful breathing or another relaxation technique that you can use to calm your body and mind during a stressful situation. Your chosen method can be as simple as gradually lengthening and deepening your breathing or mentally telling each part of your body to relax. 

Leaning on the support of friends and family can help reduce stress and provide a sense of safety. However, if stress and anxiety become difficult to manage, don’t hesitate to reach out for professional help. The CDC offers this list of resources for finding a counselor in your area. 

When it comes to medical advice, rely on your healthcare provider, not the internet. Our understanding of how the coronavirus works is changing every day, so falling down a rabbit hole of outdated information could cause unnecessary anxiety. Stick to reputable, timely sources like the CDC, and always consult your doctor if you have any concerns.

Our team of patient care pharmacists at Alto is also available to chat if questions come up. We’ll make sure that you’re always able to access the medications you need throughout COVID-19—with free home delivery. Reach out any time via in-app messaging or phone at 1-800-874-5881.

Lesbian, gay, bisexual, transgender, and queer parents-to-be have many options to become parents today. In this blog post we'll share an overview of the options as well as how Alto can help you in the path to parenting.

A Guide to LGBTQ+ Family Building

Assisted reproductive technology (ART) has expanded the paths to parenthood for all types of family structures. Whether exploring fertility as a single person, within a couple, or as a family unit, parenthood is now possible for more people than ever before.

A 2018 study found that 48% of LGBTQ+ millennials (aged 18-35) were actively planning to grow their families, compared to 55% of non-LGBTQ+ millennials. Researchers noted that this gap had narrowed significantly compared to older generations—the result of advances in technology and the movement for equality. 

Still, LGBTQ+ families confront unique challenges in an industry that often fails to center their needs. However, as more and more LGBTQ+ people seek to become parents through ART, the face of fertility is shifting. 

Lesbian, gay, bisexual, transgender, and queer parents-to-be have many options to become parents today, including using a donor or surrogate for one or more components of biological conception (eggs, sperm, and uterus).

That being said, many options come with formidable costs so determining how to pay for treatment is an important part of planning. Family Equality Council shares this list of family-building grants that can help make ART more affordable. Your clinic may also offer financial assistance programs and payment plans. If prescription fertility medications are part of your treatment, we’ll comb through the available discount and rebate programs to ensure you get the lowest possible price. 

To clarify which of the many paths-to-parenthood might be right for you, it can help to seek out an organization such as Family Equality Council that can provide specialized advice for LGBTQ+ families. It’s also essential to choose a clinic and doctor who can understand your needs and put you at ease. 

For LGBTQ+ couples exploring using a donor, it’s also essential to research the laws in your state regarding legal parentage procedures after your baby is born. For a starting point, you can learn about the laws in your area through Movement Advancement Project’s interactive ART law map; however, you should also speak with an experienced LGBTQ+ family lawyer in your state. 

Every budding family follows a unique path. It may include natural conception, adoption, foster care, or ART. For those considering the latter, here are some of the places your ART journey might take you. 

For those whose bodies cannot produce sperm or are experiencing infertility, a donor can be used. There are two ways to obtain donor sperm: from someone you know or from a sperm bank.

If you use a known donor—often a friend, family member, or other acquaintance—it’s crucial that you fully discuss the relational complexities involved and consult with a lawyer who specializes in working with LGBTQ+ families in your state. When choosing an unknown donor through a sperm bank, the donation’s legalities are less complex because the donor has already surrendered their parental rights. 

If you or your partner plan to carry the pregnancy, donor insemination is the process of placing the donated sperm inside the vagina or uterus to facilitate fertilization. There are two methods of insemination that may be used: 

Intrauterine insemination (IUI) is a simple medical procedure performed by a medical doctor where the sperm is placed directly into the uterus by using a very small tube passed up through the cervix.

With intravaginal insemination (IVI), the sperm is placed directly into the vagina. You can often perform IVI at home; however, many people choose to have a medical professional complete the insemination to increase the chances of success. 

Parents-to-be who were not born with ovaries or are experiencing infertility can use an egg donor. Like with sperm donors, an egg donor can be a known donor or be found through an agency. Again, when using a known donor, be sure to thoroughly discuss the arrangement’s details and consult with a lawyer who specializes in working with LGBTQ+ families in your state.

With both known and unknown egg donors, the egg must be fertilized in a lab and placed in a uterus through a medical procedure known as in vitro fertilization (IVF). 

Intended parents who cannot or will not be carrying the pregnancy for any reason can use a gestational carrier. The gestational carrier will have the embryos (eggs fertilized by sperm) transferred into their uterus, then carry and deliver the baby.

Choosing a gestational carrier is a critical decision that can take time. After all, your relationship will last the better part of a year. An agency can help you meet and screen candidates until you find the right match. 

IVF  is one of the most common fertility treatments. It involves combining an egg and sperm in a laboratory dish then transferring the resulting embryo into a uterus. IVF can be performed with donor sperm, donor eggs, or donor embryos. 

Reciprocal IVF, also known as co-maternity, is a specific instance of IVF where one partner provides the egg and the other carries the pregnancy. In this way, one partner is genetically related to the child while the other becomes biologically bonded through pregnancy. 

Egg or sperm freezing, also known as cryopreservation, is available to preserve future fertility for those looking to delay pregnancy or undergo gender affirmation treatment. Because gender affirmation treatment may affect fertility, it’s important to discuss the possibility of freezing your sperm or eggs with your doctor before undergoing treatment if you may want children who share your DNA in the future. For those currently undergoing Hormone Replacement Therapy (HRT), there may still be options available to preserve your fertility. Talk with your doctor about which choices may be right for you. 

There are many routes available to expand your family. Ultimately, every journey has the same destination in mind: the beautifully chaotic, utterly unique, yet completely universal journey of parenthood.

As you assemble a team you trust to guide your path forward, we’ll be here to support you if prescription medications become part of your plan. Our team of specialists has experience working with the LGBTQ+ community and receives training on how the nuances of the fertility experience may vary for each individual. We’d be happy to manage your medication needs so you can focus on your family during this life-changing time. Visit us at alto.com/fertility to learn more. 

Our team is available to answer your questions from 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends; reach out by in-app secure messaging or phone.

In this article, we’re going to focus on the where, why, and how of storing your insulin medication safely.

Taking Care of Your Insulin

For those living with type 1 diabetes and for many with type 2, taking insulin is a part of daily life. That’s because people with diabetes either do not produce insulin on their own or their bodies cannot use it effectively. For more on the role insulin plays in the body and essential facts about how it’s used as medication, we recommend reading, “Understanding Insulin: The Basics.” In this article, we’re going to focus on the where, why, and how of storing your insulin medication safely.

Insulin is one medication you can’t just toss into your medicine cabinet. That’s because insulin is a protein dissolved in water. Like any protein, your insulin can spoil if it isn’t kept cool. However, unlike the mystery food container at the back of your fridge, spoiled insulin won’t make you sick. The danger is that your medication may be rendered ineffective, causing your blood glucose levels to climb higher than you expect. 

For that reason, most of the storage guidelines detailed below revolve around temperature and expiration date. The bottom line: treat your insulin more like a perishable food item than your run-of-the-mill medicine stash. 

You should always store new or unopened insulin in the refrigerator (at a temperature between 36°F and 46°F). Take a peek at the expiration date listed on your medication and place it in your refrigerator as soon as you can. It’s important to discard your insulin once it reaches its expiration date, even if it is unopened.  

To ensure your insulin is not subject to temperature fluctuations in the refrigerator, getting a temperature sensor may be a good idea. Also, try to store your insulin on the center shelf—the area most consistent with the thermostat setting—rather than on the top shelf or door compartments.

Whenever you receive a new type of insulin, review the instructions for your specific prescription with your pharmacist. If you fill your prescription with Alto, you can check your medication’s details and instructions at any time in the Alto app or your online account. Plus, our care team is always an in-app chat or call away.

Since injecting cold insulin can be uncomfortable, it’s okay to keep the open vial, cartridge, or pen you are currently using at room temperature (between 56°F and 80°F) for about a month. 

In general, you will need to discard your insulin 28 days after opening it, but be sure to check the information provided with your specific medication or reach out to your pharmacist to confirm. Label your vial, cartridge, or pen with the date you first open it so you’ll have no problem remembering when it’s time to throw it away. 

Always check both the original expiration date listed on your medication and the date of opening before every use. Do not use expired insulin. You should also inspect your insulin before every use, looking for any changes in color or clarity as well as any crystals or clumps. If you notice changes or have any doubts, use a new vial, cartridge, or pen. 

While you’re on the move, it’s still essential to keep your insulin from getting too hot or too cold. You want your insulin to remain between 36°F and  80°F. Keep in mind, even if the temperature outside isn’t extreme, your insulin can quickly heat up if left in a parked car or intense sun.  

If your insulin has been frozen or exposed to extreme heat, you should not use it—even if it has cooled back down or thawed. There’s a high probability that your insulin will be ineffective, and a blood sugar spike could catch you off guard. 

Carry your insulin with you in an insulated bag (remember—treat it like perishable food) and keep all your medication supplies in your carry-on if you’re traveling by plane, train, or bus. It’s always a good idea to make sure your prescription label is visible, especially if you’ll be going through airport security.

No one wants to stand in line at the pharmacy month after month. But insulin’s temperature sensitivity doesn’t lend itself well to being shipped through the mail—you don’t want it spending hours sitting on your doorstep or the back of a mail truck.

When you choose Alto for your prescriptions, we’ll deliver your insulin by hand using temperature-controlled packaging. You can choose a delivery window when you know you’ll be available to receive your package and place it in the refrigerator right away. We’ll monitor your medication’s temperature as it makes its way to you, and you can track our progress the whole way. Best of all, our delivery service is completely free. 

We’re here to make managing your insulin prescription easy. Our team is available to answer your questions from 9 am – 12 midnight ET Monday – Friday, and 10 am – 9 pm ET on weekends; reach out by in-app secure messaging or phone.

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

In honor of National Diabetes Month, here are seven ways we can take action together to spread the word about diabetes prevention.

Take Action in Honor of National Diabetes Month

November is National Diabetes Month — a time to raise awareness about the increasingly widespread diabetes epidemic in the U.S. It’s also a chance to come together and take action, not just for the one in ten Americans who have diabetes, but for the more than 88 million adults — 1 in 3 — who are at high risk of developing type 2 diabetes due to high blood sugar levels (a condition known as prediabetes).

More than 84% of all those living with prediabetes don’t know that they have it, partially because there often aren’t any noticeable symptoms. And while people ages 45 and older are most at risk of developing prediabetes, the condition has become more prevalent in young people in recent years, as childhood obesity — a condition linked to diabetes — remains an urgent health issue in the U.S.

The good news is that simple lifestyle changes can prevent prediabetes from progressing into type 2 diabetes, and possibly even reverse prediabetes. So this November, join us in honoring National Diabetes Month by taking small steps to prioritize your health and raise awareness of diabetes prevention. You can start with the seven actions below.

Both type 1 and type 2 diabetes — the two main types of diabetes —  involve complications with the body’s relationship to insulin, a hormone that transforms a simple sugar called glucose into energy. However, there are some important distinctions between the two conditions.

Type 1 is an autoimmune disease in which the body mistakenly destroys the pancreas’s insulin-producing cells. It often begins during childhood or adolescence, though a diagnosis may occur at any age.

In contrast, type 2 diabetes — the type of diabetes that people with prediabetes are at risk of developing — progresses gradually over time due to a mixture of genetic, lifestyle, and environmental factors.

National Diabetes Month is an opportunity to educate yourself and others about the different types of diabetes. As a starting point, read our blog post, ‘What’s the Difference between Type 1 and Type 2 Diabetes?’

(There is also a third type of diabetes — gestational diabetes — diagnosed during pregnancy, which you can learn more about here.)

Don’t be afraid to learn about your risk for prediabetes — knowing where you stand will allow you to take control of your health. The CDC-led National Diabetes Prevention Program offers a free risk test and other helpful resources at doihaveprediabetes.org. If you determine that you’re at risk, talk to your doctor so you can assess your risk level and develop a prevention strategy together. 

Consider sharing this tool with your loved ones or even via your social media channels, too — raising awareness is the best way to turn the tide on diabetes. 

Broader healthcare inequities drive racial and economic disparities in prediabetes and diabetes, which disproportionately impact individuals from underserved communities. According to the American Diabetes Association (ADA), Black Americans are 60% more likely to receive a diabetes diagnosis.

If you feel inspired to make waves for change, contact your government representatives to advocate for affordable and accessible healthcare for everyone. The ADA has created this online resource to help you reach out to lawmakers in your area and ask them to support legislation designed to end health disparities, from expanding health insurance coverage to making insulin more affordable. You can also sign up as an ADA Advocate to stay informed about issues affecting people with diabetes. 

If you or someone you know has type 1 diabetes, you might also consider signing up to become an advocate for JDRF,a nonprofit that funds research and advocates for policies to help people with type 1 diabetes (T1D). According to JDRF, “Advocates use the most powerful tools they have — their own personal stories — to communicate the financial, medical, and emotional costs of T1D to our nation's leaders.” 

From enlightening talks to a live cooking class, the ADA is hosting some amazing virtual events throughout National Diabetes Month. Ask questions, listen to inspiring stories, and learn tips that can help you live a healthier life. 

You’ll also find a slew of virtual events hosted by JDRF on their monthly calendar, including a holiday auction, various meet and greets, and a Q&A session with an endocrinologist. 

Anyone can benefit from healthy choices, regardless of their risk for diabetes. This is a great opportunity to work on a new habit throughout the month. Whether you decide to take a daily walk or experiment with healthy kitchen swaps like chickpea pasta or nut-based milk, pick an activity that you actually enjoy and try your best to keep it going. 

The jury is still out on how long it takes to solidify a new habit, but one recent study found that it took an average of 66 days before participants felt that new habits like eating fruit at lunch or running for 15 minutes became automatic. Of course, the actual time will vary by person and the perceived effort of the new activity, but the study found that daily repetition during the first few weeks was the key to making the new habits stick. 

If you’re currently living with diabetes, use this month as an annual reminder to recommit to your treatment plan. Taking medications as prescribed and keeping up a healthy lifestyle, including proper nutrition and exercise, is an essential part of reducing the impact of diabetes on your long-term health and well-being.

You may want to consider working with a certified diabetes educator. These healthcare professionals have extensive knowledge of diabetes and have been certified to coach individuals living with the condition. Their expertise spans nearly all aspects of diabetes management, from navigating insurance, connecting with support programs, and managing daily life with diabetes.

Read our previous post, ‘What Does a Diabetes Educator Do and How Can They Help You?’ to learn how a diabetes educator can support your diabetes management plan. 

"When I refer patients to Alto, it's one thing they don't have to worry about."

And if you’re among the 1.5 million people who were newly diagnosed with diabetes this year, we share some helpful tips for settling into your routine in “Managing Your New Diabetes Diagnosis.” 

7. Find the best pharmacy for your diabetes care

Managing your monthly medications should never be a struggle. Our pharmacists are on call to field medication queries and walk you through doses or injections. We can deliver whatever you need — including insulin, glucose monitors, test strips, and more — directly to your door for free. For more on how we can help, read “The Best Pharmacy for Diabetes Care.” 

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