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.

Indian Actress Dipika Kakkar, battling liver cancer, underwent another surgery last month for a 1.3 cm cyst that reappeared.

Best known for her role as Simar Bhardwaj in the hit TV show Sasural Simar Ka, Dipika underwent a major tumour-removal surgery in June 2025. She also undertook chemotherapy

In her latest vlog, Dipika shared that the unexpected recurrence has left her feeling anxious and overwhelmed as doctors evaluate the next course of treatment.

"The recurrence that happened with the 1.3 cm cyst has shaken me. I am a little scared now that it shouldn't happen again. I have started dieting, but I feel anxious," she said.

HealthandMe spoke to health experts to understand why cysts recur in liver cancer patients and how it's important to keep monitoring them.

According to health experts, a biannual liver scan is imperative, and it can detect signs of cysts.

“Simple cysts less than 2-3 Cm can be observed with repeat scans every 6 months to 1 year. Suspicious or malignant cysts need surgical resection and oncological treatment based on the histopathology and patient condition,” Dr Manjunath NML, Sr Consultant, Surgical Oncology and Robotic Surgeon, HCG Cancer Hospital, K R Road, Bengaluru.

What Are Liver Cysts? How It's Linked To Cancer

Liver cysts are like bags that are filled with fluid. They are usually not cancer. Most people who have liver cysts do not get cancer.

However, just because one has a cyst, it does not mean it's cancer.

“Cysts in the liver are typically harmless and unrelated to liver cancer. However, unusual types of cysts may suggest malignant changes that need further examination, particularly among risk groups,” Dr. Govind Nandakumar, Consultant – Gastrointestinal Surgery, Manipal Hospitals Hebbal, told HealthandMe.

The experts noted that cases of recurring cysts related to liver cancer are uncommon. But they occur because of

• the presence of cancerous cells,
• regrowth of the organ,
• chronic conditions like cirrhosis.

Also read: 1 In 4 Diabetic Patients in India Suffer from Liver Fibrosis, Finds Lancet Study

Are There Early Warning Signs Patients Should Watch For?

Many liver cysts do not cause any problems in the early stages. That is why regular check-ups with a doctor are important. If a cyst grows or becomes problematic, symptoms may begin to appear. These can include

• abdominal pain,
• bloating,
• nausea,
• weight loss,
• yellowing of the skin,
• fatigue.

Is Recurrent Cysts A Cause Of Worry?

Recurrent cysts can be effectively managed and treated over time. The recurrence does not necessarily imply the progression of the condition itself; however, more tests may be required to determine whether cysts are malignant or benign.

“Cysts with thick walls, septations inside, and solid components in them are more likely to be cancerous. If the cysts are large, they cause symptoms like pain, distension, and obstruction of the bowel or biliary tract,” Dr Manjunath said.

The experts explained that diagnosis can be achieved by scans like ultrasonography, Computerized Tomography CT or Magnetic Resonance Imaging (MRI). Suspicious cysts must be checked via biopsy to confirm malignancy.

While suspicious or malignant cysts require surgical resection and oncological treatment, symptomatic cysts, even if benign, may also require removal.

However, if a liver cyst is detected without suspicious features and is asymptomatic, it usually does not require any intervention, Dr. Manjunath noted.

What if the body whispers long before it screams? For many living with Parkinson’s disease, the earliest signs are not the tremors, but quieter changes, such as a diminished sense of smell, disrupted sleep, or gut problems. The challenge is that we are conditioned to look for the disease only once it becomes visible.

Parkinson’s disease, commonly referred to as a movement disorder, progresses slowly due to the destruction of the nerve cells in the brain.

To understand Parkinson’s disease, think of the brain as a command center where certain nerve cells produce dopamine, a chemical messenger that helps coordinate smooth movement. As these dopamine-producing cells gradually deteriorate, the brain’s signalling system gets disturbed, leading to slower movements, mistaken for normal ageing.

The majority of patients experience subtle early signs much before diagnosis, including a reduced sense of smell, sleep disturbances like insomnia, and persistent digestive problems like constipation. In these cases, timely intervention can reduce movement disability by roughly 40 percent.

Parkinson’s Treatment

Also read: Blame This Brain Region Behind Laughing, Coughing For Your Hypertension

Conventional treatment focuses on medications that boost dopamine levels, but over time, their effectiveness may decline. When drugs are no longer sufficient, doctors may recommend Deep Brain Stimulation (DBS), a surgical approach that works like a pacemaker for the brain and uses chest-connected electrodes to reset faulty signals causing stiffness and tremors.

Unlike fixed traditional stimulation, the advanced Adaptive DBS (aDBS) listens to brain signals in real-time to adjust therapy automatically. Its single threshold mode reacts instantly, boosting stimulation the moment brain signals hit a specific limit and turns it off just as fast once they improve.

Alternatively, its double threshold mode keeps stimulation steady within the safe zone," making only gradual tweaks if signals cross upper or lower limits. This smart system mimics the body’s natural rhythm to provide fluid symptom control while preventing overstimulation, ultimately helping you reclaim more "good" time and independence.

Parkinson’s Diet

There is no single ‘Parkinson’s diet,’ but certain food choices can help manage symptoms and overall well-being. A balanced diet rich in fruits, vegetables, and whole grains supports general health and may help reduce inflammation.

Plant-based flavonoids, present in berries, citrus fruits, and broccoli, which have antioxidant effects, can help protect brain cells from damage. Drinking enough water can support digestion and prevent dehydration.

Ultimately, small, consistent dietary choices, combined with medical guidance, can make a meaningful difference in managing symptoms.

Parkinson’s disease is a journey, and the earlier the signs are recognized, the better the condition can be managed. If you or a loved one is experiencing persistent changes in sleep, smell, or movement, do not wait for the symptoms to become overwhelming. Consulting a neurologist is the first step toward taking back control of your health.

While salt, cholesterol, and obesity are major factors driving high blood pressure, a recent study suggests they may not be the only causes.

Researchers from Brazil and New Zealand have identified a brain region that may increase the risk of hypertension. The study, published in the journal Circulation Research, showed that the brain region called the lateral parafacial region is the culprit.

The lateral parafacial region sits in the brainstem – the oldest part of the brain – which controls automatic functions such as digestion, breathing, and heart rate.

“The lateral parafacial region is recruited into action, causing us to exhale during a laugh, exercise, or coughing,” said lead researcher Professor Julian Paton, from the Centre for Heart Research at Waipapa Taumata Rau, University of Auckland.

“These exhalations are what we call ‘forced’ and are driven by our powerful abdominal muscles. In contrast, a normal exhalation does not need these muscles to contract; it happens because the lungs are elastic,” Paton added.

Can Breathing Patterns Signal Hypertension?

Paton and the team found that the lateral parafacial region also connects to nerves that tighten blood vessels -- a mechanism that raises blood pressure.

“We’ve unearthed a new region of the brain that is causing high blood pressure. Yes, the brain is to blame for hypertension!” Paton said.

“We discovered that, in conditions of high blood pressure, the lateral parafacial region is activated and, when our team inactivated this region, blood pressure fell to normal levels.”

The team explained that this means changes in breathing patterns – especially those involving strong abdominal muscle contractions – can trigger high blood pressure. Thus, any diagnosis of abdominal breathing in patients with high blood pressure may reveal the cause and hence direct appropriate treatment.

Can The Brain Region Help Treat Hypertension

The next question was whether the brainstem region could be treated with a medication.

“Targeting the brain with drugs is tricky because they act on the entire brain and not a selected region such as the parafacial nucleus,” Paton said.

The researchers then discovered that this region is activated by signals from outside the brain – from the carotid bodies, tiny clusters of cells in the neck near the carotid artery that sense oxygen levels in the blood.

These can be targeted safely with medication, they said.

“Our goal is to target the carotid bodies, and we are importing a new drug that is being repurposed by us to quench carotid body activity and inactivate ‘remotely’ the lateral parafacial region safely, i.e., without needing to use a drug that penetrates the brain.”

This finding could lead to new treatments for high blood pressure, especially for people who also have sleep apnea, as we know carotid bodies are activated in these patients when they stop breathing at night.

Global Burden Of Hypertension

Hypertension is commonly referred to as the "silent killer" due to its lack of noticeable symptoms. Unchecked, it progressively damages your arteries and vital organs.

It occurs when the pressure in your blood vessels is consistently higher than normal—usually 140/90 mmHg or more, states the World Health Organization (WHO). The normal and healthy level is estimated to be 120/80 mmHg. Blood pressure increases when the arteries get narrow or stiff, causing the heart to work harder.

At a global level, an estimated 1.28 billion adults aged 30 to 79 years have hypertension, and most of them live in low- and middle-income nations. Alarmingly, 46 percent of them do not even know they have it, and just 1 in 5 keeps it under control, as per WHO statistics.

Also read: Former US Senator Ben Sasse Opens Up About Battle With Terminal Stage 4 Pancreatic Cancer

In the US alone, the Centers for Disease Control and Prevention (CDC) estimates that nearly 47 percent of adults, or roughly 116 million individuals, have hypertension, yet only 24 percent control it well. The economic burden is just as overwhelming, with the US spending $131 billion each year on care related to hypertension.

Exercise, lifestyle changes, and diet are key to preventing hypertension