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A Start-Up Suggests a Fix to the Health Care Morass

But perhaps the most interesting and potentially groundbreaking company created in connection with the Affordable Care Act is Aledade, a start-up founded in 2014 by Farzad Mostashari, a doctor and technologist who was the national coordinator for health information technology at the Department of Health and Human Services in the Obama administration.


Dr. Farzad Mostashari, the founder of Aledade, a start-up that seeks to reduce the cost of health care while improving patient treatment.

Andrew Mangum for The New York Times

Aledade, which has raised about $75 million from investors, has an agenda so ambitious it sounds all but impossible: Dr. Mostashari wants to reduce the cost of health care while improving how patients are treated. He also wants to save the independent primary care doctor, whose practices have been battered by the perverse incentives of the American health care system.

And here is the most interesting part: His plan is working.

A few weeks ago, I visited two primary care practices in southeast Kansas that have worked with Aledade for more than a year. Their operations had been thoroughly remade by the company. Thanks to Aledade, the practices’ finances had improved and their patients were healthier. On every significant measure of health care costs, the Aledade method appeared to have reduced wasteful spending.

“The whole idea is to align incentives between society and doctors and patients,” Dr. Mostashari said, adding that Aledade has helped reduce hospital readmissions and decrease visits to specialists in many of its markets. “We’re reducing unnecessary and harmful utilization and improving quality of care.”

Of course, such promises are not new at the intersection of health and technology. Many companies have made big bets and blown up — among them Theranos, the lab testing start-up, which turned out to have been more puffery than product. Aledade faces its own share of hurdles, including whether its investors can ride out a long and costly expansion before it starts to realize any big paydays.

Still, its plan — which mainly involves using software to achieve its goals — looks promising.

The American health care system is a fragmented archipelago, with patients moving through doctors’ offices and hospitals that are often disconnected from one another. As a result, many primary care physicians — who often see themselves as a kind of quarterback who calls the shots on a patient’s care — have no easy way to monitor a patient’s meandering path through the health care system.

Aledade’s software addresses that by collecting patient data from a variety of sources, creating a helicopter view. Doctors can see which specialists a patient has visited, which tests have been ordered, and, crucially, how much the overall care might be costing the health care system.

More important, the software uses the data to assemble a battery of daily checklists for physicians’ practices. These are a set of easy steps for the practice to take — call this patient, order this vaccine — to keep on top of patients’ care, and, in time, to reduce its cost.


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For example, say you’re a doctor at a small practice in rural Kansas and one of your patients, a 67-year-old man with heart disease, has just gone to the emergency room.

“In the past, we’d only find out our patients were at the hospital maybe weeks afterward,” said Dr. Bryan Dennett, who runs the Family Care Center in Winfield, Kan., with medical partner, Dr. Bryan Davis. With Aledade, Dr. Dennett is now alerted immediately, so “we can call them when they’re at the emergency room and say, ‘Hey, what are you doing there? Come back here, we can take care of you!”

It is not just emergency room visits. Aledade tells doctors which of their patients is eligible for preventive care like vaccines or an “annual wellness visit.” The doctors said that during such visits they have discovered several conditions that would have ballooned into much bigger problems without treatment. The software lets doctors know when their patients have been discharged from the hospital, allowing them to schedule “transitional care management” visits.


Dr. Bryan Dennett and Dr. Bryan Davis are now alerted by Aledade to patient problems. “In the past, we’d only find out our patients were at the hospital maybe weeks afterward,” Dr. Dennett said.

Amy Kontras for The New York Times

Such visits are a gimme for the health care system — they have been proved to reduce hospital readmissions (which are extremely costly), and patients say they find them valuable in navigating the health care system. And because these visits are so effective at lowering overall health care costs, Medicare pays doctors a higher rate to provide such care — meaning that primary care doctors can make money by following Aledade’s alerts.

Yet even though Aledade thinks of itself as a technology company, its doctors said its software is the least interesting thing it does. Independent primary care doctors tend to be cautious about technology, especially if it seeks to thoroughly alter how they work. So the real battle Aledade faces is to integrate technology into doctors’ practices — and to do so in an nonintrusive and pleasing way. The software’s instructions must also prove financially rewarding for clinics, while still somehow saving money for the overall health care system.

To do all this, Aledade — which now operates in 15 states and has relationships with more than 1,200 doctors — has had to become more than a software company. It has hired a battalion of field coordinators who visit practices and offer in-depth training and advice.

The company has also taken advantage of several health care ideas that were introduced or accelerated by the Affordable Care Act. One of these is known as the accountable care organization, or A.C.O., which lets groups of health care providers unite to coordinate care for a patient. Studies have shown that such a structure lowers overall medical costs; under the Affordable Care Act, Medicare encouraged the formation of these organizations by promising to share any savings it realizes with doctors. Aledade took the accountable care organization idea and made it its primary business model. (The structure was reaffirmed by a 2015 law passed overwhelmingly by Congress, so a repeal of the Affordable Care Act would not have affected its structure.)


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For Aledade, the upshot is that it will only make a lot of money if it actually succeeds in reducing health care costs.

“Say Medicare thinks that it’s going to spend $100 million next year on our patients in Kansas,” Dr. Mostashari said. “A lot of this is from bad stuff — hospitalization, complications, you know, bad stuff. So we come in and say, if we can work with the primary care doctors to reduce bad things from happening while increasing quality, then we can save money for Medicare. Medicare says we thought we were going to spend $100 million on those patients, and we only spent $90 million. So, Medicare keeps half of the savings, and the other half of it goes to Aledade — which we split with the doctors.”

In addition to Medicare, Aledade has begun signing up several commercial health insurance companies under similar cost-savings plans. But given that the company gets paid only when it cuts health care costs (while improving health outcomes), Aledade and its investors are making a gamble.

In its first year of operation, for instance, Aledade managed to cut many costly procedures, yet its savings did not meet Medicare’s benchmark — meaning it realized virtually no revenue from the savings program.

The results for its second year are due in October. This time, because Aledade said its savings grow over time, the company is likely to begin making money. “We’re very confident in our model,” Dr. Mostashari said.

Email:; Twitter: @fmanjoo

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Sperm Count in Western Men Has Dropped Over 50 Percent Since 1973, Paper Finds

He noted that a 52.4 percent decline in concentration “may sound a lot,” but it represents a change from “normal (99 million sperm per milliliter) to normal (47 million sperm per milliliter).”

Still, Professor Pacey conceded in a recent interview that the new paper piqued his interest and represented “a step forward in the clarity of the data, which might ultimately allow us to define better studies to examine this issue.”

Possible causes

That the downtrend in sperm count is seen in Western countries suggests that “chemicals in commerce” are playing a role, Dr. Swan said.

While this survey did not focus on the causes of these declines, its authors pointed to existing research that showed that exposure to cigarette smoke, alcohol and chemicals while in utero, as well as stress, obesity and age, were factors in the drop.

“If the mother smokes, her son’s sperm count is decreased — that’s been shown in multiple studies,” she said.

A 2005 study, Dr. Swan said, showed that prenatal exposure to phthalates, also called plasticizers, affected the development of sons.


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Phthalates are a group of chemicals used to make plastics more flexible and harder to break. In several studies over the last two decades, they have been shown to disrupt the operation of male hormones like testosterone and have been linked to genital birth defects in male infants.

Dr. Swan, who conducted a 2008 study about phthalate exposure, said that scientists have had the ability to measure exposure to plasticizers only since about 2000, via urine. That has led to a 20-year lag in the process since researchers cannot enroll men to produce sperm until they are in their 20s.

That evidence is the “missing piece of the puzzle,” she said.

Professor Pacey cautions that while the changes in data may be driven by “greater exposure of pregnant women or adult men to more man-made chemicals,” it is too soon draw a conclusion.

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No trend studies were performed in the first half of the 20th century, said Niels Skakkebaek, a reproduction researcher at the University of Copenhagen, but in the 1940s, fertility doctors claimed that men should have at least 60 million sperm per milliliter to be considered normal and that many had more that 100 million per milliliter.

“Nowadays, average young men have 40-50 per milliliter,” he said.

Professor Skakkebaek, an author of a 1992 study that suggested chemicals play a role in the steady decline in semen quality, has since indicated that a rise in abnormal male reproductive systems may be linked to exposures to endocrine-disrupting chemicals.

“We must find out which ones are to blame for the problems with male reproduction, including male infertility and testicular cancer,” Professor Skakkebaek said.

The website for the Centers for Disease Control and Prevention says the effects from low-level exposure to phthalates are unknown, but it acknowledges that some types of phthalates have affected the reproductive system of laboratory animals and that more research is needed. The agency declined to offer further comment.

The National Institutes of Health also declined to comment on the research. The American Society for Reproductive Medicine did not respond to a request for comment.

The practical effects

Professor Skakkebaek pointed to Denmark and Germany as examples of how this course is playing out.


Figure reproduced from N.E. Skakkebaek et al/Physiological Reviews

“In Denmark, 8 percent of all children are now born after assisted reproduction,” he said. “In spite of this activity, the birthrates have for 40 years been significantly below replacement level.”


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“The number of young Germans have already declined 50 percent since the 1960s,” he said, adding that a similar pattern has been seen in Japan, which while not a Western country, is a developed one.


Figure reproduced from N.E. Skakkebaek et al/Physiological Reviews

In the United States, he said, the fertility rate among white people is “below the levels where the population can be sustained.”

Data about assisted pregnancies has been linked to women having children later in life, and in developed nations, statistics have shown that more women are choosing to have fewer (or no) babies, which may also contribute to the fluctuations.

Non-Western men

In the recently released research, no significant decline in sperm quality was seen in men from non-Western countries, but this segment made up only about a quarter of the results.

Dr. Hagai Levine, the head of the Environmental Health Track at the Hebrew University of Jerusalem, who led the team, said that one of the differences between Western and non-Western countries is that man-made chemicals like phthalates “became widespread much earlier in time” in developed nations.

Professor Skakkebaek said that reproductive issues among African men were less common: “It is already known that Africans have significantly lower rates of another testicular problem: testicular cancer.”

A study published last fall that looked at samples from just over 30,600 Chinese men asserted that semen quality and sperm count in the men had declined over a 15-year period ending in 2015 — with the percentage of qualified donors at a Hunan clinic falling from 55.8 percent to 17.8 percent in that time. To qualify, donors need to meet acceptable semen parameters including sperm concentration, sperm motility and semen volume.

“We urgently need international research collaboration to detect the causes,” Professor Skakkebaek said.

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Two human cases of West Nile virus found in Utah, health officials say

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Is Turmeric Good for You? Yes, but It’s Complicated.

Few foodstuffs have had scientists scratching their heads in wonder over its potential more than the widely-lauded spice called turmeric. Native to Southeast Asia and a cousin to ginger, the big fuss isn’t necessarily about the exuberantly-hued turmeric itself, but a component within called curcumin — a phytochemical scientists found to have powerful antioxidant and anti-inflammatory properties with revolutionary healing potential.

As with matcha and coconut oil, two other ingredients of the moment with the wellness set, we set out to understand why turmeric is the ingredient du jour, and whether it’s worth bolting right out to stock some of that orangey goodness in your pantry if you don’t typically have a hankering for Indian food.

A long-celebrated seasoning staple

Regardless of its potential health benefits, turmeric sure does its part in livening up a diet. According to an excerpt gleaned From Traditional Medicine to Modern Medicine, this rich, golden 4000+ year-old spice first grew popular as a culinary spice in India, where most of it is produced and consumed to this day.

While research on nutrition is key to our learnings about how to optimize our diet, you should never base your diet on any one study or one food.

While research on nutrition is key to our learnings about how to optimize our diet, you should never base your diet on any one study or one food.

But you don’t have to go to India to experience it. We’re in the midst of a huge revival, and you can roll right up to any hipster café and order yourself a turmeric ginger latte along with your vegan carob balls. Patricia Bannan, registered dietitian nutritionist and author of Eat Right When Time is Tight, recommends that her clients replace salt with certain spicy herbs and spices like turmeric to help boost weight loss, fight inflammation and lower blood sugar and cholesterol.

“Turmeric makes home cooking more exciting,” she says. “It adds a warm, earthy aroma and flavor to poultry, seafood and vegetable dishes, including curries and chutneys.” She also uses it to liven up her sweet potato soup recipe, or sprinkle on her Vanilla Chia Frozen Affogatos.

Image::Never tried turmeric? Make a pot of this Sweet Potato Turmeric Soup tonight.|||[object Object]

Never tried turmeric? Make a pot of this Sweet Potato Turmeric Soup tonight.
Patricia Bannan

The benefits are awfully promising

It seems Vedic practitioners may, indeed, have been onto something all those years ago when using turmeric medicinally. One comprehensive scientific report published in 2013 compiled the results of a collection of clinical trials of curcumin over the prior 50 years, claiming, to quote, “promising effects” for a long, long, laundry list of ailments, such as cancer, cardiovascular disease, arthritis, uveitis, ulcerative proctitis, Crohn’s disease, ulcerative colitis, irritable bowel disease, tropical pancreatitis, peptic ulcer, gastric ulcer, diabetes…and the list goes on and on. It also says, way back in 1937, curcumin was tested on otherwise healthy people with faulty gallbladders. According to the report, all but one person who took an oral remedy containing the herb for 3 weeks were cured after being observed for the next 3 years. That demonstrates a LOT of potential for a little bitty phytochemical.

Though there’s plenty of evidence on its benefits in the preclinical studies, they haven’t quite gotten to performing as many human studies as they need to understand full well how it works.

Though there’s plenty of evidence on its benefits in the preclinical studies, they haven’t quite gotten to performing as many human studies as they need to understand full well how it works.

It could be a mighty medical multitasker

According to a detailed article compiled over years by experts at the Linus Pauling Institute at Oregon State University, curcumin works in several ways, depending on what it interacts with. Barbara Delage, Ph.D., nutrition scientist with the Linus Pauling Institute’s Micronutrient Information Center and contributing author to the article, explained how a single phytochemical could possibly help with health conditions ranging from Alzheimer’s disease, to cancer to rheumatoid arthritis.

“It has become increasingly clear that oxidative stress and inflammation contribute to the development and/or progression of most (if not all) chronic conditions. This explains why an anti-inflammatory drug that works to treat a specific disease might also help treat other inflammatory conditions,” Delage says.

So how does it work in the body? “Curcumin is versatile. Within cells, it can target specific molecules or pathways that are involved in the control of the cell cycle, inflammation, oxidative stress, etc., depending of the type of cells under scrutiny,” she says, who was also careful to add that, as far as using curcumin to treat these conditions, scientists still have plenty of work to do to wrap their minds around what it can and can’t do.

For example, though there’s plenty of evidence on its benefits in the preclinical studies, they haven’t quite gotten to performing as many human studies as they need to understand full well how it works. Delage also adds that most studies conducted to date on humans have been focused on investigating the efficacy of curcumin in disease management—not disease prevention.

How you reap all those benefits is harder to say

Though curcumin is regarded as safe by the Federal Drug Adminstration and is sold in various formulas far and wide, there are no guidelines established for its intake. When asked if people should consider integrating curcumin, or turmeric, into their daily wellness regimen, it doesn’t always absorb into the body easily and thus, Delage says the jury’s still out on whether it will actually do anything for you.

If you’re bound and determined to experiment with curcumin medicinally, she recommends consulting your doctor — especially if you are already on medication — because preclinical studies have indicated it might change how other medications you use are metabolized in your body. That’s because curcumin supplements also an ingredient called piperine, which boosts the effects of curcumin but also its potential toxicity because it slows down the elimination of the curcumin and prescription drugs used for seizures, high blood pressure, angina and bipolar disorder.

To back her point that more research on people is needed, just this year, one 30-year old woman suffered a fatal outcome after receiving a turmeric-infused IV-drip holistic treatment. San Diego-area news outlet KGTV reported the woman died immediately from a heart attack after having the drip to treat her eczema.

Don’t put all your eggs in the turmeric basket

For dietitians like Bannan, who are always on the lookout for ways to optimize one’s diet, integrating a little turmeric here and there was a no-brainer due to its long history of established research. Yet, she doesn’t feel we should get too obsessed with any one herb or spice in hopes it will cure our ills.

“While research on nutrition is key to our learnings about how to optimize our diet, you should never base your diet on any one study or one food,” she says.

So when it comes to adding curcumin to your daily wellness regimen, Delage’s basic message is to do your homework and proceed with caution — even though all the data out there is mighty compelling. Hopefully, scientists will soon be able to corral all of curcumin’s promise into a revolutionarily helpful reality.

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TO YOUR GOOD HEALTH: Concerning lab results require a physician’s interpretation

DEAR DR. ROACH: I am a white male, 70 years old, over 6 feet tall and weigh 140 pounds. I am healthy except for lymphocytic colitis, which is under control with Imodium. My physical last year included a complete blood count and an automated differential. Everything was good except the RDW. It was 18.7 percent, with a standard range of 11.5 to 14.2 percent. The MCV was 96, and I had no anemia. My primary physician said to not worry about it.

I recently had a pre-op visit for some surgery, and the RDW was 21.1 percent. I asked the surgeon if this was a concern, and he said he did not know and that I should contact my primary again for further analysis. Per the internet (Mayo Clinic, for example), this can be an indication of chronic liver disease or anemia. Should I contact my primary doctor, a specialist or just not worry about it? — L.M.

ANSWER: The RDW is the “red cell distribution width.” It’s a measurement of how similar the cells are in size to each other. A large RDW indicates that there are an unusually large number of cells that are bigger and smaller than the average (which is the MCV, “mean corpuscular volume” — that’s just the red cell again). In people who have vitamin B-12 deficiency, for example, the red cells are abnormally large; in people with low iron, the cells are abnormally small. Someone with both iron deficiency and B-12 deficiency might have a normal MCV but a large RDW.

My experience is that the RDW by itself is not particularly helpful, which is why I suspect your primary doctor isn’t worried about it. With a history of colitis, I would want to be sure you don’t have iron deficiency (iron deficiency can happen before any anemia shows up).

It’s scary to read about the many causes of a finding in your labs, but it’s wise to not get too worried about conditions that you are unlikely to have. It’s not necessary for a physician to chase down every possibility, but they must stay alert for early signs of conditions. Finding that balance is one of the hardest jobs for a clinician.

DEAR DR. ROACH: Over a decade ago, I had a heart attack for which I had a stent put in. I was prescribed Lipitor. I had a bad reaction to Lipitor and was subsequently given Vytorin, which works well. Now I am being changed to rosuvastatin. Will this new drug work as well as the Vytorin? Most important, though, will I have the same side effects as I did with Lipitor — memory problems and soreness? — B.L.

ANSWER: People with blockages in the arteries of the heart, with or without a history of heart attack, surgery or stent, benefit from statin drugs, which reduce the risk of recurrent heart attack and death. Atorvastatin (Lipitor) and rosuvastatin (Crestor) are two of the most potent statin drugs. Vytorin is a combination of simvastatin (Zocor) and a non-statin drug, ezetimibe.

All statin drugs can have side effects. Muscle aches or soreness and memory issues are reported side effects; however, sometimes people get these side effects from one statin but not another. There is no predicting whether the rosuvastatin will cause any problems for you.

I don’t understand why you are switching from a treatment that is working well; I suspect it’s an insurance problem. If so, you may be able to get back on Vytorin if the rosuvastatin doesn’t work. I have had to write similar letters to get medications approved for my own patients.

READERS: Diabetes has become epidemic in North America. The booklet on it provides insight on its diagnosis and treatment. Readers can order a copy by writing:

Dr. Roach

Book No. 402

628 Virginia Dr.

Orlando, FL 32803

Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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Ensuring everyone has opportunities to achieve good health [Commentary]

Part of our series of essays from leaders imagining the future of Columbia.

When Columbia took root 50 years ago, its founders worked with Johns Hopkins and established a group of medical doctors to provide health care to our earliest residents. They emphasized the importance of preventing illness and promoting wellness. They understood that the health of the community is directly intertwined with the health of the people.

As Columbia grows in diversity and density, it is increasingly important that we stay true to these roots while recognizing the community’s changing needs. These changes call for a renewed commitment to building a Howard County that supports good health.

We are one of the nation’s wealthiest and most educated counties – yet despite these factors typically associated with better health, we still face serious health challenges.

Heart Walk Kick-Off encourages healthy living in Santa Maria

A suspicious death investigation is underway in Cayucos after deputies say they approached a parked SUV, smelled something foul coming from it, and found a woman, a girl, and a dead man inside.

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Heart Walk encourages healthy living in Santa Maria – | San Luis Obispo and Santa Barbara Area News

A suspicious death investigation is underway in Cayucos after deputies say they approached a parked SUV, smelled something foul coming from it, and found a woman, a girl, and a dead man inside.

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Healthy Living: Customizing granola


Leia Flure Registered Dietician joins us today to make customized granola. 

Homemade granola is easy, delicious, and completely customizable. You can have more control over the ingredients that go in it – from the type of dried fruit and nuts to the amount of sugar and fat. Plus, the taste can’t be beat!


Leia’s Basic Granola

Makes about 5 cups



· 1 cup chopped nuts/seeds (e.g., pecans, walnuts, slivered almonds, sunflower seeds, peanuts, etc.)

· 1 cup bite-sized dried fruit (e.g., raisins, apricots, cherries, cranberries, blueberries, etc.)

· 2 ½ cups old-fashioned oats (also called rolled oats)

· 1/3 cup – ½ cup honey or maple syrup

· ¼-1/3 cup vegetable oil or melted butter



1. Preheat oven to 300 degrees F. Line a large rimmed baking sheet with parchment paper or aluminum foil.

2. In a large bowl, combine nuts/seeds, dried fruit, and oats.

3. In a glass measuring cup or small bowl, whisk together honey or maple syrup with the oil or melted butter. Pour over dry ingredients and stir to combine and coat.

4. Spread mixture in an even layer on the prepared baking sheet.

5. Bake for 25-30 minutes, stirring every 10 minutes or so. (Baking longer will cause granola to get crunchier, but be careful not to let it burn!)

6. Once granola is golden brown or desired color, remove from oven and let cool in pan. Break into pieces once it has cooled. Store in an airtight container in the refrigerator.


Serving suggestions and tips:

· Enjoy as a topping on yogurt, eat as a cold cereal with milk, or eat out of hand for a quick snack.

· Remember that granola is very concentrated in calories, so portion control is important!

o Recommended portions:

§ Top yogurt with 2 tablespoons of granola (70 calories)

§ ¼ cup for a snack (140 calories)

§ 2/3 cup with low-fat milk (370 calories, not including milk)

· Total calories, carbohydrates, and fat will be lower when you use the smaller amounts of sweetener and oil/butter. You can also increase the ratio of oats to nuts, but this will increase the carbohydrate count while decreasing fat and protein.


Nutrition Facts (1/4 cup; based on using ½ cup maple syrup and 1/3 cup melted butter): 140 calories, 7 g total fat, 8 mg cholesterol, 23 mg sodium, 18 g total carbohydrate, 2 g dietary fiber, 3 g protein

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Increase your intake of iron, calcium: 5 tips for healthy nails

Increase your intake of iron, calcium and massage your nails with olive oil to keep your nails healthy, say experts.

Ishika Taneja, Executive Director Alps Group, and Ragini Mehra, founder, Beauty Source, list down some tips to keep nails healthy. Follow these on a regular basis, and we’re sure you shall have healthy, shiny nails in no time!

1. Continuous applications of nail polish make nails go dull. Rub lemon at least thrice in a week to get rid of yellowness.

2. You can also massage your nails every alternative day for about three to five minutes with olive or coconut oil to add moisture to them. Repeat the process and you’ll restore shine within a few days.

3. Nails tend to get dry when exposed to water repeatedly. So, to lock in the natural moisture of the nails, simply massage your nails with any good quality oil every day to prevent your nails from getting dry and brittle. You can apply lukewarm oil and leave overnight. It softens the nails and cuticles and moisturise your hands.

4. Increase your intake of iron, calcium, zinc, and vitamins A, C, D and E. All these nutrients are essential for healthy and shiny nails. One of the most common items that has all these ingredients is yogurt. Also, eat foods rich in protein to give your nails the essential strength, health, and shine because nails are made up of the structural proteins known as keratin.

5. Practice good nail hygiene. Keep fingernails dry and clean. Avoid using chemicals on your nails.

Follow @htlifeandstyle for more

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