Category: Health

I’m a fan of all things fall, but pumpkin spice can get old after a while. This delicious, healthy apple crisp recipe features sweet and tart apples, fragrant apple pie spice, and a melt in your mouth crunchy topping. All of the flavors you could want on a cool autumn day.

Most of us grew up with apple pie, apple crisp, and apple cobbler. These classic dishes tasted so good, but they were also absolutely packed with sugar! This updated version still has all the flavors you love about the original apple crisp, but it’s naturally sweetened and grain-free.

The (not so) secret ingredient is my homemade apple pie spice. Once you have a batch mixed up (it’s earned a permanent place in my pantry!), it’s really easy to flavor your apple crisp. Or pancakes, or muffins, or anything else you want to add some delicious fall flavor to.

Healthy Apple Crisp Ingredients

Apple crisp typically has oats, but not always. Sometimes the terms apple crisp and apple crumble are used interchangeably and many of the ingredients overlap. All you really need to know though is that this apple crisp tastes amazing!

Instead of regular flour and oats it uses almond flour and coconut flour. These give the crumble topping a nice crunch without the grains. The toasted pecans also add to the crunchy, nutty flavor. It’s naturally sweetened with coconut sugar and maple syrup, but if you can find maple sugar it really amps up the fall flavor.

How to Make Toasted Pecans

You can use raw pecans, but toasting them really adds another depth of flavor. There are several methods, but I find the stovetop method the easiest. Nuts start to burn quickly once they’re toasted, so be sure to keep a close eye on them!

• Heat a skillet to medium low heat.
• Add the pecans and stir continually until they smell nutty and fragrant, about 1-2 minutes.
• Immediately remove pecans from the pan.

And here’s how to make a delicious and healthy apple crisp recipe that’s perfect for company or everyday dessert!

What are some of your favorite ways to eat apples? Leave a comment and let us know!

As industrial digitization accelerates, the attack surface expands. To improve the security posture and enable active defense, industrial organizations need detailed, real-time visibility of all industrial assets. At the same time, provisioning secure remote access for vendors and staff is essential for troubleshooting and maintenance in OT environments.

Until now, addressing these needs often required deploying dedicated appliances and point solutions. For industrial organizations with numerous sites and thousands of assets, this “bolted-on” approach increases cost and complexity to unbearable levels. As a result, most OT security deployments only provide visibility to the higher levels of the industrial networks and rely on traditional VPN solutions that give broad network access. Both of these approaches deliver suboptimal security outcomes: incomplete OT asset visibility and an increase in remote access risk.

To help organizations gain comprehensive visibility of their industrial networks and enforce zero-trust OT remote access, Cisco is announcing major updates to its OT security offering.

Secure Your OT Network with Your Industrial Switch

We are now packaging our two core OT security solutions – Cisco Cyber Vision for OT visibility and Secure Equipment Access (SEA) for OT remote access – into a single offering under Cyber Vision. For every Cyber Vision license you purchase, you automatically receive an equivalent SEA license at no additional cost.

We are taking this integrated solution a step further by making it a standard feature of our Cisco IE3500 Rugged Series and Cisco IE9300 Rugged Series Switches. This helps industrial organizations kick-start their OT security projects cost effectively as they are modernizing their OT networks with Cisco’s Industrial Ethernet switches.

 

 

By making advanced OT security a standard feature in selected industrial network switches, Cisco is laying the foundation for a modern, zero-trust OT network architecture in ways that were previously not available. Here is how:

• Cisco Cyber Vision: Cisco’s OT security solution inventories all connected assets, maps their communication activities, and provides detailed visibility into your OT security posture. Cyber Vision is embedded in your networking equipment to deliver unmatched visibility, even at the lowest levels of the Purdue model, eliminating the need for dedicated appliance or SPAN collection networks.
• Cisco Secure Equipment Access (SEA): A purpose-built, self-service remote access solution for OT teams. It enforces least-privilege zero-trust policies, granting users access to specific assets only. This is a major improvement over traditional VPNs which are ill-suited for OT environments as they often provide overly broad network access and require advanced IT skills to be managed properly.

Modernize and secure your industrial network today

With Cisco’s latest OT security offering you can strengthen your OT security posture and upgrade your network with one integrated solution. When you purchase any Cisco IE3500 Rugged Series or Cisco IE9300 Rugged Series switch with a Network Advantage license, you will receive the following at no additional cost:

• A 3-year license for Cisco Cyber Vision for 24 endpoints.
• A 3-year license for Cisco Secure Equipment Access for 24 endpoints.
• Additional endpoints can be purchased separately as your needs scale.

Final word

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By age 40, more than half of Americans have high blood pressure, but many are unaware of it. Hypertension has long been known as the silent killer. When it’s left untreated it can be deadly. And it’s considered a silent threat since most people have no symptoms. You can’t feel the pressure in your blood vessels increasing.

New recommendations from the American Heart Association aim for early treatment, including lifestyle changes and medications, once systolic blood pressure rises above 130/80 mm Hg, (which stands for millimeters of mercury, a measure of pressure). Experts say it’s clear that the sooner you take action, the more you can protect yourself.

Hypertension is a leading cause of heart disease, which is the #1 cause of death of both men and women in the U.S. High blood pressure also increases the risk of kidney disease and dementia. And, research shows that hypertension can lead to damage in small blood vessels in the brain, which is linked to cognitive decline.

“There’s a really enormous preventive health opportunity in treating hypertension earlier,” says Dr. Jordana Cohen, a nephrologist and hypertension specialist at the University of Pennsylvania. She says millions of adults in the U.S. could benefit from medications and lifestyle changes.

“If you catch it early, and treat it early, you can end up with many more years of healthy life expectancy,” Cohen says, pointing to a reduced risk of heart attacks, strokes, kidney damage and dementia.

The new guidelines point to decades old advice about the benefits of a low-sodium diet, which can be challenging to follow, given more than half the calories consumed in the U.S. come from ultra-processed foods, which tend to be high in salt.

The new guidelines also emphasize lifestyle strategies including exercise, limiting alcohol consumption, and stress reduction in the form of meditation, yoga, or deep breathing. For people with systolic blood pressure ( the upper number) in the 130s, the recommendation is to start with these diet and lifestyle-related changes, then move to medication if blood pressure doesn’t improve.

For people who hit the risky range of a systolic blood pressure of 140 or higher, which is considered stage 2 hypertension, evidence shows starting on high blood pressure medications is beneficial.

“For all people with a blood pressure over 140/ 90, mm Hg, we recommend beginning with two medications,” Dr. Dan Jones, chair of the guideline writing committee at the Heart Association, told NPR. Research shows one medication alone is often not enough to lower blood pressure to the optimal range, he says.

Jones says even when people are aware they have hypertension, more than half don’t manage to lower it to the normal range, which is 120 /80 mm Hg or lower. Some of the challenges include side effects of the medications and individual differences in how well the medication works, as well an unwillingness to take medicines among some people. In addition, some people struggle the everyday hurdles of making lifestyle changes. Jones points out that healthcare providers also use a risk calculator to estimate a person’s individual risk of heart disease, as part of a treatment plan.

When George Solomon was told about the risks of high blood pressure he was hesitant to take medications. “I felt fine,” he says. Then, at age 63, he had a stroke.

Solomon had retired from a career in law enforcement, and was settling into a new routine, making time for exercise and hobbies, such as splitting wood on his farm. One day in the spring of 2023, he started to feel off.

” I went upstairs to watch TV, and when I sat down in the chair, I couldn’t get back up. I had a sensation that came up across my back,” he recalls and he lost feeling in his arm and leg. An ambulance took him to Duke University Hospital, near his home, where he underwent treatment and rehab for a stroke.

He estimates that he’s now about 80% recovered, and back to exercising and working on his farm. He realizes now that he needs healthy lifestyle habits and medications to prevent another stroke.

” I feel I’m on the right path ,” he says. He’s lost weight and he’s doing more cardio and strength training. He’s sharing his story in hopes it encourages others to take action.

Medications: what’s out there, what’s coming

There are several types of medications used to treat hypertension. They include diuretics that help the body get rid of extra salt and water, ACE inhibitors that help block the production of a hormone called angiotensin II, and help relax the blood vessels and calcium channel blockers that slow down the movement of calcium into cells, which can help lower pressure.

But many people with hypertension don’t get enough reduction with current medications, and University of Pennsylvania’s Cohen says there’s a lot of interest in a new class of medication that works by targeting the hormone aldosterone, which helps regulate fluid and sodium in the body. Too much of the hormone is one cause of high blood pressure. The drug is not yet on the market, but new study results could pave the way for a new treatment option.

“In hypertension, we haven’t seen anything new that’s effective since the nineties,” Cohen says. So another tool in the toolkit for treatment could be beneficial, she says.

A study published in the New England Journal of Medicine found the aldosterone blocking drug, known as baxdrostat, was effective in lowering blood pressure in many people who have difficulty controlling their hypertension.

The study included about 800 people who, despite taking two or three medications, still had not lowered their blood pressure to the normal range. “What we saw is that after 12 weeks of treatment, there was about a ten point improvement in blood pressure in the patients treated with baxdrostat, over the placebo effect, Dr. Jennifer Brown, a cardiologist at Brigham and Women’s Hospital, who is one of the researchers behind the study, told NPR. The study was sponsored by drugmaker Astra Zeneca, which plans to share its data with regulatory authorities by the end of the year.

A 10 point drop in systolic blood pressure is linked to about a 20% reduction in the risk of heart attacks and strokes, and also a decreased risk of dementia.

Nope, we’re not talking about cookware and cute black and white bears. PANS and PANDAS syndrome has gotten more attention in recent years. For children with PANDAS parents say it’s like a switch was flipped. All of the sudden their child becomes consumed by anxiety, OCD, tics and compulsions. 

This kind of abrupt transformation can be a sign of PANS or PANDAS. In these conditions the immune system and brain become tangled in ways that most parents (and even many doctors) don’t expect.

Though not widely recognized in conventional medicine, these conditions are increasingly being discussed by parents, functional practitioners, and researchers who see their profound effects. It’s estimated that at least every 1 in 200 children has PANDAS, but many cases are likely misdiagnosed as other disorders. 

What Are PANS and PANDAS?

PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. It describes a group of sudden-onset symptoms that appear in children after a strep infection. 

PANS, or Pediatric Acute-onset Neuropsychiatric Syndrome, is broader. It refers to the same kind of abrupt symptoms, but triggered by other causes, such as viral or bacterial infections, environmental toxins, or disruptions in the immune system.

Both conditions involve a misdirected immune response. Instead of focusing solely on fighting the infection, the immune system mistakenly affects the brain, especially areas that regulate behavior and mood. Because children’s brains and immune systems are still developing, they are more vulnerable to this kind of misfire.

Causes and Triggers

For PANDAS, the trigger is usually a strep infection. For PANS, it might be another infection such as Lyme disease, Epstein-Barr virus, or even something environmental like mold exposure. In both cases, the root issue is an immune system under stress. The majority of PANDAS families also report a history of family autoimmune disease.

When the immune system is overwhelmed or misdirected, it can spark inflammation that affects the brain. The result is not a gradual shift in personality, but an abrupt and dramatic change. Parents often describe it as their child becoming a completely different person in a matter of days or even hours.

Recognizing the Symptoms

The hallmark of PANS and PANDAS is sudden onset. A child who was calm and focused one week may suddenly develop obsessions, compulsions, or extreme separation anxiety the next. Other symptoms can include irritability, aggression, motor tics, sleep disturbances, food restrictions, or a sharp decline in school performance.

Because these behaviors overlap with conditions like ADHD, OCD, or autism spectrum disorders, children are often misdiagnosed. Many families report years of frustration as they are told the issues are purely psychological or behavioral. In reality though, the symptoms are being driven by brain inflammation.

Understanding that these behaviors can be immune-driven can be very helpful for parents. It opens the door to different kinds of testing and treatment that address the root cause instead of just managing the outward behaviors.

Can Symptoms Be Prevented or Improved?

The good news is that children can improve, and many do. Early recognition and intervention can make a big difference, but even children who have struggled for years often see relief once the root causes are uncovered.

These conditions highlight the deep connection between the immune system and the brain. By calming inflammation, supporting the body’s healing pathways, and giving the nervous system time to reset, symptoms can improve. 

Testing for PANS and PANDAS

One of the most frustrating parts of these conditions is that there’s no single definitive test. Instead, diagnosis usually involves a combination of lab work, medical history, and symptom tracking.

Common Lab Tests for PANDAS

• Throat culture or rapid strep test: To check for a current or recent strep infection.
• ASO (antistreptolysin O) and anti-DNase B titers: These blood tests measure antibodies to strep and can indicate if the body is reacting strongly to it.
• Cunningham Panel: A specialized test that looks at antibodies associated with autoimmune neuropsychiatric disorders.
• Inflammatory markers: Tests like CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate) can show systemic inflammation.
• Other infection panels: Depending on the child’s history, a practitioner may test for Lyme, Epstein-Barr virus, mycoplasma, or mold exposure.

Functional medicine testing helps identify nutrient deficiencies, gut imbalances, or toxin exposures. Since the gut and immune system are so closely linked, uncovering food sensitivities or digestive imbalances can shed light on what’s driving inflammation.

The Role of Observation

Parents are often the best historians. Writing down when symptoms started, what infections the child had recently, and any environmental changes can help practitioners connect the dots. Keeping a simple log of sleep, diet, mood changes, and flare-ups can be invaluable in shaping a care plan.

Natural and Holistic Ways to Support PANDAS

While medical testing and professional guidance are important, there’s  a lot families can do at home. Small, steady changes can calm the immune system and help the body heal. 

Nutrition for Calming Inflammation

Food is one of the most powerful tools we parents have. An anti-inflammatory approach often makes a noticeable difference. This doesn’t have to mean a highly restrictive diet, but focusing on whole, nutrient-dense foods helps reduce the burden on the immune system.

• Prioritize healthy fats like avocados, olive oil, and wild-caught fish
• Include plenty of colorful vegetables, which provide antioxidants that calm inflammation
• Aim for protein at every meal to stabilize blood sugar and support neurotransmitters
• Skip the processed foods, added sugars, unhealthy fats, and artificial dyes, which can all increase inflammation

For some children, addressing food sensitivities, such as gluten or dairy, is key. Some children see improvements after doing an elimination diet so these can also be a helpful tool. 

Supporting the Nervous System

PANS and PANDAS flare-ups often leave children stuck in fight-or-flight mode. Simple practices that regulate the nervous system can be very helpful.

• Gentle breathing exercises, with slow, deep breaths
• Short guided meditations or calming bedtime stories
• Sensory tools such as weighted blankets, swings, or soothing music
• Time in nature for vitamin D and lower stress hormones. Even better if they play in the dirt!

Even ten minutes a day of intentional relaxation can help shift the nervous system out of constant alarm.

Sleep and Rhythm

Consistent routines matter. A predictable bedtime, avoiding blue light at night, and calming rituals like warm baths or reading can help the body reset. Sleep is when our brain clears inflammation, so prioritizing it is foundational.

Supplements to Consider

We’re all individuals so it’s best to tailor any supplements to your child’s individual needs. That said, these ones are commonly recommended for PANDAS. 

All the supplements in the world won’t fix a bad diet, so it’s important to pair them with healthy, whole foods. 

Reducing Environmental Triggers

Many children with PANS and PANDAS are sensitive to toxins in their environment. Simple steps can help reduce exposure:

• Use air filters to reduce mold, pollen, and chemical exposure indoors
• Test the home for mold or other toxins and remediate as needed
• Choose clean personal care and cleaning products
• Stay hydrated with plenty of filtered water
• Spend more time outside in fresh air and natural light

By reducing the body’s overall burden, this allows the immune system to focus on healing instead of always playing defense.

Getting to the Root Cause

Healing from PANS or PANDAS isn’t about finding a quick fix. It’s about peeling back layers to see what’s fueling the immune system’s reaction. For some families, that means addressing hidden strep infections. For others, it’s uncovering mold exposure in the home or resolving gut imbalances.

The process often looks like this:

1. Test and identify potential triggers
2. Support detox and digestive health with food and hydration
3. Calm the nervous system daily with small, consistent practices
4. Fill in nutrient gaps through food and thoughtful supplementation
5. Reduce environmental stressors at home.

It’s not about doing everything at once, but taking manageable steps that steadily build resilience. Parents who have walked this path often say the slow, steady approach not only improved symptoms but also made their child stronger overall.

Final Thoughts on PANDAS Syndrome

PANS and PANDAS may sound intimidating, but understanding them can change everything for a struggling child. Mental health and physical health are deeply connected and we can’t address one without the other. A sudden change in behavior or mood can be signs of immune dysregulation and brain inflammation.

As more people become aware of PANDAS and its effect on children, more functional practitioners are stepping up to help. And thankfully, while healing may take time, many children return to themselves once the root causes are addressed. The key is supporting their body by calming inflammation and finding the root cause behind their symptoms.

Has your child ever struggled with PANDAS? What strategies have you found to be helpful? Leave a comment and share below!

Background: The Unique Landscape of the Black Hat NOC

Operating the Black Hat Security and Network Operations Center (NOC) presents a unique set of challenges and expectations. Unlike a typical corporate environment where any hacking activity is immediately deemed malicious, the Black Hat conference is a nexus for cybersecurity research, training, and ethical hacking. Consequently, we anticipate and even expect a significant volume of activity that, in other contexts, would be considered highly suspicious or outright hostile. This includes various forms of scanning, exploitation attempts, and other adversarial simulations, often conducted as part of official trainings or independent research.

Adding to this complexity is the Bring Your Own Device (BYOD) nature of the conference network. Attendees connect a wide array of personal devices, making traditional endpoint telemetry (like EDR solutions) a significant challenge for comprehensive monitoring. As such, our primary focus was on robust network-based telemetry for detection and threat hunting.

Overview

This writeup details a recent investigation within the Black Hat Security and Network Operations Center (SNOC), highlighting the critical role of integrated security tools and early detection in mitigating potential threats, particularly when originating from within a high-profile training environment.

On August 4, 2025, a Cisco XDR analytics alert flagged “Suspected Port Abuse: External – External Port Scanner.” The alert indicated an internal host from the “Defending Enterprises – 2025 Edition” training room was actively targeting an external IP address, which resolved to a domain belonging to the Def Con cybersecurity conference. This activity aligned with the MITRE ATT&CK framework’s Reconnaissance tactic (TA0043), specifically the Active Scanning technique (T1595).

Investigation Workflow: A Multi-Tool Approach to Rapid Response

Phase 1: Attack Triage With Cisco XDR

The Cisco XDR analytics incident provided the initial alert and connection flows, offering immediate visibility into the suspicious network activity. Detecting this at the reconnaissance phase is crucial, as early detection in the MITRE ATT&CK chain significantly reduces the risk of an adversary progressing to more impactful stages.

We observed a high confidence incident involving two IP addresses from an internal subnet connecting with a single external IP address. The associated alert was classified as a suspected port abuse by Cisco XDR.

Cisco XDR’s ‘Investigate’ feature then allowed us to further drill down into and visualized the connection flows associated with that external IP address. It also searched against multiple threat intelligence sources for any reputation associated with the observables. The external host was not found to have a malicious reputation.

Phase 2: Target Identification With Cisco Umbrella

We used Cisco Umbrella (DNS resolver) to confirm that the target IP resolves to a single domain. The domain appears to be owned by Def Con and hosted in the United States, by Comcast. The direct association with the Def Con Cybersecurity Conference immediately raised concerns about unauthorized reconnaissance against another major event’s infrastructure.

Cisco Umbrella smart search lookup of the domain confirmed that the domain has a low risk and is classified under the “Hacking/Conventions” category. It was confirmed by Cisco Umbrella to belong to the Def Con convention.

Phase 3: Traffic Analysis

Examining the NetFlow traffic in XDR analytics gives us an immediate insight that port scanning has likely occurred.

Pivoting into Cisco Firepower Management Console (FMC), we ran a report of the associated traffic from the Cisco Firepower Management Console.

The report graphed the top 100 destination ports associated with the traffic and painted a very clear picture. It showed that the internal host was systematically scanning various ports on the external target. Notably, we excluded common web ports like 80 and 443, which helped us avoid looking at potentially legitimate traffic. Each port was scanned precisely four times, indicating a methodical, automated activity, entirely consistent with a dedicated port scan.

For further validation and quantification, we then queried Palo Alto Networks firewall logs in Splunk Enterprise Security (ES). The Splunk query confirmed 3,626 scanning events between 2025/08/04 17:47:07 and 2025/08/04 18:20:29.

Consistent port counts further validated automated scanning.

Phase 4: Culprit Identification

Utilizing our team’s Slack Bot API, which is integrated with Palo Alto Cortex XSIAM, we were able to quickly identify the source machine. This included its MAC address and hostname, and we pinpointed it as operating directly from the Black Hat training room, specifically ‘Defending Enterprises – 2025 Edition’:

Lastly, we were able to capture the full PCAP of the traffic as additional evidence, using our full packet capture tool, Endace Vision. This investigation confirmed that the unauthorized scanning originated from a student in a training room. The offender was quickly identified and instructed to cease the activity. The incident was then closed, with continued monitoring of the training room and its participants.

Potential Risks Highlighted by the Incident

• Reputational Damage: Such incidents can damage the reputation of Black Hat as a premier cybersecurity event, eroding trust among participants, partners, and the wider security community.
• Facilitating unlawful Activity: More critically, if left unchecked, these actions could lead to Black Hat infrastructure being leveraged for unlawful activity against external third parties, potentially resulting in legal repercussions and severe operational disruptions. Swift detection and remediation are essential to uphold trust and prevent such outcomes.

Resolution and Key Takeaways: Enforcing Policy and the Value of Swift Action

The investigation confirmed unauthorized scanning originating by a student. Following this, the offender was quickly identified and made to cease the activity. The incident was closed, with continued monitoring of the training room.

• The Criticality of Early Detection: This case exemplifies the value of detecting adversarial activity at the Reconnaissance phase (TA0043) via techniques like Active Scanning (T1595). By identifying and addressing this behavior early, we prevented potential escalation to more damaging tactics against an external target.
• Integrated Tooling: The seamless integration of Cisco XDR, Cisco Umbrella, Cisco FMC, Splunk ES, Slack API integration, Endace Vision and Palo Alto Cortex XSIAM enabled rapid detection, detailed analysis, and precise attribution.
• Vigilance in Training Environments: Even in controlled, educational settings like Black Hat, continuous monitoring and swift response are paramount. The dynamic nature of such environments necessitates robust security controls to prevent misuse and maintain network integrity.
• Policy Enforcement: Clear communication and consistent enforcement of network usage policies are essential to manage expectations and prevent unauthorized activities, whether intentional or experimental.

About Black Hat

Black Hat is the cybersecurity industry’s most established and in-depth security event series. Founded in 1997, these annual, multi-day events provide attendees with the latest in cybersecurity research, development, and trends. Driven by the needs of the community, Black Hat events showcase content directly from the community through Briefings presentations, Trainings courses, Summits, and more. As the event series where all career levels and academic disciplines convene to collaborate, network, and discuss the cybersecurity topics that matter most to them, attendees can find Black Hat events in the United States, Canada, Europe, Middle East and Africa, and Asia. For more information, please visit the Black Hat website.

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BOWMAN, N.D. — Retta Jacobi stepped onto a metal platform that lifted her to an entrance on the side of a custom-designed semitrailer. Once inside, she lay down on a platform that technicians slid into an MRI machine. Jacobi hoped the scan would help pinpoint the source of the pain in her shoulders.

The mobile MRI unit visits Southwest Healthcare Services, the hospital in Bowman, North Dakota, each Wednesday. Without it, the community’s 1,400 residents would have to drive 40 minutes to get to an MRI machine, an expensive piece of medical equipment the hospital couldn’t afford on its own.

Southwest Healthcare Services and 21 other independent, rural North Dakota hospitals are part of the Rough Rider Network, which used its members’ combined patient rolls to negotiate better prices for the mobile imaging truck.

“Clinically integrated networks”

Independent rural hospitals are increasingly joining what are called clinically integrated networks, collaborative groups that allow them to avoid selling out to larger health systems while sharing resources to save money and improve patient care. Many are motivated by the chance to combine their patient rolls for value-based care contracts, a growing reimbursement model in which insurers pay providers based on the quality of care they provide and the health outcomes of their patients.

Supporters of the networks are exploring whether funding from the $50 billion Rural Health Transformation Program — part of President Donald Trump’s recent tax and spending bill — can be used to help start or expand such organizations.

For independent, rural hospitals, the networks are an alternative to shutting down or reducing services, or to giving up local autonomy and joining a large hospital system.

“Anything that can help our rural hospitals and add services is awesome,” said Jacobi, who provides speech therapy to children in the local school district.

Closing, or courting a big buyer

Since 2010, 153 rural hospitals in the U.S. have shuttered completely or stopped offering inpatient services, according to the Sheps Center for Health Services Research at the University of North Carolina. A far larger number, 441, merged with or were acquired by hospital systems between 2011 and 2021. That’s according to a report commissioned by the Coalition to Strengthen America’s Healthcare, an advocacy group comprising hospitals and health associations.

The Rough Rider Network provides negotiating leverage to its members, which serve about two-thirds of rural North Dakotans, said Dennis Goebel, CEO of the Bowman hospital.

Health care vendors “probably wouldn’t be talking to us if we’re by ourselves,” he said. “They’re not looking for the little, tiny crumbs. They want a big contract, and they’ll give you better pricing.”

Some rural networks share specialists who aren’t needed full time at any one hospital, according to the Commonwealth Fund, a nonprofit focused on improving the health care system. Some networks also invest in broadband, housing, and other community development projects that can help people stay healthy and access care.

A business to create new networks

Hospitals can pool staffers for a network-wide employee health insurance plan, said Nathan White, CEO of Cibolo Health, a company that helps launch and manage networks in rural areas. He said they can also enter shared contracts for telehealth, prescription drug programs, and other services.

White said he started Cibolo Health after a leader from an independent, rural North Dakota hospital asked him about collaborating with similar facilities. The Rough Rider Network launched in late 2023 with assistance from the company and $3.5 million from the North Dakota Legislature.

Since then, Cibolo Health has helped start networks in Minnesota, Nebraska, Montana, and Ohio. Once a sixth one opens in September, Cibolo-affiliated networks will represent more than 120 hospitals, with service areas covering 4.7 million people, White said.

The networks, which are nonprofits owned by the hospitals, pay an annual fee to Cibolo Health, a for-profit company, for management services. White said leaders from 10 other states are considering joining this model.

Similar networks have been around for more than 30 years but became more popular after the passage of the 2010 Affordable Care Act, according to a report by the Rand Corp., a research nonprofit.

Rural health care providers are increasingly interested in forming such networks, said Marnell Bradfield, executive director of the Community Care Alliance, a network of hospitals and independent primary care offices that launched in 2015 in rural western Colorado. About once a month, she said, she gets a call from health care leaders exploring similar networks and asking about her experience.

The Rand Corp. wrote in its 2020 paper that it didn’t find any academic studies that examined whether these networks do what its supporters claim — save money and improve patient care.
“In theory, quality should improve with the alignment of health care organizations, but there is no evidence,” the report said. The paper also said such networks could end up increasing prices, something that can occur with traditional mergers and acquisitions.

Bradfield and White said they have the evidence, at least for their organizations.

Community Care Alliance members have reduced their insurance costs while improving patient outcomes, such as reducing their need for inpatient and emergency care, Bradfield said.
White said data from a pilot program between Caret Health, a care coordination company, and SMP Health-St. Kateri, one of Rough Rider’s hospitals, showed the program helped a significant number of patients catch up with preventive care.

Reaching out to patients, bringing in business

Gabby Wilkie, finance director at the St. Kateri hospital, in Rolla, N.D., near the Canadian border, said Caret Health staff called and texted patients who were behind on annual physicals, cancer screenings, vaccinations, and other visits. She said staffers explained to patients why this preventive care is important for their health before setting up a three-way call with St. Kateri staff to schedule an appointment.

White said it took an average of 11 outreach attempts before patients came in for any visits.

“To be honest, we didn’t have the resources to reach out,” Wilkie said.

She said St. Kateri would have spent an estimated $300,000 to do that kind of outreach for 1,000 patients. Meanwhile, she said, the hospital estimates it will earn more than $100,000 when that many patients come in for their preventive care. Cibolo Health and the Rough Rider Network both contribute to the cost of the Caret Health service, which is now rolling out to other network hospitals.

Goebel said joining a network to remain independent is also beneficial for the economy of rural areas, where hospitals are often major employers. He said health systems sometimes cut services and staff at rural hospitals they acquire.

Jacobi is taking medication and doing physical therapy after a doctor examined her MRI results. If that doesn’t work, she may need to make a five-hour round trip to Bismarck to get an ultrasound-guided steroid shot. Jacobi was thankful she could get a diagnosis and treatment advice without having to travel far for the MRI.

“Anytime we can maintain more local control, it’s a good thing for our small towns,” she said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF .

If you’ve heard of billionaire Bryan Johnson, you’ve likely encountered the phrase “bio age testing.”

Johnson, the subject of the Netflix documentary Don’t Die, says he’s on a quest to achieve the lowest possible “biological age” (also known as bio age).

He reportedly spends millions each year on anti-aging treatments—dozens of daily supplements, weekly acid peels for his skin, injections to boost collagen production, hyperbaric oxygen therapy, and plasma infusions extracted from his 17-year-old son’s body.

To determine what’s working, Johnson has undergone numerous tests to assess his bio age. Johnson says these tests show his age is now 5.1 years younger than when he embarked on his anti-aging quest.

Apparently, he’s aging in reverse.

Granted, not everyone’s buying it. A New York Times exposé, for example, claims Johnson’s biological age, in reality, has increased by 10 years.¹

Still, Johnson’s “don’t die” crusade is gaining traction.

Bio age tests are a frequent topic on popular podcasts by Peter Attia, Joe Rogan, and Andrew Huberman. Google “bio age testing” and you’ll see dozens of ads for mail-order blood or urine testing kits that claim to reveal your biological age, pace of aging, and more. With prices tumbling into affordability, it’s natural to wonder…

Should you or your client sign up for bio age testing?

If so, which test is best? Just as importantly, what should you do with the information?

In this story, you’ll learn:

What is your bio age?

Your biological age (bio age) refers to how your cells function. It’s not necessarily the same as your chronological age, which refers to the number of candles on your birthday cake.

For example, let’s say Chang, a 50-year-old man, works at a desk, spends his free time in front of the TV, lives in the most polluted city in the world, eats a candy bar for lunch, and smokes. On the other hand, Jabari, a different 50-year-old man, hits the gym several times a week, lives in the mountains, doesn’t smoke, relishes his five servings of veggies a day, meditates, and spends most evenings in his garden.

Genetics aside, you’d be wise to wager that Jabari’s bio age is younger than Chang’s.

How do these tests measure bio age?

Bio age testing kits measure one or more biological markers of aging, also known as biomarkers.

For example, some tests focus on the size of your telomeres, the protective caps at the ends of chromosomes. Others measure DNA methylation, a physiological process that chemically alters DNA.

Once a company isolates and measures these markers from your blood or urine, it plugs the bio data into a formula that calculates your bio age.

However, if you see a doctor with any regularity, you’re likely already tracking some biomarkers of aging. For example, biomarkers such as blood pressure, cholesterol levels, and blood glucose can help predict your risk of future cardiovascular disease, a leading cause of premature death.

What’s the point of biomarker testing?

Biomarker testing can help you monitor your wellness proactively rather than waiting for disease symptoms to appear.

For some, it also serves as a motivator. If you learn you have the bones of someone 20 years older, this may give you the nudge you need to start strength training consistently.

In addition, biomarkers provide objective data, allowing you to track and evaluate various health-related actions quantitatively. By monitoring your blood pressure, you might learn that consistent exercise helps, but your late-afternoon energy drink does the opposite.

5 FREE biomarker tests

You don’t have to be a billionaire (or even a millionaire) to track biomarkers of aging.

In this section, we’ll cover several massively underappreciated, scientifically validated tests you can use to gain insight into your bio age—for FREE.

Before scientists developed high-tech blood-based bio age tests, researchers used these free tests to calculate the pace of aging in the people they studied.

FREE biomarker test #1: Get off the floor

People who are fitter and stronger tend to live longer.²

That’s because muscles do more than just move us around. They also secrete anti-inflammatory substances, help to regulate blood sugar, slow cellular aging, protect the lining of the arteries, and more. All this helps reduce the risk of age-related diseases, such as type 2 diabetes, high blood pressure, and heart disease, a phenomenon we explore in our article, The New Science of Muscle.

Related to strength, your ability to balance is also key. If you’re middle-aged or older and can’t stand on one foot for at least 10 seconds, your risk of dying in the next seven years is double that of someone who can stand for longer, according to a study of 1,700 people.³

The Sitting-Rising Test (SRT) is one way to assess both strength and balance at the same time.

People with low scores on this test have a higher risk of dying from cardiovascular disease, according to a 12-year study of 4,200 adults between the ages of 46 and 75.⁴

▶ How to measure it

Lower yourself to the floor with your legs in a crisscross position. Then, with your legs in the same position, stand back up. As you stand, notice if you must use a part of your body—hand, shin, knee—as leverage.

To score yourself, start with 10 points. Then, for each body part you used to stand, deduct a point. Subtract a half point if you became unsteady or lost your balance.

Keep in mind that this (and other tests) serve as a proxy for your fitness. A low score indicates that your balance and coordination, muscle strength and power, and mobility may all require some attention.

FREE biomarker test #2: Squeeze a ball

Like the SRT test, your grip strength provides insight into your overall fitness. If the muscles in your hands are weak, the muscles throughout your body are more likely to be weak, too.

Poor grip strength can also predict future muscle weakness. In one study, people with a weak grip were more likely to walk slowly and be unable to rise from a chair, complete rigorous housework, or climb a flight of steps 25 years later.⁵

Low grip strength has also been associated with:⁶

• Low bone mineral density
• Increased risk of falls
• Poor nutritional status
• Depression
• Poor sleep, cognitive function, and/or quality of life
• Increased risk of heart disease, cancer, and premature mortality

According to one study, grip strength was a better indicator of longevity (or lack thereof) than blood pressure.⁷

▶ How to measure it

Grab a standard tennis ball, and squeeze as hard as you can, for as long as you can.

If you can manage 15 to 30 seconds before your grip fatigues, you’re doing fine. Ninety seconds puts you well above average—anything over 90 ranks you solidly in the upper-third percentile.

If you’re below 15, keep in mind that this test is also just one indicator of your overall strength. (And squeezing balls to improve grip strength without training the rest of your body is unlikely to make significant improvements in your overall health and fitness.)

A hand-held dynamometer—available for use at most occupational therapists’ and some gyms—can also test grip strength. (If you’re willing to shell out some cash, you can buy your own for somewhere between $100 and $500.)

FREE biomarker test #3: Stand on one foot

An ability to balance on one foot for an extended period can help reduce your risk of falls, one of the leading causes of injury-related death among older adults.

In addition, many different bodily systems—the eyes, inner ear, skeletal muscles, and brain—must work together to help you stay upright.

Conditions like diabetes, heart disease, and cancer can all affect balance. As a result, an inability to stand on one foot can serve as a warning sign for eroding health and fitness.⁸

▶ How to measure it

Stand near a wall or chair for safety. Keep your eyes open and hands on your hips. Then, lift your dominant leg and start timing yourself. Once you put your foot down, stop the clock. Repeat the test with your non-dominant leg.

Once you have your times, compare them to the following averages, from a study out of Duke University, to see how you did compared to your age-matched peers.⁹

Age	Seconds on one leg (males)	Seconds on one leg (females)
30-39	59	56
40-49	56	55
50-59	42	48
60-69	40	38
70-79	27	25
80+	13	11

FREE biomarker test #4: How you feel

Sometimes you know why you’re tired, such as the morning after binge-watching the last few episodes of a thriller. Once you catch up on your sleep, the weariness lifts.

That’s not the same thing as fatigue, which describes persistent exhaustion that worsens over time and interferes with life. In addition to feeling physically tired, someone who’s fatigued feels mentally dull and emotionally exhausted.

Think of fatigue as an early sign that something’s off, especially if you don’t know the cause.

Let’s say you’ve already ruled out the usual suspects like too much caffeine, dehydration, too much alcohol, medication side effects, chronic stress, or too much or too little exercise. What’s left is likely a sleep disorder or a developing health problem such as anemia, obesity, depression, cancer, or diabetes, to name a few.

If you’re 60 or older, fatiguability—or how worn out you feel after an activity—can also predict longevity.

According to research out of the University of Pittsburgh Medical Center, the higher someone scores in fatiguability, the higher their risk of death in the future.¹⁰ Other research has linked high fatiguability with declines in gait speed, walking ability, and other tests of fitness.¹¹

▶ How to measure it

To measure fatigability, use a tool called the Pittsburgh Fatigability Scale. Using a 0 (no fatigue) to 5 (extreme fatigue) scale, rate how fatigued you think you would feel after completing the following activities:

Activity	Duration	Score (0 to 5)
Leisurely walking	30 minutes
Brisk or fast walking	1 hour
Light household activity	1 hour
Heavy gardening or yard work	1 hour
Watching television	2 hours
Sitting quietly	1 hour
Moderate-to-high intensity strength training	30 minutes
Participating in a social activity	1 hour
Hosting a social event for 60 minutes	1 hour
High intensity activity	30 minutes
Add all scores:

If you score less than 15, you’re doing well. Scores between 15 and 24 are a warning sign. Anything 25 and above is regarded as severe, and worth mentioning to your healthcare professional.¹²

FREE biomarker test #5: Body composition

Despite popular belief, both too little and too much body fat can influence health for the worse, as we explore in our infographic, Is body fat good or bad for you?

Too much fat raises the risk for:	Too little muscle raises risk for:
Heart disease	Heart disease
High blood pressure	High blood pressure
Cancer	Cancer
Fatty liver disease	Stroke
Insulin resistance	Insulin resistance
Type 2 diabetes	Faster cellular aging
Inflammation	Inflammation
Joint distress	Depression and anxiety
Sleep apnea	Falls and loss of balance

Your muscle mass also plays a role, which is why someone’s body composition matters more than their weight.

The gold standard methods that estimate body composition—underwater weighing, air displacement (Bod Pod), and dual-energy X-ray absorptiometry (DEXA)—certainly aren’t free.

However, a recent study determined that a good old-fashioned (and cheap) tape measure can provide a comparably accurate estimate of body composition.¹³

▶ How to measure it

To use a tape measure to keep track of your body fat percentage, measure:

• The widest part of your neck
• The narrowest part of your waist (For some people, this will be at the navel. For others, it might be slightly above the navel)
• The widest part of your hips

Ensure the tape is snug but not so tight that it cuts into the skin. Once you have your measurements, plug those numbers—along with your age, sex, height, and weight—into our FREE Body Fat Calculator, which will take it from there.

Doctor-approved biomarker tests

Depending on where you live in the world, the following tests may not be free. However, as part of routine preventative care, your insurance might cover them.

Doctor-approved test #1: Blood panel

If your primary care doctor recommends yearly blood work, it’s for good reason.

By keeping tabs on several blood markers, you can see if your health is trending toward type 2 diabetes or heart disease, both leading causes of premature mortality.

Many blood markers can also be influenced relatively quickly (within 6 to 12 weeks) through lifestyle changes, supplement protocols, or medications. This makes them practical tools for monitoring whether various lifestyle or medical modifications are working.

▶ How to measure it

If you’re not already doing so, consider having the following blood markers tested annually. Then, talk to your health care professional about what your numbers mean. They might use the following numbers, along with your blood pressure, to calculate a cardiovascular disease risk score.

Blood marker	Optimal range
Total cholesterol	< 200 mg/dL*
LDL	< 100 mg/dL for those without heart disease < 70 mg/dL for those with a history of heart attack or stroke
HDL	> 60 mg/dL
Triglycerides	< 150 mg/dL
Alipoprotein B (Apo B)	< 133 mg/dL (males) < 117 mg/dL (females)
Lipoprotein (a)	< 30 mg/dL
C-reactive protein	< 2.0 mg/L**
Fasting glucose	< 100 mg/dL
Hemoglobin A1C	< 5.7%

*Milligrams per deciliter of blood
**Milligrams per liter

Doctor-approved test #2: Bone density

When researchers study healthy super-agers aged 90 and older, strong bones are one of their defining features.¹⁴

That may be because, like muscles, bones are live organs that secrete substances that may be beneficial to overall health and longevity.¹⁵

For example, bones secrete osteocalcin, a hormone that plays a role in bone remodeling. When osteocalcin circulates in the body, it’s thought to play a role in everything from helping muscles to produce ATP to regulating brain neurotransmitters.

Because of these varied roles, it’s thought that, as bones wear away, osteocalcin levels drop, contributing to many age-related health problems, including diabetes, low muscle mass, and cognitive issues.^{16 17} (At least, that’s the theory. Most of this research has been done on mice.)

Osteocalcin aside, loss of bone density can, of course, lead to fractures, which can increase your risk of death for up to 10 years after a break.¹⁸

It’s especially important to keep tabs on bone health if you’re in any of these high-risk categories:

• You’re female and went through menopause before age 45.
• You’ve been sedentary most of your adult life.
• You take medications such as diuretics or stomach-acid blockers, which are linked with an increased risk of osteoporosis.
• You have a history of nicotine use or excessive alcohol consumption.
• You have a medical condition, such as diabetes or thyroid disease, that raises your risk.
• You have a family history of osteoporosis.

▶ How to measure it

Dual-energy X-ray absorptiometry (DEXA) scans are a type of X-ray that measures the amount of bone mineral content packed into a square centimeter of bone.

Insurance often won’t cover these scans for people younger than 65 unless there’s a documented risk of developing osteoporosis. Out of pocket, the average cost is about $300.

When you receive your DEXA results, you’ll see a T-score that represents how your bone density compares to the average bone density of a young adult with peak bone mass. A T-score of +1.0 to -1.0 means you have normal bone mineral density for someone your age. Anything below -1.0 means you might have osteopenia (low bone mineral density) or osteoporosis (porous bones that are prone to fracture).

Commercial bio age tests

If you have some money to burn, you can learn an awful lot about your body.

Here, you’ll find a quick run-down on some of the more high-tech tests you can get and what they can tell you.

However, before we get into the details, we want to point out a few caveats:

▶ Biological age can vary over time, and by organ. Someone may go through a period of accelerated aging—saying, during a period of intense stress—then their rate of aging may slow as they focus more on recovery. Additionally, organs can age at different rates. For example, someone with heart disease may have a relatively older heart than their kidneys. (Not all tests measure individual organ age, but it’s becoming more common.)

▶ Commercial tests won’t always accurately reflect the changes you’re making. Until more research supports the reliability of these tests, evaluate your behaviors over isolated test results. If you’re eating more fruits and veggies, exercising more consistently, managing stress, and otherwise slaying the healthy lifestyle department, don’t sweat your results. Focus on doing the things we know improve health.

▶ If a company pairs your test results with a hard sell for a proprietary and expensive supplement protocol, be wary. It’s better to share and discuss your results with a trusted health professional than take health advice from a profit-seeking stranger over the internet.

Commercial test #1: DNA methylation

DNA methylation is a biological process that chemically alters DNA. Because the rate of methylation accelerates with aging, it can be used to estimate someone’s biological age and life expectancy, finds research.^{19 20 21}

The Horvath Clock and DunedinPACE both measure specific biomarkers that can be used to better understand someone’s methylation rate. Scientists developed these tests to help other scientists study how various lifestyle factors, environmental exposures, and medicines affect aging. They didn’t develop the tests as a way for the average person to pinpoint their biological age. (Which hasn’t stopped companies from selling DNA methylation testing kits to the public.) They cost about $300.

If you decide to get one of these tests, keep in mind your results won’t give you a complete picture of your health and longevity. Aging typically occurs at varying rates throughout the body. Your liver might age faster than your heart or brain, for example. So if you measure DNA methylation in your blood, that’s all you know about. Put another way, a DNA methylation test isn’t a substitute for your annual wellness checkup or blood work.

Commercial test #2: Telomere analysis

Telomeres—the protective caps on the ends of chromosomes—wear away with age. The length of a telomere can predict how many times a specific cell can divide before dying.

Abnormally short telomeres are associated with several genetic diseases. For this reason, when physicians suspect someone might have inherited a genetic disease, they’ll order a specific type of telomere test—the flow-FISH test—to measure the telomere length in all the cells in a blood sample.^{22 23}

It’s more debatable whether telomere tests can predict aging in healthy people.

Just as importantly, the telomere test marketed to the public, known as the qPCR telomere test, isn’t used in research or medicine. These $100 tests are fine if you’re merely curious—just don’t base health and fitness decisions on your results.

Commercial test #3: VO2 Max

For years, only elite athletes cared about VO2 max, which describes the maximum amount of oxygen that your body can use during exercise.

More recently, however, some experts have suggested that VO2 max can serve as a measure for athletes and non-athletes alike to track the rate at which their bodies are aging.

People with high VO2 max tend not only to be more physically fit but also less likely to develop heart disease, diabetes, cancer, or stroke.^{24 25 26 27}

In an observational study that followed the health outcomes of 5,107 Danish men over 46 years, men with above-average V02 max during middle age lived an average of five years longer than men with below-average V02 max. Each unit increase in VO2 max was associated with a 45-day increase in longevity. The researchers suggested VO2 max may more accurately predict all-cause mortality than high cholesterol, obesity, high blood pressure, and insulin resistance.²⁸

You might think of V02 max as a canary and your aging body as a coal mine.

As you age, your chest wall becomes more rigid, the muscles that surround the lungs weaker, and the oxygen-carrying blood vessels calcified and less elastic. The heart also squeezes with less force, max heart rate drops, muscle mass and strength decline, the mitochondria in cells and muscles lose their effectiveness, among other differences.

In addition to raising your risk for many different diseases, these changes can also affect VO2 max, which tends to decline 10 percent per decade starting around age 30.^{29 30}

In the past, the only way to reliably measure VO2 max was in a fitness lab.

You would wear a metabolic mask and a heart monitor while you ran or cycled to exhaustion. The mask collected your expired carbon dioxide and monitored how much oxygen you sucked into your lungs. This lab-based testing is still the most accurate way to measure V02 max as well as other key fitness metrics such as:

• Max heart rate, or the highest number of times your heart can beat per minute during exercise
• Ventilatory threshold 1, or the point during exercise when the body switches from mainly using fat for fuel to using a combination of fat and glucose or glycogen (stored glucose) for fuel.
• Ventilatory threshold 2, or the point where your body moves away from aerobic metabolism (which uses oxygen) to anaerobic metabolism (which doesn’t use oxygen).
• Tidal volume is the amount of air inhaled or exhaled during each breath

Depending on where you live, you might be able to get your VO2 max tested for around $150.

However, if you don’t have access to a VO2 max clinic, three somewhat less accurate options exist.

▶ The 1-mile walk test

Wear a heart rate monitor as you walk one mile on a flat surface, such as a treadmill or running track. As soon as you complete the mile, record your heart rate and walk time. Then, plug it into the following formula to calculate your VO2 max:

132.853 — (0.0769 × Weight) — (0.3877 × Age) + (6.315 × Sex) — (3.2649 × Time) — (0.1565 × Heart rate)

If that feels like too much math, you can also use a free online tool.

▶ The smartwatch test

Many smartwatches will estimate your VO2 Max for you based on information the watch gathers from your workouts, sex, and age. Compared to in-office testing, smart watches can over- or underestimate V02 max, especially in people who are very out of shape or extremely fit.³¹

Because of this, you don’t necessarily want to use your smart watch measurement to determine your current state of health. However, it can help you to see trends. For example, does your VO2 estimate drop after a few weeks of skipping your usual spin class? If so, that’s good information to have.

▶ The PR test

Fitness performance correlates with longevity. If you’re getting faster at running a certain distance or can go a longer distance than before, you’re getting fitter and increasing your chances of living a long, healthy life.

One way to test this: the 12-minute run test, also known as the Cooper test. (This is a validated way to estimate VO2 max—and shows about a 90 percent correlation with lab-based measurements.)

Here’s how it works:

Run as fast as you can on a flat surface, such as a treadmill set at a 1 percent incline or running track, for 12 minutes. After 12 minutes, record your distance. Then, plug it into one of the following formulas to calculate your VO2 max.

	Distance in Miles	Distance in Kilometers
VO2 Max =	(35.97 x distance in miles) – 11.29	(22.351 x distance in kilometers) – 11.288

In lieu of doing math, you can also use a free online calculator.

How to change your biological age

Try to think of the information you gather about your body as just that—information.

It’s not a moral judgment of who you are as a person.

Just as importantly, it’s not a permanent situation.

• If you’re weaker than other people your age, you can grow stronger.
• If your cholesterol or blood glucose levels are high, you can take steps to lower them.
• If your body is aging faster than your birthdays, consider exploring key lifestyle changes that may help turn the situation around.

You have options. However, most people make two big mistakes when it comes to longevity-related lifestyle changes.

Mistake #1: Ignoring evergreen, big-impact strategies

It’s the simple, boring, “I’ve heard this a million times before” health practices that, when done consistently, add up to a long, healthy life.

We’re talking about things like…

• Eating more minimally processed foods and fewer ultra-processed foods
• Consuming more brightly colored fruits and veggies
• Moving your body regularly
• Getting enough rest and sleep
• Enjoying community, time in nature, and other activities that make life meaningful
• Keeping alcohol intake moderate
• Not using tobacco
• Wearing sunscreen
• Flossing

And that’s just a partial list.

According to thousands of studies, people who practice these and other high-impact strategies not only live longer, but also live better. They’re stronger, happier, and less likely to spend their later years disabled or in pain.

(If you’d like to see where you stand when it comes to big impact health and longevity strategies, check out our FREE Longevity Assessment.)

However, when it comes to health, fitness, and longevity, many people pursue options with minimal impact (at best). They reach for the latest, trendy supplement rather than taking steps to quit smoking, as just one example.

Here’s the thing: Big rock strategies require changes in behavior. If daily physical activity were as easy as popping a pill, walkers and cyclists would clog up the streets in your neighborhood.

(It’s precisely this reason why so many people need the support of a certified health coach who has undergone training in the science of behavior change.)

Mistake #2: Not turning data into action

The data gathered from biomarker aging tests can give you a sense of control.

However…

Data, in isolation, doesn’t lead to a longer life.

Gathering data without changing your behavior is like checking your reflection in the mirror, seeing spinach wedged between your incisors, and leaving it there.

You need to remove the spinach for the mirror check to be worthwhile.

Biomarker testing is the same.

If you don’t use your bio data to inform behavior change, you’re wasting your money and time.

Consider your biomarker data as a baseline or starting point.

Then, use it to assess whether various lifestyle changes or medical interventions are moving you closer to your goal of living a longer, healthier life.

References

Click here to view the information sources referenced in this article.

If you’re a coach, or you want to be…

You can help people build sustainable nutrition and lifestyle habits that will significantly improve their physical and mental health—while you make a great living doing what you love. We’ll show you how.

If you’d like to learn more, consider the PN Level 1 Nutrition Coaching Certification. (You can enroll now at a big discount.)

I’ve experimented with plenty of DIY projects over the years. Everything from lotion bars to toothpaste to vanilla latte scrub. I get a lot of questions about natural makeup and what I use. So it’s probably no surprise that I’ve learned how to make a lot of my own DIY natural makeup!

Makeup was definitely one of the toughest things for me to find natural alternatives for. In college, I practically collected makeup, and had endless tubes, compacts, and brushes that never even got half used.

Here’s a collection of what I’ve made and had the best results with. 

Natural Makeup

While there are some good natural alternatives that you can buy (see list below), the cheapest and most natural way is to just make your own. You might have all of the ingredients in your kitchen already!

Want to Buy It?

Not into DIYing your own makeup or don’t want to purchase all of the ingredients? Here are my favorite places to buy natural, healthier makeup. You’ll find everything from foundation to blush to lipstick to eye makeup, and more. 

Natural Skin Care

What you do to your skin before you use makeup is just as important as the makeup you use. Thankfully there are some great natural options for skin care. 

I absolutely love the oil cleansing method, which leaves skin soft and smooth by using natural oils to balance the skin. I typically use the oil cleansing method at night and wash my face with raw honey if needed in the morning. 

You can also use sugar scrubs and face masks to keep skin glowing. Find a ton of natural skincare recipes to customize your own skincare routine here. 

With proper skin care, the skin will be naturally healthy and you won’t even need to wear makeup most of the time. Most days, I skip the makeup altogether. When I do wear it, these are the recipes and products I use.

Natural Foundation

I’ve used cocoa powder for dry shampoo before, so why not try it for makeup too? A friend of mine recommended using cocoa for bronzer, so I experimented with my own natural foundation powder using it. The resulting recipe is similar to mineral makeup 

I start with arrowroot powder and zinc oxide, then slowly add in cocoa powder and finely ground cinnamon. I also add a pinch of white cosmetic clay, Fuller’s Earth Clay, French green clay, and a touch of gold mica powder. Just add a little at a time until you get the shade you want. The zinc offers more coverage, and the mica makes it smoother and my skin looks more radiant. 

Don’t have those ingredients? A simple mix of arrowroot and a small amount of cocoa powder and cinnamon works well. They won’t offer as much coverage (and be careful since cinnamon can irritate skin). 

Here are some more natural foundation options:

Natural Bronzer/Blush

For a simple homemade bronzer, use arrowroot, cocoa powder, and a pinch of cinnamon to get a darker shade. Some finely ground dried beet root or hibiscus flowers can also add a pink tone. They have to be very finely ground though to work! 

You can also add some zinc oxide powder to the base and red or pink mica powder for some extra sparkle. 

Natural Eye Makeup

Always be careful when using any products, even natural ones, near the eyes. Those who wear contact lenses may need to be extra careful to avoid any scratching. That said, here are some of my favorite DIY options for the eye area. 

Some days I’m just feeling lazy and want a quick mascara option. I’ll mix a few drops of natural aloe vera gel, vitamin E oil, and a pinch of activated charcoal. Not very precise… I know. Use a mascara wand to apply. 

For eyeliner, I either use a tiny bit of cocoa powder mixed with coconut oil, or a tiny dab of activated charcoal and whipped shea butter. 

To make a smoother eyeliner, I mix equal parts of coconut oil and shea butter (about 1/2 ounce of each) and add about 1/2 tsp of activated charcoal to make a thicker black eyeliner. You can also do this with cocoa powder for a brown hue.

DIY Natural Lips

You probably don’t expect to find lead in your lipstick, yet there it is in small amounts. Plus other harmful ingredients that we end up absorbing and swallowing throughout the day. Here are some recipes to avoid the toxins and make your own!

Natural Makeup Remover

Skip the need for buying an extra product (probably full of less than ideal ingredients) and try one of these simple, natural makeup removers. You probably already have the ingredients around the house!

Supplements for Skin Care

I’m firmly convinced that what we put in our bodies is just as important, if not more than what we put on it when it comes to skin health. I used to have terrible acne. Since changing my diet (removing dairy), healing my gut, and taking supplements, I don’t break out at all. And… my past scars have healed. The supplements that seemed to have made the biggest difference for me are:

• Fish Oil– For vitamins A, D, and K, omega-3s, and antioxidants, all of which are great for the skin.
• Gelatin – A precursor for collagen that’s made my hair, skin, and nails noticeably stronger and smoother (great for cellulite too).
• Magnesium– An anti-inflammatory (and most of us don’t get enough!). Topical Magnesium Oil seems to be the most effective for skin health.

Ever made your own makeup? What’s the toughest thing to find natural versions of for you? Let me know below!