Author Archives: dnaserver

Vitamins and Minerals

How can I boost my vitamin D levels?

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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.

How do I know if I have vitamin D deficiency?
There are various symptoms associated with vitamin D deficiency, including bone pain, frequent illnesses, and muscle weakness. However, many people who only have a mild 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.

Is sunshine the only way to obtain vitamin D?
No, although vitamin D is the “sunshine vitamin”, it is also naturally present in some food sources, is added to several fortified foods, and is available as a supplement too.

What foods should I eat to increase my vitamin D levels?
There are only a few foods that naturally contain vitamin D. The best sources are fish liver oils and fatty fish, such as trout and salmon. For example, just one tablespoon of cod liver oil provides 170% of the recommended daily intake for adults, while 3 ounces of salmon provides 71% (1).

Some mushrooms are available that have been treated with UV light to increase their vitamin D levels with ½ cup providing 46% of the recommended daily intake, but it is important to realize that untreated mushrooms contain significantly less vitamin D. Other foods that naturally contain small amounts of vitamin D include eggs, beef, chicken, and cheese, but the levels of vitamin D from these sources can vary depending on the animals’ diet (1).

There are also several foods available that have had vitamin D added to them, and these fortified foods provide most of the vitamin D in American diets. All dairy milk in Canada must be fortified with vitamin D, and most dairy milk in the U.S. is also fortified. Plant milk options (e.g., soy milk) are usually fortified too. Many ready-to-eat breakfast cereals have added vitamin D, and all infant formula in the U.S. and Canada must contain vitamin D. Other foods that are also commonly fortified include some brands of orange juice, yogurt, and margarine (1).

Should I increase my sun exposure to get more vitamin D?
Although most people around the world get at least some of their vitamin D from sun exposure, it is difficult to determine how much sun is needed to maintain adequate vitamin D levels. Some vitamin D researchers suggest 5-30 minutes of sun exposure at least twice a week on the face, arms, hands, and legs without sunscreen. However, it is very important to limit exposure to UV radiation, as it is the leading cause of skin cancer (1).

Are there other ways to increase my vitamin D levels?
Many different dietary supplements are available that include vitamin D, and this is the recommended way to increase vitamin D levels if dietary changes are inadequate. However, it is important not to overdose on vitamin D supplements, as vitamin D toxicity can occur, causing nausea, vomiting, excessive thirst, kidney stones, and severe pain (1).

References:
1. Vitamin D Fact Sheet for Health Professionals. NIH, Office of Dietary Supplements. Updated August 2021.

Kidney, Liver, and Thyroid Health

What could be affecting my thyroid health?

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What is the thyroid gland?
The thyroid gland is a small organ located just under the skin in the neck. This bow tie-shaped organ is usually only about 5 cm across and normally can’t be felt or seen. The thyroid releases specific hormones (chemical messengers) that act on almost every tissue in the body (1). These thyroid hormones help regulate so many vital body functions, including:

  • Heart rate
  • Skin maintenance
  • Heat production
  • Fertility
  • Growth
  • Digestion
  • Rate at which calories are burned

What happens when the thyroid isn’t functioning properly?
Thyroid hormones influence so many different parts of the body, so when they are out of balance, lots of different symptoms can occur.

Hypothyroidism is an underactive thyroid, so it does not release enough thyroid hormones. This causes many of the body’s functions to slow down, causing symptoms like fatigue, slow heart rate, constipation, weight gain, and constantly feeling cold (2).

Hyperthyroidism is an overactive thyroid, so too many thyroid hormones are released into the bloodstream. This speeds up many of the body’s functions, causing symptoms like weight loss (even though appetite is increased), rapid or irregular heart rate, frequent bowel movements, sweating, and shaky hands (3).

What are the possible causes of hypothyroidism?
An underactive thyroid is quite common, affecting nearly 5 out of 100 Americans 12 years and older, although many are only minimally affected (2). The causes of hypothyroidism include:

Hashimoto’s disease. An autoimmune disorder where your own immune system attacks the thyroid. This is the most common cause of hypothyroidism.

Thyroiditis. Inflammation of the thyroid can cause thyroid hormones to leak out (and initially increase the levels in the blood) until the thyroid eventually becomes underactive. Thyroiditis can be one of three different types:

  • Subacute thyroiditis (painfully inflamed and enlarged)
  • Postpartum thyroiditis (after pregnancy)
  • Silent thyroiditis (painless and maybe from an autoimmune condition)

Congenital hypothyroidism. Some infants are born with a thyroid that is not fully developed or not fully functional. Prompt treatment is important to prevent intellectual disability and growth failure.

Removal of part or all of the thyroid or radiation treatment of the thyroid, head, or neck. These may occur as a treatment for hyperthyroidism, large goiter, thyroid nodules, or thyroid cancers.

Medications. Certain medications can interfere with thyroid function, including some heart, bipolar, and cancer medicines.

Who is at increased risk of hypothyroidism?

  • Women, particularly if had a child within the previous 6 months
  • People over 60 years
  • People with previous thyroid issues or a family history of thyroid issues
  • Diabetics
  • People affected by certain autoimmune conditions, including celiac disease, rheumatoid arthritis, and lupus

What are the possible causes of hyperthyroidism?
Hyperthyroidism (overactive thyroid) is less common than hypothyroidism, affecting about 1 out of 100 Americans 12 years and older (3). The causes of hyperthyroidism include:

Graves’ disease. An autoimmune disorder where your own immune system attacks the thyroid causing it to make too many hormones. This is the most common cause of hyperthyroidism.

Overactive thyroid nodules. Noncancerous lumps in the thyroid that produce too many thyroid hormones.

Thyroiditis. Inflammation of the thyroid can cause thyroid hormones to leak out and increase the levels in the blood. In some cases, thyroiditis can eventually cause the thyroid to become underactive and cause hypothyroidism. Thyroiditis can be one of three different types:

  • Subacute thyroiditis (painfully inflamed and enlarged)
  • Postpartum thyroiditis (after pregnancy)
  • Silent thyroiditis (painless and maybe from an autoimmune condition)

Excess iodine. Iodine is required to make thyroid hormones, so consuming too much iodine (either through foods (e.g., kelp), supplements, or medicines) can result in hyperthyroidism.

Excess thyroid medication. This may occur in people suffering from hypothyroidism who take too much of their thyroid medication, as the amount required may differ over time.

Noncancerous tumors of the pituitary gland. The pituitary gland releases thyroid-stimulating hormone (TSH), which signals for the thyroid to produce hormones, so issues with the pituitary function can also affect thyroid function.

Who is at increased risk of hyperthyroidism?

  • Women, particularly if had a child within the previous 6 months
  • People over 60 years
  • People with previous thyroid issues or a family history of thyroid issues
  • People affected by other health problems, including diabetes, primary adrenal insufficiency (hormone disorder), and pernicious anemia (caused by vitamin B12 deficiency)
  • People who eat large amounts of food containing iodine (e.g., kelp) or take medicines with iodine

References:
1. Hershnan JM. (Modified Oct 2020). Overview of the Thyroid Gland. Merck Manual Consumer Version
2. Hypothyroidism (Underactive Thyroid). National Institute of Diabetes and Digestive Kidney Diseases. NIH. Reviewed March 2021.
3. Hyperthyroidism (Overactive Thyroid). National Institute of Diabetes and Digestive Kidney Diseases. NIH. Reviewed August 2021.

Kidney, Liver, and Thyroid Health

Kidney function – what is normal and what is not?

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What are the functions of the kidneys?
The kidneys are the major player in our body’s waste disposal system. We each have two kidneys about the size of a fist located just below the ribcage. These mighty organs continuously filter the blood at a rate of about half a cup every minute. And just like a filter in a swimming pool system, the kidneys also filter out waste through about a million filtering units (nephrons) per kidney. This waste (e.g., toxins, urea, and extra salt) is removed along with extra water and it all becomes urine, flowing from the kidneys to the bladder, where it is stored until urination occurs (1).

The kidneys are not just powerful filters, as they also play several other essential roles in the body. The kidneys remove acid that is produced by our cells, and are important for maintaining the right balance of water, salts, and minerals. If this balance is off, lots of cells, tissues, and organs in the body will not function properly (1).

Kidneys are also little hormone factories, producing erythropoietin to stimulate the production of red blood cells, activating vitamin D for healthy bones and a good immune response, and producing prostaglandins (hormone-like substances) to help control blood pressure (2).

How is kidney function measured?
Kidney function is commonly determined by measuring blood creatinine levels and calculating the estimated glomerular function (eGFR).

Creatinine is mainly produced within muscles from the breakdown of a compound called creatine, which is part of the energy production cycle in muscles. Almost all creatinine is filtered from the blood by the kidneys and excreted from the body in the urine (3).

The eGFR value is calculated from creatinine levels and also takes into account the age and gender of the tested person. The eGFR value shows how well the kidneys are functioning (3).

Measurements of blood urea (or urea nitrogen) levels are also helpful for detecting kidney damage. Normally urea is filtered from the blood by the kidneys, but blood levels can increase when the kidneys are not functioning normally.

What is considered normal kidney function?
Normal eGFR is more than 90 for adults. eGFR declines with age, even in the absence of kidney disease, so younger adults should usually have an eGFR value considerably higher than 90. For example, the average eGFR for someone aged 20–29 years is 116 (3).

eGFR values between 60 and 89 may indicate kidney disease. Values less than 60 for more than 3 months occur during moderate-to-severe chronic kidney disease (3).

Normal urea nitrogen levels in the blood are between approximately 7 and 25 mg/dL for adults with the higher levels often occurring in older people (5).

What are the signs of chronic kidney disease?
Chronic kidney disease (CKD) occurs when the kidneys are damaged and cannot function as well they should. They are unable to efficiently filter the blood and other functions are also disrupted, including the stimulation of red blood cells production and activation of vitamin D (4).

CKD can contribute to heart disease and stroke due to the inefficient removal of wastes and excessive fluid (4). Other health consequences include:

  • Reduced number of red blood cells (anemia)
  • Increased infections (in part due to low vitamin D activation)
  • Mineral imbalances in the blood
  • Appetite loss
  • Depression

More than 1 in 7 US adults are estimated to have CKD, that’s about 37 million people! However, most of these people have not been diagnosed, including as many as 40% of people with severely reduced kidney function (4). This is because many people with CKD do not notice any symptoms, or they think the symptoms are due to something else, and they don’t get a simple blood test to determine their kidney function.

People with later stage CKD often do experience symptoms (3), including:

  • Change in urination frequency
  • Itchiness
  • Fatigue
  • Swelling in their arms, legs, or feet
  • Muscle cramps
  • Nausea and vomiting

What can cause chronic kidney disease?
The major risk factors for CKD are diabetes and high blood pressure, which are estimated to cause 3 out of 4 CKD cases (4). Other risk factors include heart disease, family history of CKD, and obesity.

Tips for reducing the risk of CKD include:

  • Keep a healthy blood pressure (below 140/90 mm Hg)
  • Stay in the target blood sugar range (for diabetics)
  • Get regular physical activity
  • Lose weight if overweight
  • Abstain from smoking (it can worsen CKD and interfere with medications)
  • Take medications as prescribed by your health care professional (e.g., to lower blood pressure)
  • Get tested regularly if you are at risk. Testing is quick and easy from a simple finger-prick blood sample. 

How can I check my kidney function?
We offer very informative lab tests to evaluate your kidney function. The Kidney Health Panel measures your urea nitrogen and creatinine levels and calculates your eGFR to determine your kidney function. Alternatively, you can select the Urea Nitrogen test or the Creatinine and eGFR test.

Each test just requires a very small blood sample collected from a simple finger-prick. No doctor’s visits or needles are required.

Of course, if you receive an abnormal test result, we recommend consulting your health care professional for follow-up treatment, medication, and any other analyses.

It is also important to note that various other factors can also result in elevated blood creatinine and/or urea nitrogen, including dehydration, kidney or other urinary tract obstruction, increased protein intake, shock and stress, and severe burns. Reduced creatinine in the blood can be a sign of muscle disease (e.g., muscular dystrophy), while both reduced creatinine and reduced urea can occur due to liver disease. 

References:
1. Your Kidneys and How They Work. National Institute of Diabetes and Digestive and Kidney Diseases. NIH. Reviewed June 2018.
2. Kidneys. You and your hormones. Reviewed April 2019.
3. Estimated Glomerular Filtration Rate (eGFR). National Kidney Foundation. Reviewed September 2021.
4. Chronic Kidney Disease Basics. Chronic Kidney Disease Initiative. CDC. Reviewed August 2021.
5. Thomas L. Clinical Laboratory Diagnostics: Use and Assessment of Clinical Laboratory Results. Frankfurt/Main, Germany: TH-Books Verlagsgesellschaft mbH; 1998:374–377.

Vitamins and Minerals

Is too much iron a health problem?

Posted on by dnaserver

You may have heard about iron deficiency anemia, but did you know that too much iron is also a health risk?

Excess iron intake from dietary sources is very unlikely in adults with normal intestinal function, as usually only 8–10% of iron from the diet is absorbed. However, there are specific situations where iron overload can occur, including by intaking too much iron in supplements or medicines or in people affected by hemochromatosis.

What is hemochromatosis?
Hemochromatosis is an inherited disorder where the body absorbs three to four times more iron than normal (1). This excess iron cannot be naturally excreted from the body, so it accumulates in organs and tissues, eventually causing serious health complications. The symptoms of hemochromatosis include fatigue, joint pain, abdominal pain, memory problems, depression, decreased sex drive, shortness of breath, and heart flutters. Further serious complications can occur in untreated individuals, including heart failure, liver cirrhosis and disease, and endocrine problems (2).

How common is hemochromatosis?
About 1 in 10 whites carry the most common genetic mutation that causes hemochromatosis. However, two copies of the mutation are usually required for extra iron absorption to occur, and only about 4.4 whites per 1000 carry two copies and have hemochromatosis (3).

Is hemochromatosis treatable?
Thankfully hemochromatosis is easily treated by blood removal (phlebotomy), which also removes the excess iron. Hemochromatosis patients should also limit their dietary iron intake and avoid iron and vitamin C supplements, as vitamin C increases the absorbance of iron (3).

Unfortunately, many people with hemochromatosis are unaware of their diagnosis until symptoms occur, and by then the excess iron may have already caused tissue and organ damage that is not repaired by phlebotomy.

What are the symptoms associated with excess iron from supplements?
Gastrointestinal upsets are common from acute intakes of more than 20 mg/kg iron. Symptoms can include constipation, nausea, abdominal pain, and vomiting. If a very high dose is ingested, serious complications can occur, such as multisystem organ failure, coma, convulsions, or death (3).

How can I get my iron levels checked?
We offer several tests that can determine your iron status. All of these tests just require a simple finger prick blood sample for an accurate analysis.

  • The iron test measures the levels of iron circulating in the blood. Serum iron levels above 150 ug/dL occur in hemochromatosis patients.
  • Ferritin is a protein that helps store iron. The ferritin test measures how much of the iron stores have been used. Ferritin levels above 300 ng/mL in males or 200 mg/mL in females are indicative of hemochromatosis (4).
  • Transferrin is the main protein that binds and transports iron around the body. The transferrin test measures your levels of transferrin, while the transferrin saturation test calculates the percentage of transferrin that is bound to iron. Transferrin saturation levels above 45–50% indicate iron overload (4).

These tests are available as individual tests as well as a cost-saving combination test.

References:
1. Witte DL, et al. (1996). Hereditary hemochromatosis. Clinica Chimica Acta. 245(2), 139-200.
2. Beutler E, Felitti V, Gelbart T, Ho N. (2001) Genetics of Iron Storage and Hemochromatosis. Drug Metab Dispos. 29(4):495-499.
3. Iron, Fact Sheet for Health Professionals. NIH. Updated March 2021.
4. Crownover BK, Covey CJ. (2013) Hereditary Hemochromatosis. Am Fam Physician. 87(3):183-190.

Vitamins and Minerals

What are the symptoms of low iron?

Posted on by dnaserver

Low iron is quite common, particularly among women of reproductive age and people who follow a low-iron diet. When iron levels decrease, it can result in iron deficiency anemia, which is characterized by fatigue, weakness, pale skin, and headaches (1).

Why is iron so important?
Iron is an essential mineral with numerous important functions in the body. It is a component of hemoglobin and myoglobin, two proteins that carry oxygen–hemoglobin in red blood cells and myoglobin in muscle cells. Iron is also important for physical growth, neurological development, cell functions, and the production of some hormones (2).

What are the signs of iron deficiency?
Usually, iron deficiency develops slowly as it may take a few months for the body’s iron stores to be depleted. Often mild iron deficiency doesn’t cause any symptoms, but if the iron levels continue to fall, other signs and symptoms can occur (3). These include:

  • Brittle nails
  • Pale skin
  • Tongue swelling or pain
  • Chest pain
  • Difficulty concentrating and dizziness
  • Fatigue and weakness
  • Headache
  • Irregular heartbeat
  • Shortness of breath
  • Pica (unusual craving for non-food items, e.g., ice, clay

Can iron deficiency cause further complications?
Yes, if severe iron deficiency is not treated, it can lead to serious complications, including:

  • Depression
  • Heart problems (e.g., arrhythmias, enlarged heart)
  • Increased susceptibility to infections
  • Development delays in children
  • Pregnancy complications (e.g., preterm delivery, low birth weight)

Who is most at risk of iron deficiency?
In developed countries, the populations most at risk for iron deficiency are:

  • Pregnant women: red blood cell production increases a lot during pregnancy, so lots more iron is required. Iron deficiency during pregnancy increases the risk of premature birth and low birth weight.
  • Infants and young children are growing so quickly so have high iron requirements. Infants that are born prematurely or with low birth weight or to iron-deficient mothers are the most at-risk.
  • Women with heavy menstrual bleeding lose more blood each month, and with that blood, they lost more iron.
  • Frequent blood donors due to the iron lost with each blood donation.
  • Cancer patients, particularly those with chronic blood loss (e.g., colon cancer)
  • People with gastrointestinal issues (e.g., celiac disease) or have had gastrointestinal surgery may have reduced absorption of iron from food, or have to follow dietary restrictions that affect iron absorption
  • People with heart failure, which may be caused by poor nutrition or absorption, or the use of oral anticoagulants may contribute to increased blood loss.
  • Vegetarians and vegans may be at increased risk, as they consume less heme iron, which is found in animal sources and is more easily absorbed than non-heme iron from plant sources.

How can I get my iron levels checked?
We offer several tests that can determine your iron status. All of these tests just require a simple finger prick blood sample for an accurate analysis.

  • The iron test measures the levels of iron circulating in the blood. In some instances, people with low iron levels may actually have normal iron levels circulating in the blood but still have low iron stores.
  • Ferritin is a protein that helps store iron. The ferritin test measures how much of the iron stores have been used. Low ferritin levels (below 10 mg/dL) are indicative of iron deficiency.
  • Transferrin is the main protein that binds and transports iron around the body. The transferrin test measures your levels of transferrin, while the transferrin saturation test calculates the percentage of transferrin that is bound to iron. Transferrin saturation levels below 20% indicate iron deficiency.

These tests are available as individual tests as well as a cost-saving combination test.

References:
1. Iron-Deficiency Anemia. American Society of Hematology.
2. Iron, Fact Sheet for Health Professionals. NIH. Updated March 2021.
3. Iron-Deficiency Anemia. National Heart, Lung, and Blood Institute. NIH.

Heart Health and Diabetes

Got high blood sugar? Here’s how you can lower it

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High blood sugar is also known as high blood glucose and hyperglycemia. Glucose is required by the body for energy and blood glucose levels are usually controlled by insulin, a hormone produced by the pancreas. However, when the body isn’t properly using insulin or is unable to make enough insulin, blood glucose levels can increase to dangerous levels (1).

High blood sugar is what occurs in diabetic people. Type 1 diabetics are unable to make insulin, while type 2 diabetics may have insulin resistance (their cells don’t respond properly to the insulin) or they may not be producing enough insulin (1).

What blood sugar levels are unhealthy?
There are different ways to measure blood glucose levels. A glucose test measures the levels of glucose in the blood at the specific time the blood sample was collected. If the sample is taken in a fasting stage (no food for the previous eight hours), healthy levels are < 100 mg/dL, while 100–125 mg/dL indicates prediabetes and ≥ 126 mg/dL indicates diabetes (2).

The hemoglobin (Hb) A1c test is another way to measure blood glucose levels. It provides an average blood glucose level for the preceding 2-3 months. This provides a better understanding of where your blood glucose levels are at over an extended period. HbA1c tests also have the distinct advantage of not requiring fasting. Normal HbA1c values are <5.7%, while 5.7–6.4% indicates prediabetes and ≥ 6.5% is supportive of a diabetes diagnosis (3).

Steps to lower high blood glucose
A combination of diet, exercise, and medication can lower blood glucose levels.

Let us first focus on the recommended dietary changes to help keep blood glucose at a healthy level (4).

  • Limit sugar intake. Choose water to drink instead of juice or soda, and snack on a piece of fruit rather than a sweet treat.
  • Limit carbohydrate intake. Carbs (e.g., pasta and bread) cause blood sugar to rise more than eating an equivalent amount of proteins or fats.
  • Limit alcohol intake.
  • Eat plenty of vegetables, fruits, and whole grains. Non-starchy vegetables (e.g., broccoli, carrots, spinach) keep you feeling full for longer, provide lots of nutrients, and have fewer calories and carbs. Fruits are also loaded with vitamins, minerals, and fiber, and can help satisfy that sweet tooth without added sugar. Whole grains are a great source of fiber and lots of other beneficial nutrients.
  • Control your food portions, such as following the Plate Method. 

Are there any “superfoods” for lowering and controlling blood sugar?
According to the American Diabetes Association, there are several “diabetes superstar foods” (5).

  • Kidney, pinto, or black beans are high in fiber and full of important vitamins and minerals.
  • Dark green leafy vegetables (e.g., spinach, collards, and kale) are low in calories and carbs, but high in lots of vitamins and minerals.
  • Citrus fruits are excellent sources of vitamin C, folate, potassium, and fiber.
  • Berries are tasty treats that can not only satisfy a sweet tooth craving, but also provide lots of antioxidants, vitamins, and fiber.
  • Tomatoes provide lots of vitamin C, vitamin E, and potassium.
  • Fatty fish (e.g., salmon) are an excellent source of healthy omega-3 fatty acids.
  • Nuts are another excellent source of healthy fats, as well as magnesium and fiber.
  • Whole grains (e.g., whole oats and quinoa) provide lots of fiber as well as vitamins and minerals.
  • Milk and yogurt are good sources of calcium as well as vitamin D (in fortified products). Just make sure to choose options that are low in fat and added sugar.

Exercise is also important for controlling blood sugar
Regular physical exercise is essential for maintaining healthy blood sugar levels. When you are active, insulin is able to signal to your cells more efficiently to stimulate glucose uptake from the blood and lower your blood glucose levels (6).

And there is no need to sign up for a marathon (although no harm in that either!). Any exercise is better than nothing. Start small with a walk around the block and build from there. Go out dancing or swimming, even doing some housework can be exercise! The main aim is to consistently get some physical activity (20-25 minutes each day) to help control your blood sugar, weight, and improve your overall health.

An important thing to note is that very high blood sugar (above 240 mg/dL) can actually make physical exercise dangerous. People with values this high should check their urine for ketones before exercising, and consult with their health care professional about other ways to safely lower blood sugar (7).

Medication options for controlling blood glucose
There are different types of medications that are available to lower blood sugar levels. We won’t go into the details here, as this is something that you need to discuss with your health care professional, but they each work in different ways to maintain healthy blood sugar levels. For example, alpha-glucosidase inhibitors block the breakdown of dietary starches and slow the breakdown of some sugars to slow the rise in blood sugar that occurs after a meal, biguanides (e.g., metformin) decrease the amount of glucose produced by the liver, and meglitinides (e.g., Starlix) stimulate the pancreas to release more insulin (8).

References:
1. Hyperglycemia: What Is High Blood Sugar? Endocrine Web. Updated June 2021.
2. Diabetes Tests, Diabetes. CDC. Reviewed August 2021.
3. Understanding A1C. American Diabetes Association.
4. Manage Blood Sugar, Diabetes. CDC. Reviewed April 2021.
5. What superstar foods are good for diabetes? American Diabetes Association.
6. It’s a great time to get moving. Fitness. American Diabetes Association.
7. Get Active. Diabetes. CDC. Reviewed May 2021.
8. Oral Medication. What are my options? American Diabetes Association.

Heart Health and Diabetes

Foods to avoid if you have high cholesterol

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Your test results came back stating that you have high cholesterol? What does this mean? And what foods should you avoid to improve your heart health?

What does a high cholesterol result mean?
Cholesterol is a waxy type of fat (lipid), which travels around the body in the blood. It is an essential molecule, as it is required for building cells, producing bile for digestion, and making vitamins and hormones. But when cholesterol is elevated, it increases the risk of cardiovascular issues.

The desirable range for cholesterol in adults is < 200 mg/dL, while 200–239 mg/dL is considered borderline high, and ≥ 240 mg/dL is an unhealthy high cholesterol reading (1).

For children, desirable levels are below 170 mg/mL, borderline high is 170–199 mg/dL, and ≥ 200 mg/dL is unhealthy (2).

How can you lower your high cholesterol?
A combination of losing weight, diet, and exercise is beneficial for improving your cholesterol. Changes include increasing fiber intake, limiting carbohydrate, alcohol, and fat intake, and choosing healthier unsaturated fats instead of saturated and trans fats. Abstaining from smoking and exercising for at least 30 minutes each day is also beneficial (3).

What are specific foods that you should be avoiding or limiting?
The biggest dietary contributors to elevated cholesterol are saturated fats and trans fats. The American Heart Association recommends limiting saturated fat to less than 6% of daily calories (4). This means you should limit your intake of animal products, such as full-fat dairy products and red meats, tropical oils (e.g., palm and coconut oils), cakes, and biscuits.

Trans fats are also naturally found in some animal products, while artificial trans fats can be found in hydrogenated fat, which is in some processed foods.

Limiting your intake of added sugars, salt, and alcohol is also important. Men should have no more than two drinks per day, and women should have no more than one (5).

What foods should you eat instead?
Fats are important in our diet, as they are needed for energy, supporting cell growth, protecting our organs, keeping us warm, absorption of some nutrients (e.g., fat-soluble vitamins), and hormone production (6). So going completely fat-free is not a good idea.

However, there are good and bad fats. The bad ones are saturated and trans fats, which can raise “bad” LDL cholesterol levels in your blood. So, we want to limit those ones.

But there are also good fats – monounsaturated and polyunsaturated fats. These ones can actually lower “bad” cholesterol levels. Good sources of unsaturated fats include oily fish (e.g., salmon), nuts, seeds, avocados, and vegetable oils (6).

A heart-healthy diet includes lots of fruits, vegetables, whole grains, poultry, fish, nuts, and non-tropical vegetable oils, with limited quantities of red and processed meats, salt, and added sugar (4).

References:
1. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. (2002). Circulation. 106 (25), 3143-421.
2. American Academy of Pediatrics, Committee on Nutrition. Cholesterol in childhood. Pediatrics 1998:101(1);141–147.
3. LDL and HDL Cholesterol: “Bad” and “Good” Cholesterol. CDC. Reviewed Jan 2020.
4. Prevention and Treatment of High Cholesterol (Hyperlipidemia). American Heart Association. Reviewed Nov 2020.
5. Preventing High Cholesterol. CDC. Reviewed Sept 2021.
6. Dietary Fats. American Heart Association.

HPV

Why should I take an HPV test?

Posted on by dnaserver

Cervical cancer is the 4th most common cancer in women. Luckily, it is one of the most successfully treatable forms of cancer, but ONLY if detected and treated early (1). And this is where the problem lies—early cervical cancer often doesn’t cause any symptoms, so how can it be detected?

More than 99% of cervical cancer cases are linked to a persistent infection with one of the high-risk human papillomavirus (HPV) genotypes. And these infections can be simply detected by lab analyses of a cervical swab (1).

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. Although most women effectively clear HPV infections within 6 to 12 months (2), there are specific HPV genotypes that increase the risk of cervical cancer (1).

Which HPV genotypes are high-risk for cervical cancer?
There are more than 100 genotypes of HPV, of which 14 are considered high-risk for cervical disease – genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. Women who have persistent infection with one of these pathogenic genotypes have an increased risk for cervical carcinoma or severe dysplasia (3).

What will an HPV test tell me?
The HPV test that we offer here detects the presence of nucleic acids from the 14 high-risk HPV genotypes. If any high-risk HPV nucleic acids are detected in your cervical swab (a positive test result), it means you have an active HPV infection. However, this does not mean that you have cervical cancer.

Follow-up testing is recommended for any positive results, with protocols varying based on the results of recent pap smears. Another HPV test and/or pap smear in a shorter time period from routine testing may be all that is required. Alternatively, a colposcopy to further examine the cervix, vagina, or vulva can be used to detect abnormal cells or blood vessels. Other options include tissue biopsies, removal of abnormal cervical cells, and referral to a gynecologist (4).

How often should I take an HPV test?
HPV testing for the 14 high-risk HPV genotypes is recommended for screening for cervical cancer in women aged 30 years and older. Routine screening for HPV is not recommended for women under 30 years of age, as HPV is very common in young people, and will often clear without intervention within one to two years. However, women should still start getting Pap tests from age 21 to look for any cell changes on the cervix that might become cervical cancer if not treated correctly (5).

There are different cervical cancer screening options available for women aged 30–65 years. Pap tests alone are generally recommended once every three years (assuming results are normal), while HPV tests alone are recommended once every five years (assuming results are normal). Often an HPV test is conducted at the same time as a Pap test (called co-testing) and if both results are normal, further screening is generally not required for another five years (5).

Although HPV testing is often conducted at the same time as a routine Pap test, self-collected cervical swabs (like available here) are an efficient alternative with many studies showing similar diagnostic test accuracies as clinician-sampled HPV tests (6).

References:
1. Cervical Cancer. WHO.
2. 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.
3. 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.
4. Human Papillomavirus (HPV) Treatment and Care. (July 2021). CDC.
5. What should I know about screening? Cervical Cancer, Basic Information. (January 2021). CDC.
6. Ogale Y, Yeh PT, Kennedy CE, Toskin I, & Narasimhan M. (2019). Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis. BMJ Global Health, 4, e001349.

Posted in HPV
Men's Health

What are the signs of prostate issues?

Posted on by dnaserver

About 1 in 8 men will be diagnosed with prostate cancer during their lifetime, so chances are that you know someone who has been affected. And many men can be affected by other prostate problems too. So how do you know if there is an issue with your prostate?

Firstly, what is the prostate?
The prostate is a small gland that helps make semen. It is located just below the bladder and is wrapped around the tube that transports urine and semen out of the body (1). In young men, the prostate is about the size of a walnut, and as men get older, their prostate tends to get larger (2). If it gets too large, it can cause problems. The enlargement of the prostate may be due to cancerous growths or other non-cancer problems (1).

What are the typical symptoms of an enlarged prostate?

  • Frequent need to urinate
  • Blood in urine or semen
  • Painful urination
  • Painful ejaculation
  • Pain or stiffness in lower back, hips, pelvic or rectal area, or upper thighs
  • Dribbling of urine

What are the possible causes of an enlarged prostate?
An enlarged prostate can be caused by prostate cancer or other common non-cancer problems. First, we will discuss the less serious, non-cancer-related issues.

Benign prostatic hyperplasia (BPH) refers to an enlarged prostate, but it is not due to cancerous growths. Medications, surgery, or laser treatment may be required to help treat urinary problems associated with BPH (1).

Acute bacterial prostatitis occurs due to a bacterial infection, with symptoms appearing suddenly and often accompanied by fever or chills. Antibiotics are generally an effective treatment and other medications may also be required to help with pain (1).

Chronic bacterial prostatitis is also caused by a bacterial infection, but in this case, the infection comes back again and again. Sometimes long-term antibiotics are an effective treatment option (1).

Chronic prostatitis is also known as chronic pelvic pain syndrome and is a common prostate issue. Treatment options may include medication, surgery, and lifestyle changes (1).

Each of these issues can cause a lot of pain and discomfort, but the most serious prostate problem is of course prostate cancer. It is common in American men, with higher rates in African Americans, followed by Hispanic and Native Americans. Other risk factors for prostate cancer include being over 50 years, having a family history of prostate cancer, and following a high-fat diet (1).

How is prostate cancer diagnosed?
Routine screening is the best way to detect prostate cancer, as often early prostate cancer (when it is easier to treat) doesn’t cause any symptoms (2).

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 (3).

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 (4).

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 (5).

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 (5).

References:
1. Prostate Problems, National Institute on Aging, NIH. Reviewed July 2020.
2. What is Prostate Cancer? American Cancer Society. Revised August 2019.
3. What is screening for prostate cancer? CDC. Reviewed August 2021.
4. How is prostate cancer diagnosed? CDC. Reviewed August 2021.
5. How is prostate cancer treated? CDC. Reviewed August 2021.

Chlamydia and Gonorrhea

What is oral gonorrhea?

Posted on by dnaserver

Firstly, let’s go over a few quick facts about gonorrhea:

  • It is a common sexually transmitted disease (STD) or sexually transmitted infection (STI).
  • It is spread through sexual contact with the penis, vagina, mouth, or anus of an infected individual.
  • It can also spread from a mother to her newborn during childbirth.
  • It is caused by infection with the bacterium Neisseria gonorrhoeae.
  • 85–90% of males show symptoms of a urogenital infection but only <20% of females. Urogenital refers to the urinary tract, vagina, or penis.

How does oral gonorrhea occur?
Oral gonorrhea is also known as pharyngeal gonorrhea. It refers to a gonorrhea infection in the throat and can occur by giving oral sex to a partner with an infected penis, urinary tract, vagina, or rectum (1). Basically, the Neisseria gonorrhoeae bacterium isn’t too fussy about which mucus membranes it infects, so it is quite happy to spread to the mucus membranes in the throat. Gonorrhea transmission can occur even when an infected person is not showing any symptoms.

What are the symptoms of oral gonorrhea?
Most people with an oral gonorrhea infection do not experience any symptoms. And if they do, it is going to feel like any other sore throat (1). Other symptoms can include redness in the throat, throat inflammation, and swollen glands (2).

Can untreated oral gonorrhea cause any serious complications?
Despite an often absence of symptoms from oral gonorrhea (or urogenital gonorrhea for that matter), serious health complications are rare but possible. The gonorrhea infection can spread throughout the body causing a condition called disseminated gonococcal infection (1). The symptoms can include fever, joint pain and swelling, and skin lesions. The joints that are most commonly affected are wrists, ankles, hands, and feet. In rare cases, the infection can also affect the liver, brain, and heart tissue (2). Disseminated gonococcal infection can be caused by both untreated oral gonorrhea and untreated urogenital gonorrhea (3).

How to test for oral gonorrhea?
Oral gonorrhea can be detected by culture and nucleic acid amplification tests (NAATs) of pharyngeal (throat) swabs (4).

At least annual screening for oral gonorrhea is recommended for men who have sex with men (MSM), with increased screening (every 3–6 months) for MSM at high risk (e.g., substance abuse or multiple partners) or those at high risk of HIV acquisition (4).

How is oral gonorrhea treated?
Increased antibiotic resistance previously raised concerns about gonorrhea treatment and dual antibiotic therapy was recommended. However, due to other health concerns, only ceftriaxone is now recommended by the CDC. This is administered via a shot in the muscle (4).

References:
1. STD Risk and Oral Sex, Sexually Transmitted Diseases (STDs). Reviewed Feb 2020. CDC.
2. Mayor MT, Roett MA, Uduhiri KA. (2012). Diagnosis and Management of Gonococcal Infections. Am Fam Physician, 86(10):931-938.
3. Morris SR. (2020). Gonorrhea. Merck Manual Professional Version.
4. Gonococcal Infections Among Adolescents and Adults. Sexually Transmitted Infections Treatment Guidelines, 2021. (Reviewed July 2021). CDC.