Mon. May 10th, 2021

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    Each week, we answer “frequently asked questions” about life during the coronavirus crisis. If you have a question you’d like us to consider for a future post, email us at goatsandsoda@npr.org with the subject line: “Weekly Coronavirus Questions.” See an archive of our FAQs here.

    I’m vaccinated? Do I need to tell everyone who asks my status?

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    In a word: No.

    Legally, a vaccinated person is not required to share that information with everyone who asks, says Jennifer Piatt, an attorney and research scholar at the Center for Public Health Law and Policy Health. “Information may be deeply personal for some people, and they may choose not to share that information openly.”

    There is no legal requirement that individuals must disclose their vaccination status publicly, Piatt says, or to all interested persons. “An individual can set [their] own boundaries with respect to what information they are comfortable sharing with others.”

    That said, says Piatt, vaccination information may be required in certain situations. For example, schools require information about childhood vaccinations for public safety purposes. In addition, employers generally may be able to ask about vaccine status for safety and planning purposes, barring contrary state or local laws.

    The law, however, is still evolving on this issue. “Earlier this month, the governor of Texas issued an executive order stating that government agencies, along with private businesses and institutions that receive state funding, cannot require proof of vaccination from the public,” notes David Farber, a partner in the Washington, D.C., office of law firm King & Spalding, who specializes in Food and Drug Administration and life sciences law.

    Farber adds that Florida’s governor also signed an order stating that such passports “reduce individual freedom” and “would create two classes of citizens.” He believes that “time will tell how the law settles out on this important question.”

    Jennifer Piatt points out that if you’re asked “why haven’t you had a vaccine yet.” your answer could run afoul of the Americans with Disabilities Act (ADA). It would be a violation of the act because, if you have a disability such as an immune system disorder that prevents you from taking the vaccine, the question would in effect be asking you to disclose a disability.

    One important clarification, says Piatt, is the role of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA prevents health-care providers from sharing protected health information but does not play any role in dictating whether an individual shares (or does not disclose) their own medical information – including vaccination status.

    What are the ethical ramifications of withholding or misrepresenting your vaccine status? My dad lives in a Middle Eastern country and he won’t tell his peers he’s been inoculated because of local beliefs that the vaccine is somehow harmful.

    Nancy Berlinger, director of the Visiting Scholar Program at The Hastings Center, an ethics research institute in Garrison, N.Y., says it is unethical to say or imply you have been vaccinated when you haven’t been. This is deception that puts others at risk of harm.

    But what about the other type of deception: a vaccinated person who won’t reveal their status? Berlinger says it’s ethically problematic (not clearly wrong but not clearly right either) to say or imply that you haven’t been vaccinated when you have been: “This is also deception, which is disrespectful and corrosive, but because you are vaccinated, you’re unlikely to harm others through transmission.”

    Berlinger says a person may have valid personal reasons for concealing the fact that they are vaccinated. Maybe they’re part of a family or community that is currently skeptical of vaccination, and they’re worried about pushback.

    But many physicians on the front lines of caring for COVID-19 patients hope that the vaccinated will share that information with friends and family on the fence.

    “For some people, it will help others around them if they talk about their own vaccination experiences — why they chose to be vaccinated and how they felt afterward — to demystify the experience and to normalize vaccination,” says Leana Wen, an emergency physician and public health professor at George Washington University. “Some may not want to share this experience. Some may want to share it only with certain family members or coworkers and not others. I hope more will share their experiences so as to encourage others to be vaccinated, but everyone needs to decide their own comfort level.”

    And even though it’s always an individual decision, some physicians are big advocates of status sharing. “Absolutely divulge. Peoples’ behaviors affect one another,” says Richard Seidman, chief medical officer for L.A. Care Health Plan, a health plan that serves over two million low-income members in Los Angeles.

    Amesh Adalja, senior scholar for the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, who has treated COVID-19 patients since the start of the pandemic, agrees. “If your life is in danger, or you think you will be harmed if you disclose your vaccine status, I wouldn’t disclose it,” says Adalja. “Short of that, it is something to brag about.”

    Fran Kritz is a health policy reporter based in Washington, D.C., who has contributed to The Washington Post and Kaiser Health News. Find her on Twitter: @fkritz

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    there are so many different subcategories of the ketogenic diet nowadays but what I'm gonna focus on in this video is just the five main forms of the ketogenic diet now if you want to get down to really the nitty-gritty the ketogenic diet is just the ketogenic diet now all these different subcategories are going to talk about are just various forms that people have really kind of changed or altered to fit their specific lifestyles and as the ketogenic lifestyle tends to evolve and more people do it I think we'll see more in more of these different forms so the first one we have to talk about is the basic standard ketogenic diet this is traditionally a 75% intake of fat 20% intake of protein and 5% intake of carbohydrates now there's a lot of evidence that shows that a traditional standard ketogenic diet is phenomenal in the main study that I would like to reference in terms of the longevity piece is going to be the Verta to your health study because it took a look at subjects that have been doing keto for two years and the biggest piece here with a traditional standard ketogenic diet is there was a 74% adherence rate over the course of two years that is earth-shattering that is so amazing because that is such a high adherence so this is sort of your foundational ketogenic diet with this macronutrient breakdown great for all kinds of things ranging from modulating inflammation gut health brain health all kinds of different things but most of all modulating the glucose levels and reducing weight this is the standard the next form of the ketogenic diet is going to be that therapeutic ketogenic diet and this is 90% fat 10% protein and less than 1% carbohydrate this is used for therapeutic conditions neurological conditions epilepsy things like that and the goal here is to get your ketones really high above 3 millimoles because we have seen in patient populations with neurological conditions the higher levels of ketones tend to improve symptoms a lot of the reasoning behind why isn't known we do know that ketones burn cleaner so that could have something to do with the fact that it's less stress on the brain before people that have these neurological conditions anyhow the point is to get the ketones higher we want to get them high especially with therapeutic ketosis that's again that's where keto mojo comes in handy because if you are measuring your ketones you want to make sure you're doing so accurately and not using urine strips you want to be using blood ketone testing tests beta-hydroxybutyrate which is the primary ketone body that we want to look at so it needs to be over three millimoles that you're doing therapeutic ketogenic diet II anyhow then we move into one of my personal favorites which is cyclical ketogenic diet this is where you have periods of time where you cycle out of ketosis to keep your body somewhat adapted to utilizing glucose as a fuel source now this isn't for the everyday person this is for someone that is a little bit more of an extreme athlete perhaps a football player some that's doing a lot of anaerobic activity and needs to still be able to make sure they're adequately filled with glucose now I will say as you do the ketogenic diet for a longer period of time your body finds ways to create glucose from proteins from fat from other breakdowns it just does but if you're concerned with this and you do need an extra bolus of carbohydrates for whatever explosive reason then cyclical ketogenic diet is great okay that's where you do something like three or four days on ketosis one day off three or four days back on one day off or the other form is where you go for two or three months at a time ketogenic diet and then take two weeks off now they all come with their pros and cons the pros being yes you do become somewhat more glucose adapted and less risk of glucose intolerance but the cons are just like learning a language your body isn't as efficient at utilizing those ketones as it would be if you were to just dive in full bore but once again that's we're measuring comes in handy because if you are doing a cyclical ketogenic diet you want to frame it in such a way that once you do have your carbohydrates you get back into ketosis as quick as possible and you're gonna be able to identify that with your meter okay then we go targeted ketogenic diet is very similar to cyclical ketogenic diet except you're adding carbohydrates only at the end of a workout and quite frankly that's the best time to do it anyway because you're likely already kicked out of ketosis at the end of a workout you're going to be out of ketosis because your body up regulates glucose utilization at that point working out just drives down ketones because it burns them up and it drives up glucose because there's a demand so what that means at the end of a workout if you measure your ketones you might find your out of ketosis so you might as well if you're going to have carbohydrates have a little bit at that point in time this is called targeted keto because it's very targeted with your time frame when you have your carbs then the last one I want to talk about is true zero carb or carnivore which is really gaining a lot of popularity right now and more so than the macronutrient breakdown of it being you know pretty much 50% protein 50% fat and 0% carbohydrates more importantly than that is it's an elimination protocol so people feel really good because they're eliminating foods that could be inflammatory to them in the world of so many processed foods and so many different varieties and foods from all corners of the world it's hard for us to identify what we really resonate with as far as the food from the digestive system and the metabolism standpoint so if you reduce all those risks and you go back to basic meat you're not going to have those issues so people end up having a lot of success with that but once again we see ketone levels all over the place depending on how much protein people have etc etc so that's again where the keto mojo meter comes in handy because it helps you out with that helps you identify what your perfect macronutrient ratio should be and I hope that you understand the whole premise of this video is to show that although there are different macronutrient ratios and although there are different profiles at the end of the day it all comes down to how you feel your bio individuality and being able to test with the gold standard the keto mojo meter so as always keep it locked in here with keto mojo thanks for watching I'll see you soon

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