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 new oral GLP-1 medication has delivered encouraging results in a Phase 2b clinical trial for people living with type 2 diabetes.

According to AstraZeneca, its experimental tablet, elecoglipron, significantly lowered blood sugar levels and helped participants lose an average of 10.5% of their body weight after 26 weeks of treatment.

The findings were presented at the 2026 American Diabetes Association Scientific Sessions in New Orleans and published in The Lancet on June 8.

Elecoglipron joins a growing wave of GLP-1 therapies being developed as pills, offering an alternative to injectable drugs such as Ozempic, Wegovy, Zepbound, and Mounjaro.

The first oral GLP-1 treatment, Rybelsus from Novo Nordisk, received FDA approval in 2019 for adults with type 2 diabetes. Since then, oral options have continued to expand. In December 2025, the FDA approved a tablet version of Wegovy for weight management, while Eli Lilly’s oral obesity treatment, Foundayo, gained approval in April.

Independent experts say AstraZeneca’s results highlight the growing potential of non-injectable GLP-1 therapies for both diabetes and obesity treatment.

“It’s encouraging to see another oral medication demonstrating the benefits of GLP-1 therapy without requiring injections,” said Dr. Pouya Shafipour, a family and obesity medicine specialist at Providence Saint John’s Health Center in California.

Dr. Marilyn Tan, an endocrinologist and professor of medicine at Stanford University, noted that the rapidly expanding GLP-1 market could soon welcome another oral treatment option if elecoglipron succeeds in Phase 3 trials and ultimately secures FDA approval.

How Does GLP-1 Drug Work?

GLP-1 is a natural hormone produced in the intestines that regulates blood sugar, appetite, and digestion. Now, every time you eat, your body produces various hormones, including GLP-1. These are called post-nutrition hormones, and they help you absorb the energy you just consumed.

GLP-1 travels to your pancreas, prompting it to produce insulin. It also travels to the hypothalamus in your brain, which gives you the feeling of being full or satiated. GLP-1 pills imitate that hormone, thereby silencing the food chatter in the brain. Interestingly, for some people, this food chatter is really quiet, and for others it is an outburst. So with GLP-1, silencing this self-talk in the brain, people tend to lose their appetite and eventually weight.

However, it is important to note that losing weight includes not just fat but muscle as well. Losing too much muscle can lead to reduced strength and a shorter life span. Notably, records show that most people who start taking them stop them at 12 weeks; therefore, it is important for some but not for others.

What Are The Side Effects?

The side effects of these pills include:

• Nausea is a frequent side effect, especially when starting or increasing the dose, and vomiting may occur along with nausea.
• Diarrhoea and abdominal discomfort also show up.
• It can reduce appetite but may also lead to unintended weight loss or reduced food intake, causing discomfort for some people.
• There are certain less common, but serious side effects, like Pancreatitis, or inflammation of the pancreas.
• This drug may also cause severe kidney issues, particularly if dehydration occurs from side effects like vomiting or diarrhoea.

The most frustrating skincare experience is breaking out a week after using a new product. Niacinamide serum is the most common one that people blame when it happens. But the real question is: does Niacinamide cause purging? The answer is no, but understanding what happens in your skin when you introduce it can help you.

A well-formulated Niacinamide Serum at the right concentration is very gentle on the skin.

And pairing it with a Niacinamide Moisturizer helps your skin adjust if you are using it for the first time.

What Is Skin Purging and How Is It Different from Breakouts

Skin purging is the result of an active ingredient accelerating your skin's natural cell turnover cycle. Your skin renews itself every 28 days. Retinol, AHAs, and BHAs speed up this process, which pushes microcomedones, trapped sebum, and dead cell buildup up to the surface faster.

Your skin may appear like it is experiencing a sudden flare-up of pimples, but it is your skin clearing all the buildup in one go. True purging:

• Happens only with ingredients that increase cell turnover
• Appears in the same areas you normally break out
• Resolves within four to six weeks
• Involves small whiteheads and blackheads rather than deep cysts

A regular breakout appears in new areas with any product and does not follow the same predictable timeline. Understanding this difference is important before you blame any ingredient.

Does Niacinamide Cause Purging?

Dermatologists say no, and the reason comes down to how niacinamide works at the biological level. Purging occurs only when an ingredient accelerates cellular turnover, forcing the skin to shed faster to clear hidden congestion.

Niacinamide is a form of Vitamin B3, and its action is fundamentally different. It works in the following manner:

• Regulates sebum production through the sebaceous glands
• Strengthens the skin barrier by supporting ceramide production
• Niacinamide reduces redness and inflammation caused by acne
• Stops the transfer of melanin so that pigmentation reduces

Why Niacinamide Is Less Likely to Trigger Purging

No Cell Turnover Acceleration

Can niacinamide cause purging? Purging occurs when the old skin cells are shed, and new ones form at a faster pace. Niacinamide has no effect on this process. It works on controlling oil and improving barrier function. It does not work on exfoliation or renewal rate. There is no mechanism through which Niacinamide could cause purging without accelerating cell turnover.

Regulates Sebum, Doesn't Exfoliate

Niacinamide signals the sebaceous glands to produce less oil over time, whereas salicylic acid dissolves the sebum inside pores, and AHAs dissolve the bonds between dead skin cells. It reduces the congestion that leads to breakouts. Niacinamide for pimples works by calming the conditions that create them.

Reduces Inflammation Instead

The anti-inflammatory action of Niacinamide calms the redness and swelling around active breakouts. So, does niacinamide cause pimples? Its inflammation-reducing properties make it the safest active for acne-prone skin, which you can introduce at any concentration between 5% and 12%.

What Could Actually Be Causing Your Purging

If you started a niacinamide product and broke out, here are the more likely reasons for it.

New Product Adjustment

Any new skincare product can cause a temporary adjustment period as your skin gets used to a new formula or ingredients. This is not purging, but your skin reacting to change. It settles within one to two weeks if the formula is compatible with your skin.

Reaction to Other Formula Ingredients

Many niacinamide serums contain additional actives, such as AHAs, BHAs, Retinol, or exfoliating enzymes, which increase cell turnover in your skin. If your Niacinamide serum contains these ingredients as well, the purging may result from them. So, always check the full ingredient list before blaming a reaction on any single ingredient.

Wrong Concentration for Your Skin

Using a 20% Niacinamide formula directly when your skin has never used actives before can cause irritation that looks like a breakout. It's your skin reacting to a concentration that it is not ready for. A safe way is to start between 5% and 10% and build up slowly to prevent flare-ups.

How to Add Niacinamide Properly to Your Skincare Routine

The chances of a reaction reduce a lot when you introduce Niacinamide correctly.

1. Patch test first: Take a small amount and apply it to your inner arm or jawline, and observe for any reaction in the next 24 hours before using it on your full face. Gentle ingredients can react differently on certain skin types, so you must do a patch test.

2. Start at a lower concentration: 5% to 10% is the best starting point if you are a beginner. Give your skin four weeks at this level before going with anything stronger.

3. Introduce one product at a time: If you add multiple new products all at once, you will never know which one is causing a reaction. Add Niacinamide on its own first and give it two to three weeks before introducing other active ingredients.

4. Apply after washing your face: Niacinamide works best when the skin is fresh. Apply it after your face wash and before your moisturizer so that it absorbs better into the skin.

5. Be consistent: The oil-regulating and pore-refining benefits of Niacinamide show only after four to eight weeks of daily use. So, you may not get the results if you stop using it abruptly because of an unrelated reaction.

Conclusion

If you are still wondering, does niacinamide cause purging? It does not. An increase in cell turnover results in purging, and Niacinamide does not work that way. The main reasons for breakouts can be your skin trying to adjust to a new product or another active ingredient in the formula. Higher concentrations can also be tough for your skin to tolerate, which may result in breakouts.

Researchers have found that up to 25 per cent more adults could be classified as obese, even if their body mass index (BMI) score falls under the normal category. As per the current rules, a BMI score of 18.5 to 25 is considered healthy, 25–29 is overweight, and 30 onwards is considered obese. Obesity can contribute to a long-term risk of serious illness, but according to an international team of experts, BMI may not be the most reliable measure for ascertaining obesity levels in an individual.

Why is BMI not a reliable parameter?

Researchers have found that adding the weight-to-height ratio and waist circumference could be a good way to ascertain unhealthy body fat levels. Fat, according to scientists, builds up in people who are not considered overweight or obese under the current rules, depending on where it is stored. Older bodies have a higher fat build-up around the waist, which, when combined with loss of muscle mass, means that there is no change in total weight. This means that the fat that accumulates, known as "skinny fat," does not always raise an alarm.

The new study from scientists at the University of Southern California analysed data from 5,642 adults in the US and discovered that a quarter of them had a normal BMI but actually met the obesity criteria. Furthermore, over 50 per cent of overweight people, according to their BMI, also met the updated obesity criteria. These findings, according to experts, suggest that millions of Americans with obesity-related health complications could be missing much-needed health interventions.

BMI is problematic because it does not evaluate body fat but reflects total body weight, including muscle and bone. Therefore, a muscular person is likely to have a high BMI but not much fat. However, a person with a normal BMI can have excess body fat, which can lead to complications later. The good news, experts say, is that these obesity-related issues can be addressed. Either lifestyle changes, medication, or both can be effective in reducing body fat levels and lowering the risk of future health problems. The sooner it is diagnosed, the better it is for long-term well-being.

Read more: Why 'Normal Weight' Doesn’t Always Mean Healthy

Does obesity risk increase with age?

Researchers estimate that 30 per cent of adults living in England aged 16 years and above are obese. This increases with age, with over 35 per cent of people aged 55 to 74 years living with obesity. Under the new rules, obesity would be defined as a BMI of 30 and above, or at least one elevated measure, such as a high waist circumference, a high waist-to-height ratio, or a BMI of 40 and above. Researchers have labelled these obesity subtypes as BMI-plus-anthropometric obesity.

What is an unhealthy waist circumference?

According to the NHS, an unhealthy waist circumference is 37 inches in men and 31.5 inches or above in women. An unhealthy waist-to-height ratio occurs when the waist circumference is half or more of a person's height. According to the British Heart Foundation, BMI is calculated by dividing weight by height squared. There are multiple BMI calculators available online. It is classified as follows:

1. Underweight – below 18.5
2. Healthy weight – 18.5 to 24.9
3. Overweight – 25 to 29.9
4. Obese – 30 and above

If BMI is in the overweight category, it is linked with a heightened risk of heart disease and incidents such as stroke or heart attack. If it falls within the obese category, the risks are higher. Underweight people are not exempt from risk, as they have a greater likelihood of developing long-term health problems.