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VitalDecades Guides & Explainers

Preventive care and screenings 14 min

At what age can you stop getting colonoscopies? What each guideline says

For adults at average risk, the USPSTF, ACS, the gastroenterologists' Multi-Society Task Force and ACP all end routine colorectal cancer screening at 75. From 76 to 85 the first three make it an individual decision based on health and past screening, while ACP says stop after 75. ACS and the Task Force say no screening after 85. The USPSTF says people never screened are more likely to benefit from a late test.

Telehealth and online prescriptions 12 min

Which online GLP-1 programs bill your insurance?

Of 11 online GLP-1 programs we read on October 28, 2026, three bill insurance for clinician visits. Six of the rest say insurance does not pay their fee; the insurance help most offer is with the drug, often filing the prior authorization.

Heart health 11 min

What is a normal non-fasting triglyceride level? Why the line is 175, not 150

A non-fasting triglyceride under 175 mg/dL is not flagged under the 2016 European consensus on non-fasting lipid testing, and the 2026 ACC/AHA guideline uses 175 non-fasting and 150 fasting in its list of risk-enhancing factors. In large studies a normal meal raised average triglycerides by at most 18 to 26 mg/dL.

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Supplements 12 min

Is taking iron every other day better than daily?

Iron taken every other day is absorbed better per dose than iron taken on consecutive days, because each dose raises hepcidin for about 24 hours. In treatment trials that gave the same total iron, alternate-day dosing roughly matched daily dosing on hemoglobin and ferritin, in some trials with fewer side effects. The BSG and AGA both recognize it as an option.

Preventive care and screenings 14 min

Your mammogram says dense breasts: do you need more imaging?

Not automatically. The FDA's notice tells you only whether your tissue is dense and names no test. The USPSTF calls the evidence on supplemental ultrasound or MRI insufficient, ACOG does not recommend routine extra tests without other risk factors, and ACR recommends MRI for women with dense breasts who want supplemental screening. Your overall breast cancer risk, not density alone, is what decides it.

Supplements 13 min

Is BPC-157 legal to prescribe or buy in the US?

BPC-157 is not an FDA-approved drug and does not meet section 503A's rules for compounding ingredients. It sat in FDA's Category 2 from September 2023 to April 22, 2026. On October 28, 2026 HHS filed a draft policy not to act against licensed pharmacies and physicians compounding BPC-157 acetate for a patient under strict conditions. Research-use-only vials sold online are outside it, and WADA prohibits it.

Hormones 10 min

What does a low free T4 with a normal TSH mean?

A low free T4 should raise TSH, so a normal TSH beside it points either to a free T4 pulled down by illness, medicines, pregnancy or the assay, or to central hypothyroidism, where the pituitary or hypothalamus does not drive the thyroid. The ETA confirms it only on repeat testing after the look-alikes are excluded.

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Preventive care and screenings 11 min

What does a free PSA percentage mean?

Percent free PSA is the share of total PSA that circulates unbound, and a lower share means a higher chance of cancer on biopsy. The familiar 25% cutoff comes from a 1998 trial and one assay's FDA labeling for PSA 4 to 10, and results from different assays are not interchangeable.

Heart health 11 min

How do you know if a home blood pressure monitor is accurate? Checking that it is validated

A home blood pressure monitor is accurate when its exact model has passed a clinical validation study under a recognized protocol, and in the US the place to check is the AMA's Validated Device Listing at validatebp.org. FDA clearance, a pharmacy shelf and star ratings do not establish accuracy, and the wrong cuff size can undo a validated device.

Labs and biomarkers 12 min

What hemoglobin level is too high?

The WHO 2016 criteria treat hemoglobin above 16.5 g/dL in men or 16.0 g/dL in women as high enough to consider polycythemia vera. The number alone diagnoses nothing: a JAK2 test, the erythropoietin level and causes such as smoking, altitude, sleep apnea, testosterone and SGLT2 inhibitors decide what it means.

Labs and biomarkers 15 min

What does a FIB-4 score mean, and what number rules out liver scarring?

A FIB-4 under 1.3, or under 2.0 for people older than 65, makes advanced liver scarring unlikely under the AASLD 2023 guidance and the AGA's 2026 pathway (which applies 2.0 from age 65). It is arithmetic on age, AST, ALT and platelets, it rules out advanced fibrosis rather than all scarring, and it loses accuracy under 35 and in acute illness.

Supplements 15 min

Does berberine lower A1C, and by how much? What the trials actually show

In placebo-controlled trials of people with type 2 diabetes, berberine lowered A1C by roughly 0.4 to 0.7 percentage points, mostly over one to three months and almost entirely in trials run in China. That is well short of semaglutide, and berberine slows liver enzymes that clear many prescription drugs.

Sleep 11 min

Is Zepbound approved for sleep apnea? Who qualifies under the label and the insurers

Yes. The FDA approved Zepbound on December 20, 2024 for moderate to severe obstructive sleep apnea in adults with obesity. The label's indication prints no cutoffs; the SURMOUNT-OSA trials enrolled adults with an AHI of 15 or more and a BMI of 30 or more, without diabetes, and cut AHI by 25 to 29 events per hour over 52 weeks. The two insurers we read set different details: UnitedHealthcare's OSA-only program requires failed or unsuitable PAP therapy, such as CPAP, and excludes diabetes; Cigna's does neither.

Weight and metabolism 11 min

Is Wegovy approved for fatty liver (MASH)? What the label covers and who qualifies

Yes, for one stage of disease. The FDA approved Wegovy injection on August 15, 2025, under accelerated approval, for adults with noncirrhotic MASH and F2 to F3 liver fibrosis, alongside diet and exercise. Cirrhosis, milder fatty liver, children and Wegovy tablets are outside the label. In ESSENCE, steatohepatitis resolved in 63 percent on Wegovy against 34 percent on placebo at 72 weeks; the confirmatory outcome trial is scheduled to finish in 2029.

Preventive care and screenings 13 min

My PSA is between 4 and 10: what happens next

The AUA/SUO guideline says a newly elevated PSA, such as a first result of 4 to 10 ng/mL, should be repeated first. If it stays raised, the guideline's pathway runs through a risk assessment and may include an MRI before any biopsy decision, and lets patient and clinician forgo a near-term biopsy when the risk is sufficiently low.

Preventive care and screenings 12 min

Can you get lung cancer screening before 50? What each guideline says

None of the four US rules quoted here starts lung cancer screening before 50: the USPSTF, the American Cancer Society, CHEST's broadest band and Medicare all start at 50. CHEST recommends against screening under 50 unless clinical risk prediction or life-year gained calculators project a high net benefit, and none of the four makes family history a criterion.

Heart health 12 min

Lp(a) mg/dL to nmol/L: the conversion, and why it is not exact

Multiplying mg/dL by 2 to 2.5 gives only an estimate of Lp(a) in nmol/L. The European Atherosclerosis Society calls that range a best guess and advises against any standard factor, because apo(a) size varies from person to person and assays disagree.

Preventive care and screenings 14 min

Is Cologuard as good as a colonoscopy? What the trials and the USPSTF modeling show

As a single test, no: in the trials the FDA reviewed, Cologuard detected 92.3% to 95.3% of the cancers colonoscopy found but only 42.4% to 43.4% of advanced precancerous lesions, and a positive result needs a colonoscopy. Repeated on schedule with full adherence, USPSTF modeling estimates 303 (every 3 years) to 333 (yearly) life-years gained per 1,000 for stool DNA testing, against 337 for colonoscopy every 10 years.

Preventive care and screenings 11 min

When do you stop lung cancer screening after quitting smoking?

The USPSTF and Medicare end lung cancer screening eligibility once you have gone 15 years without smoking. The American Cancer Society removed that rule in 2023, so former smokers with a 20 pack-year history stay eligible from 50 to 80 under ACS. CHEST keeps the limit but allows a calculator-based exception.

Preventive care and screenings 11 min

Should women over 75 still get mammograms? What each guideline says

No major US guideline sets a stop age for mammograms at 75. The USPSTF calls the evidence for women 75 and older insufficient (an I statement, 2024), while ACS, ACOG and ACR tie the decision to health and life expectancy, and Medicare keeps paying for a yearly screen with no upper age.