Author Archives: dnaserver

Men's Health

What are the risk factors for prostate cancer?

Posted on by dnaserver

Prostate cancer affects about 13 out of every 100 American men, and 2–3 of these men will die from prostate cancer. So there is a high chance that you know someone who has been affected. Maybe it was someone close to you or maybe you’re concerned about your own risk. There are many different factors that contribute to an increased risk of prostate cancer, some of which cannot be changed (e.g., age), while other factors can be changed (e.g., smoking).

What is prostate cancer?
Prostate cancer occurs when malignant cells start growing out of control in the prostate, a small gland that helps make semen. Prostate cancer can cause a range of symptoms, including difficulty urinating, frequent urination, painful urination and ejaculation, blood in the urine or semen, and pain in the back, hips, or pelvis (1). However, it is important to note that these symptoms can also be caused by other issues, such as benign prostatic hyperplasia and bacterial prostatitis. For more information about other possible causes of an enlarged prostate, see our previous article here.

What are the known risk factors for prostate cancer?

  • Age is the most common risk factor for prostate cancer, with the chance of prostate cancer rising rapidly after 50 years of age. In fact, about 60% of prostate cancers are found in men over 60 years (2).
  • Race/ethnicity affects the risk of prostate cancer. In America, prostate cancer is more common in African American men and in Caribbean men of African ancestry. In addition, it tends to appear at a younger age in these ethnicities. It is currently unknown why these risk differences are present (2).
  • Where you live in the world also affects your risk, as prostate cancer is more common in North America, northwestern Europe, Australia, and on Caribbean islands. Again, the reasons for this increased risk are not clear, although lifestyle factors (e.g., diet) are thought to play a role (2).
  • Genetic factors are associated with an increased risk, such as inherited variants in the BRCA1 and BRCA2 genes (which are more commonly known to increase the risk of breast cancer) (2).
  • A family history of prostate cancer (e.g., affected brother or father) can more than double the risk, suggesting other inherited genetic factors play a role (2).

What other possible risk factors for prostate cancer are there?

  • Dietary differences may play a role, as there appears to be a slightly higher risk in men who eat a lot of dairy products (2).
  • Obesity may play a role, but studies have come to differing conclusions on the impact of body weight for the risk or prostate cancer (2).
  • Smoking has been shown in some studies to influence the risk of prostate cancer, but other studies did not reach the same conclusions. However, there is increasing evidence that smoking can increase the risk of dying from prostate cancer (2).
  • Chemical exposures may increase the risk of prostate cancer. However, further research is required to confirm these associations (2).
  • Having a vasectomy may slightly increase the risk, but further research is required to confirm this (2).

What are ways to reduce the risk of prostate cancer?
Unfortunately, many of the risk factors for prostate cancer cannot be changed, and further research is required to confirm the risks associated with the modifiable risk factors. However, routine screening is still the most effective way to reduce the chance of serious or fatal complications from prostate cancer, especially because early prostate cancer (when it is easier to treat) doesn’t usually cause any symptoms (3).

Screening for prostate cancer may include a prostate specific antigen (PSA) test, such as the one offered here. Elevated PSA can be indicative of prostate cancer, but may also occur due to benign (non-cancerous) conditions. More info about PSA is available here.

Another screening option is a digital rectal examination (DRE) when a health care provider inserts a gloved, lubricated finger into the rectum to feel the prostate. However, this is not recommended as an initial screening method by the US Preventive Services Task Force (1).

If the PSA test and/or DRE are indicating prostate abnormalities, additional diagnostic tests can be conducted, including an ultrasound and a prostate biopsy. The biopsy involves the removal of prostate tissue for examination under a microscope to detect cancer cells (1).

How is prostate cancer treated?
Treatment options for prostate cancer vary depending on the cancer stage and if it has spread elsewhere in the body. If it is determined that the cancer is unlikely to grow quickly and there are no symptoms, no treatment may occur. Instead, the affected person is closely monitored with more frequent PSA tests and prostate biopsies (1).

Other treatment options include surgery to remove the prostate (as well as surrounding tissues if necessary) and radiation therapy to kill the cancer cells. There are also several treatment options currently undergoing investigation, including cryotherapy, chemotherapy, high-intensity focused ultrasound, and hormone therapy (1).

References:
1. Prostate Cancer, Basic Information. (Reviewed August 2021). CDC.
2. Prostate Cancer Risk Factors. (Revised June 2020). American Cancer Society.
3. What is Prostate Cancer? (Revised August 2019). American Cancer Society.

Inflammation and Stress

What can cause low cortisol levels?

Posted on by dnaserver

Cortisol is a steroid hormone that has many important roles in the body, including of course its most well-known role as part of the stress response. Receptors that cortisol can bind to are found in almost all tissues in the body, which means that cortisol is able to affect nearly every organ system (1).

What are the functions of cortisol?

  • Controls the inflammatory response in an immune response
  • Cortisol surge helps provide energy during stressful situations
  • Role in the metabolism of fats, protein, and carbohydrates
  • Helps control blood pressure and salt and water balance
  • Involved in memory formation
  • Enhances the activity of epinephrine (adrenalin)
  • Supports developing fetus during pregnancy

How are cortisol levels controlled?
Cortisol is synthesized from cholesterol in the adrenal glands, with secretion controlled by the HPA axis. The HPA axis is a combination of glands that includes the hypothalamus, the pituitary gland, and the adrenal gland. This HPA axis follows a circadian rhythm, which means that cortisol levels are generally higher in the morning and lower at night (1).

When the hypothalamus detects low cortisol, low blood sugar, or times of stress, it releases corticotropin-releasing hormone (CRH), which signals for the pituitary to release adrenocorticotropic hormone (ACTH). ACTH then acts on the adrenal gland to trigger the synthesis and secretion of cortisol. Elevated cortisol levels inhibit the release of CRH and ACTH, providing a negative feedback loop to control cortisol levels (1).

What can cause low cortisol levels?
Low cortisol can be caused by different abnormalities in the HPA axis.

Primary adrenal insufficiency (Addison disease) is when there is an issue with the adrenal gland that inhibits cortisol production and release. This is most commonly caused by an autoimmune reaction (where the body’s own cells target and destroy cells in the adrenal gland), but can also be due to cancer, an infection (e.g., tuberculosis, AIDS, syphilis), an inherited disorder, drug use, or some other disease (2). Damage to the adrenal gland cells also affects the production of mineralocorticoids (e.g., aldosterone that control blood pressure) and sex hormones (e.g., testosterone and estrogen that are produced in low levels in the adrenal gland) (3).

Secondary adrenal insufficiency occurs when the pituitary gland does not produce enough ACTH; hence there is reduced stimulation of the adrenal gland and less cortisol produced. This is commonly caused by chronic exogenous glucocorticoid use but can also be due to pituitary disease, pituitary tumors or trauma, other infections (e.g., meningitis), or genetic disorders (1,2).

Tertiary adrenal insufficiency is an abnormality one step further back when the hypothalamus does not release enough CRH, therefore less stimulation of the pituitary gland, and subsequently less stimulation of the adrenal gland and less cortisol produced. It is most commonly caused by chronic exogenous glucocorticoid use, and can also be due to hypothalamic tumors, infections, and trauma (2).

What are the symptoms of low cortisol?
Generally, the symptoms of low cortisol are quite similar regardless of the cause (2). Symptoms can include:

  • Weakness
  • Fatigue
  • Weight loss and anorexia
  • Abdominal pain
  • Low blood pressure
  • Salt craving
  • Nausea
  • Vomiting
  • Diarrhea (may alternate with constipation)
  • Diminished sex drive
  • Menstruation may stop in women
  • Less pubic hair
  • Low blood sugar

Primary adrenal insufficiency is also characterized by hyperpigmentation of the skin. This is due to increased production and secretion of ACTH from the pituitary gland, as there is not enough cortisol present for the negative feedback loop to be working effectively. This hyperpigmentation does not occur in secondary and tertiary adrenal insufficiency as ACTH production is not increased (2).

The onset of adrenal insufficiency is often gradual, particularly for primary adrenal insufficiency, when more than 90% of the adrenocortical tissue is lost before symptoms occur. Often an illness or some other stress is what triggers an adrenal crisis, typically characterized by shock, and then other symptoms also become apparent (2).

How is adrenal insufficiency diagnosed?
There are three parts to an adrenal insufficiency diagnosis:

  • Demonstrating low cortisol levels: Serum cortisol levels < 3 µg/dL (80 nmol/L) at 8 am are strongly suggestive of adrenal insufficiency, while <10 µg/dL (275 nmol/L) make the diagnosis likely. Low salivary cortisol can also be used for a diagnosis (2). We offer a test of serum cortisol levels from a self-collected finger-prick blood sample. Our cortisol test is available here.
  • Determining whether the cortisol deficiency is due to primary, secondary, or tertiary adrenal insufficiency: This involves various different analyses, including measuring ACTH and CRH levels, and insulin tolerance tests (2).
  • Determining the cause: Again, various different analyses may be required here, including autoantibody screens and CT and MRI imaging (2).

References:
1. Thau L, et al. Physiology, Cortisol. StatPearls [Internet].
2. Nicolaides NC, et al. Adrenal Insufficiency. Endotext [Internet].
3. Grossman AB. (Reviewed Oct 2020). Addison Disease. Merck Manual Consumer Version.

Related Tests

Vitamins and Minerals

Are there links between low vitamin D and depression?

Posted on by dnaserver

Vitamin D is commonly known as the “sunshine vitamin” because we are able to synthesize vitamin D when our skin is exposed to sunlight. Vitamin D is important for healthy bones and muscles, a good immune system, glucose metabolism, and cell growth. But there are more than just the physical benefits of vitamin D, as this important vitamin also plays a role in mental health and cognitive function (1).

This article focuses on the links between low vitamin D and depression. For more information about vitamin D, see our previous articles:

What is depression?
Depression is also known as major depressive disorder. It is a common medical illness that is estimated to affect 1 in 6 people at some point in their life (2). Symptoms can range from mild to severe and can include:

  • Feelings of sadness
  • Losing interest in activities that previously enjoyed
  • Appetite changes along with weight changes
  • Changes in sleeping patterns (increased sleep or difficulties sleeping)
  • Lack of energy
  • Fatigue
  • More purposeless activity (e.g., pacing, handwringing)
  • Slowed movements or speech
  • Feelings of guilt or worthlessness
  • Difficulty concentrating and making decisions
  • Contemplating suicide

What evidence is there linking low vitamin D to depression?
Evidence has been shown in many studies that there is an association between low vitamin D and an increased risk of depression.

These studies have included large meta-analyses, such as a 2013 study of 31,424 participants, which showed lower vitamin D levels were found in people with depression compared to controls and an increased odds ratio of depression for the lowest versus highest vitamin D categories (3).

Another study published in 2014, analyzed 1892 participants in the Netherlands Study of Depression and Anxiety showed that low vitamin D levels were associated with the presence and severity of depressive disorder suggesting that low vitamin D may represent an underlying biological vulnerability for depression (4).

A 2017 review article examined multiple different studies to also reach the conclusion that there is an association between low vitamin D and depression. This article also discusses a link between vitamin D and Seasonal Affective Disorder (SAD), which is a depressive subtype characterized by symptoms that occur in the darkest time of the year (5).

A recent review article (January 2020) again found an inverse correlation between vitamin D levels and clinical depression (6). There have been a number of other studies that have also been published in recent years, each finding an association to some degree between low vitamin D and the risk of depression. However, whether this relationship is causal (i.e. low vitamin D causes depression) remains to be confirmed.

Are vitamin D supplements effective for treating depression?
Despite the increasing evidence supporting an association between low vitamin D and depression, there are conflicting results about whether or not vitamin D supplements are beneficial for reducing the risk and treating depression. This is likely because the actual relationship between vitamin D and depression has yet to be confirmed. It is likely that low vitamin D doesn’t actually cause depression, but maybe low vitamin D could be considered as a marker of depression, and other factors are also involved.

A recent clinical trial (published August 2020) investigated whether long-term supplementation with vitamin D3 could prevent depression in the general adult population. The study followed 18,353 adults for five years to see if there was a difference in rates of depression in those receiving a vitamin D3 supplement compared to those receiving a placebo. The results from this trial do not support the use of vitamin D3 in adults to prevent depression (7).

Another study in 2013 showed that daily vitamin D3 supplementation for 6 months did not provide a reduction in symptoms of depression (8).

However, a small November 2020 study found that a single parenteral administration of high-dose vitamin D was associated with significant improvements in depression over 12 weeks in individuals that had both major depression and vitamin D deficiency (9). This small study does have some limitations (e.g., small sample size and a single-center design); however, it does illustrate the there may be a vitamin D supplementation approach that is beneficial to treat depression.

How can I measure my vitamin D levels?
Checking your vitamin D levels is quick and simple. It just requires a simple finger prick blood sample with our Vitamin D Test. This test measures your blood concentration of 25-OH vitamin D, which is the main indicator of vitamin D status. This test can tell you if your levels are in the healthy optimal range, or if you have mild to moderate deficiency, or if you have a severe deficiency. It can also detect vitamin D levels that are too high (vitamin D toxicity), which can occur in people who take an excessive amount of vitamin D supplements.

References:
1. Jones G. (2014). Vitamin D. In A. C. Ross, et al., Modern Nutrition in Health and Disease (11th ed). Philadelphia: Lippincott Williams & Wilkins.
2. What is Depression? American Psychiatric Association.
3. Anglin RES, et al. (2013) Vitamin D deficiency and depression in adults: Systematic review and meta-analysis. British J Psychiatry, 202(2): 100-107.
4. Milaneschi Y, et al. (2014). The association between low vitamin D and depressive disorders. Mol Psychiatry 19: 444–451.
5. Parker GB, et al. (2017). Vitamin D and depression. J Affect Disord. 208: 56-61.
6. Menon V, et al. (2020). Vitamin D and depression: A critical appraisal of the evidence and future directions. Indian J Psychol Med. 42(1): 11-21.
7. Okereke OI, et al. (2020). Effect of long-term vitamin D3 supplementation vs placebo on risk of depression or clinically relevant depressive symptoms and on change in mood scores. A randomized clinical trial. JAMA. 324(5): 471-480.
8. Hansen JP, et al. (2019). Vitamin D3 supplementation and treatment outcomes in patients with depression (D3-vit-dep). BMC Res Notes12(203).
9. Vellekkatt F, et al. (2020). Effect of adjunctive single dose parenteral Vitamin D supplementation in major depressive disorder with concurrent vitamin D deficiency: A double-blind randomized placebo-controlled trial. J Psychiatr Res. 129: 250-256.

Heart Health and Diabetes

What are the risk factors for type 2 diabetes?

Posted on by dnaserver

Type 2 diabetes is by far the most common form of diabetes, accounting for 90–95% of all diabetics. Type 2 diabetics cannot use insulin efficiently and therefore cannot keep their blood sugar at normal levels.

For more information about type 2 diabetes, see “Type 2 Diabetes Quick Facts“. In this article, we discuss in more detail the factors that are associated with an increased risk of type 2 diabetes.

Obesity and fat distribution
People who are carrying excess body weight have a higher risk of type 2 diabetes. This is especially true if that extra fat is predominantly around in the abdomen (1). Obesity is classed as having a body mass index (BMI) of 30 or more, but even individuals with a BMI of 25–29.9 (overweight) are still at risk of type 2 diabetes. Calculate your BMI using this simple online calculator to see if you should lose a few pounds.

Family history of type 2 diabetes
A family history of type 2 diabetes is associated with an increased risk of disease, partly due to inherited genetic variants and also related to lifestyle influences (e.g., eating and exercise habits). There is no clear pattern of inheritance for type 2 diabetes because multiple different genetic variants all play a role (2).

High blood pressure
High blood pressure is linked to an increased risk of type 2 diabetes. Having type 2 diabetes is also linked to an increased risk of high blood pressure. The combination of both type 2 diabetes and high blood pressure significantly increases the risk of diabetic complications as well as cardiovascular health issues (3).

Altered lipid levels
Low levels of “good” HDL cholesterol and high levels of triglycerides are associated with an increased risk of type 2 diabetes. This increased risk occurs even when there are normal levels of “bad” LDL cholesterol (4).

Lack of physical activity
Physical activity is important for maintaining a healthy weight, using up extra glucose, and increasing cell responses to insulin. Therefore, those that are not getting enough exercise are at increased risk of type 2 diabetes, by not only increasing their risk of obesity but also influencing how their body responds to insulin (5).

Smoking
Smokers are 30–40% more likely to develop type 2 diabetes compared to non-smokers. High levels of nicotine can lessen the effects of insulin, meaning that smokers have to produce more insulin to get a proper response (6). Smoking is also associated with a higher likelihood of the serious health complications of diabetes, including heart disease, kidney disease, infections, ulcers, and eye problems (7).

Gestational diabetes
Gestational diabetes is a type of diabetes that develops during pregnancy, but blood sugar levels usually return to normal after delivery. However, about 50% of women with gestational diabetes go on to develop type 2 diabetes later in life. Gestational diabetes also increases the risk of the baby developing type 2 diabetes later in life too (8).

Prediabetes
A diagnosis of prediabetes means blood sugar (glucose) levels are above the normal range but are not considered high enough to be diabetes. However, prediabetes is taking a step in the wrong direction in regards to metabolic health. People with prediabetes have an increased risk of developing type 2 diabetes. The good news is, prediabetes can be reversed before developing any health complications associated with diabetes. See our previous article here for more information about prediabetes.

Race and ethnicity
People of certain races and ethnicities have an increased risk of type 2 diabetes, although the reasoning for this increased risk is still not fully understood. Races and ethnicities with an increased risk include African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, and Pacific Islander (1).

Age
Type 2 diabetes develops over many years, as the body struggles more and more to control the high level of glucose in the blood, combined with increasing insulin resistance as well as impaired pancreatic islet function with aging. The pancreatic islet cells are where insulin, the hormone that controls blood sugar, is produced. Therefore, increasing age is associated with an increased risk of type 2 diabetes, particularly after 45 years of age (9).

Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a common cause of female infertility. Affected women may have elevated androgen levels (hyperandrogenemia) and/or small cysts on one or both ovaries (polycystic ovaries) (10). Women with PCOS are often insulin resistant, meaning that their body is not effectively using insulin. This increases the risk of type 2 diabetes, with more than half of women with PCOS developing type 2 diabetes by 40 years of age (11). See our previous article here for more information about PCOS.

Depression
Depression is a risk factor for type 2 diabetes, with comparable importance to smoking and physical inactivity (12). Studies have also shown that more severe depression is associated with a higher risk of type 2 diabetes. In addition, type 2 diabetics have an increased risk of depression (13).

Areas of darkened skin
Areas of darkened skin, known as acanthosis nigricans, are a strong predictor for future diabetes. This is because excess insulin stimulates normal skin cells to reproduce at a rapid rate and these new skin cells contain more melanin so appear darker than the surrounding skin (14).

How is type 2 diabetes diagnosed?
Type 2 diabetes is diagnosed by measuring blood sugar (glucose) levels. The most effective method for this is with an HbA1c test, which is available here. HbA1c is glycated hemoglobin. It forms when hemoglobin within red blood cells joins with glucose. HbA1c levels reflect the average blood glucose level during the preceding 2-3 months. This differs from a blood glucose test, which measures the concentration of glucose at only the point at which the blood sample was collected.

  • Healthy HbA1c levels are less than 5.7%
  • 5.7% – 6.4% indicates prediabetes (increased risk of developing diabetes)
  • >6.5% supports a diabetes diagnosis

How can type 2 diabetes be prevented and treated?
Simple, proven lifestyle changes can help prevent or delay the onset of type 2 diabetes. These include losing excess body weight, eating healthier (especially reducing sugar and carbohydrate intake), and getting regular physical exercise. There are also different medication options available to help lower blood sugar levels. Read our previous article here for more tips to lower your blood sugar.

References:
1. Risk Factors for Type 2 Diabetes. (Reviewed Dec 2016). NIH, National Institute of Diabetes and Digestive and Kidney Diseases.
2. Ali O. (2013). Genetics of type 2 diabetes. World J Diabetes. 4(4): 114-123.
3. Golden SH, et al. (2003). Blood pressure in young adulthood and the risk of type 2 diabetes in middle age. Diabetes Care. 26(4): 1110–1115.
4. Krauss RM. (2004). Lipids and lipoproteins in patients with type 2 diabetes. Diabetes Care. 27(6): 1496–1504.
5. Venkatasamy VV, et al. (2013). Effect of physical activity on insulin resistance, inflammation and oxidative stress in diabetes mellitus. J Clin Diagn Res. 7(8): 1764–1766.
6. Cigarette smoking: A risk factor for type 2 diabetes. FDA.
7. Smoking and Diabetes. (Reviewed August 2021). CDC.
8. Gestational Diabetes. (Reviewed August 2021). CDC.
9. Kirkman MS, et al. (2012). Diabetes in older adults. Diabetes Care. 35(12): 2650–2664.
10. Ndefo UA et al. (2013) Polycystic Ovary Syndrome. Pharmacy and Therapeutics. 38(6): 348-355.
11. PCOS (Polycystic Ovary Syndrome) and Diabetes. (Reviewed March 2020). CDC.
12. Knol MJ et al. (2006) Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia. 49: 837–845.
13. Deleskog A, et al. (2019). Severity of depression, anxious distress and the risk of type 2 diabetes – a population-based cohort study in Sweden. BMC Public Health. 19, 1174.
14. Barwell J, Reviewed by Cobb C. (2019). Acanthosis Nigricans. Healthline.

HPV

Are all HPV types associated with an increased risk of cervical cancer?

Posted on by dnaserver

No, there are more than 100 genotypes of HPV but only 14 are considered high-risk for cervical cancer.

What exactly is cervical cancer?
Cervical cancer occurs when malignant (cancer) cells form in the tissues of the cervix. The cervix is the lower, narrow end of the uterus (womb where a fetus grows). It connects the vagina (birth canal) to the upper part of the uterus (1). More information about cervical cancer is available here.

What is HPV?
Human papillomavirus (HPV) is a common sexually transmitted DNA virus. It is transmitted through vaginal, anal, or oral sex, and can be spread even when an infected individual does not show any symptoms. It is the most common sexually transmitted disease in the United States, with an estimated 43 million HPV cases in 2018. Almost every non-vaccinated sexually active individual will get HPV at some time in his or her life (2). See our previous article “HPV Quick Facts” for more information.

Which HPV genotypes are associated with an increased risk of cervical cancer?
Genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68 are considered “high-risk” genotypes. Nearly all cervical cancers are caused by a persistent infection with one of these genotypes. The persistent viral infection can cause changes in the cervical cells, called dysplasia. Although dysplasia itself is not cancer, it can sometimes become cancer (3).

Do the other genotypes cause any health issues?
Some HPV types infect mucosal surfaces, including the “high-risk” types mentioned above, as well as “low-risk” types, which are not linked to cancer risk but can cause genital warts and papillomas (warts) in other mucosal areas (e.g., respiratory tract) instead. Other HPV types are considered cutaneous types as they infect the skin and cause “common” warts on the skin instead, most commonly the hands and feet (4).

Is there a test for HPV?
There are no tests to find out a person’s “HPV status”, as there are so many different types of HPV. However, nucleic acid tests (such as this one) are available to accurately identify individuals who are infected with one of the 14 high-risk HPV strains. Detection of HPV nucleic acid (a positive test result) is indicative of an active HPV infection but does not mean that cervical dysplasia or cervical cancer is present.

Trying to decide if you should take an HPV? Read our previous article “Why should I take an HPV test?” to learn all about the health benefits.

How can I protect myself from HPV?
Anybody who is sexually active is at risk of catching HPV, as HPV is a very common sexually transmitted infection.

Using condoms correctly lowers the risk of catching HPV, but HPV can still infect areas that are not covered by a condom, so condoms do not provide full protection.

HPV vaccination is safe and effective to prevent diseases (including cancer) caused by HPV. It is recommended at age 11 or 12 years, and for everyone through to 26 years, if not vaccinated already. Vaccination for individuals older than 26 years provides less benefit, as most sexually active adults have already been exposed to HPV (2).

Routine screening for cervical cancer with pap smears is also recommended for women aged 21–65 years (2). 

References:
1. Basic information about cervical cancer. CDC. Reviewed Jan 2021.
2. Genital HPV Infection – Fact Sheet. (2021, January). CDC.
3. Cuschieri KS, Whitley MJ, & Cubie HA. (2004). Human papillomavirus type-specific DNA and RNA persistence–implications for cervical disease progression and monitoring. J Med Virol, 73 (1), 65-70.
4. Cervical Cancer. WHO.
5. HPV and HPV Testing. (Revised July 2020). American Cancer Society. 

Posted in HPV
Men's Health, Women's Health

Testing your estradiol level is quick and easy

Posted on by dnaserver

Estradiol is the strongest of the three estrogen hormones and is one of the most important hormones in a woman for a healthy and normal menstrual cycle, ovulation, and fertility. Estradiol is naturally produced in both genders with much higher levels in females. It is predominantly produced within the ovarian follicles, but also in other tissues, such as the adrenal glands, fat, liver, breasts, brain, testes, and placenta (during pregnancy) (1).

Abnormal estradiol levels can lead to health issues in both males and females. Symptoms of high estradiol can include:

  • Acne
  • Constipation
  • Diminished sex drive
  • Depression
  • Weight gain
  • Fertility issues
  • Increased cancer risks (e.g., breast and uterine cancers)
  • Development of breast tissue in males

Symptoms of low estradiol can include:

  • Skeletal issues (e.g., osteoporosis)
  • Delayed puberty in females
  • Depression
  • Fatigue
  • Mood swings

Testing your estradiol levels is quick and easy

We offer several different tests to measure your estradiol levels. These tests just require a small blood sample collected from a simple finger prick in the privacy of your own home. Test results are available through our online portal, thereby avoiding the need to make any doctor or lab appointments. Of course, you may also wish to discuss your results with your healthcare professional, and this is highly recommended if you receive any results that fall outside the normal range.

The Estradiol (E2) test measures just your estradiol levels. For females of reproductive age, it is helpful to know what stage of your menstrual cycle your sample was collected at, as normal levels vary throughout each cycle.

There are various combination tests available for females that include estradiol along with other important hormones:

Males may wish to order the Estradiol (E2) test (estradiol alone) or the Men’s Health Hormone Panel (6 biomarkers), which includes estradiol along with other hormones that are important for male health.

References:
1. Oestradiol. You and your Hormones, an education resource from the Society for Endocrinology. Reviewed Mar 2018.

Sexual Health

Are STDs during pregnancy dangerous?

Posted on by dnaserver

Sexually transmitted diseases (STDs) can complicate pregnancy and may cause serious health complications for both a woman and her unborn child. Some STDs are curable, while others are not, but treatment and prevention options are still available. In this article, we will discuss the risks associated with various STDs and ways that these risks can be reduced.

Chlamydia and Gonorrhea:
Chlamydia and gonorrhea are both caused by bacterial infections. Most infected people do not show any symptoms, but there is still a health risk during pregnancy. Both of these STDs can cause ectopic pregnancy (1), which is when a fertilized egg implants itself outside of the womb, usually in one of the fallopian tubes. This egg will not develop into a baby and a woman’s health may be at risk if the pregnancy continues.

Untreated chlamydia and gonorrhea can also develop into pelvic inflammatory disease (PID). This is an infection of a female’s reproductive organs and can cause long-term pelvic/abdominal pain, infertility, and an increased risk of ectopic pregnancy (2). See our previous article for more information about the long-term complications of chlamydia.

Gonorrhea during pregnancy is also associated with premature birth and stillbirth (1).

Chlamydia and gonorrhea can transfer from the mother to the baby during delivery, which can lead to eye infections (both), as well as pneumonia (for chlamydia) (1).

Antibiotics are an effective treatment for chlamydia and gonorrhea for both mother and baby (1).

Trichomoniasis
Trichomoniasis is caused by an infection with a protozoan parasite. The majority of infected people do not show any symptoms; however, an untreated infection can cause fallopian tube damage, as well as increase the risk of premature birth and low birth weight (1).

Antibiotics are an effective treatment for trichomoniasis for both mother and baby (1).

Syphilis
Syphilis is caused by a bacterial infection. It has four distinct stages, each with different symptoms. See our previous article here for more information about the four stages of syphilis.

Syphilis during pregnancy can result in miscarriage, stillbirth, or infant death shortly after delivery in up to 40% of cases (3). There is also about a 70% chance of an untreated woman passing syphilis to her fetus resulting in congenital syphilis (4). Congenital syphilis can result in serious health complications, including enlargement of the liver and spleen, rashes, fever, neurosyphilis, lung inflammation (5), developmental delays, seizures, and other fatal complications (6). See our previous article here for more information about congenital syphilis.

Penicillin is the most effective treatment for both mother and baby. Routine screening during pregnancy and prompt treatment is the preferred option to prevent transmission to the fetus. If a child is born with syphilis, treatment must begin immediately to prevent serious complications (6).

Human Papillomavirus (HPV)
HPV is a very common STD. Many people do not show any symptoms and effectively clear infection within 6–12 months (7). However, some HPV genotypes can lead to genital warts, while other genotypes can cause cell changes that lead to cervical cancer (8).

Genital warts that form in the birth canal can cause complications during delivery. In very rare cases, the virus may also be transmitted to the baby during delivery, and potentially cause warts in the newborn’s throat which will require surgery (1).

Wart treatment in the mother is possible during pregnancy (1). There is also a vaccine available for HPV, which is recommended at age 11 or 12 years, and for everyone through to 26 years, if not vaccinated already. Vaccination for individuals older than 26 years provides less benefit, as most sexually active adults have already been exposed to HPV (9).

Hepatitis B
Hepatitis B is caused by a viral infection that can spread from mother to child at birth (perinatal transmission), as well as through blood (e.g., sharing needles), and sexual contact. Many people with an acute (short-term) infection remain asymptomatic, while others can experience a range of symptoms, including yellowing of the skin or eyes, nausea, and fatigue. Chronic (long-term) infection is common in infants and young children, but rare in adults. Chronic infection can lead to liver cirrhosis and liver cancer (10).

About 90% of pregnant women with an acute hepatitis B infection and 10–20% of pregnant women with chronic infection will pass the virus to their babies. If the perinatal transmission is a risk, the baby must receive their first hepatitis B vaccine dose, along with a dose of HBIG (hepatitis B immune globulin), shortly after birth. HBIG provides immediate, short-term protection against hepatitis B (11).

There are treatments available for chronic infection to suppress the replication of the virus and slow disease progression. However, these medications do not cure hepatitis B, so must continue for life (10). The best defense against hepatitis B is to obtain the very safe and effective vaccine.

Hepatitis C
Hepatitis C is caused by a viral infection that is commonly spread through sharing needles but can also spread through sexual contact (rare) and from mother to child at birth (only ~6% of infants of infected mothers) (12). Hepatitis C often doesn’t cause any symptoms in both acutely infected and chronically infected people. However, chronic hepatitis C, which develops in more than 50% of cases (13), is associated with an increased risk of liver disease, including cirrhosis and liver cancer (14).

Hepatitis C is treated with antiviral medications to eliminate the virus from the body. However, these medications are not recommended during pregnancy due to the risks for the developing fetus. In addition, hepatitis C medications should be stopped at least 6 months before pregnancy, as the risk of birth defects persists for up to 6 months after taking the medication (15).

HIV
HIV is caused by a viral infection that can spread through contact with infected blood, semen, pre-ejaculate, and vaginal fluids, as well as from mother to child during pregnancy, at childbirth, or while breastfeeding. HIV targets cells in the immune system, and untreated HIV eventually leads to AIDS (16).

Effective antiretroviral therapy (ART) prevents the virus from multiplying, thereby reducing the amount of virus in the body (known as the viral load). When the viral load is very low (<200 copies per milliliter of blood), it is referred to as viral suppression. When viral suppression is achieved, there is a very low risk of transmission from mother to child (17). See our previous article here for more information about viral load and suppression.

References:
1. Sexually Transmitted Diseases (STDs) during Pregnancy. American Pregnancy Association.
2. Pelvic Inflammatory Disease (PID) – CDC Fact Sheet. (Reviewed Nov 2020). CDC.
3. Syphilis – CDC Fact Sheet (Detailed). (2017, January). 
4. Sheffield JS, et al. (2002). Congenital syphilis after maternal treatment for syphilis during pregnancy. Am J Obstet Gynecol, 186(3), 569-573.
5. Woods CR. (2009). Congenital syphilis-persisting pestilence. Pediatr Infect Dis J, 28 (6), 536-537.
6. Sexually Transmitted Diseases Treatment Guidelines, 2015. (2015). MMWR, 64(RR-3).
7. Cuschieri KS, Whitley MJ, & Cubie HA. (2004). Human papillomavirus type-specific DNA and RNA persistence–implications for cervical disease progression and monitoring. J Med Virol, 73 (1), 65-70.
8. Cervical Cancer. WHO.
9. Genital HPV Infection – Fact Sheet. (2021, January). CDC. 
10. Hepatitis B, World Health Organization. July 2020.
11. Hepatitis B and Hepatitis C in Pregnancy. (Updated June 2021). ACOG
12. Viral Hepatitis – Q&As from the Public. (2020, July). CDC.
13. Liang TJ, Rehermann B, Seef LB, & Hoofnagle JH. (2000) Pathogenesis, natural history, treatment, and prevention of hepatitis C. Ann Intern Med,132(4), 296-305.
14. Thomas DL & Seef LB. (2005) Natural history of hepatitis C. Clin Liver Dis,9(3), 383-398.
15. HCV in Pregnancy. (Updated August 2020). AASLD
16. HIV/AIDS. World Health Organization.
17. HIV Treatment. Reviewed May 2021. CDC. 

Men's Health

High estrogen in males – causes and effects

Posted on by dnaserver

What is estrogen?
Estrogen is traditionally considered a female sex hormone but is actually a critical hormone in males too. Just as testosterone, considered a male sex hormone, is also important in females.

The strongest of the three estrogen hormones is called estradiol (also known as oestradiol and E2). Estradiol is especially important for male sexuality and must stay in balance with testosterone to control libido, erectile function, and sperm production (1). See our previous article here for more information about estradiol.

What are the roles of estrogen in males?
Estrogen plays important functions in the:

  • Male reproductive system
  • Skeletal system
  • Skin health
  • Nervous system
  • Cardiovascular system

What can cause higher estrogen levels?
There are various factors that can contribute to elevated estrogen (2), including:

  • Some antibiotics
  • Some herbal remedies
  • Phenothiazines (used to treat mental health issues)
  • Stress
  • Excess body fat
  • Some tumors
  • Liver disease

What happens if estrogen levels are too high?
The balance between estrogen and testosterone is very important in males. However, as men age, their testosterone naturally decreases. Usually, this doesn’t cause any problems; however, if estrogen levels are abnormally high, this imbalance can cause various symptoms and health risks (2).

The symptoms of high estrogen in males can include:

  • Infertility, as high estrogen can slow down sperm production
  • Gynecomastia (increased breast tissue)
  • Erectile dysfunction
  • Ejaculatory dysfunction (premature ejaculation and delayed ejaculation)
  • Slowed growth (if high estrogen occurs in children and teens)
  • Lower sex drive
  • Fatigue
  • Hair loss
  • Reduced muscle mass
  • Increased body fat (more fat tissue can also increase estrogen so this effect is compounded)
  • Difficulty concentrating
  • Loss of bone density

Can high estrogen cause any serious health complications?
Higher estrogen levels in males are associated with an increased risk of:

  • Thyroid problems
  • Blood clots
  • Heart attack
  • Stroke
  • Breast cancer
  • Prostate cancer

Are there ways to reduce estrogen?
Lifestyle changes may be all that are required to control estrogen levels. Increased physical activity can help reduce body fat, as well as boost testosterone levels to correct an estrogen: testosterone imbalance. Following a diet that is low in fat and high in fiber is also beneficial. Specific foods to include are broccoli and kale, shiitake and portobello mushrooms, red grapes, and green tea (2).

If lifestyle changes are ineffective, there are also medications available to lower estrogen levels back to within the healthy normal range (2).

How can I check my estrogen levels?
We offer two different tests for males to measure estradiol levels. Estradiol is the strongest of the three estrogen hormones. These tests just require a small blood sample collected from a simple finger prick in the privacy of your own home. Test results are available through our online portal, thereby avoiding the need to make any doctor or lab appointments. Of course, you may also wish to discuss your results with your healthcare professional, and this is highly recommended if you receive any results that fall outside the normal range.

The Estradiol (E2) test measures just your estradiol levels, while the Men’s Health Hormone Panel includes estradiol along with five other important biomarkers of male health.

References:
1. Schulster M, et al. (2016) The role of estradiol in male reproductive function. Asian J Androl. 18(3): 435–440.
2. Jewell T (Reviewed by Biggers A) (2019). Risk factors of having high or low estrogen levels in males. Healthline.

Kidney, Liver, and Thyroid Health

What are the links between thyroid health and mental health?

Posted on by dnaserver

The messenger molecules that are released from the thyroid are called thyroid hormones. These hormones are thyroxine (T4) and triiodothyronine (T3) and they act on cells all around the body by interacting with thyroid hormone receptors. And this is where the strong link to mental health comes in. The brain has some of the highest expression of these thyroid hormone receptors and neurons are often more sensitive to thyroid abnormalities than other cells (1).

Thyroid health and neurological effects in infants and children
When the brain is still developing, the actions of thyroid hormones are very important. This is because certain thyroid hormone actions must occur during specific time windows. If thyroid abnormalities occur during brain development, they may lead to irreversible brain damage. The extent of this damage depends on both the severity of thyroid problems, as well as the specific onset and duration of the thyroid problems (2).

This potentially serious impact of thyroid abnormalities is why normal thyroid function is critical during pregnancy. For the first trimester, a fetus is completely dependent on thyroid hormones from the mother (passed through the placenta). At around 12 weeks, the fetus starts to make its own thyroid hormones, but it is still reliant on maternal thyroid hormones until 18–20 weeks of pregnancy (3).

Thyroid health and mental health in adults
Most thyroid-associated mental health problems in adults are reversible with proper treatment, unlike the sometimes-irreversible brain damage seen in infants and children (2). However, that doesn’t mean that thyroid-associated mental health problems in adults should be ignored.

Hypothyroidism (underactive thyroid) is associated with:

  • Memory impairment
  • Bipolar affective disorders
  • Depression
  • Mood disorders
  • Dementia
  • Confusion
  • Personality changes
  • Loss of cognitive function

Hyperthyroidism (overactive thyroid) is associated with:

  • Anxiety
  • Irritability
  • Mood disorders
  • Dementia
  • Confusion
  • Personality changes

Of course, the lists above are only covering the thyroid dysfunction symptoms that are linked to mental health. Thyroid abnormalities can also cause a range of other symptoms, including:

  • Puffy eyes and face
  • Heart rate changes (slower for hypothyroidism, faster for hyperthyroidism)
  • Temperature changes (feeling colder for hypothyroidism and excessive sweating for hyperthyroidism
  • Weight changes (gain for hypothyroidism, loss for hyperthyroidism)
  • Fertility issues

Thyroid testing
If you are experiencing symptoms that could be associated with abnormal thyroid function, don’t hesitate to get tested. We offer a range of tests from just a simple self-collected finger-prick. Take our simple Thyroid Stimulating Hormone (TSH) Test for TSH alone, our Thyroid Health Panel to also include T4 and T3 along with TSH, or opt for the Thyroid Health, Complete Panel to also include Anti-Tg and Anti-TPO.

TSH is the thyroid-stimulating hormone, which is produced in the pituitary gland and signals for the thyroid to produce thyroid hormones. TSH is commonly the first molecule measured when investigating thyroid health. Read our previous article here for more information about TSH.

T4 and T3 are the two hormones produced by the thyroid.

Anti-Tg and Anti-TPO are antibodies to proteins produced by the thyroid gland. Elevated levels of these antibodies signal that the body’s own immune system is targeting and harming the thyroid, which is what occurs in some autoimmune disorders.

References:
1. Rege S. (Updated April 2021) 15 little known things about your thyroid that can affect your mental health. Psych Scene Hub.
2. Bernal J. Thyroid hormones in brain development and function. Endotext [Internet].
3. Thyroid disease & pregnancy. (Reviewed Dec 2017). NIH, National Institute of Diabetes and Digestive and Kidney Diseases.

Vitamins and Minerals

Ways to increase your folate levels

Posted on by dnaserver

Folate is a very important nutrient that is absolutely essential for a healthy normally functioning body. It’s needed for the formation of DNA and RNA, the formation of neurotransmitters, the metabolism of amino acids, and the proper formation of the nervous system (1). See our previous post “The importance of folate” for more information about folate.

Folate, also known as vitamin B9 is even more important during pregnancy to ensure the health of the unborn baby.

Folate is naturally present in many foods, but there is also a synthetic form, called folic acid, that is added to many enriched foods, as well as available as a dietary supplement.

How do you know if you are getting enough folate?
Folate requirements differ by age and pregnancy and breastfeeding status. Normally adults require 400 mcg DFE per day, with increasing amounts required during pregnancy (600 mcg) and while breastfeeding (500 mcg).

DFE stands for dietary folate equivalent. This term is used because synthetic folic acid has a much higher bioavailability than dietary folate (85% versus 50%). Basically, this means that the body is able to use a lot more folic acid compared to folate (2).

The easiest way to check your folate levels is with our Folate Test from a simple self-collected finger-prick blood sample.

Foods to eat to obtain more natural folate

  • Beef liver: A single 3 oz serving can provide 54% of the recommended daily value (DV) for an adult.
  • Spinach: An excellent source of folate with one serving providing 33% of an adult’s DV.
  • Asparagus and brussels sprouts: Both provide 20-22% of an adult’s DV from one serving.
  • Lettuce, avocado, broccoli, mustard greens, and green peas: All provide 12-16% of an adult’s DV from one serving.
  • Kidney beans and wheat germ: One serving provides 10-12% of an adult’s DV.

Enriched foods to eat to obtain more folic acid
These foods have had the synthetic form (folic acid) added to them, so they are another very beneficial source of this essential nutrient:

  • Rice and pasta: Generally, a single serving contains 19-22% of an adult’s DV.
  • Breakfast cereals: Many ready-to-eat breakfast cereals have been enriched with 25% of an adult’s DV in a single serving.
  • Bread: Enriched bread provides 13% of an adult’s DV from a single slice.

These folate and folic acid food contents were obtained from Folate, Fact Sheet for Health Professionals (1). The foods shown here are by no means an exclusive list, as there are many other foods that also naturally contain folate.

Dietary supplements
Folic acid is available as folic acid alone, as well as part of many multivitamins and prenatal vitamins. Usually, these supplements contain 680–1360 mcg DFE for adults, with 340–680 mcg DFE for children’s vitamins. When these supplements are taken with food, about 85% of the folic acid is able to be absorbed and utilized by the body. However, if consumed without food, nearly 100% of the folic acid can be absorbed (1).

References:
1. Folate: Fact Sheet for Health Professionals. (2020, June 3). NIH
2. Bailey LB, & Caudill MA. (2012). Folate. In J. W. Erdman, I. A. Macdonald, & S. H. Zeisel, Present Knowledge in Nutrition. Washington, DC: Wiley-Blackwell. 321-342.