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.

A 27-year-old woman in US' state of Arizona suffered a cardiac arrest after using kratom, an over-the-counter supplement she purchased at a local gas station.

Amanda Goodsell, who had never taken kratom before, suffered a cardiac arrest after nearly a week of using the supplement and is now on life support, according to her family.

The mother of 3½-year-old twins tried the kratom gummies at the suggestion of her husband, Mike Goodsell, while seeking relief from persistent leg pain.

“Everybody knew what Kratom was. So I was like, well, okay, well, here, just take this. You could just buy it at the gas station. It’s not going to hurt you,” Mike Goodsell was quoted as saying to the media.

Nearly a week later, Mike found his wife unresponsive in their bed, and rushed her to the hospital, where she was placed on life support

“She like, was like red and her lips were blue, and she was foaming. So I like jumped out of bed. I grabbed her, and then (I) was trying to wake her up,” he said.

“They had to have her on a ventilator to help her breathe. And then they had to put her on a bunch of medications because her heart percentage was at 15%,” Mike added.

After spending two weeks in the hospital, Amanda Goodsell's condition began to improve. Although she has shown significant improvement, as per the doctors she will need a defibrillator and heart medication for the rest of her life.

Also read: Legionnaires' Disease Claims 5th Life In New York City: Health Officials

What Is Kratom?

Kratom is a plant-based substance derived from the Mitragyna speciosa tree, native to Southeast Asia. Traditionally used in countries such as Thailand and Malaysia for pain relief and increased energy, it has gained popularity in the US as an over-the-counter supplement.

Kratom is sold in multiple forms, including powders, capsules, teas, drinks and gummies.

Although it remains legal in many parts of the US, the Food and Drug Administration (FDA) has classified kratom as a "drug of concern" and has not approved it for any medical use.

According to the Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health, an estimated 1.7 million Americans aged 12 and older used kratom in 2021.

The substance, sometimes referred to as "gas-station heroin," is banned in at least eight US states—Alabama, Arkansas, Connecticut, Indiana, Louisiana, Tennessee, Vermont and Wisconsin. Several other states, including Iowa and Idaho, are considering restrictions or outright bans.

Why Does The FDA Warn Against Kratom?

Read More: Hantavirus Claims 3 Lives In Venezuela: What The Rat-borne Virus Does To The Brain

According to a University of Virginia study, there were 43 hospitalizations linked solely to kratom in 2015. By 2025, that number had risen to 538. Researchers said the increase coincided with the emergence of highly concentrated synthetic products, including 7-OH.

The FDA has stated that kratom should not be used as a dietary supplement.

"Kratom is not appropriate for use as a dietary supplement. FDA has concluded from available information, including scientific data, that kratom is a new dietary ingredient for which there is inadequate information to provide reasonable assurance that such ingredient does not present a significant or unreasonable risk of illness or injury."

The agency has warned consumers not to use kratom because of the risk of serious adverse events, including liver toxicity, seizures and substance use disorder (SUD).

The FDA also notes that, in rare cases, deaths have been associated with kratom use, although these cases usually involved other drugs and the contribution of kratom remains unclear.

The agency is also aware of cases involving neonatal abstinence syndrome, in which newborns experienced withdrawal symptoms such as jitteriness, irritability and muscle stiffness following prolonged exposure to kratom during pregnancy.

When it comes to climate change, we often visualise melting glaciers, rising sea levels, raging wildfires, or record-breaking heatwaves. But scientists are increasingly warning that climate change could also be silently affecting one of the body's most vital organs: the brain.

From rising mercury levels and worsening air pollution to floods, wildfires, and hurricanes, climate-related catastrophes are exposing millions of people across the world to conditions that could increase the risk of neurological disorders.

On World Brain Day, let's look at why brain health is another reason to take climate change seriously.

Effect Of Heatwaves On Brain Health

This can lead to poor concentration, slower reflexes, memory decline, headaches, confusion, and poor decision-making.

Older adults are particularly vulnerable because the brain's ability to regulate body temperature declines with age.

People living with neurological disorders like dementia, Parkinson's disease, multiple sclerosis, or epilepsy may also find that their symptoms worsen during periods of intense heat.

Also read: Will Waterborne Diseases Rise In The Future? New Study Says Climate Change Could Be A Major Driver

Effect Of Air Pollution On Brain Health

Climate change is worsening air pollution in many parts of the world by increasing wildfire smoke, ground-level ozone, and fine particulate matter.

These tiny pollutants, especially PM2.5, are small enough to enter the bloodstream and may even reach the brain. Studies have linked long-term exposure to air pollution with:

• Faster cognitive decline
• Memory impairment
• Increased risk of dementia
• Higher risk of stroke
• Parkinson's disease
• Poor brain development in children

Scientists believe air pollution may trigger chronic inflammation and oxidative stress, both of which can damage brain cells over time.

Also read: Europe Heatwave Causes 10,000 Excess Deaths; England, Wales Record 2,700 More Fatalities

Effects Of Wildfires On Brain Health

While smoke affects the lungs, it can also impact the brain.

Wildfire smoke contains fine particles and toxic chemicals that have been associated with headaches, reduced attention, poorer cognitive performance, and increased emergency visits for neurological conditions.

People with existing neurological diseases may experience worsening symptoms during periods of heavy smoke exposure.

Also read: Dangerous Heat Dome To Grip Eastern US, Canada, Putting Over 220 Million Lives At Risk: How To Stay Safe

Extreme Weather Can Accelerate Brain Ageing

Climate change is also increasing the frequency and intensity of floods, hurricanes, droughts, and other natural disasters. Beyond physical injuries, these disasters can leave lasting effects on the brain and mental health. People affected by climate disasters often experience:

• Anxiety
• Depression
• Post-traumatic stress disorder (PTSD)
• Sleep disturbances
• Chronic stress

Children, older adults, and disaster survivors are among the groups most vulnerable to these long-term psychological effects.

How To Protect Your Brain?

While tackling climate change is a long-term strategic plan, individuals can maintain few self-care habits to reduce the risks. Experts recommend:

• Staying hydrated during heatwaves
• Avoiding outdoor activity during peak afternoon heat
• Monitoring local air quality before going outside
• Wearing a well-fitting mask during heavy wildfire smoke or severe pollution
• Keeping homes cool whenever possible

Brain health is often associated with old age, but according to neurologists, the foundation for healthy cognitive function is laid much earlier.

On World Brain Day, they warned that the 30s and 40s are a crucial period to protect the brain, as lifestyle habits and underlying health conditions can quietly affect memory, concentration, and overall cognitive health.

Brain Ages Alongside the Heart

Speaking to HealthandMe, Dr. Gurucharan Adoor, Neurologist, Apollo Hospitals Bannerghatta Road, Bengaluru, said brain health is closely linked to cardiovascular health. High blood pressure, high cholesterol, and elevated blood sugar can silently damage the brain years before noticeable symptoms appear.

His advice? Make preventive health checks a routine by monitoring blood pressure, blood glucose or HbA1c, cholesterol, weight, and waist circumference—especially for people with a family history of diabetes, stroke, or early heart disease.

Brain Fog A Warning Signal

Also read: Neurological Disorders Emerging As India's Next Major Public Health Challenge, Say Experts

Dr. Adoor said sleep is often the first thing people sacrifice during their busiest years, but the brain pays the price.

Irregular sleep schedules, untreated sleep apnea, and repeated nights of poor-quality sleep can lead to mental fatigue, difficulty concentrating, and persistent brain fog. If brain fog continues, he said, it should not be ignored, as it may indicate an underlying health issue that requires attention.

Dr. Bhushan Joshi, Consultant Neurologist, Manipal Hospital, Kharadi, Pune, told HealthandMe that he is "seeing more professionals in their 30s and 40s complaining of brain fog than ever before". According to him, hormonal changes and chronic inflammation are among the common but often overlooked causes.

Hormonal Changes Can Affect Cognitive Function

Dr. Joshi noted that hormonal fluctuations can significantly influence brain function. Women entering perimenopause may experience difficulty concentrating, while others may notice "word retrieval and short-term memory due to changing estrogen levels that influence brain function."

He added that it is not limited to women. Men also undergo age-related hormonal changes that can affect energy levels and cognitive performance. While these changes are often temporary, they can still be distressing.

Read More: Aspartame, Saccharin, Erythritol Linked To Faster Brain Ageing: Study

Chronic Inflammation May Reduce Mental Clarity

Dr. Joshi explained that chronic low-grade inflammation can also contribute to brain fog. Conditions such as obesity, diabetes, autoimmune diseases, and persistent infections can trigger inflammatory responses that interfere with the brain's ability to process information efficiently. In some people, inflammation has been linked to reduced attention, poor memory, and diminished mental clarity.

Small Lifestyle Changes Key

The good news: Simple daily habits can support long-term brain health. Regular physical activity—whether it's walking, cycling, dancing, or strength training several times a week—improves blood flow to the brain, boosts mood, and supports healthy ageing.

Dr. Adoor also recommends limiting unnecessary screen time, taking regular breaks from phones and digital devices, and focusing on one task at a time to reduce mental overload.

When Should You See A Doctor?

Occasionally feeling mentally sluggish is common, but worsening memory problems or cognitive changes that begin interfering with work or daily life should not be ignored, Dr. Joshi said.

He added that these symptoms may stem from treatable conditions such as thyroid disorders, vitamin deficiencies, anxiety, or depression, making timely medical evaluation important.