A condition, known commonly as "black urine disease" or Alkaptonuria is a rare genetic disorder involving protein metabolism, and it has its root in the mutation of the homogentisate 1,2-dioxygenase gene, which in turn causes homogentisic acid accumulation in the body. The appearance of dark urine after exposure to air is due to this kind of accumulation; however, a variety of symptoms can be expected, such as joint stiffness, changes in pigmentation, and other long-term health complications. Although the prevalence has been estimated to be between 1 in 250,000 and 1 in 1 million people in the United States, its effects are indeed high on those affected.

Alkaptonuria is an autosomal recessive disease, meaning that the child must inherit a defective copy of the HGD gene from both parents. If both parents are carriers, their offspring have a 25% chance of inheriting two faulty genes and developing alkaptonuria. The condition is genetic but is often not diagnosed for years because it progresses slowly and its early symptoms appear to be harmless.

Symptoms of Alkaptonuria

The most characteristic and common initial symptom of alkaptonuria is dark urine. The reason for this is due to the fact that excess HGA is excreted in the urine and upon oxidation in the presence of air, it gives the urine a brown or black color. Though it is often considered cosmetic, the long-term accumulation of HGA within the connective tissues produces more complicated health problems.

Progressive joint pain and stiffness: The accumulation of HGA in cartilage leads to early-onset osteoarthritis, making movement increasingly difficult over time.

Skin and eye pigmentation changes: Affected individuals may develop bluish or grayish discoloration of the sclera (white part of the eye) and the skin, particularly in areas exposed to friction.

Cardiovascular and respiratory problems: With age, HGA accumulation can lead to valve calcifications in the heart and stiffening of connective tissues in the respiratory tract, which can cause problems in middle and old age.

Decreased mobility and spinal problems: The spine may become stiff and painful due to chronic cartilage degeneration.

These symptoms usually begin to manifest during adulthood, leading to severe complications in a person's 40s or 50s and significantly affecting the quality of their life.

How is Alkaptonuria Diagnosed?

Because of its rarity, alkaptonuria is often mistaken or overlooked early in life. However, there are several ways to confirm the condition:

Urine Testing: The gold standard in the diagnosis is the testing of urine samples for high levels of homogentisic acid via gas chromatography. In case of oxidation, which changes the color of urine to black, it is indicative of alkaptonuria.

Genetic Testing: Confirmatory genetic testing reveals mutations of the HGD gene to diagnose the condition conclusively.

Blood Tests: High levels of HGA in the blood can be used as further evidence.

Imaging Studies: X-rays and MRIs will expose cartilage and joint damage characteristic of alkaptonuria.

Management of Alkaptonuria: Is There A Cure?

At present, there is no cure for alkaptonuria; however, various treatment approaches can reduce its symptoms and slow the disease's progress:

Nitisinone Therapy: Nitisinone is a drug that inhibits the production of HGA. It has been shown to reduce HGA levels and slow tissue damage. However, it needs to be taken under close medical supervision because of potential side effects.

Low-Protein Diet: Since HGA is a byproduct of protein metabolism, reducing protein intake—especially foods rich in tyrosine and phenylalanine—may help decrease HGA production.

Pain Management: OTC pain relievers and anti-inflammatory medications can be used to relieve joint pain and stiffness.

Physical Therapy: Exercise regularly, as it may improve mobility and strengthen muscles, thus reducing strain on affected joints.

Surgical Interventions: Most people with alkaptonuria develop severe osteoarthritis necessitating joint replacement in their old age. Also, some may require heart valve replacement surgery if cardiovascular complications develop.

Life with Alkaptonuria

Although alkaptonuria is not fatal, it severely affects the quality of life. The progressive deterioration of the joints and associated symptoms can make everyday activities difficult, requiring lifestyle changes and medical interventions. The disease may cause premature aging of the joints, requiring walking aids and mobility assistance earlier than expected.

Ongoing research will continue to work on improving the treatment options by focusing on gene therapy and alternative enzyme replacement therapies. However, because of its rarity, the clinical trials and research remain sparse.

As genetic research advances, more hope for better management and possible curative approaches for alkaptonuria exists. Scientists are searching extensively for enzyme replacement therapies and innovative drugs that can target the root cause of the disorder. Being aware and being diagnosed early helps individuals better their condition and ultimately have better long-term health outcomes.

Alkaptonuria is a striking example of how one gene mutation can have widespread effects on the body. Though still a rare and often misunderstood condition, growing awareness and advances in treatment are paving the way for better care. If you or a loved one suspect symptoms of alkaptonuria, it is essential to seek early diagnosis and medical guidance to manage the disease effectively and preserve quality of life.

Higher education has changed far more than we often acknowledge. Universities are no longer simply places where students earn degrees. They are where young adults spend some of the most formative years of their lives, away from familiar support systems, making independent decisions, navigating uncertainty and, for many, encountering the first signs of a mental health condition. That quiet shift has expanded the role of educational institutions in ways that were never envisaged a decade ago.

The conversation around student wellbeing has evolved alongside this change. Mental health is no longer viewed as a subject to be discussed only after a crisis. Students are speaking more openly, parents are asking different questions, faculty members are becoming more aware and institutions are recognising that emotional wellbeing is closely linked to learning, participation and long term outcomes. This change deserves to be welcomed because it has helped move mental health from the margins of campus life to the centre of institutional responsibility.

Why A Counsellor Alone Is Not Enough?

Yet one assumption continues to shape much of this conversation. The presence of a counsellor is often seen as evidence that a campus is equipped to support student mental health. Counsellors remain indispensable and, for many students, they provide exactly the support that is needed. The challenge arises when counselling is expected to fulfil every role within a mental healthcare system.

Every effective healthcare system is built on layers of expertise. A physician does not replace a surgeon. A laboratory does not replace a diagnosis. Emergency care does not replace rehabilitation. Mental healthcare should be viewed no differently. Counselling is often the first point of contact, but the needs of students do not end there.

Some require structured therapy, others psychiatric evaluation, some ongoing clinical monitoring, and a few immediate crisis intervention. A mature campus mental healthcare system should be equipped to respond across this entire spectrum. The conversation should therefore move beyond whether campuses have counsellors to whether they have a system capable of supporting every stage of care.

Also read: Why People With Mental Health Conditions Are More Likely To Struggle With Tobacco Addiction

Building A Comprehensive Campus Mental Healthcare System

Encouragingly, public policy is beginning to recognise this changing reality. The University Grants Commission’s draft guidelines on mental health and wellbeing for higher educational institutions, with recommendations on counsellor ratios, dedicated wellbeing centres, round the clock helplines and mechanisms for early identification of distress, mark an important step in strengthening institutional support. More importantly, they open the door to a broader conversation on what comprehensive mental healthcare within higher education should look like over the coming years.

Building such a system requires looking beyond individual appointments. One of the most valuable lessons from developing healthcare services is that outcomes are rarely determined by the first consultation alone. They depend on how seamlessly care continues afterwards. If a counsellor recognises that a student needs specialised assessment, how quickly can that happen?

Also read: Lindsay Clancy Trial: What Postpartum Psychosis Really Looks Like, From A Survivor

If medication becomes necessary, is psychiatric care available without delay? If a student experiences a crisis outside campus hours, is there a clearly defined pathway to immediate support? If treatment begins, who ensures continuity during semester breaks or after the student returns home? These are not administrative questions. They are questions that shape recovery.

A comprehensive campus mental healthcare ecosystem should therefore bring together different levels of expertise rather than rely on one profession alone. Counsellors, clinical psychologists, psychiatrists, experienced mental health specialists and emergency support services each play a distinct role. Their contribution becomes most effective when they work as part of an integrated network with clear referral pathways, shared clinical responsibility and continuity of care that extends beyond the physical boundaries of the campus.

Prevention And Early Intervention Matter Too

Also read: Sugar Rationing In First 1,000 Days Linked To Lower Depression, Cancer Risk In Adulthood

Equally important is recognising that mental healthcare should not begin only after a student seeks help. Institutions have long understood the value of preventive healthcare through regular physical health assessments, vaccination drives and awareness programmes. Mental health deserves the same thoughtful approach.

Periodic, voluntary mental health check ins, appropriate screening, trained faculty and peer support networks, backed by specialist expertise, can help identify concerns early while respecting privacy, dignity and informed consent. Early recognition is not about labelling students. It is about ensuring that support reaches them before distress becomes disabling.

Technology can strengthen this ecosystem, but it cannot replace it. Digital consultations, secure follow up, coordinated records and access to specialists across locations can make care more continuous, particularly for students studying away from home. Their real value lies in connecting different parts of the system rather than functioning as isolated solutions.

Mental Healthcare As Part Of The Institutional Foundation

The quality of a university has traditionally been measured through its academic standards, faculty and research. Increasingly, it will also be measured by how well it supports the people who make learning possible. Mental healthcare deserves to be seen as part of that institutional foundation, not as an additional welfare service that sits alongside education.

The conversation has already moved beyond whether student mental health matters. The next step is to recognise that no single professional, however skilled, can meet every need that students may bring with them. Every campus needs more than a counsellor because every student deserves access to a mental healthcare system that is prepared not only to listen, but also to respond, support and care through every stage of that journey.

By Dr. Jothi Neeraja, Founder, Chairwoman and Managing Director, Maarga Mindcare

Anxiety and depression are major concerns in adulthood, but could nutrition during the earliest stages of life influence health decades later? Two new studies suggest that lower sugar exposure during the first 1,000 days of life may be associated with lower risks of anxiety, depression and even several cancers later in life.

The findings, from studies published in Translational Psychiatry and PNAS point to the potential long-term effects of early-life nutrition. However, the findings do not mean that restricting sugar in infancy directly prevents these diseases.

Sugar Rationing And Mental Health

A 2026 study led by researchers from the University of Surrey, UK, analyzed 46,448 people born between October 1951 and March 1956.

Participants were grouped according to how long they were exposed to sugar rationing: from in utero only to 24 months. People conceived after food rationing had ended served as the main comparison group.

Researchers also analyzed brain MRI data from 5,990 participants.

Lower Risk Of Anxiety And Depression

Compared with people conceived after rationing ended, those exposed to sugar rationing for the three longest periods had significantly lower hazards of both anxiety and depression.

• Shorter-exposure groups did not show significant differences.
• The associations were stronger in women.
• Adult sugar intake was broadly similar across groups, at about 58–59 g/day of free sugar and 122–124 g/day of total sugar.

When later-life sugar intake was considered, the association with anxiety persisted among those exposed throughout pregnancy and the first two years of life, while the association with depression weakened and was no longer statistically significant.

Further, MRI analysis found differences across rationing groups in 80 of 139 gray matter regions. Analysis identified 11 regions that differed from participants conceived immediately after rationing ended, including the brainstem, occipital fusiform gyrus and several cerebellar regions.

Sugar And Cancer Risk

A separate study published in PNAS examined whether sugar exposure during the first 1,000 days could influence cancer risk later in life.

Researchers from China Agricultural University and the University of Cambridge used the abrupt end of UK sugar rationing in September 1953 as a natural experiment. The analysis included 64,761 UK Biobank participants born between 1951 and 1956.

Compared with those whose first 1,000 days were not affected by rationing, participants exposed to rationing showed lower incidence of several cancers:

• Liver/intrahepatic bile duct cancer: 69% lower
• Prostate cancer: 52% lower
• Lung cancer: 41% lower
• Rectal cancer: 40% lower
• Breast cancer: 36% lower

The researchers identified two possible pathways behind the association.

How Could Early Sugar Exposure Matter?

• Long-term dietary habits: People exposed to rationing consumed less sugar, ate smaller quantities and had healthier, more diverse diets even five decades later, suggesting that early-life exposure may influence lasting food preferences.

• Biological ageing: The rationed groups had longer leukocyte telomeres, equivalent to about 2.2 fewer years of biological ageing, along with lower levels of Granzyme B, a marker linked to chronic immune activation.

Sugar's Link With Mental Health And Cancer

Sugar is an important source of energy for the brain, and very low blood glucose can impair brain function. However, excess sugar intake has also been associated with metabolic problems that can affect long-term health.

When it comes to cancer, sugar does not directly cause cancer, and cutting out all sugar does not “starve” cancer cells. Both healthy and cancer cells use glucose for energy.

However, consistently consuming excessive amounts of added sugar can contribute to weight gain and obesity, which are established risk factors for several cancers.

Men who consume higher amounts of dietary nitrite may have a greater risk of colorectal cancer, particularly the type affecting the distal colon, according to a new study published in the Journal of the National Cancer Institute.

The study followed 82,009 middle-aged and older adults in Sweden for more than two decades and identified 3,170 cases of colorectal cancer.

Researchers found that men in the highest category of nitrite intake had a 23% higher risk of colorectal cancer overall compared with those in the lowest category. The strongest association was for for distal colon cancer, where the risk was 50% higher.

The findings were not seen in women, and dietary nitrate was not associated with colorectal cancer in either men or women.

More About The Study

Researchers from Karolinska Institutet in Sweden used dietary information collected in 1997 and updated in 2009 and 2019. They linked this information with Sweden's cancer registry to identify colorectal cancer cases through 2022.

Rather than relying only on participants' diet at the beginning of the study, researchers used repeated measurements to capture changes in nitrite and nitrate intake over time. Among men, the highest versus lowest levels of nitrite consumption were associated with a hazard ratio of 1.23 for colorectal cancer. For distal colon cancer, the hazard ratio rose to 1.50.

Also read: How Genetic and Genomic Testing Can Help Women Make Smarter Cancer Decisions

Difference Between Nitrite And Nitrate

Nitrite and nitrate are related compounds, but they are found in different foods and behave differently in the body. Nitrate occurs naturally in vegetables, particularly leafy greens, as well as drinking water. Nitrite is also naturally present in some foods but is commonly used as a preservative in processed meat and other animal products.

The researchers found no association between dietary nitrate and colorectal cancer, making the distinction particularly important.

Also read: Moderna-Merck’s Personalized mRNA Vaccine: Ushering In A New Era In Cancer Care?

Why Nitrite Could Be A Concern For Cancer Risk?

A possible explanation involves N-nitroso compounds, which can form when nitrate and nitrite undergo chemical reactions in the body. Some N-nitroso compounds are known to be carcinogenic in animals.

The researchers saw that previous studies have also investigated possible links between nitrite exposure and cancers of the gastrointestinal tract. However, the exact biological mechanism behind the association observed in this study remains uncertain.

The researchers also found that the association was specific to men, and they said the reason for this difference is unclear.

Sex Difference Needs More Investigation

The authors noted that the higher risk associated with nitrite intake was confined to men and suggested several possible biological explanations, including differences in oxidative stress and other sex-specific factors.

But they stressed that these mechanisms have not been established as the reason for the finding. The study concludes that further research should examine nitrite and colorectal cancer separately in men and women and.

The study was observational, meaning researchers identified an association between dietary nitrite intake and cancer risk but could not prove a direct cause and effect relationship.