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How Long Can Someone Fast Safely? A Comprehensive Guide

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Fasting is a practice as ancient as it is modern. It has long been woven into the cultural, spiritual, and health narratives across the globe. The act of voluntarily staying away from food has been documented from the sands of time to contemporary clinics. That illustrates both its ceremonial significance and its practical approach to health and wellness. 

In 1965, a striking example emerged when Angus Barbieri set a record by fasting for 382 days under medical supervision. He ended up losing an astonishing 125 kilograms. Non-caloric fluids and vitamins fueled his journey. It shows the human body’s extraordinary adaptability and also highlights the extreme risks involved.

Fasting is reclaiming its spot in modern health discourse, especially in India, where it collides with numerous cultural practices. This reclamation prompts us to explore: How long can someone fast? This article aims to decode the scientific aspects of fasting and also to address the popular yet controversial practice of using fasting as a weight loss strategy.

Understanding the Concept of Fasting

People generally regard fasting as voluntary abstinence from food and drinks. However, the practice of fasting varies widely. It ranges from intermittent fasting, which cycles between periods of eating and fasting, to more extreme forms, such as prolonged water or dry fasts. 

Historically and culturally, fasting is a part of many traditions worldwide as a means of spiritual cleansing and discipline. In the contemporary wellness landscape, people frequently consider it for its potential health benefits, such as improved metabolic health and longevity. However, fasting is distinct from starvation, which is an involuntary lack of food with harmful health consequences.

What Happens to the Body When You Starve?

When food intake stops, the body initially uses glucose stored in the liver for energy. Once the body depletes these stores, it turns to fat, and eventually muscle, as a source of energy. This process can have profound impacts on bodily functions:

Central Nervous System

The brain is a high-energy organ that relies heavily on glucose derived from dietary carbohydrates. During fasting, as dietary glucose depletes, the body initially uses stored glucose (glycogen) from the liver. However, within 24 hours, these stores diminish. This state forces the brain to adapt to alternative energy sources like ketone bodies produced during fat breakdown. Due to the brain’s preference for glucose, this shift can lead to mood changes and cognitive effects, such as decreased concentration and an altered mental state.

Cardiovascular System

Early into a fast, the body maintains blood pressure and heart rate by reducing blood volume. It conserves energy that the body will use for digestion. Over time, prolonged lack of nutrient intake leads to decreased production of essential cellular energy. That weakens heart muscle functionality. It can lead to arrhythmias or a drop in blood pressure, making prolonged fasting particularly risky for those with pre-existing heart conditions.

Gastrointestinal System

The GI tract reacts quickly to the absence of food intake by slowing down overall function. The GI tract conserves energy but can lead to discomforts such as constipation and gastric distress. Gastric acid production continues even when there is no food to digest. It raises the risk of stomach ulcers if the mucosal lining becomes too thin.

Endocrine System

Hormone production has a close association with nutrient intake. Key hormones such as insulin, which regulates blood sugar levels, decrease with lower food intake. Other hormones, such as cortisol, may increase as part of the body’s stress response to fasting. Over time, sustained fasting significantly disrupts hormonal balance. That affects everything from reproductive hormones to thyroid function, which can have long-term health implications.

How Long Can Someone Fast? 

The duration of time someone can fast without severe health consequences varies significantly based on individual health, the purpose of the fast, and, crucially, whether they consume water. For example, if they have water, they can survive up to two months without eating.

Fasting for a Day

A 24-hour fast is generally safe for most healthy adults. It can help reset the digestive system and enhance metabolic regulation. People often use this kind of fasting in intermittent fasting routines like the 16/8 method without significant health risks.

Fasting for 2-3 Days

Extending a fast to this length begins to hamper the body’s reserves significantly. While the body shifts to more extensive fat metabolism, essential proteins in muscles start to break down. This process can weaken muscle function and overall physical resilience.

A Week of Fasting

By this stage, the body has deeply entered ketosis for energy production. However, the lack of protein intake leads to more significant muscle breakdown. Significant loss of muscle mass, including cardiac muscle, poses serious health risks. At the same time, it leads to nutrient deficiencies unless you carefully manage nutrient intake and medical supervision.

14 Days of Starvation

Extending a fast beyond two weeks is dangerous. By this time, starvation will jeopardise the functioning of each vital organ. That leads to a growing risk of irreversible health damage. Electrolyte imbalances become critical, and they can potentially lead to fatal cardiac or neurological outcomes. One should only consider prolonged fasting under strict medical guidance to monitor and mitigate these risks.

Factors that Influence the Survival Length of Fasting in Individuals 

Several key factors determine how long an individual can safely fast without irreversible health consequences:

Biological Factors

Age, sex, and genetic predispositions play significant roles. Younger individuals typically have a higher basal metabolic rate and more muscle mass. That potentially offers more resilience in fasting conditions. Conversely, older adults might have weaker organ function, which could increase the risks associated with prolonged fasting.

Body Composition

Individuals with higher body fat percentages have more energy reserves in the form of fat. These reserves can sustain longer periods of fasting. However, lean individuals are at a higher risk of adverse effects sooner, as they lack adequate fat reserves.

Hydration Status

Proper hydration is crucial during fasting. Water does not provide calories but is essential for maintaining blood volume. Additionally, it is vital for regulating body temperature and facilitating cellular functions. Dehydration during fasting can lead to serious complications, including kidney failure and cardiovascular instability.

Activity Level and Environmental Conditions

Lower physical activity conserves energy. It potentially extends the safe duration of fasting. Environmental conditions, such as extreme heat or cold, also affect energy expenditure and can modify the safe duration of fasting.

Side Effects and Risks of Fasting for Prolonged Periods 

Fasting, particularly over extended periods, can lead to several complex health challenges that go beyond temporary discomforts. These complications arise from the body’s adaptive responses to severe nutrient deficiency:

1. Electrolyte Imbalances: As the body dehydrates and depletes its nutrient stores, it leads to an imbalance of vital electrolytes such as sodium, potassium, and magnesium. This disruption can cause cardiac arrhythmias, muscle cramps, and, in extreme cases, cardiac arrest.

2. Muscle Wasting: Extended fasting causes the body to consume its protein stores for energy after exhausting its fat reserves. This process leads to muscle wasting, including the deterioration of heart muscle. It compromises cardiac function and overall physical resilience.

3. Nutritional Deficiencies: Prolonged fasting deprives the body of essential nutrients. As a result, the body experiences deficiencies that can affect bone density, blood cell production, and immune system function. Deficiencies in vitamins such as B12, D, and other micronutrients can have long-lasting detrimental effects on health.

4. Cognitive Impairment: The brain’s need for a constant supply of glucose or ketones can suffer during long fasts. It leads to decreased cognitive function, difficulty concentrating, and altered mental health states, including depression and irritability.

5. Hormonal Imbalances: Extended fasting disrupts the hormonal balance. It affects thyroid function, stress hormones like cortisol, and reproductive hormones. That can lead to irregular menstrual cycles, infertility, and other endocrine disorders.

6. Immune System Suppression: Chronic nutrient deficiencies weaken the immune system, increasing susceptibility to infections and slowing down recovery from illness.

7. Gastrointestinal Distress: Lack of food intake reduces digestive system activity. It leads to gastrointestinal discomfort, such as nausea, abdominal pain, and severe constipation.

Safest Length to Fast 

To fast safely, it is crucial to understand the optimal duration that balances benefits with minimal risks. For most individuals, short-term fasts—lasting 24 to 48 hours—are typically manageable. For some individuals, they can contribute positively to metabolic health without undue stress on the body. These fasts should include adequate water intake to prevent dehydration.

For those new to fasting or with health concerns, starting with intermittent fasting techniques like the 16/8 method (fasting for 16 hours and eating within an 8-hour window) may offer a gentler introduction to the practice. Fasts exceeding two days increase the risk of severe side effects. Hence, you should only undertake it under medical supervision.

HealthifyMe Note 

While occasional, well-managed fasting can be part of a healthy lifestyle, it is vital to approach it with a mindset focused on overall nutritional balance and health sustainability. Prolonged fasting without proper guidance can lead to significant health risks rather than wellness benefits. Instead, incorporating regular, balanced meals and healthy snacks into your daily routine, alongside maintaining an active lifestyle, remains the ultimate way to improve long-term health and weight management. Remember, fasting is not a shortcut to weight loss but a tool that you must use wisely and in moderation. Reaching out to your healthcare provider before starting on a fasting journey is of utmost importance.

The Final Word

Fasting has a place in cultural traditions and modern health practices. However, it is not a one-size-fits-all solution for weight loss or health improvement. Understanding your body’s limits and the science of fasting can help you effectively navigate the risks and benefits. Adopting a balanced diet and regular physical activity remains the ultimate key to good health.

Looking for a balanced approach to health and wellness? Consult with experts at HealthifyMe and explore a range of health plans tailored to your needs. Discover sustainable ways to achieve and maintain your health goals today!

Frequently Asked Questions

Q: How long can someone fast without severe health risks?

A: Most healthy adults can safely fast for 24-48 hours if they stay well-hydrated. However, the duration can vary based on individual health conditions and lifestyle. It is vital to consider all the health factors before starting a fast.

Q: Can an obese person fast longer?

A: Individuals with higher body fat may fast longer due to greater energy reserves in fat stores. However, fasting for extended periods is risky without medical supervision due to potential metabolic imbalances.

Q: What is the safest length to fast for weight loss? 

A: Short intermittent fasting periods, such as 16/8 or a complete 24-hour fast, are safe for most people. They can aid in weight loss without significant health risks. However, it is vital to consult your healthcare provider before doing so.

Q: How long can you fast before you start losing muscle? 

A: Muscle catabolism or the loss of muscle can begin within 48-72 hours of fasting. That is because, during this time, the body turns to protein sources for energy once carbohydrate and fat stores are depleted.

Q: How does fasting for 14 days affect the body?

A: A 14-day fast can lead to critical health issues, including severe electrolyte imbalances, profound muscle loss, and potential organ failure. One should not attempt it without medical supervision.

Q: Is it safe to fast if I have diabetes? 

A: Fasting can be particularly hazardous for individuals with diabetes as it can exacerbate blood sugar control issues. It should only be attempted under close medical supervision to manage risks like hypoglycemia.

Research Sources

1. Longest survival without food

2. Intermittent Fasting and Human Metabolic Health

3. Physiology, Fasting

4. Complete and Voluntary Starvation of 50 Days

5. To Fast or Not to Fast Does When You Eat Matter?

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Post-Holiday Yoga Recovery: Reclaim Balance & Wellness

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Post-Holiday Yoga Recovery: Reclaim Balance & Wellness

This entry was posted on Dec 19, 2024 by Vanessa Coomans.

Introduction: Easing Back into Your Practice

It’s early January. The festive lights have dimmed, the last of the holiday treats are gone, and life is settling back into a familiar pace. While the holiday season may leave you with beautiful memories, it can also bring a sense of imbalance. Your body might feel stiff from long car rides, heavy meals, or late nights, and your mind may still be humming with holiday buzz.

Now is the perfect time for a gentle yoga recovery process: a slow, intentional way to reawaken your practice and restore harmony in body and mind. Think of this period not as something to “fix,” but as an invitation to nurture yourself. Below, we’ll explore how to ease tension, rebuild energy, and pave the way for a steady start to the new year. We’ll also touch on how to transition mindfully back into more dynamic styles like Vinyasa or Ashtanga when you’re ready.

1. Start small with gentle movement for your yoga recovery

After weeks of indulgences and irregular schedules, jumping straight into intense flows can feel jarring. Instead, begin with simple, soothing poses that help your muscles gently unwind. A yoga recovery approach highlights comforting postures that release tension, especially in areas that tend to tighten during busy times—shoulders, neck, hips, and lower back.

Suggested Poses:

2. Rediscover your breath

To truly reset, look to your breath. Deep, mindful breathing can soften the edges of post-holiday tension, shifting your state from scattered to serene. By paying attention to each inhale and exhale, you create mental space to refocus on yourself.

Try This:

  • Three Part Breath (Dirga Pranayama): Inhale slowly, filling your belly, ribs, and chest, then exhale just as steadily. This simple technique clears mental clutter and reconnects you with the present moment.

Pro Tip: Enhance this quiet time by draping a blanket over your legs. The comforting weight reminds you to slow down, settle in, and embrace your yoga recovery journey.

3. Embrace restorative yoga for deep reset

Restorative yoga is a powerful method for yoga recovery, encouraging profound rest and balance. With bolsters, blocks, and blankets, these postures require minimal muscular effort, letting you linger in each pose and gently reset your nervous system.

Restorative favorites:

  • Reclined Bound Angle (Supta Baddha Konasana): Lie back on a bolster placed lengthwise along your spine, allowing the chest to open. Support your knees with blocks or folded blankets. This heart opening pose can lift holiday heaviness and welcome in fresh, compassionate energy.
  • Legs Up the Wall (Viparita Karani): Resting your legs against a wall soothes weary legs and fosters calm. Drape a soft blanket over your belly for warmth as you let gravity and time do the work of relaxation.

4. Releasing the need to “Make Up” for the holidays

Your yoga recovery period isn’t about punishment or burning off those extra holiday cookies. It’s about healing and honoring your body’s current needs. Swap out any guilt driven thoughts for a mindset focused on replenishment and kindness. Yoga should always be a space of self respect and compassion, not a chore.

Gentle Flow ideas:

  • A few rounds of Cat Cow to awaken your spine.
  • Low lunges to stretch hips tight from sitting.
  • Gentle twists to aid digestion and help you feel lighter.

By listening closely to your body, you create a space where yoga becomes truly nourishing rather than another stressful item on your to-do list.

5. Returning to your vinyasa or Ashtanga practices

Once you’ve spent time nurturing yourself with gentle and restorative yoga, you may feel ready to reintroduce more dynamic styles into your routine. Vinyasa and Ashtanga practices, known for their flowing sequences and building internal heat, can eventually help restore your strength, flexibility, and stamina.

Tips for transitioning back:

  • Shorter Sessions: Start with a shorter Vinyasa flow or a Half Primary Ashtanga sequence. Just 20–30 minutes of focused movement can rekindle muscle memory without overtaxing your body.
  • Extra Props: Even in a more dynamic practice, props are friends, not crutches. Use blocks for stability and modify postures if you feel any lingering tightness.
  • Pace Yourself: Don’t rush back into advanced variations. Focus on foundational poses first. Sun Salutations, standing sequences, and gentle backbends. Only adding more complex asanas as your body regains strength and fluidity.

Remember that yoga recovery isn’t a separate world from your regular practice. It’s a stepping stone, a gentle bridge that leads you back into the rhythmic flow of Vinyasa and the disciplined structure of Ashtanga, but without risking burnout or injury.

6. Set intentions for the new year

As you navigate this yoga recovery period, consider what you’d like your practice—and your life—to feel like in the coming year. Maybe you want more patience, steadiness, or joy. Your mat can be a sacred space to set these intentions, allowing them to guide both your slower sessions and your stronger flows.

Try Journaling:

After each practice, note how you feel. Over time, these reflections become a guiding compass, helping you identify when it feels right to step up intensity, or when to continue gently nurturing yourself.

7. Consistency is key in all phases of your practice

Whether you’re easing into a gentle flow or gradually reigniting your Vinyasa or Ashtanga routine, consistency helps solidify positive habits. Start small, a few minutes each day, and trust that time will bring clarity and comfort.

Consistency Tips:

  • Short Sessions: Begin with short practices to rebuild trust and stability in your body.
  • Identify your best time: Mornings can gently wake you up, while evenings help release the day’s tensions.
  • Visual cues: Keep your props visible and accessible. Seeing them is often all it takes to remind you of your intention to practice.

Conclusion: A compassionate path forward

The holidays may have left you feeling scattered or fatigued, but embracing a period of yoga recovery allows you to move back into harmony with yourself. By starting gently and focusing on nurturing postures, you can gradually reintroduce more dynamic practices like Vinyasa or Ashtanga as your body and mind become ready.

This new year, let your yoga journey be guided by kindness, patience, and a steady, supportive foundation, no matter which style you return to. As you step onto your mat, remember that you’re always allowed to pause, adjust, and honor the place you find yourself in today.


Ready to build a supportive environment for your yoga recovery and beyond? Explore
Hugger Mugger’s mats,bolsters, blocks, and blankets to create a cozy, welcoming space that nurtures your body and spirit at every stage of your practice.

About Vanessa Coomans

Vanessa is a 500h RYT Yoga instructor who has shared her passion for yoga and teaching since 2014. Vanessa is a dedicated Ashtanga practitioner who believes in the value of incorporating Yin into her practice. She is also trained in Yin Yoga and received both 200hr and 300hr teacher training certifications from Tim Feldmann & Kino MacGregor through Miami Life Center. She’s a student of Sharath Jois and assists Kino on trainings and retreats. It truly nourishes her soul to help people reconnect with their true selves and with their bodies. It keeps her humble and grateful. For Vanessa, Yoga is not something that she does, rather it is who she is and how she tries to live her life. She loves to teach beginners yoga as it reminds her of her own journey. She hosts yoga retreats around the world.



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Already Battered Disability Providers Say More Cuts Could Be Coming

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Disability service providers across the nation are struggling to maintain their offerings, with many reporting that they are turning away new referrals and discontinuing programs and they’re concerned that it could get worse.

A survey released this week finds that 90% of providers serving people with intellectual and developmental disabilities have faced moderate or severe staffing shortages in the last year. As a result, 69% said they had declined new clients and 39% indicated that they shuttered programs or services. More than a third said they were considering additional program cuts.

The findings come from an annual survey conducted by the American Network of Community Options and Resources, or ANCOR, which represents disability service providers nationally. It is based on responses from 496 community-based services providers in 47 states and Washington, D.C., more than half of whom indicated that they serve areas where there are few or no other options.

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When forced to make cuts due to staffing challenges, 37% of providers said that they had eliminated residential habilitation services and nearly a third cut back on home-based and day habilitation services or employment supports.

The survey findings suggest that the situation is having a very real impact on people with developmental disabilities with nearly 6 in 10 case managers indicating that they had difficulty connecting people to services and almost half of providers saying that they are seeing reportable incidents more often as a result of staffing shortages.

Despite the dire picture, however, officials with ANCOR say that many of the metrics actually represent “modest improvements” over the results from last year’s survey. They attribute the gains in part to $37 billion in federal COVID-19 relief funding in recent years for Medicaid home and community-based services, much of which was directed toward wage increases for direct support professionals who assist people with disabilities living in the community. But, that money must be used by March 31, 2025 and it’s unclear how states and providers will maintain any pay bump after that point.

“While it is encouraging to see a decrease in the percentage of program and service closures due to insufficient staffing, we remain deeply concerned that a lack of legislative action will render this fragile progress temporary,” said Barbara Merrill, CEO of ANCOR. “We have already heard countless stories from providers who are extremely concerned about their state’s ability to bridge the gap that will be left, and how they will recruit direct support workers in their state when they are already struggling to compete with the private sector.”

Meanwhile, there are broader worries about what the future of Medicaid could look like amid reports that newly empowered Republican leaders in Washington are considering changes to the program.

“The stakes could not be higher for individuals with intellectual and developmental disabilities who depend on Medicaid home and community-based services,” said Lydia Dawson, vice president for government relations at ANCOR. “Particularly in light of the funding shortfalls service providers are already facing this year, any further cuts to community-based services — whether directly at the federal level or in other areas that put pressure on states to slash their Medicaid investments further — would be devastating.”

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Tom Cruise Receives Highest Civilian Honor From the Navy

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Tom Cruise is known for producing some of the most captivating action sequences in cinema history. From Mission Impossible to Edge of Tomorrow, but his commitment to presenting legitimate glimpses of the military has earned him fans from all forces, and a pretty hefty award to boot.

For his portrayal of ‘Maverick’ in the Top Gun movies, Cruise had already been named as the U.S. Navy’s 36th Honorary Naval Aviator. The recent movie sequel was widely credited with reigniting younger viewer’s interest in the possibility of joining the Navy. This week, for his continued staunch advocacy of the force, he’s been awarded further and given the Department of the Navy Distinguished Public Service (DPS) Award.

Tom Cruise received the DPS Award

The presentation was made on December 17 for “bringing awareness and appreciation for the Navy’s highly trained personnel and the sacrifices they make while in uniform,” according to an official press release. The award itself was presented by Secretary of the Navy, Carlos Del Toro and is the highest honor that the secretary can bestow on a civilian. The time and preparation that Cruise puts into both his characters and their risky scenarios continues to inspire. “It was an honor to present Tom Cruise with a Defense Public Service award for his decades of naval advocacy through many movies,” said Del Toro following the event. “His work has inspired generations to serve in our Navy and Marine Corps.”

Cruise has long been commended by movie critics for his commitment during almost 40 years of filmmaking. He is famous for performing most of his own stunts, and is a huge supporter of the military. “I’m happy I have been able to be a source of inspiration to many of the sailors who serve today or have served in the past,” said the Hollywood icon on accepting the honor. “The effort was not just on my end, but the cast and crew I get to work with on all our sets. They are what really bring the work to life.”

From climbing skyscrapers to submerging himself underwater, and hanging off the side of an aircraft, Cruise has earned his cinema stripes. He joins Steven Spielberg and Tom Hanks as a recipient of the highly limited DPS award.

Rumor has it that the star is also currently working on Top Gun 3, while next year will see the premiere of Mission Impossible: The Final Reckoning on May 23, 2025.



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Evolution of orphan drug – Healthcare Economist

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A study by Fermaglich and Miller (2023) evaluated trends in orphan drug designations and approvals after the Orphan Drug Act of 1983 was passed in the US. The authors use FDA data to evaluate between 1983 and 2022 and find that:

Over the 40 years of the ODA, 6,340 orphan drug designations were granted, representing drug development for 1,079 rare diseases. Additionally, 882 of those designations resulted in at least one FDA approval for use in 392 rare diseases. Much of this development has been concentrated in oncology as seven of the top ten most designated and approved diseases were rare cancers.

Evolution of orphan drug – Healthcare Economist
Orphan drug designations and initial orphan drug approvals, 1983–2022

Of the orphan drug designations (approvals), the top 5 top diseases areas were:

  • Oncology: 38% of designations (38% of approvals)
  • Neurology: 14% (10%)
  • Infectious Disease: 7% (10%)
  • Metabolism 6% (7%)
  • Hematology: 5% (8%)

You can find more detail on orphan drug designations and approvals in the full paper here.



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Should you ditch the data in 2025?

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In a world where every runner seems to have the latest GPS watch on their wrist or a smartphone tracking every step, choosing to run without technology might seem like rebellious. But running digital-free isn’t just about making a statement—according to a Finnish study, it can be deeply meaningful, freeing and empowering. Here’s what you need to know to decide if ditching the data is right for you.

winter running

The study

Conducted by researchers at the University of Jyväskylä in Finland. They surveyed over 1,000 recreational runners, asking them about their reasons for not using digital sports technology. By analyzing the participants’ responses, the researchers identified recurring themes, including a feeling of freedom and a deeper connection to running, as reported by those who choose to unplug.

Dueter Traick vest
Dueter Traick. Photo: Dueter

More than numbers

Runners often get caught up in the data: pace, heart rate, splits and VO2 max readings. What happens when you let go of the numbers? According to the study, some runners felt that technology took away from the value of the sport. Running without devices allows you to focus on how you feel, the rhythm of your breath, and the sound of your feet hitting the ground, helping runners connect with the experience of running rather than analyzing it.

happy woman runner

Freedom to move

One of the study’s key findings was that ditching technology offered them a sense of freedom. You’re probably used to heading out the door and pausing to wait for your watch to find that GPS signal and pick up your heart rate. Without data, running becomes simpler and more spontaneous. You are able to tune into your body, and you can go as far or as fast as you feel.

For many runners, ditching devices gave them a fresh appreciation for the beauty of their surroundings. Instead of staring at a screen mid-run, they noticed the changing colours of the leaves or the crunch of snow under their feet. Running became more about being present than hitting a goal.

group of happy women runners

Is it for you?

Does thinking about leaving your watch at home still give you the creepy crawlies? Going digital-free doesn’t have to mean throwing your watch in the garbage, and using metrics to accurately assess your runs can be useful when aiming for certain targets or training for a particular event. Many runners in the study switched between using devices for training and leaving them behind on easy runs. Start small—try one technology-free run a week and see how it feels.



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He Went in for a Colonoscopy. The Hospital Charged $19,000 for Two.

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Tom Contos is an avid runner. When he started experiencing rectal bleeding in March, he thought exercise could be the cause and tried to ignore it. But he became increasingly worried when the bleeding continued for weeks.

The Chicago health care consultant contacted his physician at Northwestern Medicine, who referred him for a diagnostic colonoscopy, at least partly because Contos, 45, has a family history of colon issues.

“I work out a lot,” he said. “But my partner said this isn’t normal. My primary care physician said, ‘Given your family history, let’s get you in.’”

Northwestern Memorial Hospital asked him to prepay $1,000 out-of-pocket, and he underwent the procedure in June.

Then the bill came.

The Medical Procedure

Colonoscopies are performed in the United States more than 15 million times a year. Rates of colorectal cancer are on the rise, particularly among younger people.

The procedure, which is also a recommended screening for people 45 or older, involves examining the large intestine using a tube with a video camera that can also collect tissue samples.

It typically takes less than one hour, with another hour spent taking the patient’s history, administering anesthesia, and monitoring their recovery, said Glenn Littenberg, a physician who recently chaired the reimbursement committee of the American Society of Gastrointestinal Endoscopy.

According to Contos’ medical record, the gastroenterologist who performed his colonoscopy described it as “not difficult.” He biopsied and removed small growths called polyps from two spots and identified large internal hemorrhoids, which are swollen veins.

The biopsy samples were sent to pathology for testing and found to be precancerous. But the gastroenterologist reported finding no evidence of cancer, and after reviewing the pathology report, he concluded hemorrhoids were the likely cause of the bleeding.

The Final Bill

The hospital charged a total of $19,206 for the procedure, including physician fees. The insurer negotiated the price to $5,816 and paid $1,979, leaving a patient share of $4,047. (It wasn’t clear why the payments added up to slightly more than the negotiated price.) After Contos had paid $1,000 up front, plus $1,381 right after the procedure, the hospital said he still owed $1,666.

The Billing Problem: Colonoscopies That Find Polyps Cost More

Contos was shocked and angry when he received his itemized bill. “I said, ‘I don’t understand this.’ Then I started to research the cost.”

He asked the hospital what it charges for a diagnostic colonoscopy and was told he’d been sent a cost estimate through his online patient portal prior to the procedure.

The estimate, which took his deductible of $3,200 into account, listed a total price of $7,203, with an out-of-pocket bill of $2,381. He asked Northwestern why the charges were nearly three times the estimate and why his out-of-pocket share was nearly twice as high.

One big reason was revealed in an explanation of benefits (EOB) statement from Contos’ insurance company, Aetna: Northwestern had charged for two colonoscopies, at $5,466 each. And there were two fees for the gastroenterologist — $1,535 and $1,291.

The first procedure was listed as “colonoscopy and biopsy,” while the second was listed as “colonoscopy w/lesion removal.” Aetna’s negotiated member rate reduced the first $5,466 hospital charge to $3,425, while the charge for the second procedure was lowered to $1,787 — $1,638 less.

Neither the bill nor the EOB explained why there was a second procedure listed, at a reduced price.

After examining Contos’ bill, Littenberg said it’s standard for providers to bill for two colonoscopies if they remove two or more polyps in different ways, because of the extra work. As in this case, hospitals typically use a modifier code that reduces the amount charged for the second billed colonoscopy so they charge only for the extra work, he added.

“How do you explain that in sensible terms that anyone could understand?” Littenberg said.

Even with that reduction, Littenberg said, he thought Contos’ total out-of-pocket cost of $4,047 was “a lot, though not rare for large academic centers.”

A man sits at a table near a window. A poinsettia plant, laptop, and notebook with pen rest on the table in front of him.
Contos paid a fee up front, then made another payment after his procedure. He was shocked and angry when he got his itemized bill showing he still owed more.(Taylor Glascock for KFF Heath News)

Contos’ insurance documents show Aetna’s negotiated rate for his colonoscopy at Northwestern was more than twice the insurer’s median negotiated rate for the same procedure at other Chicago-area hospitals, according to Forrest Xiao, director of quantitative research at Turquoise Health, a company that gathers health care price data.

In exchanges with Northwestern and Aetna representatives, Contos asked why he was charged for two colonoscopies. A Northwestern representative said that because of the modifier code, he wasn’t actually being billed for two procedures, which Contos found bewildering.

“I told Northwestern, ‘I’m not paying that, and I don’t care if you send me to collections,’” he said. He filed appeals with the hospital and Aetna but was ultimately told the billing was correct.

The Resolution

In an email, Contos told the billing department that its charge was “ridiculously high.” A representative responded that Northwestern’s pricing is in line with other academic medical centers in Chicago and “non-negotiable” — and that his account would be turned over to a collections agency.

CVS Health spokesperson Phillip Blando said in a written statement to KFF Health News that the claims for Contos were “paid accurately” by Aetna, declining further comment. (CVS Health owns Aetna.)

Northwestern did not respond to multiple requests for comment.

Contos said he wrote to his physician that he was regretfully dropping him and leaving Northwestern entirely because of the health system’s high pricing.

He said he’s still experiencing periodic symptoms, which he relieves with over-the-counter Preparation H. A one-ounce tube of the ointment costs $10.99 at CVS.

The Takeaway

To get a colonoscopy at a lower price, Littenberg said, patients should consider going to a freestanding endoscopy center or ambulatory surgery center not associated with a hospital. A 2023 study found that ambulatory surgery centers billed insurers an average of about $1,030 for a colonoscopy with biopsy or with removal of a polyp, compared with $1,760 at a hospital.

To get a sense of how much a diagnostic colonoscopy could cost, patients can consult a hospital’s price website and an insurer’s cost-estimator website, both required by federal price transparency rules.

Patients also can look up a good-faith estimate of the cash price, which can be lower than the price for patients using insurance to pay for a procedure. In addition, they can check prices through websites such as Turquoise Health and Fair Health, which draw from federal price transparency data or claims data from insurers.

Still, the actual cost could be higher than the estimate if the colonoscopy finds one or more polyps that need to be removed and biopsied, which occurs in at least 40% of all colonoscopies, Littenberg said. Patients should ask whether the price includes those potentially extra services. After all, the point of a diagnostic colonoscopy is to find and, if necessary, treat lesions that could cause problems — regardless of the number found.

It all should be easier for patients, Xiao said: “You shouldn’t have to be a medical billing expert to know what you’re going to pay.”

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it!



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The Season of Generosity – Hugger Mugger

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This entry was posted on Dec 19, 2024 by Charlotte Bell.

generosity

One of my clearest, most nostalgic memories from growing up is that of the excitement of Christmas morning. Our parents would round up my two sisters and me so that we could all converge on the living room simultaneously, run to our piles of presents, and ooooh and ahhhh in unison. The excitement of seeing my wishes granted, and the surprise of gifts I hadn’t asked for was just so much fun. That excitement sustained me through the day as we visited relatives and friends.

But the next day was always a different story. I can remember the hollow feeling that arose from knowing that the orgy of getting stuff was over. Life was back to its unexciting normal. I had a few more things, but inevitably, some of them would have already lost their sparkle. It wasn’t until much later that I began to understand that the joy my parents felt in giving was a far more sustaining feeling than the excitement of getting what I’d yearned for.

The Difference Between Heaven and Hell

A traditional Chinese parable tells the story of an old man who knows he will die soon. Worried about the afterlife, he seeks out the village wise man and asks him to tell him about heaven and hell. The wise man says, “Come, follow me.”

They walk down a long path until they come to a large dwelling. When they walk inside they find a huge dining room. In the center of the room is a long wooden table bearing a sumptuous buffet of unimaginable proportions—all the culinary delights anyone could possibly desire. Many frustrated and unhappy people ring the table. They have been given chopsticks that are twelve feet long and therefore are unable to feed themselves. The food remains untouched, the people hungry and dissatisfied. The old man says, “This must be hell.”

They walk down the path a bit further until they reach a similar large house. Inside they find the same beautiful buffet, same ring of people, same twelve-foot chopsticks. However, in this scenario there is much laughter and conviviality. The people here have learned to use the impossible utensils. “In heaven,” says the teacher, “people feed each other.”

Generosity Benefits the Giver and the Receiver

It is said that the Buddha told his monks, “If you knew, as I do, the power of generosity, you would never let a meal pass without sharing some of it.” In Asian spiritual traditions, the practice of dana, or generosity, is the foundation of spiritual life. Rather than beginning with rigorous meditation practices, seekers initially learn to practice more worldly disciplines, the first being the cultivation of generosity.

The Buddha spoke of the freedom of letting go. Our attachments to our material goods, relationships and beliefs keep us from seeing our own boundless nature. When we practice giving, we learn the happiness of letting go. It does not matter how great or small an act of generosity might be; in each instance we cultivate the habit of letting go. Each time we give we can appreciate the benefits to ourselves and others, which brings motivation to share again.

In her book, Lovingkindness: The Revolutionary Art of Happiness, Sharon Salzberg says that “giving brings happiness at every stage of its expression. We experience joy in forming the intention to be generous; we experience joy in the actual act of giving something; and we experience joy in remembering the fact that we have given.”

“A single act of giving has a value beyond what we can imagine,” says Salzberg. “So much of the spiritual path is expressed and realized in giving: love, compassion, sympathetic joy, equanimity.”

How to Practice Generosity

There are many creative ways to cultivate generosity in our lives. One way is to resolve to follow through every time we feel the impulse to give. In practicing this resolve I’ve found that I often hear almost instantly from the voices of my own lack. These voices remind me that I might someday need the object to be given, or that I can’t possibly afford to share. While it is wise to consider the magnitude of my generosity according to the resources available to me, when the impulse arises I always follow it in some way. I have never found myself lacking because I have given.

Here are some more ideas: Buy a gift or share a meal. Donate some of your possessions to a friend or to a charitable organization. Offer some of your time and energy, perhaps volunteering for a non-profit group or serving at a shelter. Be available to the people in your life. Make a phone call to a distant friend. Write an old-fashioned longhand letter. Next time a friend wants to tell you a story or ask your advice, really listen. An act of generosity does not have to be grandiose.

Then be generous with yourself. Allow yourself to celebrate the joy you have created in another’s life and in your own. There is a huge difference between the expansive feelings that accompany an act of giving and the constricted ones that accompany the habit of wanting or hoarding. Letting yourself feel the blessings of giving can be a great motivator for future acts of kindness.

Cultivating generosity is a practice. There are times when it will be easy and times when it will not be so easy. There are times when we give freely, and times when we give with reservation. But with practice, like any other quality we choose to develop, generosity can flow freely and naturally. It can be not just a quality we have, but who we are.

About Charlotte Bell

Charlotte Bell discovered yoga in 1982 and began teaching in 1986. Charlotte is the author of Mindful Yoga, Mindful Life: A Guide for Everyday Practice and Yoga for Meditators, both published by Rodmell Press. Her third book is titled Hip-Healthy Asana: The Yoga Practitioner’s Guide to Protecting the Hips and Avoiding SI Joint Pain (Shambhala Publications). She writes a monthly column for CATALYST Magazine and serves as editor for Yoga U Online. Charlotte is a founding board member for GreenTREE Yoga, a non-profit that brings yoga to underserved populations. A lifelong musician, Charlotte plays oboe and English horn in the Salt Lake Symphony and folk sextet Red Rock Rondo, whose DVD won two Emmy awards.



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Stephanie Sanzo’s Cable Machine Shoulder Workout 

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The holiday season is upon us and for many, thoughts of revealing our shoulders during Christmas social occasions have us wishing we’d tried a bit harder for the past 12 months! Still, if you want to get a perfect pump before putting on that new dress, fear not, because Stephanie Sanzo’s shoulder workout can be done in the busiest of gyms, and you’ll also tax your core for good measure.

Gyms often become less frequented in winter, only to see a spike in December when panic sets in regarding those slinky numbers that were purchased weeks ago, for upcoming Christmas parties (and don’t get us started on January!) If you are in a hurry but want to get your sweat on during a busy gym session, Stephanie Sanzo’s cable shoulder workout could be the gift that keeps on giving. “This was a short but effective workout using the cable machine, targeting the shoulders,” said the fitness instructor and Instagram star after demonstrating the details for her 3.5 million Instagram followers. “Great if you’re pressed for time and in a busy gym but still want to get a quick pump done.” Try it for yourself:

Stephanie Sanzo’s Cable Machine Shoulder Workout

Superset 1:

1A. Single Arm Cable Lateral Raise x 10

1B. Single Arm Y Press x 10

Superset 2:

2A. Rope Hammer Press x 15

2B. Kneeling Face Pulls x 15

Superset 3:

3A. Kneeling Single Arm Cable Front Raise x 20

3B. Bent Over Single Arm Reverse Fly x 20

Workout Breakdown

Sanzo challenges you to aim for 3 to 4 rounds of this workout, and while you will be seriously working those scapulas, you’ll also be tightening the core and even working the legs as you replicate this fitness coaches perfect posture. There’s a mixture of double and single limb work, meaning you’ll be working on balance in addition to power. “Saved,” wrote multiple IG followers, either hoping to make all the difference at an upcoming gathering, or more realistically hoping to reach their goals in 2025. “Perfect technique, you are my inspiration,” wrote another fan. If 3 to 4 rounds seems too intense for your level of fitness, simply reduce the frequency, but work with a weight that is challenging while maintaining form, and be sure to keep those rest periods limited.

If you stayed to the end Stephanie Sanzo’s workout video, you’ll have seen an adorable doggie make an appearance. Mascots are not obligatory, but gains are guaranteed!

For more body firming tips follow Stephanie Sanzo on Instagram



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Grand Slam Track completes roster for inaugural season

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On Thursday, Grand Slam Track announced the signing of their five final Racers–rounding out their official inaugural roster of 48 athletes. With the Slam dates and host venues already set, all that’s left to be revealed are the four Challengers that will compete in each event at each of the four competitions.

The circuit will commence with its first meeting on April 4 to 6 at Independence Park Sports Complex in Kingston, Jamaica.

Slam host cities and venues

  • Slam 1: April 4-6, Independence Park in Kingston, Jamaica.
  • Slam 2: May 2-4, Ansin Sports Complex in Miami.
  • Slam 3: May 30-June 1, Franklin Field, Philadelphia.
  • Slam 4: June 27-29, Drake Stadium, Los Angeles

Athletes from 16 countries will be taking part in GST’s first season. Twenty American athletes are named to the roster–at least one in each event. Olympic silver medallist Marco Arop is the only Canadian in the entire league, slated to race against the entire Paris 2024 Olympic 1,500m podium: Josh Kerr, Yared Nuguse and Cole Hocker.

Short sprints (100m, 200m)

Men

  1. Kenny Bednarek (U.S.)
  2. Fred Kerley (U.S.)
  3. Oblique Seville (Jamaica)
  4. Zharnel Hughes (Great Britain)

Women

  1. Melissa Jefferson (U.S.)
  2. Daryll Neita (France)
  3. Gabby Thomas (U.S.)
  4. Brittany Brown (U.S.)
Gabby Thomas
Gabby Thomas takes the gold medal in the women’s 200m final at Paris 2024. Photo: Kevin Morris

Short hurdles (100m/110m hurdles, 100m flat)

Men 

  1. Devon Allen (U.S.)
  2. Daniel Roberts (U.S.)
  3. Sasha Zhoya (France)
  4. Freddie Crittenden (U.S.)

Women

  1. Masai Russell (U.S.)
  2. Cyrena Samba-Mayela (France)
  3. Jasmine Camacho-Quinn (Puerto Rico)
  4. Ackera Nugent (Jamaica)
Mariam Abdul-Rashid and Masai Russell
Canada’s Mariam Abdul-Rashid and American hurdler Masai Russell in the semi-finals of the women’s 60mH at the 2024 World Athletics Indoor Championships in Glasgow. Photo: Kevin Morris

Long sprints (200m, 400m)

Men 

  1. Muzala Samukonga (Zambia)
  2. Quincy Hall (U.S.)
  3. Matthew Hudson-Smith (Great Britain)
  4. Jareem Richards (Trinidad and Tobago)

Women

  1. Marileidy Paulino (Dominican Republic)
  2. Salwa Eid Naser (Bahrain)
  3. Alexis Holmes (U.S.)
  4. Nickisha Pryce (Jamaica)
Quincy Hall
Quincy Hall takes the gold in the men’s 400m at the Paris 2024 Olympics. Photo: Nick Iwanyshyn

Long hurdles (400m hurdles, 400m flat)

Men

  1. Alison Dos Santos (Brazil)
  2. Clément Ducos (France)
  3. Roshawn Clarke (Jamaica)
  4. Caleb Dean (U.S.)

Women

  1. Sydney McLaughlin-Levrone (U.S.)
  2. Jasmine Jones (U.S.)
  3. Rushell Clayton (Jamaica)
  4. Shamieer Little (U.S.)
Sydney McLaughlin-Levrone
American Sydney McLaughlin-Levrone in the heats of the women’s 400m hurdles at the Paris 2024 Olympic Games. Photo: Kevin Morris

Short distance (800m, 1,500m)

Men 

  1. Josh Kerr (Great Britain)
  2. Yared Nuguse (U.S.)
  3. Cole Hocker (U.S.)
  4. Marco Arop (Canada)

Women

  1. Nikki Hiltz (U.S.)
  2. Jessica Hull (Australia)
  3. Mary Moraa (Kenya)
  4. Deribe Weltije (Ethiopia)
Marco Arop
Marco Arop wins silver in the men’s 800m final at Paris 2024. Photo: Nick Iwanyshyn

Long distance (3,000m, 5,000m)

Men

  1. Grant Fisher (U.S.)
  2. Ronald Kwemoi (Kenya)
  3. Luis Grijalva (Guatemala)
  4. Hagos Gebrhiwet (Ethiopia)

Women 

  1. Agnes Ngetich (Kenya)
  2. Tsigie Gebreselama (Ethiopia)
  3. Elise Cranny (U.S.)
  4. Nozomi Tanaka (Japan)
Grant Fisher American record
American distance runner Grant Fisher headlines the men’s long-distance category. Photo: James Rhodes (@jrhodesahtletics)

Challengers

It took six months for all Racers to be revealed—fans now wait for up to 192 more of their favourite world-class athletes to be listed as Challengers. Four additional athletes will be invited to each Slam to fill out the field of eight competitors, totalling 48 Challengers per meet. These athletes will be selected by GST on recent performances and to fuel exciting rivalries. It has not yet been announced when the Challengers will be revealed.

Prize purse

Place Prize Money Per Slam
1st $100,000.00
2nd $50,000.00
3rd $30,000.00
4th $25,000.00
5th $20,000.00
6th $15,000.00
7th $12,500.00
8th $10,000.00

 

Athletes can earn up to US$400,000 for winning all four Slam titles; however, lucrative prizes are offered for all competitors at each event.



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