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Flu season is just around the corner, and health officials are urging everyone to get their flu shot. According to the Centers for Disease Control and Prevention (CDC), people with diabetes are at high risk of developing serious flu-related complications, such as pneumonia. The CDC recommends that everyone 6 months of age and older get a yearly flu vaccine, but it’s especially important for people with diabetes to get vaccinated.
Your body needs extra energy to fight any infection.
Thus, the body manufactures additional glucose for its fuelling needs.
Further, the infection may stimulate the release of stress hormones like adrenaline and cortisol, both of which can reduce the effectiveness of insulin.
Insulin is responsible for regulating (or lowering) blood sugar levels in the body.
Additional glucose production combined with the lower effectiveness of insulin can make it difficult for the glucose levels to lower back to normal.
This is more profoundly seen in people with diabetes (PWD).
When the glucose levels become too high, the body gets dehydrated, trying to compensate for the levels.
This condition is called hyperosmolar hyperglycemic nonketotic syndrome (HHNS) and can be life-threatening.
The flu wreaks havoc on the body, but it is more so for PWD.
Diabetes weakens the immune system, leaving PWD more susceptible to the flu.
A changed eating pattern combined with dehydration can make it difficult to manage blood sugar levels.
PWD are at an increased risk for complications from the influenza virus, like bronchitis, worsening heart diseases, and pneumonia.
The risk is even higher in those over 65 with diabetes.
Further, the incidences of other chronic conditions like chronic obstructive pulmonary disease (COPD), hypertension, and renal diseases are higher in PWD.
This puts them at higher risk for complications and hospitalizations due to the influenza virus.
Researchers have identified several genes associated with diabetes.
In the sample report below, we've attempted to analyze some important genes that increase the risk of diabetes.
You can identify your genetic risk of diabetes by using your 23andMe DNA data and placing an order for the Gene Health Report.
In the United States, flu viruses are common in fall and winter.
It can begin to peak during October and November and may extend up to early May.
The timing can, however, vary with each season.
According to the CDC, the longest stretch of flu season was from Oct 01, 2018, to May 04, 2019, at that time.
The 2020 and 2021 years saw lower incidences of flu due to increased precautionary methods adopted in light of the COVID pandemic.
However, this year (2022-2023) flu season, many experts suggest, will bring in many more flu cases in the United States than in recent years.
Yearly flu shots are advisable for everyone, including PWD, autoimmune disorders, and mothers with gestational diabetes.
30% of adults hospitalized due to flu in the last few seasons had some type of diabetes.
Further, PWD are three times more likely to have severe COVID than those without diabetes.
So, it is important for all PWD and their families to get their flu shots.
Since the strain of virus emerging every year is different, the CDC recommends yearly flu shots.
According to the CDC, there are several types of flu vaccines:
| Flu Shot | Description |
| Standard dose flu shots | Traditional vaccine |
| Cell-based flu shots | Approved for people 6 months and older |
| Recombinant flu shots | Stronger immune response, shorter shelf life |
| High-dose flu shots | For the elderly (65 years and above) |
| Adjuvant flu shots | For the elderly; contains an adjuvant to boost immune response |
| Nasal spray vaccine | Made with weakened live flu viruses; not recommended for pregnant or immunocompromised people |
According to the CDC, the best vaccine for PWD is injectable dead-virus flu vaccination due to its long-established safety record.
The immune system reacts to the dead/weakened virus in the vaccine, causing the blood sugar levels to spike, just like an infection would.
However, there’s not much research to explain how flu shots can lead to higher blood sugar levels.
According to a report in the Annals of Pharmacotherapy, there has been only one report of an unusual spike in blood glucose levels after vaccination.
However, their healthcare team could not identify a specific reason for the glucose rise, nor did they mention that it was caused directly by the flu shot itself.
This 2022 study included 34 adults with an average age of 75 years with diabetes during the 2018 to 2020 flu seasons.
The researchers examined their blood sugars in the first 24 hours after they got their vaccinations.
They reported higher blood glucose levels on the first day after the flu shot.
The levels returned to baseline by the second day.
The study authors say that they agree with vaccination recommendations for PWD and that the benefits outweigh the risk of transient, acute hyperglycemia.
Diabetes affects immune functioning, and therefore people with diabetes (PWD) are at a higher risk for flu-related complications and hospitalizations.
The CDC recommends everyone, especially PWD get their yearly flu vaccinations.
The best vaccine for PWD is injectable dead-virus flu vaccination due to its long-established safety record.
Spikes in blood sugar levels may be observed a day post-vaccination, but the levels return to baseline the following day.
There may be a small risk for transient acute hyperglycemia following vaccination, but the vaccination benefits for PWD outweigh this risk.
Myopia or nearsightedness is a common eye condition in which individuals cannot clearly see distant or far-away objects.
According to the American Academy of Ophthalmology, nearly half the world’s population will have nearsightedness by 2050.
Nearsightedness among children increases as they grow old, and their glasses prescription usually stabilizes in their 20s.
Myopia is a complex condition that affects the structure of the eye.
When the eyeball is too long, or the cornea (protective outer layer of the eye) is too curved, light that enters the eye is not focussed properly.
As a result, the image is focused in front of the retina rather than on it. This causes blurred vision and is called a refractive error.
Though myopia's exact cause is unclear, it is said to develop due to an interaction between genetic and environmental factors.
In high myopia, the eyeball grows more than normal and becomes long from front to back.
Apart from myopia, people with this eye structure are also at a greater risk for cataracts, glaucoma and detached retina.
Degenerative myopia is a type of nearsightedness that an individual typically inherits from their parents.
In this type of myopia, the eyeball elongates too quickly and causes severe myopia. This condition worsens into adulthood.
People with degenerative myopia are at a higher risk for other visual conditions like a detached retina, glaucoma, and abnormal vessel growth in the eye.
Image: Overview of Myopia
Researchers have found over 200 genes associated with myopia and refractive errors.
In some people who inherit myopia, lifestyle factors like reading a book, using a laptop, or watching the TV from a close distance can result in nearsightedness.
Myopia usually appears in childhood. The condition may settle down or worsen with age.
Researchers at Columbia Medical Center have discovered a gene that may increase the risk of myopia in people who spend a significant amount of time doing near-work like childhood reading.
People with a variant of the APLP2 gene are five times more likely to develop myopia in their teens if they read for at least one hour per day in their childhood.
People with the APLP2 gene but who spent less time reading had no additional risk of developing myopia.
Myopia is a complex condition influenced by many genes and environmental factors, it does not have a clear inheritance pattern.
Some studies show that myopia can be inherited, as you are more likely to develop the condition if one or both of your parents have it.
The risk of myopia is greater when first-degree relatives like parents and siblings of the individual have the condition.
High myopia occurs when an abnormal change (mutation) in a single gene exists.
This form of nearsightedness follows an autosomal dominant (having one copy of the affected gene can cause the condition), autosomal recessive (having two copies of the affected gene causes the condition), or X-linked ( when the affected gene is present on the chromosome and is sufficient to cause the condition in males) inheritance pattern.
Researchers have identified several genes associated with vitiligo.
In the sample report below, we've attempted to analyze some important genes that increase the risk of vitiligo.
You can identify your genetic risk of vitiligo by using your 23andMe DNA data and placing an order for the Gene Health Report.
Autoimmune diseases occur when the immune system attacks the body, destroying healthy cells.
In normal cases, the immune system can differentiate between healthy body cells and foreign cells and attack only the latter.
In people with autoimmune conditions, this differentiation does not happen.
Vitiligo is an autoimmune condition characterized by loss of pigmentation (color) in the skin.
Melanin is a pigment in the skin, eyes, and hair that gives them color. Melanin is produced by the melanocyte cells.
In this condition, the body’s immune cells start destroying melanocytes. As a result, melanin production is reduced or stopped.
This leads to the formation of white patches on the skin. Over time, the white patches spread throughout the body.
About 0.5% to 2% of people worldwide are affected by vitiligo.
There are two types of vitiligo identified.
This is also called generalized vitiligo and is more common. In this case, the white patches spread throughout the body and are often seen in:
This is also called localized vitiligo or unilateral vitiligo and is more common in children than adults.
The white patches appear on just one or around a limited body area.
The telltale symptom of vitiligo is the appearance of pale or white patches on the skin.
The pigmentation loss usually starts on the hands and face and spreads to other areas.
People also notice that the lighter patches are more sensitive to sunlight and can itch and become red on exposure to the sun.
Vitiligo is a multifactorial condition, which means several factors can cause the condition.
Genetics plays a significant role in causing vitiligo. We will discuss more of this in the coming sections.
Along with genetics, certain factors may trigger the onset of the condition.
Studies confirm that the heritability of vitiligo can range from 46% to 72%. The risk increases when the person has a first-degree relative with vitiligo.
A twin study done among the European population showed that the concordance rate (the probability that two people sharing the same genes will develop the same condition) of developing vitiligo is 23% in monozygotic twins.
According to experts, more than 50 genes could influence the risk of developing vitiligo. Some of these include:
| Gene | Related protein |
| RERE | Arginine-Glutamic acid dipeptide repeats |
| FASLG | FAS ligand |
| UBE2E2 | ubiquitin-conjugating enzyme E2 E2 |
| HLA-A | HLA class I histocompatibility antigen, A |
| IRF4 | interferon regulatory factor 4 |
| TYR | Tyrosinase |
| PMEL | pre-melanosome protein PMEL |
| XBP1P1 | X-box binding protein 1 |
Globally, 1% of the population develops vitiligo.
In the case of people with a first-degree family member with the condition, the risk is up to 5 times higher.
Unlike what people assume, vitiligo does not necessarily skip a generation.
With a first-degree relative with this condition, 1 in 20 people may develop vitiligo too.
Studies show that men and women have an equal risk of developing the condition.
25% of people develop the condition before age 10, and about 70-80% of people start seeing signs before 30 years of age.
If you have a first-degree relative with vitiligo, genetic testing may help know your extent of risk.
If you belong to the high-risk category, taking precautionary measures like the below may help postpone the onset of the condition.
Image: Contributions to vitiligo - Genetics vs. environment
Studies show that up to 25% of people with vitiligo may have another associated autoimmune disease. Other health conditions associated with vitiligo are:
A majority of vitiligo cases could be genetically influenced. Studies say that 46% to 72% of people with vitiligo inherit the condition from family members.
In some cases, a person could have the gene changes affecting vitiligo but not develop the condition or develop it very late in life.
Environmental triggers can hasten the onset of the disease, and 70-80% of people develop symptoms before the age of 30.
Genetic testing may help identify the risk early on and help people take proactive steps to handle it.
According to the Centers for Disease Control and Prevention (CDC), every year, about 800,000 people in the United States have a stroke. In India, it is estimated that about 334-424 people out of 100,000 in urban areas and about 84-262 out of 100,000 people in rural areas suffer from stroke A stroke occurs when a blood vessel that supplies oxygen and nutrients to the brain is either blocked by a clot or bursts. When this happens, part of the brain cannot get the oxygen it needs, so it starts to die. Are strokes hereditary? Keep reading to find out.
Researchers have identified several genes associated with stroke.
In the sample report below, we've attempted to analyze some important genes that increase the risk of stroke.
You can identify your genetic risk of stroke by using your 23andMe DNA data and placing an order for the Gene Health Report.
Stroke is a condition in which the blood supply to the brain is blocked, resulting in a lack of oxygen to the brain cells and, finally, death of brain cells.
It occurs when the blood vessels going to the brain is either blocked by a clot or burst.
A stroke can lead to partial or complete paralysis or even death.
In India, the highest fatality, 42%, from stroke is seen in Kolkata.
In the U.S, stroke is the 5th leading cause of death and the leading cause of disability.
There are three types of strokes, classified based on the type of disruption and the extent of disruption in blood supply to the brain:
The ApoE gene mutation was found to be associated with increased levels of cholesterol, LDL and ischemic heart disease.
It has also been shown to be significantly associated with stroke.
Specifically, the ApoE gene mutation was shown to be associated with carotid intima-media thickness, which plays a role in ischemic stroke.
Many vascular conditions are driven by an interplay between genetic factors and environmental factors.
Hence, there has been a surge in circulation-related problems coincident with a surge in the consumption of high-calorific food and an increase in a sedentary lifestyle.
Genetic risk factors, such as the ApoE gene mutation, appear to play a significant role in the disease pathogenesis of stroke.
Testing for this gene mutation may help identify a risk factor and take preemptive actions.
These factors may be modified to reduce the risk associated with the ApoE gene mutation.
In most instances, the severity of stroke can be controlled when the patient is provided with emergency medical support.
Genetic risk is an indicator of risk and does not guarentee disease onset or signify a poor prognosis.
A person with a high genetic risk for stroke should quit smoking, stay active, eat a well-balanced diet, stay away from alcohol, and keep a watch for warning signs and symptoms.
A stroke occurs when blood and oxygen flow to the brain is blocked.
The ApoE gene, famously associated with Alzheimer's, also plays a role in stroke risk.
Environmental factors like a sedentary lifestyle, consuming high-fat foods regularly, and health conditions like diabetes and hypertension can also impact stroke risk.
Common treatment options involve surgically removing the clot.
Physiotherapy and motility aids may help patients move and do some of their personal things to an extent.
Researchers have identified several genes associated with osteoarthritis.
In the sample report below, we've attempted to analyze some important genes that increase the risk of osteoarthritis.
You can identify your genetic risk of osteoarthritis by using your 23andMe DNA data and placing an order for the Gene Health Report.
Osteoarthritis (OA) is a degenerative disease of the joints. The condition makes joints stiff, weak, and painful and reduces mobility.
This is very common in older adults, and OA can affect all body parts, including knees, hands, shoulders, and hips.
Cartilage is a flexible tissue that covers joints and bones.
It allows joints to move smoothly without friction.
OA breaks down the cartilage, so the joints and bones start rubbing against one another as they move. This leads to pain, swelling, stiffness, and lowered mobility.
OA is a wear and tear condition.
As people age, the cartilage and joints go through age-related wear and tear, causing pain and stiffness.
Studies show that up to 35-65% of cases of osteoarthritis could be genetically influenced. We will discuss more on the genetic influences in the coming sections.
There could be so many environmental and lifestyle causes that increase a person’s risk of developing OA.
Some of the commonly experienced symptoms of OA are
Source: https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/
Studies show that OA has a polygenic inheritance.
This means that the condition is influenced by multiple genes instead of just one.
The age of onset of OA, its progression, and the severity of the condition could all be influenced by different gene changes and their interactions.
OA in the hands and hips could be 65% inherited, while OA in the knee could be about 40% inherited.
As mentioned above, multiple genes determine a person’s risk of developing OA. Some of the important ones are mentioned below.
The COL2A1 gene provides instructions for producing type II collagen. This collagen makes connective tissues like cartilage stronger and gives them flexibility.
Changes in this gene may lead to a lowered production of type II collagen, leading to early cartilage breakdown and OA.
Other genes that control the production of collagen in the body may also increase or decrease a person’s risk of developing OA. These include
| Genes | Manifestation |
| COL11A1 | Early onset of OA |
| COL11A2 | Early onset of OA |
| COL1A1 | Protective against hip OA in females and people assigned female at birth |
| COL9A1 | Early onset of knee OA |
Interleukins are types of proteins that are produced by White Blood Cells (WBCs).
These play a role in cell-cell communication.
Certain genes that control the production of interleukins may increase or decrease a person’s risk of developing OA.
Some of these interleukin genes are:
| Genes | Manifestation |
| IL-1A, IL-1B, IL1RN | Can cause knee and hip OA |
| IL4R | Can cause hip OA in females and in people assigned female at birth |
| IL6R | Can cause hip OA |
| IL17A, IL17F | Increases risk of developing OA |
Other genes that have been associated with OA are:
| Genes | Manifestation |
| Insulin-like growth factor 1 (IGF-1) | Increases risk of developing OA |
| Matrilin-3 (MATN3) | Can cause early onset of OA in hands and knees |
| Vitamin D receptor (VDR) | Increases overall risk of developing OA |
| Cartilage Oligomeric Matrix Protein (COMP) | Early onset of hip OA |
Some of the non-genetic risk factors for developing osteoarthritis are:
Since OA is a wear and tear disease, the risk of developing the condition increases with age.
OA occurs more frequently in women and people assigned female at birth than men and people assigned male at birth.
Carrying excess weight puts unnecessary stress on the joints, leading to OA.
Any serious injury to the joints that didn’t heal well may increase a person’s risk of developing OA.
Any deformity to joints that happened by birth may increase the person’s risk of developing OA.
Congenital deformities are one of the most common reasons people develop OA in the hip.
When the cartilage gets broken down, the body tries to repair the same using Vitamin D. Lack of vitamin D may prevent the body from healing the cartilage and lead to OA.
Image: Risk factors and treatment for osteoarthritis
While osteoarthritis could result from certain medical conditions, age, and injuries, genetics remains an important cause.
Genetics may influence the age of onset, the progression, and the severity of symptoms of OA.
Genetic testing can help understand your risk of developing the condition. If you have close family members with OA, then genetic testing may help.
Preventive medications, physical activities, and other lifestyle changes can bring down the damage to the cartilage and delay the onset of OA in high-risk individuals.
Triple-negative breast cancer is not as well known as other types of breast cancer, but it is just as serious. This type of cancer is difficult to treat because it does not respond to hormone therapy or targeted therapy drugs. Diet is a key factor that can play a role in your health, and certain foods may help prevent and even fight triple-negative breast cancer.
Estrogen and progesterone are important hormones for the female reproductive system.
Certain cells have receptors (proteins) to which these hormones bind to fuel them.
Breast cancer cells with estrogen and progesterone receptors are ER+ and PR+ breast cancer, respectively.
Her2 is another protein that acts as a growth factor, and breast cancer cells with receptors for this protein is called Her2+ breast cancer.
Triple-negative breast cancer (TNBC) is a type of breast cancer that does not have receptors for the hormones estrogen, progesterone or the Her 2 protein.
Hence, hormonal treatments targeting such receptors are ineffective against TNBC.
Your diet plays a big role in your breast cancer risk.
Consuming processed meats and high-fat dairy can increase your risk while eating plenty of fruits and vegetables can decrease it.
Alcohol consumption is also a factor. Even moderate drinking can increase your risk by 10%.
Maintaining a healthy weight is important, as well. Obesity increases your risk of developing breast cancer, especially after menopause.
According to the American Cancer Society, some foods help boost overall health and reduce the risk of several types of cancers.
Research studies report a link between the Western diet (one that is high in processed foods and added sugars) and an increased risk for breast cancer.
Additionally, Western diet-induced obesity can further increase the risk.
A 2021 study reported that obesity is associated with shorter survival among TNBC patients.
A recent study published in April 2022 analyzed the impact of diet on TNBC chemotherapy response and the risk for chemotherapy-induced heart damage.
The study reported that regardless of the dietary pattern, a high-fat diet increased TNBC growth.
Further, mice fed with the western diet showed cancer metastasis to the lung, and this was not seen in mice fed with the Mediterranean diet.
The former also shower poor cardiac function compared to the latter, with increased fibrosis.
Certain food groups help with a better outcome for TNBC treatment, as well as reduce the risk for TNBC.
They include:
Whole grains, vegetables, fruits, legumes
Phytochemical compounds have anticancer properties
Certain phytochemicals like folate, curcumin, resveratrol, epigallocatechin, and sulforaphane can help manage TNBC.
Recommended foods in this group include broccoli, kale, celery, green tea, turmeric, carrot, spinach, and pears.
According to findings presented at American Association for Cancer Research conference 2013, omega-3 fatty acids can slow down TNBC.
Foods rich in omega-3 fats include salmon, chia seeds, walnuts, and cod liver oil.
Limiting or avoiding the following food items/groups can help with slowing down the progression of TNBC, increase the likelihood of favorably responding to treatments, and reduce the overall risk for TNBC.
TNBC is one of the toughest types of breast cancer to treat since the cancer cells do not have any hormone receptors.
Diet plays a major role in influencing cancer risk, cancer progression, treatment outcome, and survival.
A diet high in processed foods, sugar, and fats has been linked to an increased risk for TNBC and poor chemotherapy outcomes.
A diet rich in whole grains, phytochemicals, omega-3 fats, fruits, and vegetables can help reduce the risk of all types of cancer and can further help with slowing down cancer progression.
