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Health care bots are only as good as the data and doctors they learn from

The number of tech companies pursuing health care seems to have reached an all-time high: Google, Amazon, Apple, and IBM’s Watson all want to change health care using artificial intelligence. IBM has even rebranded its health offering as “Watson Health — Cognitive Healthcare Solutions.” Although technologies from these giants show great promise, the question of whether effective health care AI already exists or whether it is still a dream remains.

As a physician, I believe that in order to understand what is artificially intelligent in health care, you have to first define what it means to be intelligent in health care. Consider the Turing test, a point when a machine becomes indistinguishable from a human.

Joshua Batson, a writer for Wired magazine, has mused whether there is an alternative measurement to the Turing test, one where the machine doesn’t just seem like a person, but an intelligent person. Think of it this way: If you were to ask a random person about symptoms you experience, they’d likely reply “I have no idea. You should ask your doctor.” A bot supplying that response would certainly be indistinguishable from a human — but we expect a little more than that.

The challenge of health care AI

Health is hard, and that makes AI in health care especially hard. Interpretation, empathy, and knowledge all have unique challenges in health care AI.

To date, interpretation is where much of the technology investment has gone. Whether for touchscreen or voice recognition, natural language processing (NLP) has seen enormous investment including Amazon’s Comprehend, IBM’s Natural Language Understanding, and Google Cloud Natural Language. But even though there are plenty of health-specific interpretation challenges, interpretation challenges are really no greater in this particular sector than in other domains.

Similarly, while empathy needs to be particularly appropriate for the emotionally charged field of health care, bots are equally challenged trying to strike just the right tone for retail customer service, legal services, or childcare advice.

That leaves knowledge. The knowledge needed to be a successful conversational bot is where health care diverges greatly from other fields. We can divide that knowledge into two major categories: What do you know about the individual? And what do you know about medicine in general that will be most useful their individual case?

If a person is a diabetic and has high cholesterol, for example, then we know from existing data that the risks of having a heart attack are higher for that person and that aggressive blood sugar and diet control are effective in significantly lowering that risk. That combines with a general knowledge of medicine which says that multiple randomized controlled trials have found diabetics with uncontrolled blood sugars and high cholesterol to be twice as likely as others to have a cardiac event.

What is good enough?

There are two approaches to creating an algorithm that delivers a customized message. Humans can create it based on their domain knowledge, or computers can derive the algorithm based on patterns observed in data — i.e., machine learning. With a perfect profile and perfect domain knowledge, humans or machines could create the perfect algorithm. Combined with good interpretation and empathy you would have the ideal, artificially intelligent conversation. In other words, you’d have created the perfect doctor.

The problem comes when the profile or domain knowledge is less than perfect (which it always is), and then trying to determine when it is “good enough.”

The answer to “When is that knowledge good enough?” really comes down to the strength of your profile knowledge and the strength of your domain knowledge. While you can make up a shortfall in one with the other, inevitably, you’re left with something very human: a judgment call on when the profile and domain knowledge is sufficient.

Lucky for us, rich and structured health data is more prevalent than ever before, but making that data actionable takes a lot of informatics and computationally intensive processes that few companies are prepared for. As a result, many companies have turned to deriving that information through pattern analysis or machine learning. And where you have key gaps in your knowledge — like environmental data — you can simply ask the patient.

Companies looking for new “conversational AI” are filling these gaps in health care, beyond Alexa and Siri. Conversational AI can take our health care experience from a traditional, episodic one to a more insightful, collaborative, and continuous one. For example, conversational AI can build out consumer profiles from native clinical and consumer data to answer difficult questions very quickly, like “Is this person on heart medication?” or “Does this person have any medications that could complicate their condition?”

Not until recently has the technology been able to touch this in-depth and profile on-the-fly. It’s become that perfect doctor, knowing not only everything about your health history, but knowing how all of that connects to combinations of characteristics. Now, organizations are beginning to use that profile knowledge to derive engagement points to better characterize some of the “softer” attributes of an individual, like self-esteem, literacy, or other factors that will dictate their level of engagement.

Think about all of the knowledge that medical professionals have derived from centuries of research. In 2016 alone, Research America estimated, the U.S. spent $171.8 billion on medical research. But how do we capture all of that knowledge, and how could we use it in conversational systems? This lack of standardization is why we’ve developed so many rules-based or expert systems over the years.

It’s also why there’s a lot of new investment in deriving domain knowledge from large data sets. Google’s DeepMind partnership with the U.K.’s National Health Service is a great example. By combining their rich data on diagnoses, outcomes, medications, test results, and other information, Google’s DeepMind can use AI to derive patterns that will help it predict an individual’s outcome. But do we have to wait upon large, prospective data analyses to derive medical knowledge, or can we start with what we know today?

Putting data points to work

Expert-defined vs. machine-defined knowledge will have to be balanced in the near term. We must start with the structured data that is available, then ask what we don’t know so that we can derive additional knowledge from observed patterns. Domain knowledge should start with expert consensus in order to derive additional knowledge from observed patterns.

Knowing one particular data point about an individual can make the biggest difference in being able to read their situation. That’s when you’ll start getting questions that may make no sense whatsoever, but will make all the sense in the world to the machine. Imagine a conversation like this:

BOT: I noticed you were in Charlotte last week. By any chance, did you happen to eat at Larry’s Restaurant on 5th Street?

USER: Uh, yes, I did actually.

BOT: Well, that could explain your stomach problems. There has been a Salmonella outbreak reported from that location. I’ve ordered Amoxicillin and it should be to you shortly. Make sure to take it for the full 10 days. The drug Cipro is normally the first line therapy, but it would potentially interact badly with your Glyburide. I’ll check back in daily to see how you’re doing.

But while we wait for the detection of patterns by machines, the knowledge that is already out there should not be overlooked, even if it takes a lot of informatics and computations. I’d like to think the perfect AI doctor is just around the corner. But my guess is that those who take a “good enough” approach today will be the ones who get there first. After all, for so many people who don’t have access to adequate care today, and for all that we’re spending on health care, we don’t yet have a health care system that is “good enough.”

Dr. Phil Marshall is the cofounder and chief product officer at Conversa Health, a conversation platform for the health care sector.

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Your Good Health: Diabetic finds monitoring system too painful

Dear Dr. Roach: I am a 71-year-old woman who is Type 2 diabetic, but I find the glucose monitoring systems requiring blood samples so painful to use that I don’t test.

At present, I get along by taking a 500-mg metformin tablet three times a day and having bloodwork done about twice a year. My last fasting glucose test result (1/19/18) was 134 mg/dL, and my HbA1c was 6.9 per cent. Should I consider a continuous glucose monitor? I am overweight, so that is a factor I am working on.


A continuous glucose monitor checks and electronically records many blood sugar readings, as often as every five minutes, which can sometimes be read by the user in real time or can be downloaded by the clinician at the end of two weeks (at which point, another unit is placed). The units themselves look like large buttons and contain a very thin needle with a sensor that measures the blood sugar.

CGM systems are used most often in people with Type 1 diabetes, but some patients with Type 2 may be candidates for the system, particularly those whose blood sugars are known or suspected to go too low.

I spoke with an expert at my institution, Esther Wei, a nurse practitioner and certified diabetes instructor, who would not recommend CGM for you, as it is unlikely that you would have low blood sugars being on metformin. Most insurances also require that their members be on both long-acting and short-acting insulin for them to cover CGM.

Your blood sugar levels are excellent, and your A1c levels are near the optimum advised in the most recent guidelines. Losing weight may improve several areas of health, but from the standpoint of diabetes, I wouldn’t increase your monitoring if it is so painful for you.

Dear Dr. Roach: During the past year or two, I have been using a daily sublingual vitamin B-12 supplement, sort of as witchcraft, to treat minor numbness in my feet, recognizing in the absence of signs, symptoms or laboratory evidence of deficiency that taking it has no science.

Today, I opened a fresh bottle of tablets and found that the tablet no longer dissolved under my tongue and actually was nondissolvable and hard (the previous tablet had been chalky and dissolvable). The small print on the new label said to swallow with food once daily, whereas the small print on the former bottle said to dissolve under the tongue three times daily. The dosage also had changed from 500 to 1,000.


Even the most educated people may still benefit from the placebo response, which is the likely case for you, in absence of known B-12 deficiency. B-12 is safe and relatively inexpensive.

In people with known B-12 deficiency, sublingual (under the tongue) preparations and swallowed tablets were equally effective at returning blood B-12 levels to normal.

The study looked at vegans, who do not get B-12 in the diet, as well as people with pernicious anemia, who are unable to absorb B-12 efficiently due to an autoimmune disease that prevents the body from making a protein called intrinsic factor.

Intrinsic factor improves B-12 absorption greatly, but with enough B-12 (1,000 mcg once a day or 500 mcg three times a day are more than enough), the body can absorb as much B-12 as it needs. You can take either preparation.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to

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Your Good Health: Fatigue after prostate cancer issue of low testosterone

Dear Dr. Roach: Fifteen years ago, I had a successful brachytherapy treatment for prostate cancer. Subsequent annual PSA results indicate minimal levels. I am 82 years old and in otherwise excellent condition, and generally very active. However, in the past few years, I have had periods of considerable fatigue. My blood counts are within the normal range, but my testosterone is at a very low level. My family physician counsels against testosterone therapy because of the possibility of reigniting prostate cancer. This seems to be based on a long history of a causal relationship.

A senior fitness trainer at my squash club argues that quality of life is important, so I should try testosterone therapy and then watch my PSA levels carefully. He says this because there have been a number of more recent trials in which there seemed to be a changing view that there is no definite connection that testosterone therapy causes new cancer. He has several clients who have found renewed energy from testosterone therapy. I have reviewed endless articles on the topic, but find nothing definitive. This might be different for males who have not had a previous history of prostate cancer. What’s your opinion? The fatigue is troublesome, and I would like to try testosterone, but not at a real risk of setting myself back 15 years.


I am glad your prostate cancer seems to be in remission. Brachytherapy is the use of implanted radiation “seeds” or “pellets” to destroy prostate cancer cells.

I can’t recommend a course of action that your own physician has counselled against, as he or she will have more information about you than I do.

The reason you aren’t finding any definitive articles is that there are no well-done scientific studies looking at people with a history of prostate cancer being treated with testosterone. There are some data, however. A 2013 review looked at seven studies with a total of about 200 men with a history of prostate cancer treated with testosterone. Only one had an increase in PSA level suggesting recurrence; most men were able to get normal testosterone levels, and most but not all had improvement in symptoms. Fatigue is a common symptom in men with low testosterone, but is not specific for low testosterone. Many conditions can be associated with fatigue.

My own practice, in consultation with the patient’s urologist, is to consider a trial of testosterone replacement in men who are thought to be cured of prostate cancer based on very low or nondetectable PSA levels, who have symptoms (and often physical exam findings) that are very consistent with low testosterone and who have a low level on laboratory testing. I agree that PSA levels (along with a history and physical exam) should be checked carefully.

Ultimately, it is a balance of risks. If the symptoms are bad enough to be worth a small risk of cancer recurrence, and for a patient who is able to weigh those risks himself and chooses to, I have cautiously prescribed testosterone.

Dear Dr. Roach: Can you give me your opinion on a pain-relief pill called “arthro?”


I found several brands with similar names (“arthro” is from the Greek word for “joint”), all of which contained one or more supplements intended for joint health, especially glucosamine, chondroitin, methylsulfonylmethane, collagen and turmeric. These individually are marginally better than placebo, but placebo works surprisingly well, meaning that a lot of people will get relief with these products, which are generally safe. In combination, there might be more effectiveness, but also a larger (but still small) risk of side-effects.

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Sprouts touts healthy living but fails Restaurant Report Card | FOX31 …

DENVER — Every week, FOX31 looks at health inspections at restaurants in metro Denver and along the Front Range.

Sprouts Farmers Market — Thornton

The Thornton location failed the report card with 12 critical health code violations in April 2018 and April 2017.

The mistakes included:

  • Meat department employee wiping hands on apron
  • Hot and cold food were not at the right temperature
  • An employee was eating

“Our top priority is the health and safety of our guests, and we are committed to ensuring clean and sanitary conditions for our customers and team members,” Sprouts Farmers Market said in a statement.

“The Thornton store immediately took action to address the violations and received a follow-up inspection with no violations observed. We work hard to partner with all regulatory agencies towards improving every day.”

The Sprouts in Thornton is at 1131 E. 120th Ave.

Mount Fuji Japanese Hibachi — Westminster

A Tri County inspector cited the restaurant for 11 critical health code violations in April.

The issues included:

  • Person in charge did not know food safety
  • Employee washing their hands with cold water
  • Raw chicken stored above ready to eat cabbage

The restaurant did not respond to calls and emails and a manager was unable to speak in-person.

Mount Fuji Japanese Hibachi is at 14643 Orchard Parkway in Westminster. It passed its follow-up inspection.

Hilario’s Mexican Restaurant

The “A” goes to Hilario’s Mexican Restaurant in Lakewood for going three years without a critical violation.

“We follow the rules with the health inspections. It’s not really hard to make the ‘A,’ but you have to follow the rules and train your workers you hire, first hire and that’s pretty much what we do here,” owner Hilario Banuelos said.

“This is our second time and we are very honored to make the ‘A’ plus. Hopefully, in the future we can get another ‘A’ or that would be nice.”

Hilario’s is at 955 S. Kipling Parkway.

How restaurants appear on the Report Card

Restaurant Report Card features health inspections in the city and county of Denver, Jefferson County, Weld County, Broomfield and restaurants under the jurisdiction of the Tri-County Health Department. The Tri-County Health Department includes Adams, Arapahoe and Douglas counties.

An inspection is a “snapshot” of what is happening during the day and time of the inspection. On any given day, a restaurant could have more or fewer violations than noted in an inspection. Also, at the time of an inspection, violations are recorded and can be corrected prior to the inspector leaving the restaurant. If violations are not corrected, a follow-up inspection is scheduled.

The criteria FOX31 Denver uses to give a restaurant a failing grade includes the evaluation of two unannounced inspections by county health inspectors. A failing restaurant must have five or four critical violations on their most recent regular inspection and five or four critical violations on the previous regular inspection. The restaurant may also fail for nine or ten or more violations in one inspection. Health inspectors may conduct critical or follow-up inspections, due to the number of critical violations found during a regular inspection. Those inspections may also be considered for our reports. We recognize restaurants with two regular inspections in a row, with no critical violations, by awarding them an A.

Check your favorite restaurants


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Healthy Living: Robot Heart Repairs

Three million Americans every year struggle with a leaky mitral valve.

The condition can put strain on the heart, and can cause the muscle to flutter, or beat irregularly.

Now, a minimally invasive procedure is helping patients get back on their feet faster.

We show you how in Healthy Living.

Dr. Murphy says not every patient with a mitral valve leak needs surgery.

If the leak is mild, most doctors will monitor the condition closely to make sure it doesn’t get worse.




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Peel Health offers tips to keep your cool this summer

Now that summer has finally arrived, Peel Health is offering some advice to help residents keep their cool.

“During the summer, and especially during heat events, we encourage our residents to take steps to keep cool, and check-in on friends, family and neighbours who may be vulnerable,” says Peel Medical Officer of Health Dr. Jessica Hopkins, in a press release.

“In particular, some residents with the greatest risks of heat-related illness are infants and young children, seniors, people with chronic diseases and those who are experiencing homelessness,” Hopkins added.

Dave Phillips, senior climatologist with Environment Canada, says this summer will be hotter than normal in all provinces.

Peel Health issues heat warnings when there are at least two days of high temperatures or humidity — putting people at greater risk of heat-related illnesses. Signs of heat-related illness include: rapid breathing and heartbeat, dizziness or fainting, vomiting, extreme thirst, decreased urination, and unusually dark yellow urine.

People experiencing any of these ill effects should cool off as soon as possible by moving to a shaded or air-conditioned area, increasing fluid intake and resting. If the symptoms persist, Peel Health advises people to seek medical attention.

Heat stroke is a more serious condition characterized by high body temperature, confusion, loss of consciousness, and/or the absence of sweating. If someone is exhibiting these signs, people should call 911 immediately.

Residents can prevent heat-related illnesses by following these tips:

• drink plenty of fluids, preferably water;

• avoid strenuous activities between 10 a.m. and 4 p.m. when the sun is at its hottest;

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5 Tips to Plan for Health Care Costs in Retirement

Vanguard and Mercer Health and Benefits have developed a new framework that pre-retirees, retirees and their advisors can use to forecast health care expenses in retirement.

Unlike many other models, the framework focuses on annual costs, rather than costs over a lifetime, which can be daunting. It also separates long-term care costs from annual health care costs because long-term care costs are less predictable and many retirees will never incur them.

Here are the top tips from the framework discussed in Vanguard’s new report, Planning for Health Care Costs in Retirement.

1. Frame costs in annual terms. The Employee Benefit Research Institute estimates that a typical 65-year-old couple will spend a total $265,000 in health care costs over their lifetime. The Boston College Center for Retirement Research estimated in 2010 a $197,000 outlay for a retiree couple. Neither estimate includes long-term care. These lump sums are overwhelming and potentially very inaccurate.

There are many variables involved in estimating health care costs in retirement and the total number can vary widely, according to the Vanguard report. A 65-year-old has a 50% chance of living another 24 years, and if she does, she could spend about $200,000 on health care. But if she dies by 81, she could spend less than $120,000, and if she lives to 95, she could spend more than $272,000.

“The range is wide and accounts for only 50% of the possible outcomes. This is why retirement planning professionals should focus on annual spending plans,” according to the report. They should also consider, however, that costs will rise as seniors age due to inflation and the consumption of more health care services.

2. Personalize health care costs. Knowing a person’s health history and current health status as well as the costs and coverage for Medicare plans, including Medicare Parts B (doctors and labs) and D (prescription drugs), Supplemental Medigap and/or Medicare Advantage Plans are important to understanding health care costs in retirement.

The Vanguard/Mercer Model considers 12 chronic health conditions, along with smoker status and number of annual doctor visits to establish a retiree’s likely health care costs and divides people into three risk categories: low, medium and high.

It also considers geography, marital status, age at retirement and coverage choices, and models costs for women rather than men since their health care costs tend to be slightly higher over a lifetime — 2%.

The median annual health care cost for a 65-year-old woman is $5,200, according to the Vanguard/Mercer model, but it ranges from $3,000 to $26,000 based on risk, geography, type of coverage and income. (Taxpayers with adjusted gross income above $85,000 for individuals filing separately and couples above $170,000 filing jointly are subject to Medicare surcharges.)

Vanguard recommends also that pre-retirees understand their employer contributions to their health care coverage — it averages $5,300 per year for workers — because they will have to cover that cost in retirement.

In addition, it recommends that retirees understand the benefits and costs of different health care options: Medicare with prescription drug coverage only, Medicare with prescription drug coverage and a supplemental Medigap plan and Medicare Advantage plans, and the choices within each category where they live.

Retirees should also reassess prescription drug plans and Medicare Advantage plans annually. (They may encounter difficulties in changing Medigap plans if their health has worsened without a significant hike in premium and possibly a denial of coverage.)

3. Target higher replacement ratios. Financial plans typically suggest that retirees will spend 70% to 85% of their current annual income in retirement, but those ratios may be too low, according to the Vanguard report. It doesn’t take into account an individual who may have high medical costs.

In addition, it uses a ratio based on a 2008 study from Aon Consulting, which tends to undercount how much employers contribute today to health care coverage of pre-retirees. In the baseline case, it assumes an employee making $60,000 per year will spend $1,086 for health care coverage in retirement and in the worst case, $4,800, but according to the Vanguard report, “it is not hard to envision scenarios in which ‘worst case’ could be double that assumption.”

4. View health care costs in relation to other costs. “Although health care costs increase, spending in virtually all other categories tends to decline with age,” according to the Vanguard report, referring to categories such as transportation and entertainment. That doesn’t mean, however, that advisors and their clients should plan on saving less. Forecasting higher overall spending growth can serve as a hedge against rising health care costs and ‘worst case’ scenarios.

5. Plan for long-term care costs. “Long-term care costs may actually be the biggest concern for most retirement planning scenarios because the consumption of long-term care varies significantly,” according to the Vanguard report. It notes half of retirees won’t incur these costs; one-quarter will spend less than $100,000 on long-term care and 15% will spend more than $250,000.

“Even if the probability of incurring expensive care is relatively low, the number is of a magnitude that is hard to ignore,” according to the Vanguard report. The median annual cost for a private room in a nursing home runs over $92,000, according to a 2017 Genworth Financial report cited by Vanguard.

It suggests that retirees consider potential long-term care options: unpaid care from family and/or friends, types of facilities and services available in their area, and expenses that can be eliminated or reduced so more funds are available for long-term care and Medicaid. Consultation with an elder law attorney can help seniors understand the role that Medicaid can play and the rules involved.

For those retirees and pre-retirees who believe long-term care insurance will take care of these costs, Vanguard has another message: “Long-term care insurance pays for only a small portion of care in the U.S.” Policies are expensive, include benefit caps and are not always fully useful “in the most severe scenarios,” according to Vanguard.

Financial assets, home equity, income annuities and health savings accounts can also help pay for long-term care costs.

— Related on ThinkAdvisor:

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Putting your best foot forward: Tips for healthy feet

ORLANDO, Fla. – One survey found that eight out of 10 Americans have experienced some type of foot problem. From ingrown toenails to chronic pain, foot issues can make everyday activities difficult. 

The average American takes about 5,000 steps a day. That’s 5,000 times your feet pound the pavement. So, how can you keep your tootsies in tip-top shape?

Wear the right shoes

Dr. John Campbell, an orthopedic surgeon at Mercy Medical Center said, “If you’re going to play basketball, wear a basketball sneaker, don’t wear a running shoe. It’s not the same kind of event. It’s not designed to protect you for that.” 

When deciding on a new pair of shoes, make sure you have at least half an inch between your longest toe and the front of the shoe. Walk in the shoes to make sure there’s no slipping or rubbing. If your feet aren’t the same size, buy the shoes to fit your larger foot. Also, be sure to replace running shoes every 300 miles.

How to avoid ingrown toenails

To avoid ingrown toenails on your feet, cut your nails straight across. Don’t round them. And if you do develop an ingrown nail, see a doctor instead of dealing with it yourself. To prevent bacterial and fungal infections, bathe daily and take time to dry the skin between your toes. If you suffer an injury, see a professional. It might be more serious than you think.

“The old wives tale where people say, well if you can walk on it it’s not broken, absolutely false,” Campbell said.  

Another tip is to avoid high heels as much as possible. They don’t support your ankle and can actually change the natural position of your foot.

Copyright 2018 by Ivanhoe Newswire – All rights reserved.

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6 Health Benefits of Onions

Get ready to cry some happy tears, because onions definitely deserve a spot on your cutting board this summer. White, yellow, red/purple, and green—all varieties of onions offer some pretty impressive health benefits. The veggie has long been held in high regard: Archeologists have uncovered traces of onions dating back to 5000 B.C. It’s said that in ancient Egypt, onions were worshipped because their shape and concentric circles symbolized eternity. And in the Middle Ages, onions were used to pay for goods and services, and given as gifts. It’s no wonder when you consider just how good they are for you. Below, six excellent reasons to enjoy onions even more.

Onions are rich in antioxidants

They may not be overflowing with vitamins and minerals: One medium onion, which contains about 44 calories, provides 20% of your daily vitamin C needs, and between 5 and 10% of of the DV for B6, folate, potassium, and manganese. But onions are chock-full of antioxidants. They supply dozens of different types, including quercetin, a potent anti-inflammatory compound. The outer layers of an onion pack the greatest antioxidant punch.

They may protect against cancer

In a study published in the American Journal of Clinical Nutrition, researchers looked at how often people in Italy and Switzerland ate onions and another Allium vegetable, garlic. They found that among the populations studied, there was an inverse link between the frequency of use of these veggies and the risk of several common cancers—meaning the more onions and garlic people ate, the lower the cancer rate.

RELATED: To Ward Off Cancer, Choose Red Onions Over White

And improve bone density

One study that looked at perimenopausal and postmenopausal Caucasian women 50 and older found a link between onion consumption and bone health. Women who ate onions more frequently had better bone density, and decreased their risk of hip fracture by more than 20% compared to those who never ate onions.

Onions also support healthy digestion

That’s because they’re rich in inulin, a type of fiber that acts as a prebiotic. In a nutshell, prebiotics serve as food for probiotics, and help those beneficial microbes flourish. Inulin also helps prevent constipation, improve blood sugar regulation, boost nutrient absorption, and support healthy bone density. It’s possible it can support weight loss too, by curbing appetite.

They may help lower cholesterol

One interesting study looked at overweight or obese women with polycystic ovary syndrome. In this randomized controlled clinical trial, the patients were assigned to either a high onion diet (consisting of raw red onion) or a low onion diet. After eight weeks, researchers found decreases in the cholesterol levels in both groups, but the drop was greater (including the reduction in “bad” LDL cholesterol) among the people eating a high onion diet. Another study tracked 24 women with mildly high cholesterol and found that those who drank onion juice daily for eight weeks had reductions in total cholesterol, LDL, and waist measurements compared to those who downed a placebo.

RELATED: 5 Foods That Lower Cholesterol Naturally

And onions make tomatoes better for you too

Food synergy is the idea that the benefits of eating two specific foods together outweigh the benefits of eating each food separately. That seems to be the case with onions and tomatoes: Scientists believe sulfur compounds in onions boost the absorption of lycopene, an antioxidant in tomatoes tied to protection against cancer and heart disease, as well as brain, bone, and eye health. Fortunately, tomatoes and onions make a delicious combination in omelets, salads, soups, and sautés.

How to reap the benefits of onions

Animal research suggests onions may also help control blood sugar levels, and support fertility. That means there will likely be more human studies to come on this superstar veggie. In the meantime, you’ll do your body good by consuming a variety of types and colors, and eating them both raw and cooked.

If slicing onions makes your eyes water, here’s a tip: Cut them (safely) under running water or near a vent. This can help prevent some of the gas from making contact with your eyes. Or invest in a par of stylish kitchen goggles. And be sure to avoid touching your eyes after your onion prep!

Cynthia Sass, MPH, RD, is Health’s contributing nutrition editor, a New York Times best-selling author, and a consultant for the New York Yankees and Brooklyn Nets.

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Fearing Deportation, Some Immigrants Opt Out Of Health Benefits For Their Kids

A young girl waits for care in a medical clinic. A growing number of citizen children of immigrant parents are losing out on Medicaid because their parents fear deportation.

Jonathan Kirn/Getty Images

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Jonathan Kirn/Getty Images

A young girl waits for care in a medical clinic. A growing number of citizen children of immigrant parents are losing out on Medicaid because their parents fear deportation.

Jonathan Kirn/Getty Images

The fear of family separation is not new for many immigrants already living in the U.S. In fact, that fear, heightened in recent weeks, has been forcing a tough decision for some families. Advocates say a growing number of American children are dropping out of Medicaid and other government programs because their parents are undocumented.

Marlene is an undocumented resident of Texas and has two children who are U.S. citizens. (NPR is not using Marlene’s last name because of her immigration status.) One of her kids has some disabilities.

“My son is receiving speech therapy,” she says in Spanish. “But it’s been difficult.”

It was a long journey to get the right evaluations and diagnoses and her son is finally making progress, Marlene says. But she is also bracing for a day when he might have to do without this therapy and others that are paid for through Medicaid. Because she’s undocumented, she’s extremely nervous about filling out applications for government programs like this.

Already, she has decided to stop receiving food stamps, now known as SNAP, which her children, as citizens, are entitled to based on the family’s income.

She dropped it because the application to receive those benefits changed, she says.

“They are asking a lot of questions,” she says. “They are investigating one’s life from head to toe.”

Marlene says she was nervous, in particular, about being asked to provide years of pay stubs. She says there were eligibility requirements she had never seen before. Marlene says the application alone made her “sick from stress.”

NPR repeatedly contacted Texas health officials to ask about the changes in the benefits application process and got no response.

Marlene’s son has Medicaid for the next several months. But she is worried how that application will change, too, next time she has to apply.

Health care groups say they’ve observed other immigrant families making similar choices, and they think it will accelerate if a proposed change to green card eligibility becomes law.

Under the proposed change, if family members receive government services — even if those family members are citizens — it would ding the applicants’ chances of approval for permanent residency.

Maria Hernandez runs Vela, a non-profit in Austin that helps children with disabilities. She says some undocumented parents are afraid of signing up for services for their citizen children.

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Maria Hernandez runs Vela, a non-profit in Austin that helps children with disabilities. She says some undocumented parents are afraid of signing up for services for their citizen children.

Jorge Sanhueza-Lyon/KUT

“We are seeing families having to make this impossible choice,” says Maria Hernandez, the founder of Vela, a non-profit in Austin that helps parents who have children with disabilities.

Hernandez teaches parents how to advocate for their children, how to find the appropriate health care and therapies for their kids, and helps them find community support, among other things.

She teaches many of these classes in what used to be an elementary school on the east side of Austin, known as one of the most diverse areas of the city. She says about seven in ten of the families she works with are immigrants – mostly from Mexico.

“We are working with families who the parents are immigrants but the children are born here,” Hernandez says.

Parents tell Hernandez they feel like they can’t risk any attention from the government, even if that means losing badly-needed benefits for their kids.

In the first year of the Trump administration, Central Texas experienced an uptick in immigration raids and deportations. Hernandez says since then a lot of people in the immigrant community have been making critical choices out of fear.

“It’s out of fear of deportation,” she says. “It’s out of fear of having their children being penalized in some way and potentially losing a parent that until this point has been their fierce advocate.”

In Texas, this is a decision that is bound to affect a significant number of children, says Anne Dunkelberg with the Center for Public Policy Priorities in Austin. Dunkelberg has been closely watching various immigration proposals and their effect on access to government services.

“A quarter of Texas children have at least one parent who is not a U.S. citizen,” she says. “Now, I am sure that not a hundred percent of those kids – and it’s about 1.8 million kids – not a hundred percent of them are using a public benefit, but a very high percentage will be.”

Dunkelberg says families opting out of Medicaid could further raise the number of uninsured in Texas, which is already the highest in the nation.

Hernandez says parents who have children with disabilities have told her without Medicaid they’ll rely on emergency rooms, “as needed.”

“We know that that is not a good plan for kids that for forever have been followed by a neurologist because they have seizures or have been going to occupational therapy for years and are finally making progress,” she says.

Approximately 10 million citizen children in the U.S. have at least one non-citizen parent.

This story is part of a reporting partnership that includes KUT, NPR and Kaiser Health News.

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