Latest news with #endocrinologists
Yahoo
a day ago
- Health
- Yahoo
The founder of Deliciously Ella started a blog when suffering from severe chronic pain. Now, her multimillion-dollar snack empire is going global
In 2011, when Ella Mills was 20, chronically ill, and bedridden with fatigue, migraines, and heart palpitations up to 190 beats per minute, she nearly passed out when standing. As a student at St. Andrews University, she had to sleep between 16 and 18 hours a day because the fatigue was unbearable. 'You're so dizzy, it's like your head's disconnected from your body,' Mills recalls, who had to go home to manage the symptoms. Mills, now a mother of two who lives in the UK, saw a dozen doctors and underwent over 40 procedures, including visits to endocrinologists and gastroenterologists. Several months later, she was finally diagnosed with postural orthostatic tachycardia syndrome (POTS), a disorder involving the autonomic nervous system that causes rapid heartbeat, nausea, brain fog, fainting, and fatigue. There's no official cure for the disorder, which primarily affects women between the ages of 15 and 50—although it has now been tied to post-COVID symptoms. At one point, Mills was on 25 medications a day. None of them worked. 'I very much hit rock bottom, and I think it became really clear that I wasn't doing anything to help myself either,' she says. Like many at a place of hopelessness, Mills turned to the internet. She read stories of countless women who have her disorder, many of whom felt desperate for any way forward and have since turned to medications and a combination of diet and other lifestyle changes. 'I just felt I had nothing to lose but try to kind of overhaul my diet and overhaul my lifestyle, but I couldn't cook and I didn't like vegetables,' she tells Fortune. In 2012, although not a self-proclaimed unhealthy eater, Mills made a change to her diet, opting for natural ingredients and cooking at home. In a desperate plea for help and to keep herself accountable, she posted her cooking trials and tribulations on a blog. Over a decade later, the $20 WordPress blog account named Deliciously Ella transformed into a business that brings in $25 million in revenue yearly, with a cookbook that has sold over 1.5 million copies, and a social media following of over 4 million (a reach far surpassing other plant-based snack competitors in the field). It has become the fastest-growing snack brand in the UK and is now expanding globally with the launch in the U.S. at Whole Foods in May of this year. In 2024, the brand was acquired by Hero Group, a Swiss manufacturer. While the company won't disclose the deal, Mills and her husband share that 'we have had numerous approaches to sell or partner with other food companies over the years, but only this one felt right.' The company is currently valued around $35 million, according to estimates from S&P. 'I taught myself to cook, and I did it on a blog, as I'm a very all-or-nothing person. I was like, I know I need to hold myself accountable,' she says. 'It's taken us a decade of experiments and trials and errors to get to the point where we know how to create genuinely, really good tasting products using only kitchen cupboard ingredients.' The 'accidental founder' Within two years, Mills tells Fortune her site garnered 130 million hits and reached people in about 80 countries. While she was still weaning off medications, Mills's minimalist and home-cooked diet improved her illness. Two years later, she was not on any medications, and her business was growing in step. She began posting more on social media about the recipes she was making and what she was learning. In 2014, she compiled all the recipes into an app, and in 2015, she published a cookbook that sold out before its release, instantly becoming an Amazon and New York Times bestseller. Mills describes herself as an 'accidental founder,' who doesn't have an entrepreneurial brain or the experience scaling a business. 'I'm not trying to pretend to be what I wasn't,' she says. It's no surprise that she wasn't a professional chef or nutritionist, but she marketed herself as a self-proclaimed 'home cook' who wanted to—simply put—feel better. The beginning of the wellness craze A month after the cookbook's release, Mills met her now-husband and business partner, Matt—a finance nerd at heart with the eagerness to scale a brand. Two weeks after she met him, he quit his job to work alongside her, helping her scale her business and build products that aligned with her mission. 'He can't cook. I can't build an Excel spreadsheet,' she says, adding that she never wanted to license the brand to a third party to manufacture products either. 'I put two really obvious skill sets together, and neither of us had any interest in the other person's job.' Deliciously Ella's first product, a cacao and almond energy ball, was released in 2016, followed by a line of other products. As of print, the brand has sold over 100 million products, and the company's membership, available for $2.74 a month, provides access to thousands of recipes, along with meal plans and blog posts. 'It really kind of coincided with this world of wellness starting to form, and the industry taking shape, and people starting to think, 'oh, there's actual commercial value in this,'' she says. 'I felt almost evangelical, just so passionate, about trying to get this to as many people as possible. I didn't really care how many obstacles there were. I didn't care about the fact that it took over my life completely.' Over a decade later, the importance of lifestyle changes, including diet, exercise, and sleep, in impacting both physical and mental health has become much more mainstream. The craze to limit ultra-processed foods has been featured in headlines, opening up a lane for brands promoting the use of minimal ingredients. Limiting ultra-processed foods has been shown to reduce the risk of chronic conditions like heart disease, diabetes, and early mortality. According to the Cleveland Clinic, diet is an integral pillar, albeit not foolproof, in treatment plans for improving those with POTS. And wellness and lifestyle brands have surged. Companies specializing in healthy eating, nutrition, and weight loss account for $1 trillion of the over $6 trillion wellness industry, a marketplace poised to grow to nearly $9 billion by 2028, according to the Global Wellness Institute. 'I think you have that naive optimism when you start a business. It's so critical because you've got to believe you can do the impossible. But we both just felt like, this is going to be a giant experiment,' she says. 'It was like, how do we create something of meaning, of scale, that's genuinely disruptive to the food industry, but keeping that 100% natural, and never using ultra-processed foods?' Building a brand beyond fads Mills recognizes that if you don't iterate and evolve your brand to meet the demand, you can lose relevancy. However, she didn't want to give in to the latest wellness fads as a way to stay ahead. Deliciously Ella was strategically simple in scope. 'We had a moment where turmeric was everything, where Beyonce wore a kale jumper, and the meat minute boom where the whole world was going to eat Impossible burgers,' she says. 'We're just going to stay in our lane. We've never jumped on any of them.' Mills admits there was a lot of luck to being on the lifestyle train at a time when social media wasn't as noisy and brands were less focused on the harm of ultra-processed foods than they are today. But she credits her success to hustling to create a community of loyal followers and being consistent. 'There are 1,000 more trends that we could jump on, but to me, that isn't a long-term way to build the brand, or actually shift the dial on health,' she says. 'If it doesn't taste good or is way too expensive, it's just not going to stay a part of someone's life.' This story was originally featured on
Medscape
4 days ago
- Health
- Medscape
Rapid Review: Exocrine Pancreatic Insufficiency (EPI)
While historically underdiagnosed, increased awareness and improved diagnostic strategies for exocrine pancreatic insufficiency (EPI) have helped identify patients earlier, thus facilitating more effective management. However, despite advances in treatment modalities, patient outcomes vary considerably due to differences in individual physiology, adherence to treatment regimens, and concurrent health issues. Efforts to address these disparities focus increasingly on personalized medicine, emphasizing the integration of tailored nutritional strategies, patient education, and multidisciplinary care teams to improve patient outcomes comprehensively. Recent guidelines advocate for the prompt initiation of PERT as soon as EPI is diagnosed. Additionally, a multidisciplinary evaluation to assess further nutritional needs and coordination with endocrinologists for the evaluation and treatment of diabetes is also warranted. Untreated EPI can impair growth in pediatric patients, and is associated with a number of clinical symptoms including gastrointestinal effects, osteoporosis, sarcopenia, coagulopathy, neuropathy, and other sequelae related to nutrient deficiency. Although other tests can help in certain cases, EPI can be sufficiently diagnosed with a validated pancreatic function test, and awaiting further confirmatory information such as severe clinical symptoms, positive imaging findings, or documented nutritional deficiencies is not necessary. Learn more about management approaches for EPI. Digestion of fat is a central function of the pancreas, with dysfunction causing deficiency in fat soluble essential vitamins. Although the American Gastroenterological Association (AGA) guidelines recommend a low-to-moderate-fat diet for patients with EPI, they specifically recommend against a very-low fat diet as this can exacerbate deficiencies. Further, meals should be more frequent and smaller, and vitamin and mineral deficiencies should be screened for at diagnosis and annually thereafter. Learn more about diet in EPI. Although fecal fat testing is considered the gold-standard for assessing fecal fat malabsorption, which is a measure of pancreatic dysfunction, it has low specificity for EPI since other diseases can present with steatorrhea. The AGA notes that fecal fat testing is 'rarely needed', it is burdensome (requires a 72 hour stool collection), and can only be done when the patient is on a high-fat diet. Additionally, fecal fat tests are known to be susceptible to false positive results in patients with diarrhea, which is a common symptom of EPI. The AGA recommends fecal elastase as the best test for initial screening, although fecal fat may be useful in cases with inconclusive clinical features and imaging. Learn more about pancreatic function tests. The AGA Clinical Practice Update emphasizes that while cross-sectional imaging — such as CT, MRI, and endoscopic ultrasound — cannot directly diagnose EPI, it plays an essential role in identifying benign and malignant pancreatic diseases that may underlie or contribute to exocrine insufficiency. Imaging can reveal features like advanced calcific chronic pancreatitis, ductal changes, or significant pancreatic atrophy, which correlate with the presence of EPI. However, moderate changes in imaging do not reliably correlate with EPI, and normal imaging is associated with its absence. Although advanced tools like secretin-enhanced MRCP or elastography show promise, current imaging lacks sufficient accuracy to predict EPI on its own. Therefore, imaging should be viewed as a complementary tool in the diagnostic process, providing context about pancreatic structure rather than functional status. For dosing of PERT, the AGA has specific recommendations dependent on fat content of meals and current symptom profile, not imaging findings. Learn more about the multidisciplinary workup for patients with EPI. The latest AGA guidelines emphasize the importance of regular and comprehensive monitoring of nutritional status in all patients with EPI, including regular DEXA scans every 1-2 years. Additionally, baseline and periodic assessment of anthropometric indicators, biochemical markers, and clinical evaluation should be established. DEXA scanning can help to detect sarcopenia, which is possible even in patients with obesity. It can be caused by the nutritional deficits seen in patients with EPI and is associated with increased adverse outcomes and physical disability. The AGA also notes that other muscle mass and function tests can be considered as well. Learn more about the management of patients with EPI.
Medscape
07-07-2025
- Health
- Medscape
Copeptin as a Prognostic Marker in Emergency Hyponatremia
TOPLINE: Measuring copeptin levels in patients with hypotonic hyponatremia on emergency department (ED) admission provided key diagnostic insights. The copeptin to urinary sodium ratio more accurately predicted preserved extracellular fluid (ECF) than urinary sodium alone, and higher copeptin levels were linked to an increased risk for mortality. METHODOLOGY: Hypotonic hyponatremia is frequently observed during hospitalization and can increase the risk for mortality; in this context, copeptin, the C-terminal portion of the arginine vasopressin precursor, has emerged as a valuable marker for predicting complications associated with hypotonic hyponatremia. Researchers reported findings from a prospective cohort study conducted between June 2018 and August 2019 at a hospital in Italy, evaluating the accuracy of copeptin in identifying preserved ECF patterns and its predictive value in critically ill patients admitted to the ED. They included 84 adult patients (median age, 79 years; 47 women), in whom hyponatremia was confirmed by both direct and indirect ion-selective electrode assays after glucose correction; severe hyponatremia was observed in 34.5% of patients. Information on vital signs, ultrasound, medical history, and comorbidities was recorded, and pretreatment blood and urine samples were collected for laboratory analyses. ECF status was reassessed after discharge by three independent endocrinologists; in-hospital mortality and 6-month mortality were also evaluated. TAKEAWAY: Reduced ECF, increased ECF, and preserved ECF were reported in 28 patients each. A ratio of copeptin to urinary sodium of ≤ 29.5 pmol/mmol × 100 increased the likelihood of preserved ECF by more than fourfold (adjusted odds ratio, 4.28; P = .026), outperforming standard urinary sodium measurements (difference in area under the curve when the urinary sodium cut-off was > 30 mmol/L, 0.177; P = .013). Copeptin levels were positively associated with increased risks for in-hospital mortality (P < .0001) and 6-month mortality (P = .02), with levels above 13.6 pmol/L associated with a more than fourfold increased risk for 6-month mortality (hazard ratio, 4.507; P = .0001). Additional predictors of 6-month mortality included levels of N-terminal prohormone of brain natriuretic peptide (P = .031) and comorbidity burden (P = .009). IN PRACTICE: 'It is important to note that our results do not suggest replacing copeptin with other established clinical and biochemical evaluations routinely performed in emergency care, such as s-K [serum potassium] or NT-proBNP [N-terminal prohormone of brain natriuretic peptide] levels, when clinically appropriate. Rather, the aim of adjusting copeptin's predictive value for these common parameters in our analysis was to confirm its independent contribution,' the authors wrote. SOURCE: This study was led by Alessandro Maria Berton, Department of Medical Sciences, University of Turin, Turin, Italy. It was published online in The Journal of Clinical Endocrinology and Metabolism. LIMITATIONS: Patient recruitment was restricted to daytime hours and weekdays, thus limiting the generalizability. Certain analytes were not available for all patients during ED evaluation. Additional urinary parameters such as urine chloride, uric acid fractional excretion, and potassium levels were not compared with the copeptin/urinary sodium index. DISCLOSURES: This study received no specific grant from any funding agency. The authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
The Guardian
15-06-2025
- Health
- The Guardian
One million Australians missing specialist doctor appointments due to cost, report finds
One in 10 Australians pay almost $600 each year to see specialist doctors, with 1 million delaying or skipping appointments due to the cost, according to new analysis. A report by the Grattan Institute, released on Monday, revealed outpatient fees have soared over the past 15 years. The average initial out-of-pocket psychiatrist fee was $671 in 2023, with some 'extreme fee' specialists charging more than triple the scheduled Medicare fee. It found almost 2 million Australians are delaying or skipping specialist appointments each year – about half due to cost – adding pressure to the country's hospital systems. Experts say a lack of regulation of specialist consultation fees and training positions has led to ballooning costs. The report, Special Treatment: Improving Australians' Access to Specialist Care, found one in 10 low-income patients, with weekly household incomes of less than $500 a week, were billed almost $500 a year in out-of-pocket costs. Sign up for Guardian Australia's breaking news email Some specialist doctors charged more than triple the Medicare scheduled fee, the analysis found. The scheduled fee refers to a fixed payment that the federal government will pay the doctor for the service. Of these 'extreme-fee charging' specialists, psychiatrists had the highest average out-of-pocket costs for an initial consultation – $671. This was followed by $372 for endocrinologists and $369 for cardiologists. 'The specialist system isn't working and Australians – especially poorer Australians – are paying the price,' said the lead report author and Grattan Institute health program director, Peter Breadon. Prof Yuting Zhang, an expert in health economics at the University of Melbourne, said a lack of government regulation of doctors' fees had led to increased costs to patients. 'Doctors can charge whatever they like … The fees have gone up quite a lot, especially for specialist fees relative to GP fees,' she said. 'We have seen a huge increase, but also very large variation across doctors, across regions and even across patients. The same doctor could charge differently for different patients coming to see the same service.' Zhang said in other countries with similar universal healthcare models, the government had 'some role' in determining fees. She said high specialist fees led to people skipping appointments and their deteriorating illnesses requiring hospitalisation. 'That costs a lot more, so ideally you don't want people to delay,' she said. 'The worry is it increases the downstream cost.' Zhang said often, patients do not know the total cost prior to seeing a doctor, making it harder for them to make an informed decision. 'It's hard for them to compare. But even if they know the price, it might be hard for them to judge if that price is justifiable,' she said. 'Sometimes people think more expensive means better, which in healthcare, often that's not true.' Dr Elizabeth Deveny, chief executive at peak body Consumer Health Forum of Australia, said consent for fees was mandatory but not enforced. Sign up to Breaking News Australia Get the most important news as it breaks after newsletter promotion 'People shouldn't be hit with surprise bills,' she said. Delaying or avoiding specialist treatment is leading to missed diagnoses and avoidable pain, the report found. Many patients waited months or even years for an appointment. In some parts of Australia, wait times for urgent appointments extend beyond the clinically recommended maximum. The report concluded specialist care in Australia was a 'postcode lottery', with people living in the worst-served areas receiving about a third fewer services than the best-served areas. It said public clinics do not do enough to fill these gaps. Zhang said requiring the federal government to increase the training of more specialist doctors could also ease wait times. She pointed to psychiatry as a specialty plagued by shortages. 'In areas like psychiatry, the government should do something to increase supply.' The report makes five recommendations, including that the federal government withhold Medicare funding from specialists who charge excessive fees and publicly name them. It also recommends governments expand public specialist appointments in areas that get the least care to provide more than 1m services annually, enable GPs to get written advice from specialists to avoid almost 70,000 referrals each and provide $160m to train specialists workforces, with funding linked to specialities with shortages and rural positions. The federal health minister, Mark Butler, said the private health sector, including insurers and specialists, needed to do more to protect patients from exorbitant bills. 'The Albanese Labor government will help Australians find the best value when they need specialist medical advice and treatment, by upgrading the Medical Costs Finder to give more transparency on fees,' he said. 'We are committed to working with consumers, the colleges and private health providers on the design and implementation of this important cost transparency measure.'
