Author Archives: dnaserver

What can increase the risk of low vitamin D?

Vitamin D is commonly known as the “sunshine vitamin”. It has this nickname because when our skin is exposed to sunlight, our body is able to synthesize Vitamin D. Vitamin D is important for healthy bones and muscle, a good immune system, glucose metabolism, and cell growth. But in many populations around the world, vitamin D deficiency is common.

In this article, we will discuss the various things that can contribute to an increased risk of vitamin D deficiency, along with the common symptoms that occur in vitamin D deficiency, and ways to improve low vitamin D levels.

What populations have an increased risk of vitamin D deficiency?

  • Breastfed infants: Human milk alone does not usually provide enough vitamin D to meet adequate intake levels. In addition, the American Academy of Pediatrics (AAP) advises parents to keep infants under 6 months old out of direct sunlight (1), so vitamin D through UV exposure does not usually occur in infants.
  • Older adults: Vitamin D synthesis in the skin reduces with age and older adults are more likely to spend more time indoors (2).
  • People with limited sun exposure: For example, those that wear head coverings for religious purposes or have occupations that limit sun exposure (3).
  • People with darker skin: Increased skin melanin (which is what makes skin darker) reduces vitamin D synthesis because the increased melanin absorbs more of the sun rays before vitamin D synthesis is triggered (3).
  • People who have conditions that limit fat absorption: For example, celiac disease and Crohn’s disease. These conditions reduce the absorption of vitamin D in the gut, as it is a fat-soluble vitamin.
  • Obese people: Obesity is associated with an increased risk of deficiency, as the increased subcutaneous fat in obese individuals sequesters more of the vitamin D synthesized from sun exposure, so there is less available throughout the rest of the body (4).
  • Stomach surgery: Unfortunately, the type of surgery that can be used to help with weight loss can also contribute to an increased risk of vitamin D deficiency, as it can affect the ability to absorb vitamin D and other vitamins and minerals from food (5).
  • People with kidney disease: The kidneys convert vitamin D from supplements and the sun into an active form that can be used by the body. Chronic kidney disease inhibits this conversion (6).
  • People taking certain medications: Some drugs can inhibit the body’s natural ability to convert vitamin D into its active form. These include antiepileptics, anti-inflammatories, antibiotics, some herbal remedies (e.g., St John’s wort), steroids, drugs used to treat some breast cancers, and cholesterol-lowering drugs (7).

What are the common symptoms of vitamin D deficiency?
Vitamin D deficiency can cause a range of symptoms (2), including:

  • Fatigue
  • Bone pain
  • Muscle weakness, aches, and cramping
  • Mood changes, e.g., depression

Long-term vitamin D deficiency can lead to rickets in children and osteomalacia in adults, which are both characterized by soft and weak bones (2). Vitamin D deficiency also increases the risk of various other health complications, including diabetes, obesity, high blood pressure, cardiovascular disease, inflammatory diseases, asthma in children, and specific cancers (1).

How can I boost my vitamin D levels?
Many people who only have a mild vitamin D deficiency do not show any noticeable symptoms, and it is always better to diagnose and treat a health problem BEFORE it gets worse.

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.

Ways to increase your vitamin D levels include:

  • Increase consumption of foods that naturally contain vitamin D, such as fish liver oils and fatty fish (e.g., cod liver oil, trout, and salmon)
  • Ensure that you are choosing common foods that have been fortified with vitamin D (had vitamin D added to them). These include most dairy milk and plant milk options, and ready-to-eat breakfast cereals.
  • Take dietary supplements that contain vitamin D, but be careful not to overdose on vitamin D.

References:
1. Davis CD, & Dwyer JT. (2007). The ‘sunshine vitamin’: benefits beyond bone? J Natl Cancer Inst. 99, 1563-1565.
2. Dietary Reference Intakes for Calcium and Vitamin D. (2010). Washington, DC, USA: National Academy Press.
3. Vitamin D: Fact Sheet for Health Professionals (2020, October 9). NIH
4. Jones G. (2014). Vitamin D. In Ross AC, et al. Modern Nutrition in Health and Disease (11th ed). Philadelphia: Lippincott Williams & Wilkins.
5. Johnson JM, et al. (2006) The long-term effects of gastric bypass on vitamin D metabolism. Ann Surg. 243(5): 701-705.
6. Vitamin D: The Kidney Vitamin? National Kidney Foundation. August 2014.
7. Gröber U & Kisters K. (2012) Influence of drugs on vitamin D and calcium metabolism. Dermatoendocrinol. 4(2): 158-166.

Type 1 versus type 2 diabetes

Diabetes is a disorder that occurs when the pancreas is no longer able to make sufficient insulin, or when the body cannot make good use of the insulin it produces. This inhibits the control of blood glucose (sugar) levels and leads to raised blood glucose (hyperglycemia), which causes damage to various tissues and organs in the body.

What exactly is insulin?
Insulin is an essential hormone (messenger molecule) normally produced by the beta cells in the pancreas. It controls the amount of glucose in the bloodstream, helps move that glucose into the liver, fat, and muscles, and regulates the metabolism of carbohydrates, fats, and proteins (1).

What happens if there is not enough insulin?
When the body doesn’t produce enough insulin (or the cells do not respond properly to the available insulin), blood glucose levels increase. The cells around the body also don’t receive the energy that they would normally obtain from blood glucose, so fatigue and weakness can occur. Weight loss may also occur if the body seeks energy from other tissues instead (e.g., fat and muscle) (2).

How do insulin production and response differ in type 1 and type 2 diabetes?
Type 1 diabetics cannot produce insulin, so that essential hormone is absent and there is no control of blood glucose levels. Type 1 diabetes is due to an autoimmune reaction that targets the body’s own insulin-producing cells in the pancreas.

Type 2 diabetics can produce insulin but cannot use it efficiently, so blood glucose levels are not controlled properly. Type 2 diabetes is commonly caused by lifestyle factors, such as obesity, inactivity, smoking, and high cholesterol (3).

Are the symptoms the type 1 and type 2 diabetes the same?
Yes, generally the same symptoms occur in both types of diabetes. Symptoms can include:

  • Frequently very thirsty and hungry
  • Frequent urination
  • Fatigue
  • Blurry vision
  • Cuts or sores that don’t heal properly or take a long time to heal
  • Mood changes
  • Numbness and tingling in hands and feet

When do symptoms appear?
Although type 1 and type 2 diabetics share the same symptoms, the onset of these symptoms varies a lot. Symptoms in a type 1 diabetic usually develop quickly, over just a few weeks, with symptoms usually appearing in childhood or adolescence. In contrast, type 2 diabetics develop symptoms over many years (usually in adulthood), or they may not even experience any noticeable symptoms until other health complications occur (4).

Are type 1 and type 2 diabetes caused by the same factors?
No, the causes are quite different.

Type 1 diabetes occurs due to an aberrant immune response. Basically, the body’s own immune cells target and destroy the insulin-producing beta cells in the pancreas. These are the only cells in the body that can produce insulin, so when they are destroyed, there is a complete absence of insulin production (5). The underlying cause of this aberrant immune response is not fully understood. It could be due to genetic factors and environmental factors, such as exposure to a virus that affects how the immune system responds.

Type 2 diabetes is predominantly caused by lifestyle factors, with some genetic variation also playing a role in the risk of this common disorder. Lifestyle factors that increase the risk of type 2 diabetes include obesity, high blood pressure, alter lipid levels (e.g., high LDL “bad” cholesterol), lack of physical activity, and smoking (3).

How common are type 1 and type 2 diabetes?
Type 2 diabetes is much more common than type 1 diabetes. Type 2 diabetes accounts for 90–95% of all diabetics, which in the United States equates to 30–32.5 million people! And there are another 88 million adults in the United States who have prediabetes, which is when blood glucose is higher than normal but not as high as a diabetic. Prediabetes can be thought of as the first step down the path to type 2 diabetes (6).

How are type 1 and type 2 diabetes diagnosed?
The same blood tests are used for the diagnosis of both type 1 and type 2 diabetes. An HbA1c test is commonly used. This test measures your levels of glycated hemoglobin, which provides an average blood glucose level for the previous 2–3 months. We offer an HbA1c test from a small blood sample collected from a self-collected finger prick. More information about our HbA1c test is also available here.

Alternatively, a blood glucose test can be taken. A blood sample for a glucose test is commonly collected after a period of fasting (usually overnight). We offer a blood glucose test here.

References:
1. Jaffe L & Hess-Fischl A. (Updated October 2021). What is insulin? Endocrine Web.
2. What is insulin? (Updated Nov 2018) Hormone Health Network.
3. What causes diabetes? Find out and take control. American Diabetes Association.
4. Diabetes Symptoms. CDC. April 2021.
5. What is Diabetes. CDC. June 2020.
6. National Diabetes Statistics Report, 2020. CDC. Reviewed August 2020.

What is cervical cancer?

Cervical cancer occurs when malignant (cancer) cells form in the tissues of the cervix. It used to be the leading cause of cancer death in women in the United States, but regular screening (Pap tests) has significantly decreased the number of cervical cancer deaths (1).

What is cancer?
Cancer occurs when cells in the body grow out of control and start spreading to places that they normally wouldn’t grow. Normal cells in the body only grow when they receive signals to tell them to, and they stop dividing when they receive signals for apoptosis (programmed cell death). In contrast, cancer cells grow even when there are no growth signals and continue growing even when they are signaled to stop growing (2).

Cancer cells can also tell blood vessels to grow towards them to provide extra nutrients and oxygen, as well as tricking the immune system into protecting the tumor rather than attacking it. Cancer cells can spread into other areas of the body and they also accumulate lots of changes in their chromosomes, including large duplications and deletions (2).

Where does cervical cancer occur?
Cancer can start almost anywhere in the body, and the place that it starts is what the cancer is called, even if it then spreads elsewhere in the body. When cancer starts in the cervix, it is called cervical cancer. 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 (3).

What are the symptoms of cervical cancer?
Cervical cancer usually develops slowly over many years. Before cancer cells form, a process called dysplasia occurs, where abnormal (but non-cancerous) cells appear in the cervical tissue (4). There are no symptoms associated with these abnormal cells, and often there are also no symptoms associated with the early stages of cervical cancer. Cervical cancer is one of the most successfully treatable forms of cancer, but ONLY if detected and treated early (5). This is why routine screening is highly recommended (see ‘How can I reduce my risk of cervical cancer?’ section below).

Advanced cervical cancer can cause abnormal bleeding or discharge from the vagina, such as bleeding after sex. These symptoms can also be caused by other things, but if you experience these symptoms, it is very important that you see your healthcare professional for an examination and consultation (3).

How common is cervical cancer?
Due to increased access to screening tests (Pap smears and HPV tests), the incidence of cervical cancer and associated deaths in the United States is now a lot lower than it used to be. In 2018, 12,733 new cervical cancer cases were reported in the United States, with 4,138 deaths from cervical cancer (6).

What are the risk factors for cervical cancer?
Human papillomavirus (HPV) infection is the cause of nearly all cervical cancers. But that’s not to say that everyone who has an HPV infection will get cervical cancer! HPV is a very common sexually transmitted virus. There are more than 100 genotypes of HPV, of which 14 are considered high-risk for cervical disease. Women who have persistent infection with one of the high-risk genotypes have an increased risk of cervical cancer (7). Read our HPV Quick Facts article for more information.

Other factors that are associated with an increased risk of cervical cancer include (3):

  • HIV infection reduces the body’s ability to defend itself from pathogens, including HPV
  • Other health issues that inhibit the body’s normal immune response
  • Smoking
  • Extended use of birth control pills (5+ years)
  • Giving birth to 3 or more children
  • Having several sexual partners

How can I reduce my risk of cervical cancer?

  • Get the HPV vaccine. This vaccine is recommended at 11–12 years of age and for anyone through to 26 years if they have not been vaccinated already. It is of less benefit for adults over 26 years, as most people of this age have already been exposed to HPV. The vaccine prevents new HPV infections but does not treat existing infections (3).
  • Get regular Pap tests (Pap smears). These are generally recommended once every three years (assuming results are normal) from 21 years of age. Pap tests detect abnormal cell changes in the cervix that may lead to cervical cancer (3).
  • Take an HPV test, such as this one here. These tests detect the 14 high-risk HPV genotypes, which are associated with an increased risk of cervical cancer. HPV tests are often recommended from ages 30–65 years (3).
  • Abstain from smoking
  • Use condoms during sex
  • Limit your number of sexual partners

References:
1. Cervical Cancer Statistics. CDC. Reviewed June 2021.
2. What is cancer? NIH, National Cancer Institute. Updated May 2021.
3. Basic information about cervical cancer. CDC. Reviewed Jan 2021.
4. Cervical Cancer Treatment (PDQ®)–Patient Version. NIH, National Cancer Institute. Updated August 2021.
5. Cervical Cancer. WHO.
6. S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2020 submission data (1999-2018): U.S. Department of Health and Human Services, CDC, Released in June 2021.
7. Kjaer SK, et al. (2002). Type-specific persistence of high-risk human papillomavirus (HPV) as an indicator of high grade cervical squamous intraepithelial lesions in young women: population-based prospective follow-up study. BMJ, 325 (7364), 572-579.

Posted in HPV

What are the signs of high estrogen in females?

Estrogen is one of the two primary female sex hormones, with the other being progesterone. Estrogen is absolutely essential for female reproductive health and pregnancy, and also plays a number of other roles in the body too.

The roles of estrogen in females include:

  • Maturing and maintaining the reproductive system (mammary gland, uterus, vagina) (1)
  • Helping prepare the uterus for pregnancy (1)
  • Influencing sexual desire (linked to when a woman is most fertile) (2)
  • Development of secondary sexual characteristics (3)
  • Helping maintain bone health by controlling rate of bone resorption (4)
  • Increasing collagen production and maintaining moisture for skin health (5)
  • Improving blood flow (6) and regulating blood clotting (7)
  • Regulating cholesterol levels (8)

As you can see estrogen has an extensive range of roles! So, an imbalance in this important hormone is going to cause a few health issues.

What are the signs of high estrogen in females?

  • Fluid retention and weight gain, particularly around the abdomen, hips, and thighs
  • Acne
  • Severe premenstrual syndrome symptoms
  • Constipation
  • Decreased libido (sex drive)
  • Irregular menstrual periods
  • Depression
  • Mood swings
  • Fertility issues
  • Noncancerous lumps in the breasts and uterus
  • Fatigue
  • Headaches
  • Sleeping issues

High estrogen can also increase the risk of more serious health complications (9), including:

What are the possible causes of high estrogen?

  • Estrogen replacement therapy (used to treat menopause symptoms)
  • Hormonal contraceptives
  • Certain antibiotics and herbal remedies
  • Obesity (increases the conversion of fat into estrogen)
  • Ovarian tumors
  • Liver disease (inhibits the normal breakdown of extra estrogen)
  • Genetic variation
  • Poor nutrition
  • Excess alcohol and drug use
  • Low progesterone levels (causes a hormone imbalance)

How can I check my estrogen levels?
We offer several different tests to measure your 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. 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:

What are ways to lower high estrogen?

  • Lose weight (if overweight)
  • Moderate exercise may be beneficial (10)
  • Follow a healthy diet, particularly with high fiber (11) and only limited alcohol (12)
  • Change medications if they could be the cause of elevated estrogen (discuss any medication changes with your healthcare provider)
  • Limit certain animal products, including red and processed meats (13)

References:
1. Oestradiol. You and your Hormones, an education resource from the Society for Endocrinology. Reviewed Mar 2018.
2. University of California – Santa Barbara. “Hormone levels and sexual motivation among young women.” ScienceDaily. 25 April 2013.
3. Estrogen’s Effects on the Female Body. John Hopkins Medicine.
4. Seifert-Klauss V & Prior JC. (2010) Progesterone and Bone: Actions Promoting Bone Health in Women. J Osteoporos. 2010: 845180.
5. Shah MG, Maibach HI. (2001) Estrogen and skin. An overview. Am J Clin Dermatol. 2(3): 143-50.
6. Prior JC. (2011). Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology and potential for perimenopause. Facts Views Vis Obgyn, 3 (2), 109-120.
7. Mendelsohn ME (2002). Protective effects of estrogen on the cardiovascular system. Am J Cardiol. 89(12, S1): 12-17.
8. What is Estrogen? Hormone Health Network. Updated August 2018.
9. Leonard J (reviewed by Biggers A) (2018) What are the symptoms of high estrogen? Medical News Today.
10. Kossman DA, et al. (2011) Exercise lowers estrogen and progesterone levels in premenopausal women at high risk of breast cancer. J Appl Physiol (1985). 111(6): 1687-93.
11. Cui X, et al. (2010) Dietary fat, fiber, and carbohydrate intake and endogenous hormone levels in premenopausal women. Horm Cancer. 1(5): 265-276.
12. Erol A, et al. (2019) Sex hormones in alcohol consumption: a systematic review of evidence. Addict Biol. 24(2): 157–169.
13. Harmon B, et al. Estrogen levels in serum and urine of vegetarian and omnivore premenopausal women. Public Health Nutr. 17(9): 2087–2093.

What is secondary syphilis?

Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum subspecies pallidum. It has been called “The Great Pretender”, as symptoms can resemble other diseases. If syphilis is untreated, it can cause serious health complications. There are distinct stages of a syphilis infection, known as primary, secondary, latent, and tertiary.

What symptoms can occur in secondary syphilis?

  • Skin rashes of varying appearance (usually the first sign of secondary infection)
  • Sores in the mouth, vagina, or anus
  • Large, raised, gray, or white lesions in warm, moist areas (e.g., mouth, armpits, groin)
  • Fever
  • Swollen lymph glands
  • Sore throat
  • Patchy hair loss
  • Headaches
  • Weight loss
  • Muscle aches
  • Fatigue

Not everyone who has secondary syphilis will develop all of these symptoms, but skin rashes usually occur, although sometimes they may be so faint that they are unnoticed. The symptoms of secondary syphilis eventually disappear whether or not treatment is received. Untreated cases will progress to the tertiary stage, and possibly the potentially fatal tertiary stage. Treatment cures syphilis and prevents the progression of the disease (1).

How long does syphilis take to progress to the secondary stage?
On average, it takes 21 days after exposure before an infected individual shows the first symptom of syphilis, which is one or more chancres (in the primary stage). However, some people may notice a chancre just 10 days after they become infected, while it can take up to 90 days for other people. The chancres of a primary infection typically last 3–6 weeks before they disappear (whether or not treatment is received) (1).

Some people develop symptoms of a secondary infection while the primary chancre is healing (1), but more typically the secondary stage doesn’t begin until 2–8 weeks after the chancre has disappeared (2).

 How can I prevent secondary syphilis?
A single dose of Benzathine penicillin G 2.4 administered intramuscularly is effective to treat and cure anyone with a primary infection to prevent it from progressing to the secondary stage. This treatment is also effective in the secondary and early latent stages, but three doses are required for the late latent stage (1).

The correct use of latex condoms does reduce the risk of syphilis, but only when the infected area (e.g., chancre) or site of potential exposure is covered (1).

How can I get tested for syphilis?
Lab testing from a simple, self-collected finger-prick blood sample can accurately diagnose a syphilis infection. There are two types of lab tests–nontreponemal and treponemal, which are both required for an accurate diagnosis. We offer a treponemal assay, which detects antibodies specific to syphilis, but these antibodies usually remain detectable for life even after successful treatment; hence this assay identifies both current and past (resolved) infections (3).

References:
1. Syphilis – CDC Fact Sheet (Detailed). (2017, January).
2. Tudor ME, et al. (Updated October 2021). Syphilis. StatPearls [Internet].
3. Henao-Martinez AF & Johnson SC. (2014). Diagnostic tests for syphilis. Neurol Clin Pract. 4 (2), 114-122.

Signs of vitamin B deficiency

Anemia is a term that many people are familiar with. It can cause fatigue, weakness, and pale skin. But often people don’t realize that iron deficiency is not the only cause of anemia. A deficiency in certain B vitamins (especially folate and B12) can also lead to a type of anemia, called megaloblastic anemia.

Megaloblastic anemia is characterized by the production of abnormally large immature red blood cells in the bone marrow, which results in low numbers of healthy fully-matured red blood cells in circulation (1).

In this article, we will discuss the symptoms, including anemia, that are associated with vitamin B deficiency.

What are B vitamins?
B vitamins are a class of water-soluble compounds that play important roles in health and wellness, particularly cell metabolism and synthesis of red blood cells. There are eight different B vitamins: B1 (thiamin), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folate), and B12 (cobalamin) (2).

What are the best sources of B vitamins?
The best sources of B vitamins are meat, eggs, fish, and dairy products, as well as leafy green vegetables and legumes for many B vitamins (with the notable exception of vitamin B12, which is generally not present in plant foods).

What are the roles of B vitamins? And what happens during deficiency?
B vitamins are essential for the functions of numerous enzymes throughout the body (2). Here is a quick overview of what each of the B vitamins does, and the symptoms that can occur when people are deficient in these important vitamins:

  • B1 (thiamin) is important for the growth and function of various cells. Symptoms of deficiency can include weight loss, confusion, muscle weakness, reduced immune function, and peripheral neuropathy (reduced feeling in hands and feet) (3).
  • B2 (riboflavin) is essential for cell growth, energy production, and the breakdown of fats, steroids, and medications. Symptoms of deficiency can include swelling and pain in the tongue, mouth, and throat, hair loss, anemia, and eye problems (4).
  • B3 (niacin) helps for the generation of energy, cholesterol, and fats, and the creation and repair of DNA. Deficiency can cause depression, headache, fatigue, hallucinations, a scaly skin rash, and constipation or diarrhea (5).
  • B5 (pantothenic acid) helps break down fatty acids and build fats. Deficiency symptoms can include headaches, fatigue, sleep issues, muscle cramps, nausea, and numbness or burn in the hands or feet (6).
  • B6 (pyridoxine) is important for the proper breakdown of proteins, carbs, and fats, maintenance of homocysteine levels, immune function, and brain health. Deficiency is usually in conjunction with a deficiency in another B vitamin (e.g., B9 or B12) and can cause anemia, skin conditions, depression, reduced immunity, and confusion (7).
  • B7 (biotin) is another B vitamin important for breaking down fats, carbs, and proteins from food. Deficiency symptoms can include thin hair, skin rashes, and brittle nails (8).
  • B9 (folate) is the natural form of this vitamin, while folic acid is the synthetic form that is added to foods and available as a supplement. It is essential for the formation of nucleic acids, protein metabolism, and the generation of red blood cells. Deficiency can cause megaloblastic anemia, which is characterized by weakness, fatigue, irregular heartbeat, shortness of breath, hair loss, pale skin, and mouth sores (9).
  • B12 (cobalamin) is also essential for red blood cell production and the formation of DNA, as well as the function and development of brain and nerve cells. B12 deficiency is the most common B vitamin deficiency and can cause megaloblastic anemia (with the same symptoms as described for B9), as well as nerve damage leading to numbness in the hands and legs, depression, and seizures in extreme cases (10).

What factors can increase the risk of deficiency?
Each of the B vitamins deficiency can have different factors that contribute to an increased risk, but the primary reasons are a non-balanced diet, malnutrition, excess alcohol consumption, drug and medication use, and health complications that affect absorption (e.g., Celiac disease). Other factors that can also influence the risk include thyroid issues (for B2), carcinoid syndrome (for B3), genetic variants (e.g., MTHFR variants can affect folate levels), pregnancy (particularly for folate), vegan diets (particular for B12 as it is only naturally found in foods from animal sources).

How can I determine if I have a deficiency?
A simple blood test is all that is required to diagnose a deficiency. We offer lab tests for the most common B vitamin deficiencies–folate and B12. These tests just require a simple self-collected finger-prick blood sample and results are available online as soon as testing is complete. We recommend discussing any abnormal results with your healthcare provider to determine the next steps to improve your health.

References:
1. Anemia, Megaloblastic. Rare Disease Database, National Organization of Rare Disorders.
2. B Vitamins. The Nutrition Source, Harvard School of Public Health.
3. Thiamin – Vitamin B1. The Nutrition Source, Harvard School of Public Health.
4. Riboflavin – Vitamin B2. The Nutrition Source, Harvard School of Public Health.
5. Niacin – Vitamin B3. The Nutrition Source, Harvard School of Public Health.
6. Pantothenic Acid – Vitamin B5. The Nutrition Source, Harvard School of Public Health.
7. Vitamin B6. The Nutrition Source, Harvard School of Public Health.
8. Biotin – Vitamin B7. The Nutrition Source, Harvard School of Public Health.
9. Folate (Folic Acid) ­– Vitamin B9. The Nutrition Source, Harvard School of Public Health.
10. Vitamin B12. The Nutrition Source, Harvard School of Public Health.

What does a prediabetes diagnosis actually mean?

A diagnosis of prediabetes means that you have blood sugar (glucose) levels that 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.

How is prediabetes diagnosed?
Prediabetes is diagnosed by measuring blood glucose levels. The most common test is an HbA1c test, which is available here. This test provides an average blood glucose level for the preceding 2–3 months. An HbA1c test result of 5.7–6.4% is classified as prediabetes (1). For more information about HbA1c testing, see our previous article here.

Prediabetes can also be diagnosed by a glucose test (available here). However, this test often requires fasting (an HbA1c test doesn’t) and only provides a blood glucose level for the specific time that the blood sample was collected. Blood glucose levels fluctuate throughout the day and are dependent on recent food consumption and exercise etc., so a blood glucose test does not provide the same average blood glucose level as the HbA1c test (2). A fasting blood glucose test result of 100–125 mg/dL is indicative of prediabetes (3).

Does prediabetes cause any symptoms?
There are no clear symptoms of prediabetes, which is why many people are unaware of their diagnosis. In fact, more than 84% of approximately 88 million prediabetic American adults do not know that they have prediabetes (4).

What increases the risk of prediabetes?
Several factors increase the risk of prediabetes and type 2 diabetes (2), including:

  • Obesity
  • Family history of type 2 diabetes
  • High blood pressure
  • Altered lipid levels (e.g., elevated LDL “bad” cholesterol)
  • Lack of physical activity
  • Smoking
  • Previously had gestational diabetes

How can I reduce my blood sugar back to normal healthy levels?
If you are overweight, losing even just a small amount of weight (5–7% of your body weight) is beneficial. Combing this weight loss with regular physical activity (150 minutes a week) is the best approach to lower blood glucose levels and reduce the risk of developing type 2 diabetes (4). Read our previous article here for more tips for lowering high blood glucose.

Should I get regular blood sugar tests?
The CDC recommends people over the age of 45 should get screened for diabetes and prediabetes. An HbA1c test is the most informative and convenient test for this screening. People who have normal HbA1c values (<5.7%) usually don’t need to be screened again for three years, while those with prediabetes levels (5.7-6.4%) should be tested again in 1-2 years (1).

People under 45 years with certain risk factors may also need to take an HbA1c test. These risk factors include begin overweight or obese, high blood pressure, history of heart disease, and physical inactivity (1).

References:
1. All About Your A1C. CDC. (Reviewed August 2021)
2. Fonseca V, Inzucchi SE, Ferrannini E. (2009). Redefining the diagnosis of diabetes using glycated hemoglobin. Diabetes Care. 32(7), 1344- 1345.
3. Diabetes Tests. CDC. Reviewed August 2021.
4. Prediabetes – Your chance to prevent type 2 diabetes. CDC. Reviewed June 2020.

Why does female fertility decrease with age?

In many countries around the world, the age of a mother at the birth of her first child is increasing. And with this increasing maternal age comes an increased risk of fertility issues, as well as an increased risk of chromosomal abnormalities. Yet, paternal age (father’s age) doesn’t have such an effect. Why is this the case? Read on to find out.

Sperm production versus egg production
Males can produce more than 100 million sperm a day, with an average ejaculate containing more than 40 million sperm (1).

In contrast, females have a peak number of oocytes (immature eggs) while they themselves are only 20-week-old fetuses. By birth, the number of viable oocytes has already dropped to 1–2 million, and by puberty, there are usually only 300,000–500,000 viable oocytes remaining. Throughout a women’s reproductive life, she will ovulate 400–500 oocytes and the remainder will be lost to atresia (normal degeneration) (1).

Is it only about lower egg quantity? Or is egg quality affected too?
During a women’s 20s and early 30s, there is about a 1 in 4 chance of conceiving during any single menstrual cycle (2). However, when a woman reaches 32 years, her fertility begins to decline, with a more rapid decline from the age of 37 (3). By age 40, a woman has only about 3% of her pre-birth egg supply (3), and there is only about a 1 in 10 chance, or less, of conceiving in any single menstrual cycle (2).

But it is not just the number of eggs that matter. The eggs in an older woman have been around since before she was born, so there is a much higher risk of chromosomal abnormalities, such as Down syndrome (3).

Are there things that increase egg loss?
Yes, smoking, as well as certain chemotherapies and radiation can accelerate egg loss in females.

What other factors influence female fertility?
Older women also have a much higher risk of other disorders that can affect the chance of getting pregnant, such as uterine fibroids (growths in the uterus) and endometriosis (a painful disorder where tissue that normally lines the uterus grows outside the uterus) (3).

As women age, they also have an increased risk of complications during pregnancy, including preeclampsia, premature birth, miscarriage, and stillbirth (2).

Do sperm quantity and quality decrease with age too?
Fully understanding the influence of male age on fertility is difficult, as an older male is more likely to be having a child with an older female, so it is difficult to distinguish between the influence of the increasing female age versus the increasing male age. However, it has now been shown that fertility in males actually does also decrease with age, just not to the same extent as in females. Older males may have decreased semen quality and also have increased rates of DNA fragmentation, which can cause fertility issues. In addition, there is a link between male age and the likelihood of birth defects and chromosomal abnormalities (1).

What tests are available to determine my egg count?
A measurement of follicle-stimulating hormone (FSH) levels provides an indirect analysis of egg count or ovarian reserve as it is commonly known. We offer an FSH test, as well as a Fertility Panel that includes five biomarkers to gain a better understanding of your hormone levels and how they could be influencing your likelihood of conceiving.

References:
1. Harris ID et al. (2011) Fertility and the Aging Male. Rev Urol. 13(4): e184-e190.
2. Having a baby after age 35: How aging affects fertility and pregnancy. ACOG. Reviewed October 2020.
3. Lewis R (Reviewed by Kallen A) (2020) How many eggs are women born with? And other questions about egg supply. Healthline.

Is there a link between HIV and cancer?

Human immunodeficiency virus (HIV) is a sexually transmitted disease (STD), which targets the cells of the immune system, in particular, a type of white blood cell called a helper T cell (or CD4+ T cell) (1).

Helper T cells are probably the most important cell type in adaptive immunity. They release cytokines (messenger molecules) to activate B cells (antibody-producing immune cells) and activate cytotoxic T cells (white blood cells that kill infected target cells) (2). So, when there are not enough helper T cells, the whole immune system is affected, and this is exactly what happens in people with HIV, particularly untreated HIV that develops into AIDS.

HIV patients suffer from a range of symptoms, including very high susceptibility to various microbes, some of which are normally harmless in healthy people. HIV patients also have an increased risk of developing specific cancers, known as “HIV-associated cancers”. Three cancers, in particular, are termed “AIDS-defining cancers” or “AIDS-defining malignancies” (3).

What are the three “AIDS-defining cancers”?

  • Kaposi sarcoma (500x increased risk in HIV patients)
  • Aggressive B-cell non-Hodgkin lymphoma (12x increased risk)
  • Cervical cancer (3x increased risk)

If someone with HIV is diagnosed with one of these cancers, it confirms a diagnosis of AIDS (3).

What other cancers are most common in HIV patients?
Other cancers that are more common in HIV patients are collectively termed “non-AIDS-defining cancers” (3) and include:

  • Hodgkin lymphoma (8x increased risk)
  • Anal cancer (19x increased risk)
  • Liver cancer (3x increased risk)
  • Oral cavity/pharynx cancers (2x increased risk)
  • Lung cancer (2x increased risk)

HIV patients are not only at a greatly increased risk of developing one of these cancers, but they also are at a much higher likelihood of dying from cancer too (3).

Why are these cancers more common in HIV patients?
HIV severely weakens the immune system by killing off helper T cells that are so vital for a good immune response. This means HIV patients are a lot more susceptible to viral infections, including viruses that can lead to cancer (3). Examples of these viruses include:

  • Kaposi sarcoma-associated herpesvirus (KSHV) aka human herpesvirus 8 (HHV-8) – causes Kaposi sarcoma and some lymphoma subtypes
  • Epstein-Barr virus (EBV) – causes some non-Hodgkin and Hodgkin lymphoma subtypes
  • Human papillomavirus (HPV) – high-risk types can cause cervical, vaginal, and vulvar cancers, anal cancer, penile cancer, as well as mouth and throat cancer
  • Hepatitis B and hepatitis C viruses – cause liver cancer

There are also other reasons that cancer is more common in HIV patients, including:

  • Increased likelihood of other risk factors (e.g., smoking, heavy alcohol consumption)
  • Immunosuppression and inflammation may increase cancer risk

Does antiretroviral therapy decrease the cancer risk in treated HIV patients?
Antiretroviral therapy (ART) has reduced the number of people affected by certain cancers (e.g., Kaposi sarcoma) but the risk in HIV patients is still higher than in people not infected with HIV (3). In addition, effective ART significantly increases the lifespan of HIV patients, but this also means there are now more older people living with HIV (that prior to ART would have succumbed at a much younger age). This means that there is now an increased incidence of cancers common in older age in people with HIV (3).

What are ways for HIV patients to reduce their cancer risk?

  • Start on ART as early as possible and continue to take ART medications as instructed
  • Abstain from smoking
  • Limit alcohol intake
  • Get tested for Hepatitis B and Hepatitis C and obtain treatment if required
  • Regular screening for cervical cancer (HPV high-risk test available here)
  • Get the HPV vaccine (if less than 26 years of age)

 References:
1. Al-Jabri AA. (2003) How does HIV-1 infect a susceptible human cell? J Sci Res Med Sci. 5(1-2): 31-44.
2. Alberts B, et al. (2002) Molecular Biology of the Cell. 4th edition. New York: Garland Science; 2002. Helper T Cells and Lymphocyte Activation.
3. HIV Infection and Cancer Risk. NIH, National Cancer Institute. Reviewed Sept 2017.

Posted in HIV

What are the signs of low testosterone in males?

Testosterone is that all-important male sex hormone. It is necessary for sex formation, pubertal effects (e.g., body hair and deepening of the voice), sperm development, muscle growth, and the regulation of platelet aggregation (1). So, what happens when a male doesn’t have enough testosterone? Read on to find out about the common signs of low testosterone and what can be done to increase testosterone levels.

Note: Testosterone (at low levels) is also important in females, but this article is focused on male testosterone levels only.

What is defined as low testosterone?
The American Urology Association (LINK) defines low blood testosterone in men as less than 300 ng/dL (~10 nmol/L).

Signs of low testosterone in males
Low testosterone has differing effects depending on the age of the individual. Testosterone deficiency during fetal development can cause the incomplete development of male characteristics, while deficiency at puberty can slow growth and reduce the development of pubic hair, deeper voice, and penis and testes growth (2,3).

Low testosterone in adult males can cause a range of symptoms (2), including:

  • Reduced sex drive
  • Infertility
  • Fatigue
  • Reduced lean muscle mass
  • Increased body fat
  • Irritability
  • Erectile dysfunction
  • Depression
  • Loss of body hair
  • Sleeping issues
  • Osteoporosis

It is also important to note that these symptoms can be caused by other factors unrelated to testosterone levels, such as opioid use, diabetes, and obesity.

What are the possible causes of low testosterone?
Low testosterone can occur due to conditions that males are born with, such as Klinefelter syndrome, or testosterone may also decline for other reasons, including testicle injury, chemotherapy, infection (e.g., HIV), autoimmune disease, malnutrition, and hormonal imbalances. Metabolic syndrome (which encompasses high blood sugar, unhealthy cholesterol levels, and belly fat), obesity, and using certain medications can also lead to low testosterone production (2).

How is low testosterone diagnosed?
A simple blood test can be taken to measure testosterone levels, such as the test offered here. Additional tests may also be required to determine the cause of the low testosterone, including a luteinizing hormone (LH) blood test and MRI to determine if low testosterone is due to a pituitary problem, as well as an HbA1c test to screen for elevated blood sugar caused by diabetes (2).

What are ways to increase low testosterone?
Often simple lifestyle changes may be all that are required to increase testosterone levels, such as increasing physical activity and improving diet to lose weight for overweight males. In other instances, testosterone therapy may be required. However, testosterone therapy also comes with some potential risks, including an increased risk of blood thickening and interruption of normal sperm production (2).

References:
1. Understanding how testosterone affects men. NIH Research Matters. Sept 2013.
2. What is Low Testosterone? Urology Care Foundation.
3. You and your Hormones, an education resource from the Society of Endocrinology. Reviewed May 2021.