OBESITY

Overview

Obesity is a complex disease involving an

excessive amount of body fat. Obesity isn't just a cosmetic concern. It's a medical
problem that increases the risk of other diseases and health problems, such as heart
disease, diabetes, high blood pressure and certain cancers.

There are many reasons why some people have difficulty losing weight. Usually,
obesity results from inherited, physiological and environmental factors, combined
with diet, physical activity and exercise choices.

The good news is that even modest weight loss can improve or prevent the health
problems associated with obesity. A healthier diet, increased physical activity and
behaviour changes can help you lose weight. Prescription medications and weight-
loss procedures are additional options for treating obesity.

Symptoms
Body mass index (BMI) is often used to diagnose obesity. To calculate BMI, multiply
weight in pounds by 703, divide by height in inches and then divide again by height
in inches. Or divide weight in kilograms by height in meters squared.

BMI Weight status

Below 18.5 Underweight

18.5-24.9 Normal

25.0-29.9 Overweight

30.0 and higher Obesity

Asians with BMI of 23 or higher may have an increased risk of health problems.

For most people, BMI provides a reasonable estimate of body fat.

However, BMI doesn't directly measure body fat, so some people, such as muscular
athletes, may have a BMI in the obesity category even though they don't have
excess body fat.

Many doctors also measure a person's waist circumference to help guide treatment
decisions. Weight-related health problems are more common in men with a waist
circumference over 40 inches (102 centimeters) and in women with a waist
measurement over 35 inches (89 centimeters).

When to see a doctor

If you're concerned about your weight or weight-related health problems, ask your
doctor about obesity management. You and your doctor can evaluate your health
risks and discuss your weight-loss options.

 
Causes
Although there are genetic, behavioral, metabolic and hormonal influences on body
weight, obesity occurs when you take in more calories than you burn through normal
daily activities and exercise. Your body stores these excess calories as fat.

In the United States, most people's diets are too high in calories — often from fast
food and high-calorie beverages. People with obesity might eat more calories before
feeling full, feel hungry sooner, or eat more due to stress or anxiety.

Many people who live in Western countries now have jobs that are much less
physically demanding, so they don't tend to burn as many calories at work. Even
daily activities use fewer calories, courtesy of conveniences such as remote controls,
escalators, online shopping and drive-through banks.

factors
Obesity usually results from a combination of causes and contributing factors:

Family inheritance and influences

The genes you inherit from your parents may affect the amount of body fat you store,
and where that fat is distributed. Genetics may also play a role in how efficiently your
body converts food into energy, how your body regulates your appetite and how your
body burns calories during exercise.

Obesity tends to run in families. That's not just because of the genes they share.
Family members also tend to share similar eating and activity habits.
Lifestyle choices

 Unhealthy diet. A diet that's high in calories, lacking in fruits and

vegetables, full of fast food, and laden with high-calorie beverages and
oversized portions contributes to weight gain.

 Liquid calories. People can drink many calories without feeling full,

especially calories from alcohol. Other high-calorie beverages, such as
sugared soft drinks, can contribute to significant weight gain.

 Inactivity. If you have a sedentary lifestyle, you can easily take in more
calories every day than you burn through exercise and routine daily
activities. Looking at computer, tablet and phone screens is a sedentary
activity. The number of hours spent in front of a screen is highly
associated with weight gain.

Certain diseases and medications

In some people, obesity can be traced to a medical cause, such as Prader-Willi

syndrome, Cushing syndrome and other conditions. Medical problems, such as
arthritis, also can lead to decreased activity, which may result in weight gain.

Some medications can lead to weight gain if you don't compensate through diet or
activity. These medications include some antidepressants, anti-seizure medications,
diabetes medications, antipsychotic medications, steroids and beta blockers.

Social and economic issues

Social and economic factors are linked to obesity. Avoiding obesity is difficult if you
don't have safe areas to walk or exercise. Similarly, you may not have been taught
healthy ways of cooking, or you may not have access to healthier foods. In addition,
the people you spend time with may influence your weight — you're more likely to
develop obesity if you have friends or relatives with obesity.

Age

Obesity can occur at any age, even in young children. But as you age, hormonal
changes and a less active lifestyle increase your risk of obesity. In addition, the
amount of muscle in your body tends to decrease with age. Generally, lower muscle
mass leads to a decrease in metabolism. These changes also reduce calorie needs
and can make it harder to keep off excess weight. If you don't consciously control
what you eat and become more physically active as you age, you'll likely gain weight.

Other factors

 Pregnancy. Weight gain is common during pregnancy. Some women

find this weight difficult to lose after the baby is born. This weight gain
may contribute to the development of obesity in women.

 Quitting smoking. Quitting smoking is often associated with weight

gain. And for some, it can lead to enough weight gain to qualify as
obesity. Often, this happens as people use food to cope with smoking
withdrawal. In the long run, however, quitting smoking is still a greater
benefit to your health than is continuing to smoke. Your doctor can help
you prevent weight gain after quitting smoking.

 Lack of sleep. Not getting enough sleep or getting too much sleep can
cause changes in hormones that increase appetite. You may also crave
foods high in calories and carbohydrates, which can contribute to weight
gain.
  Stress. Many external factors that affect mood and well-being may
contribute to obesity. People often seek more high-calorie food when
experiencing stressful situations.

 Microbiome. Your gut bacteria are affected by what you eat and may
contribute to weight gain or difficulty losing weight.

Even if you have one or more of these risk factors, it doesn't mean that you're
destined to develop obesity. You can counteract most risk factors through diet,
physical activity and exercise, and behavior changes.

Complications
People with obesity are more likely to develop a number of potentially serious health
problems, including:

 Heart disease and strokes. Obesity makes you more likely to have high
blood pressure and abnormal cholesterol levels, which are risk factors for
heart disease and strokes.

 Type 2 diabetes. Obesity can affect the way the body uses insulin to
control blood sugar levels. This raises the risk of insulin resistance and
diabetes.

 Certain cancers. Obesity may increase the risk of cancer of the uterus,

cervix, endometrium, ovary, breast, colon, rectum, esophagus, liver,
gallbladder, pancreas, kidney and prostate.

 Digestive problems. Obesity increases the likelihood of developing

heartburn, gallbladder disease and liver problems.
  Sleep apnea. People with obesity are more likely to have sleep apnea, a
potentially serious disorder in which breathing repeatedly stops and
starts during sleep.

 Osteoarthritis. Obesity increases the stress placed on weight-bearing

joints, in addition to promoting inflammation within the body. These
factors may lead to complications such as osteoarthritis.

 Severe COVID-19 symptoms. Obesity increases the risk of developing

severe symptoms if you become infected with the virus that causes
coronavirus disease 2019 (COVID-19). People who have severe cases
of COVID-19 may require treatment in intensive care units or even
mechanical assistance to breathe.

Affect on Quality of life

Obesity can diminish the overall quality of life. You may not be able to do physical
activities that you used to enjoy. You may avoid public places. People with obesity
may even encounter discrimination.

Other weight-related issues that may affect your quality of life include:

 Depression

 Disability

 Shame and guilt

 Social isolation

 Lower work achievement

HAIR LOSS
Overview
Hair loss (alopecia) can affect just your scalp or your entire body, and it can be
temporary or permanent. It can be the result of heredity, hormonal changes, medical
conditions or a normal part of aging. Anyone can lose hair on their head, but it's
more common in men.

Baldness typically refers to excessive hair loss from your scalp. Hereditary hair loss
with age is the most common cause of baldness. Some people prefer to let their hair
loss run its course untreated and unhidden. Others may cover it up with hairstyles,
makeup, hats or scarves. And still others choose one of the treatments available to
prevent further hair loss or restore growth.

Before pursuing hair loss treatment, talk with your doctor about the cause of your
hair loss and treatment options.

Symptoms

Male-pattern baldnessOpen pop-up dialog box

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 Patchy hair loss (alopecia areata)Open pop-up
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Traction alopeciaOpen pop-up dialog box

Frontal fibrosing alopeciaOpen pop-up

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Hair loss can appear in many different ways, depending on what's causing it. It can
come on suddenly or gradually and affect just your scalp or your whole body.

Various signs and symptoms noticed for hair loss includes:

 Gradual thinning on top of head. This is the most common type of hair

loss, affecting people as they age. In men, hair often begins to recede at
the hairline on the forehead. Women typically have a broadening of the
part in their hair. An increasingly common hair loss pattern in older
women is a receding hairline (frontal fibrosing alopecia).
  Circular or patchy bald spots. Some people lose hair in circular or
patchy bald spots on the scalp, beard or eyebrows. Your skin may
become itchy or painful before the hair falls out.

 Sudden loosening of hair. A physical or emotional shock can cause

hair to loosen. Handfuls of hair may come out when combing or washing
your hair or even after gentle tugging. This type of hair loss usually
causes overall hair thinning but is temporary.

 Full-body hair loss. Some conditions and medical treatments, such as

chemotherapy for cancer, can result in the loss of hair all over your body.
The hair usually grows back.

 Patches of scaling that spread over the scalp. This is a sign of

ringworm. It may be accompanied by broken hair, redness, swelling and,
at times, oozing.

When to see a doctor

See your doctor if you are distressed by persistent hair loss in you or your child and
want to pursue treatment. For women who are experiencing a receding hairline
(frontal fibrosing alopecia), talk with your doctor about early treatment to avoid
significant permanent baldness.

Also talk to your doctor if you notice sudden or patchy hair loss or more than usual
hair loss when combing or washing your or your child's hair. Sudden hair loss can
signal an underlying medical condition that requires treatment.

 
Causes
People typically lose 50 to 100 hairs a day. This usually isn't noticeable because new
hair is growing in at the same time. Hair loss occurs when new hair doesn't replace
the hair that has fallen out.

Hair loss is typically related to one or more of the following factors:

 Family history (heredity). The most common cause of hair loss is a

hereditary condition that happens with aging. This condition is called
androgenic alopecia, male-pattern baldness and female-pattern
baldness. It usually occurs gradually and in predictable patterns — a
receding hairline and bald spots in men and thinning hair along the
crown of the scalp in women.

 Hormonal changes and medical conditions. A variety of conditions

can cause permanent or temporary hair loss, including hormonal
changes due to pregnancy, childbirth, menopause and thyroid problems.
Medical conditions include alopecia areata, which is immune system
related and causes patchy hair loss, scalp infections such as ringworm,
and a hair-pulling disorder called trichotillomania

 Medications and supplements. Hair loss can be a side effect of certain

drugs, such as those used for cancer, arthritis, depression, heart
problems, gout and high blood pressure.

 Radiation therapy to the head. The hair may not grow back the same
as it was before.
  A very stressful event. Many people experience a general thinning of
hair several months after a physical or emotional shock. This type of hair
loss is temporary.

 Hairstyles and treatments. Excessive hairstyling or hairstyles that pull

your hair tight, such as pigtails or cornrows, can cause a type of hair loss
called traction alopecia. Hot-oil hair treatments and permanents also can
cause hair to fall out. If scarring occurs, hair loss could be permanent.

Risk factors
A number of factors can increase your risk of hair loss, including:

 A family history of balding on your mother's or father's side

 Age

 Significant weight loss

 Certain medical conditions, such as diabetes and lupus

 Stress

 Poor nutrition

Prevention
Most baldness is caused by genetics (male-pattern baldness and female-pattern
baldness). This type of hair loss is not preventable.

These tips may help you avoid preventable types of hair loss:
  Be gentle with your hair. Use a detangler and avoid tugging when
brushing and combing, especially when your hair is wet. A wide-toothed
comb might help prevent pulling out hair. Avoid harsh treatments such as
hot rollers, curling irons, hot-oil treatments and permanents. Limit the
tension on hair from styles that use rubber bands, barrettes and braids.

 Ask your doctor about medications and supplements you take that might
cause hair loss.

 Protect your hair from sunlight and other sources of ultraviolet light.

 Stop smoking. Some studies show an association between smoking and

baldness in men.

 If you're being treated with chemotherapy, ask your doctor about a

cooling cap. This cap can reduce your risk of losing hair during
chemotherapy.

MENTAL ILLNESS
Mental illness, also called mental health disorders, refers to a wide range of mental
health conditions — disorders that affect your mood, thinking and behavior.
Examples of mental illness include depression, anxiety disorders, schizophrenia,
eating disorders and addictive behaviors.

Many people have mental health concerns from time to time. But a mental health
concern becomes a mental illness when ongoing signs and symptoms cause
frequent stress and affect your ability to function.

A mental illness can make you miserable and can cause problems in your daily life,
such as at school or work or in relationships. In most cases, symptoms can be
managed with a combination of medications and talk therapy (psychotherapy).
Symptoms
Signs and symptoms of mental illness can vary, depending on the disorder,
circumstances and other factors. Mental illness symptoms can affect emotions,
thoughts and behaviors.

Examples of signs and symptoms include:

 Feeling sad or down

 Confused thinking or reduced ability to concentrate

 Excessive fears or worries, or extreme feelings of guilt

 Extreme mood changes of highs and lows

 Withdrawal from friends and activities

 Significant tiredness, low energy or problems sleeping

 Detachment from reality (delusions), paranoia or hallucinations

 Inability to cope with daily problems or stress

 Trouble understanding and relating to situations and to people

 Problems with alcohol or drug use

 Major changes in eating habits

 Sex drive changes

 Excessive anger, hostility or violence

  Suicidal thinking

Sometimes symptoms of a mental health disorder appear as physical problems,

such as stomach pain, back pain, headaches, or other unexplained aches and pains.

When to see a doctor

If you have any signs or symptoms of a mental illness, see your primary care
provider or a mental health professional. Most mental illnesses don't improve on their
own, and if untreated, a mental illness may get worse over time and cause serious
problems.

If you have suicidal thoughts

Suicidal thoughts and behavior are common with some mental illnesses. If you think
you may hurt yourself or attempt suicide, get help right away:

 Call 911 or your local emergency number immediately.

 Call your mental health specialist.

 Call a suicide hotline number. In the U.S., call the National Suicide
Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or use its
webchat on suicidepreventionlifeline.org/chat.

 Seek help from your primary care provider.

 Reach out to a close friend or loved one.

 Contact a minister, spiritual leader or someone else in your faith

community.

Suicidal thinking doesn't get better on its own — so get help.

Helping a loved one

If your loved one shows signs of mental illness, have an open and honest discussion
with him or her about your concerns. You may not be able to force someone to get
professional care, but you can offer encouragement and support. You can also help
your loved one find a qualified mental health professional and make an appointment.
You may even be able to go along to the appointment.
If your loved one has done self-harm or is considering doing so, take the person to
the hospital or call for emergency help.

 
Causes
Mental illnesses, in general, are thought to be caused by a variety of genetic and
environmental factors:

 Inherited traits. Mental illness is more common in people whose blood

relatives also have a mental illness. Certain genes may increase your
risk of developing a mental illness, and your life situation may trigger it.

 Environmental exposures before birth. Exposure to environmental

stressors, inflammatory conditions, toxins, alcohol or drugs while in the
womb can sometimes be linked to mental illness.

 Brain chemistry. Neurotransmitters are naturally occurring brain

chemicals that carry signals to other parts of your brain and body. When
the neural networks involving these chemicals are impaired, the function
of nerve receptors and nerve systems change, leading to depression and
other emotional disorders.

Risk factors
Certain factors may increase your risk of developing a mental illness, including:

 A history of mental illness in a blood relative, such as a parent or sibling

 Stressful life situations, such as financial problems, a loved one's death

or a divorce

 An ongoing (chronic) medical condition, such as diabetes

 Brain damage as a result of a serious injury (traumatic brain injury), such

as a violent blow to the head

 Traumatic experiences, such as military combat or assault

 Use of alcohol or recreational drugs

 A childhood history of abuse or neglect

 Few friends or few healthy relationships

  A previous mental illness

Mental illness is common. About 1 in 5 adults has a mental illness in any given year.
Mental illness can begin at any age, from childhood through later adult years, but
most cases begin earlier in life.

The effects of mental illness can be temporary or long lasting. You also can have
more than one mental health disorder at the same time. For example, you may have
depression and a substance use disorder.

Complications
Mental illness is a leading cause of disability. Untreated mental illness can cause
severe emotional, behavioral and physical health problems. Complications
sometimes linked to mental illness include:

 Unhappiness and decreased enjoyment of life

 Family conflicts

 Relationship difficulties

 Social isolation

 Problems with tobacco, alcohol and other drugs

 Missed work or school, or other problems related to work or school

 Legal and financial problems

 Poverty and homelessness

 Self-harm and harm to others, including suicide or homicide

 Weakened immune system, so your body has a hard time resisting

infections

 Heart disease and other medical conditions

Prevention
There's no sure way to prevent mental illness. However, if you have a mental illness,
taking steps to control stress, to increase your resilience and to boost low self-
esteem may help keep your symptoms under control. Follow these steps:
  Pay attention to warning signs. Work with your doctor or therapist to learn
what might trigger your symptoms. Make a plan so that you know what to do if
symptoms return. Contact your doctor or therapist if you notice any changes in
symptoms or how you feel. Consider involving family members or friends to
watch for warning signs.

 Get routine medical care. Don't neglect checkups or skip visits to your primary
care provider, especially if you aren't feeling well. You may have a new health
problem that needs to be treated, or you may be experiencing side effects of
medication.

 Get help when you need it. Mental health conditions can be harder to treat if
you wait until symptoms get bad. Long-term maintenance treatment also may
help prevent a relapse of symptoms.

 Take good care of yourself. Sufficient sleep, healthy eating and regular

physical activity are important. Try to maintain a regular schedule. Talk to your
primary care provider if you have trouble sleeping or if you have questions
about diet and physical activity.

DIABETES
Diabetes mellitus refers to a group of diseases that affect how your body uses blood
sugar (glucose). Glucose is vital to your health because it's an important source of
energy for the cells that make up your muscles and tissues. It's also your brain's
main source of fuel.

The underlying cause of diabetes varies by type. But, no matter what type of
diabetes you have, it can lead to excess sugar in your blood. Too much sugar in your
blood can lead to serious health problems.
Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially
reversible diabetes conditions include prediabetes and gestational diabetes.
Prediabetes occurs when your blood sugar levels are higher than normal, but not
high enough to be classified as diabetes. And prediabetes is often the precursor of
diabetes unless appropriate measures are taken to prevent progression. Gestational
diabetes occurs during pregnancy but may resolve after the baby is delivered.

Symptoms
Diabetes symptoms vary depending on how much your blood sugar is elevated.
Some people, especially those with prediabetes or type 2 diabetes, may sometimes
not experience symptoms. In type 1 diabetes, symptoms tend to come on quickly
and be more severe.

Some of the signs and symptoms of type 1 diabetes and type 2 diabetes are:

 Increased thirst

 Frequent urination

 Extreme hunger

 Unexplained weight loss

 Presence of ketones in the urine (ketones are a byproduct of the

breakdown of muscle and fat that happens when there's not enough
available insulin)

 Fatigue

 Irritability

 Blurred vision

 Slow-healing sores

 Frequent infections, such as gums or skin infections and vaginal

infections

Type 1 diabetes can develop at any age, though it often appears during childhood or
adolescence. Type 2 diabetes, the more common type, can develop at any age,
though it's more common in people older than 40.
When to see a doctor

 If you suspect you or your child may have diabetes. If you notice any
possible diabetes symptoms, contact your doctor. The earlier the condition is
diagnosed, the sooner treatment can begin.

 If you've already been diagnosed with diabetes. After you receive your

diagnosis, you'll need close medical follow-up until your blood sugar levels
stabilize.

Causes
To understand diabetes, first you must understand how glucose is normally
processed in the body.

How insulin works

Insulin is a hormone that comes from a gland situated behind and below the stomach
(pancreas).

 The pancreas secretes insulin into the bloodstream.

 The insulin circulates, enabling sugar to enter your cells.

 Insulin lowers the amount of sugar in your bloodstream.

 As your blood sugar level drops, so does the secretion of insulin from your
pancreas.

The role of glucose

Glucose — a sugar — is a source of energy for the cells that make up muscles and
other tissues.

 Glucose comes from two major sources: food and your liver.

 Sugar is absorbed into the bloodstream, where it enters cells with the help of
insulin.

 Your liver stores and makes glucose.

  When your glucose levels are low, such as when you haven't eaten in a while,
the liver breaks down stored glycogen into glucose to keep your glucose level
within a normal range.

Causes of type 1 diabetes

The exact cause of type 1 diabetes is unknown. What is known is that your immune
system — which normally fights harmful bacteria or viruses — attacks and destroys
your insulin-producing cells in the pancreas. This leaves you with little or no insulin.
Instead of being transported into your cells, sugar builds up in your bloodstream.

Type 1 is thought to be caused by a combination of genetic susceptibility and

environmental factors, though exactly what those factors are is still unclear. Weight
is not believed to be a factor in type 1 diabetes.

Causes of prediabetes and type 2 diabetes

In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your
cells become resistant to the action of insulin, and your pancreas is unable to make
enough insulin to overcome this resistance. Instead of moving into your cells where
it's needed for energy, sugar builds up in your bloodstream.

Exactly why this happens is uncertain, although it's believed that genetic and
environmental factors play a role in the development of type 2 diabetes too. Being
overweight is strongly linked to the development of type 2 diabetes, but not everyone
with type 2 is overweight.

Causes of gestational diabetes

During pregnancy, the placenta produces hormones to sustain your pregnancy.

These hormones make your cells more resistant to insulin.

Normally, your pancreas responds by producing enough extra insulin to overcome

this resistance. But sometimes your pancreas can't keep up. When this happens, too
little glucose gets into your cells and too much stays in your blood, resulting in
gestational diabetes.
Risk factors
Risk factors for diabetes depend on the type of diabetes.

Risk factors for type 1 diabetes

Although the exact cause of type 1 diabetes is unknown, factors that may signal an
increased risk include:

 Family history. Your risk increases if a parent or sibling has type 1 diabetes.

 Environmental factors. Circumstances such as exposure to a viral illness

likely play some role in type 1 diabetes.

 The presence of damaging immune system cells

(autoantibodies). Sometimes family members of people with type 1 diabetes
are tested for the presence of diabetes autoantibodies. If you have these
autoantibodies, you have an increased risk of developing type 1 diabetes. But
not everyone who has these autoantibodies develops diabetes.

 Geographical boundaries. Certain countries, such as Finland and Sweden,

have higher rates of type 1 diabetes.

Risk factors for prediabetes and type 2 diabetes

Researchers don't fully understand why some people develop prediabetes and type
2 diabetes and others don't. It's clear that certain factors increase the risk, however,
including:

 Weight. The more fatty tissue you have, the more resistant your cells become
to insulin.

 Inactivity. The less active you are, the greater your risk. Physical activity helps
you control your weight, uses up glucose as energy and makes your cells more
sensitive to insulin.

 Family history. Your risk increases if a parent or sibling has type 2 diabetes.

 Race or ethnicity. Although it's unclear why, certain people — including Black,

Hispanic, American Indian and Asian American people — are at higher risk.
  Age. Your risk increases as you get older. This may be because you tend to
exercise less, lose muscle mass and gain weight as you age. But type 2
diabetes is also increasing among children, adolescents and younger adults.

 Gestational diabetes. If you developed gestational diabetes when you were

pregnant, your risk of developing prediabetes and type 2 diabetes increases. If
you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're
also at risk of type 2 diabetes.

 Polycystic ovary syndrome. For women, having polycystic ovary syndrome —

a common condition characterized by irregular menstrual periods, excess hair
growth and obesity — increases the risk of diabetes.

 High blood pressure. Having blood pressure over 140/90 millimeters of

mercury (mm Hg) is linked to an increased risk of type 2 diabetes.

 Abnormal cholesterol and triglyceride levels. If you have low levels of high-
density lipoprotein (HDL), or "good," cholesterol, your risk of type 2 diabetes is
higher. Triglycerides are another type of fat carried in the blood. People with
high levels of triglycerides have an increased risk of type 2 diabetes. Your
doctor can let you know what your cholesterol and triglyceride levels are.

Risk factors for gestational diabetes

Pregnant women can develop gestational diabetes. Some women are at greater risk
than are others. Risk factors for gestational diabetes include:

 Age. Women older than age 25 are at increased risk.

 Family or personal history. Your risk increases if you have prediabetes — a

precursor to type 2 diabetes — or if a close family member, such as a parent or
sibling, has type 2 diabetes. You're also at greater risk if you had gestational
diabetes during a previous pregnancy, if you delivered a very large baby or if
you had an unexplained stillbirth.

 Weight. Being overweight before pregnancy increases your risk.

 Race or ethnicity. For reasons that aren't clear, women who are Black,
Hispanic, American Indian or Asian American are more likely to develop
gestational diabetes.

Complications
Long-term complications of diabetes develop gradually. The longer you have
diabetes — and the less controlled your blood sugar — the higher the risk of
complications. Eventually, diabetes complications may be disabling or even life-
threatening. Possible complications include:

 Cardiovascular disease. Diabetes dramatically increases the risk of various

cardiovascular problems, including coronary artery disease with chest pain
(angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you
have diabetes, you're more likely to have heart disease or stroke.

 Nerve damage (neuropathy). Excess sugar can injure the walls of the

tiny blood vessels (capillaries) that nourish your nerves, especially in
your legs. This can cause tingling, numbness, burning or pain that
usually begins at the tips of the toes or fingers and gradually spreads
upward.
 Kidney damage (nephropathy). The kidneys contain millions of tiny blood
vessel clusters (glomeruli) that filter waste from your blood. Diabetes can
damage this delicate filtering system. Severe damage can lead to kidney failure
or irreversible end-stage kidney disease, which may require dialysis or a kidney
transplant.

 Eye damage (retinopathy). Diabetes can damage the blood vessels of the

retina (diabetic retinopathy), potentially leading to blindness. Diabetes also
increases the risk of other serious vision conditions, such as cataracts and
glaucoma.

 Foot damage. Nerve damage in the feet or poor blood flow to the feet
increases the risk of various foot complications. Left untreated, cuts and blisters
can develop serious infections, which often heal poorly. These infections may
ultimately require toe, foot or leg amputation.

 Skin conditions. Diabetes may leave you more susceptible to skin problems,

including bacterial and fungal infections.

 Hearing impairment. Hearing problems are more common in people with

diabetes.

 Alzheimer's disease. Type 2 diabetes may increase the risk of dementia, such

as Alzheimer's disease. The poorer your blood sugar control, the greater the
risk appears to be. Although there are theories as to how these disorders might
be connected, none has yet been proved.

 Depression. Depression symptoms are common in people with type 1 and type

2 diabetes. Depression can affect diabetes management.
Prevention
Type 1 diabetes can't be prevented. However, the same healthy lifestyle choices that
help treat prediabetes, type 2 diabetes and gestational diabetes can also help
prevent them:

 Eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus
on fruits, vegetables and whole grains. Strive for variety to prevent boredom.

 Get more physical activity. Aim for about 30 minutes of moderate aerobic activity
on most days of the week, or at least 150 minutes of moderate aerobic activity a
week.

 Lose excess pounds. If you're overweight, losing even 7% of your body

weight — for example, 14 pounds (6.4 kilograms) if you weigh 200 pounds
(90.7 kilograms) — can reduce the risk of diabetes.

Don't try to lose weight during pregnancy, however. Talk to your

doctor about how much weight is healthy for you to gain during
pregnancy.

To keep your weight in a healthy range, focus on permanent

changes to your eating and exercise habits. Motivate yourself by
remembering the benefits of losing weight, such as a healthier
heart, more energy and improved self-esteem.

 Sometimes medication is an option as well. Oral diabetes drugs such as

metformin (Glumetza, Fortamet, others) may reduce the risk of type 2
diabetes — but healthy lifestyle choices remain essential. Have your blood
sugar checked at least once a year to check that you haven't developed type
2 diabetes.
HIGH BLOOD PRESSURE

Overview
High blood pressure (hypertension) is a common condition in which the long-term
force of the blood against your artery walls is high enough that it may eventually
cause health problems, such as heart disease.

Blood pressure is determined both by the amount of blood your heart pumps and the
amount of resistance to blood flow in your arteries. The more blood your heart
pumps and the narrower your arteries, the higher your blood pressure. A blood
pressure reading is given in millimeters of mercury (mm Hg). It has two numbers.

 Top number (systolic pressure). The first, or upper, number measures the

pressure in your arteries when your heart beats.

 Bottom number (diastolic pressure). The second, or lower, number

measures the pressure in your arteries between beats.

You can have high blood pressure for years without any symptoms. Uncontrolled
high blood pressure increases your risk of serious health problems, including heart
attack and stroke. Fortunately, high blood pressure can be easily detected. And once
you know you have high blood pressure, you can work with your doctor to control it.

Symptoms
Most people with high blood pressure have no signs or symptoms, even if blood
pressure readings reach dangerously high levels.

A few people with high blood pressure may have headaches, shortness of breath or
nosebleeds, but these signs and symptoms aren't specific and usually don't occur
until high blood pressure has reached a severe or life-threatening stage.

When to see a doctor

You'll likely have your blood pressure taken as part of a routine doctor's
appointment.

Ask your doctor for a blood pressure reading at least every two years starting at age
18. If you're age 40 or older, or you're 18 to 39 with a high risk of high blood
pressure, ask your doctor for a blood pressure reading every year.

Blood pressure generally should be checked in both arms to determine if there's a

difference. It's important to use an appropriate-sized arm cuff.

Your doctor will likely recommend more-frequent readings if you've already been
diagnosed with high blood pressure or have other risk factors for cardiovascular
disease. Children age 3 and older will usually have blood pressure measured as a
part of their yearly checkups.

If you don't regularly see your doctor, you may be able to get a free blood pressure
screening at a health resource fair or other locations in your community. You can
also find machines in some stores that will measure your blood pressure for free.

Public blood pressure machines, such as those found in pharmacies, may provide
helpful information about your blood pressure, but they may have some limitations.
The accuracy of these machines depends on several factors, such as a correct cuff
size and proper use of the machines. Ask your doctor for advice on using public
blood pressure machines.

Causes
There are two types of high blood pressure.

Primary (essential) hypertension

For most adults, there's no identifiable cause of high blood pressure. This type of
high blood pressure, called primary (essential) hypertension, tends to develop
gradually over many years.

Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type
of high blood pressure, called secondary hypertension, tends to appear suddenly
and cause higher blood pressure than does primary hypertension. Various conditions
and medications can lead to secondary hypertension, including:

 Obstructive sleep apnea

 Kidney disease

 Adrenal gland tumors

 Thyroid problems

 Certain defects you're born with (congenital) in blood vessels

 Certain medications, such as birth control pills, cold remedies, decongestants,

over-the-counter pain relievers and some prescription drugs

 Illegal drugs, such as cocaine and amphetamines

Risk factors
High blood pressure has many risk factors, including:

 Age. The risk of high blood pressure increases as you age. Until about age 64,
high blood pressure is more common in men. Women are more likely to
develop high blood pressure after age 65.

 Race. High blood pressure is particularly common among people of African

heritage, often developing at an earlier age than it does in whites. Serious
complications, such as stroke, heart attack and kidney failure, also are more
common in people of African heritage.

 Family history. High blood pressure tends to run in families.

 Being overweight or obese. The more you weigh, the more blood you need to
supply oxygen and nutrients to your tissues. As the amount of blood flow
through your blood vessels increases, so does the pressure on your artery
walls.

 Not being physically active. People who are inactive tend to have higher
heart rates. The higher your heart rate, the harder your heart must work with
each contraction and the stronger the force on your arteries. Lack of physical
activity also increases the risk of being overweight.
  Using tobacco. Not only does smoking or chewing tobacco immediately raise
your blood pressure temporarily, but the chemicals in tobacco can damage the
lining of your artery walls. This can cause your arteries to narrow and increase
your risk of heart disease. Secondhand smoke also can increase your heart
disease risk.

 Too much salt (sodium) in your diet. Too much sodium in your diet can
cause your body to retain fluid, which increases blood pressure.

 Too little potassium in your diet. Potassium helps balance the amount of

sodium in your cells. A proper balance of potassium is critical for good heart
health. If you don't get enough potassium in your diet, or you lose too much
potassium due to dehydration or other health conditions, sodium can build up in
your blood.

 Drinking too much alcohol. Over time, heavy drinking can damage

your heart. Having more than one drink a day for women and more than
two drinks a day for men may affect your blood pressure.

If you drink alcohol, do so in moderation. For healthy adults, that means

up to one drink a day for women and two drinks a day for men. One drink
equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof
liquor.

 Stress. High levels of stress can lead to a temporary increase in blood

pressure. Stress-related habits such as eating more, using tobacco or drinking
alcohol can lead to further increases in blood pressure.

 Certain chronic conditions. Certain chronic conditions also may increase your

risk of high blood pressure, including kidney disease, diabetes and sleep
apnea.

Sometimes pregnancy contributes to high blood pressure as well.

Although high blood pressure is most common in adults, children may be at risk, too.
For some children, high blood pressure is caused by problems with the kidneys or
heart. But for a growing number of kids, poor lifestyle habits — such as an unhealthy
diet and lack of exercise — contribute to high blood pressure.

Complications
The excessive pressure on your artery walls caused by high blood pressure can
damage your blood vessels as well as your organs. The higher your blood pressure
and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

 Heart attack or stroke. High blood pressure can cause hardening and

thickening of the arteries (atherosclerosis), which can lead to a heart attack,
stroke or other complications.

 Aneurysm. Increased blood pressure can cause your blood vessels to weaken

and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-
threatening.

 Heart failure. To pump blood against the higher pressure in your vessels, the
heart has to work harder. This causes the walls of the heart's pumping chamber
to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may
have a hard time pumping enough blood to meet your body's needs, which can
lead to heart failure.

 Weakened and narrowed blood vessels in your kidneys. This can prevent

these organs from functioning normally.

 Thickened, narrowed or torn blood vessels in the eyes. This can result in

vision loss.

 Metabolic syndrome. This syndrome is a group of disorders of your body's

metabolism, including increased waist size, high triglycerides, decreased high-
density lipoprotein (HDL) cholesterol (the "good" cholesterol), high blood
pressure and high insulin levels. These conditions make you more likely to
develop diabetes, heart disease and stroke.

 Trouble with memory or understanding. Uncontrolled high blood pressure

may also affect your ability to think, remember and learn. Trouble with memory
or understanding concepts is more common in people with high blood pressure.

 Dementia. Narrowed or blocked arteries can limit blood flow to the brain,

leading to a certain type of dementia (vascular dementia). A stroke that
interrupts blood flow to the brain also can cause vascular dementia.
HEART DISEASE
Overview
Heart disease describes a range of conditions that affect your heart. Heart diseases
include:

 Blood vessel disease, such as coronary artery disease

 Heart rhythm problems (arrhythmias)

 Heart defects you're born with (congenital heart defects)

 Heart valve disease

 Disease of the heart muscle

 Heart infection

Many forms of heart disease can be prevented or treated with healthy lifestyle
choices.

Symptoms
Heart disease symptoms depend on what type of heart disease you have.

Symptoms of heart disease in your blood vessels

A build up of fatty plaques in your arteries, or atherosclerosis (ath-ur-o-skluh-ROE-

sis) can damage your blood vessels and heart. Plaque build up causes narrowed or
blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke.

Coronary artery disease symptoms may be different for men and women. For
instance, men are more likely to have chest pain. Women are more likely to have
other signs and symptoms along with chest discomfort, such as shortness of breath,
nausea and extreme fatigue.

Signs and symptoms can include:

 Chest pain, chest tightness, chest pressure and chest discomfort (angina)
  Shortness of breath

 Pain, numbness, weakness or coldness in your legs or arms if the blood

vessels in those parts of your body are narrowed

 Pain in the neck, jaw, throat, upper abdomen or back

You might not be diagnosed with coronary artery disease until you have a heart
attack, angina, stroke or heart failure. It's important to watch for cardiovascular
symptoms and discuss concerns with your doctor. Cardiovascular disease can
sometimes be found early with regular evaluations.

Heart disease symptoms caused by abnormal heartbeats

(heart arrhythmias)

Your heart may beat too quickly, too slowly or irregularly. Heart arrhythmia signs and
symptoms can include:

 Fluttering in your chest

 Racing heartbeat (tachycardia)

 Slow heartbeat (bradycardia)

 Chest pain or discomfort

 Shortness of breath

 Light headedness

 Dizziness

 Fainting (syncope) or near fainting

Heart disease symptoms caused by heart defects

Serious heart defects that you're born with (congenital heart defects) usually are
noticed soon after birth. Heart defect signs and symptoms in children could include:

 Pale gray or blue skin color (cyanosis)

 Swelling in the legs, abdomen or areas around the eyes

 In an infant, shortness of breath during feedings, leading to poor weight gain

Less serious congenital heart defects are often not diagnosed until later in childhood
or during adulthood. Signs and symptoms of congenital heart defects that usually
aren't immediately life-threatening include:

 Easily getting short of breath during exercise or activity

 Easily tiring during exercise or activity

 Swelling in the hands, ankles or feet

Heart disease symptoms caused by diseased heart muscle

(cardiomyopathy)

In early stages of cardiomyopathy, you may have no symptoms. As the condition

worsens, symptoms may include:

 Breathlessness with activity or at rest

 Swelling of the legs, ankles and feet

 Fatigue

 Irregular heartbeats that feel rapid, pounding or fluttering

 Dizziness, lightheadedness and fainting

Heart disease symptoms caused by heart infection

Endocarditis is an infection that affects the inner lining of your heart chambers and
heart valves (endocardium). Heart infection signs and symptoms can include:

 Fever

 Shortness of breath

 Weakness or fatigue

 Swelling in your legs or abdomen

 Changes in your heart rhythm

 Dry or persistent cough

 Skin rashes or unusual spots

Heart disease symptoms caused by heart valve problems

(valvular heart disease)
The heart has four valves — the aortic, mitral, pulmonary and tricuspid valves — that
open and close to direct blood flow through your heart. Many things can damage
your heart valves, leading to narrowing (stenosis), leaking (regurgitation or
insufficiency) or improper closing (prolapse).

Depending on which valve isn't working properly, valvular heart disease signs and
symptoms generally include:

 Fatigue

 Shortness of breath

 Irregular heartbeat

 Swollen feet or ankles

 Chest pain

 Fainting (syncope)

When to see a doctor

Seek emergency medical care if you have these heart disease signs and symptoms:

 Chest pain

 Shortness of breath

 Fainting

Always call 911 or emergency medical help if you think you might be having a heart
attack.

Heart disease is easier to treat when detected early, so talk to your doctor about
your concerns regarding your heart health. If you're concerned about developing
heart disease, talk to your doctor about steps you can take to reduce your heart
disease risk. This is especially important if you have a family history of heart disease.

If you think you may have heart disease, based on new signs or symptoms you're
having, make an appointment to see your doctor.

Causes
Heart disease causes depend on your specific type of heart disease. There are
many different types of heart disease. To understand the causes of heart disease, it
helps to understand how the heart works.

Development of atherosclerosis

Causes of coronary artery disease

A build up of fatty plaques in your arteries (atherosclerosis) is the most common

cause of coronary artery disease. Unhealthy lifestyle habits, such as a poor diet, lack
of exercise, being overweight and smoking, can lead to atherosclerosis.

Causes of heart arrhythmia

Common causes of arrhythmias or conditions that can lead to arrhythmias include:

 Coronary artery disease

 Diabetes

 Drug abuse

 Excessive use of alcohol or caffeine

 Heart defects you're born with (congenital heart defects)

 High blood pressure

 Smoking

 Some over-the-counter medications, prescription medications, dietary

supplements and herbal remedies

 Stress
  Valvular heart disease

In a healthy person with a normal, healthy heart, it's unlikely for a deadly arrhythmia
to develop without some outside trigger, such as an electrical shock or the use of
illegal drugs. However, in a heart that's diseased or deformed, the heart's electrical
signals may not properly start or travel through the heart, making arrhythmias more
likely to develop.

Causes of congenital heart defects

Congenital heart defects usually develop while a baby is in the womb. Heart defects
can develop as the heart develops, about a month after conception, changing the
flow of blood in the heart. Some medical conditions, medications and genes may
play a role in causing heart defects.

Heart defects can also develop in adults. As you age, your heart's structure can
change, causing a heart defect.

Causes of cardiomyopathy

The cause of cardiomyopathy, a thickening or enlarging of the heart muscle, may

depend on the type:

 Dilated cardiomyopathy. The cause of this most common type of

cardiomyopathy often is unknown. The condition usually causes the left
ventricle to widen. Dilated cardiomyopathy may be caused by reduced blood
flow to the heart (ischemic heart disease) resulting from damage after a heart
attack, infections, toxins and certain drugs, including those used to treat cancer.
It may also be inherited from a parent.

 Hypertrophic cardiomyopathy. This type usually is passed down through

families (inherited). It can also develop over time because of high blood
pressure or aging.

 Restrictive cardiomyopathy. This least common type of cardiomyopathy,

which causes the heart muscle to become rigid and less elastic, can occur for
no known reason. Or it may be caused by diseases, such as connective tissue
disorders or the buildup of abnormal proteins (amyloidosis).

Causes of heart infection

A heart infection, such as endocarditis, is caused when germs reach your heart
muscle. The most common causes of heart infection include:

 Bacteria

 Viruses

 Parasites

Causes of valvular heart disease

Many things can cause diseases of your heart valves. You may be born with valvular
disease, or the valves may be damaged by conditions such as:

 Rheumatic fever

 Infections (infectious endocarditis)

 Connective tissue disorders

Risk factors
Risk factors for developing heart disease include:

 Age. Growing older increases your risk of damaged and narrowed arteries and
a weakened or thickened heart muscle.

 Sex. Men are generally at greater risk of heart disease. The risk for women
increases after menopause.

 Family history. A family history of heart disease increases your risk of

coronary artery disease, especially if a parent developed it at an early age
(before age 55 for a male relative, such as your brother or father, and 65 for a
female relative, such as your mother or sister).

 Smoking. Nicotine tightens your blood vessels, and carbon monoxide can

damage their inner lining, making them more susceptible to atherosclerosis.
Heart attacks are more common in smokers than in nonsmokers.

 Poor diet. A diet that's high in fat, salt, sugar and cholesterol can contribute to
the development of heart disease.

 High blood pressure. Uncontrolled high blood pressure can result in

hardening and thickening of your arteries, narrowing the vessels through which
blood flows.
  High blood cholesterol levels. High levels of cholesterol in your blood can
increase the risk of plaque formation and atherosclerosis.

 Diabetes. Diabetes increases your risk of heart disease. Both conditions share

similar risk factors, such as obesity and high blood pressure.

 Obesity. Excess weight typically worsens other heart disease risk factors.

 Physical inactivity. Lack of exercise also is associated with many forms of

heart disease and some of its other risk factors as well.

 Stress. Unrelieved stress may damage your arteries and worsen other risk
factors for heart disease.

 Poor dental health. It's important to brush and floss your teeth and gums
often, and have regular dental checkups. If your teeth and gums aren't healthy,
germs can enter your bloodstream and travel to your heart, causing
endocarditis.

Complications
Complications of heart disease include:

 Heart failure. One of the most common complications of heart disease, heart

failure occurs when your heart can't pump enough blood to meet your body's
needs. Heart failure can result from many forms of heart disease, including
heart defects, cardiovascular disease, valvular heart disease, heart infections or
cardiomyopathy.

 Heart attack. A blood clot blocking the blood flow through a blood vessel that
feeds the heart causes a heart attack, possibly damaging or destroying a part
of the heart muscle. Atherosclerosis can cause a heart attack.

 Stroke. The risk factors that lead to cardiovascular disease can also lead to an
ischemic stroke, which happens when the arteries to your brain are narrowed or
blocked so that too little blood reaches your brain. A stroke is a medical
emergency — brain tissue begins to die within just a few minutes of a stroke.

 Aneurysm. A serious complication that can occur anywhere in your body, an

aneurysm is a bulge in the wall of your artery. If an aneurysm bursts, you may
face life-threatening internal bleeding.

 Peripheral artery disease. When you develop peripheral artery disease, your

extremities — usually your legs — don't receive enough blood flow. This
 causes symptoms, most notably leg pain when walking (claudication).
Atherosclerosis also can lead to peripheral artery disease.

 Sudden cardiac arrest. Sudden cardiac arrest is the sudden, unexpected loss

of heart function, breathing and consciousness, often caused by an arrhythmia.
Sudden cardiac arrest is a medical emergency. If not treated immediately, it
results in sudden cardiac death.

Prevention
Certain types of heart disease, such as heart defects, can't be prevented. However,
the same lifestyle changes that can improve your heart disease can help you prevent
it, including:

 Don't smoke.

 Control other health conditions, such as high blood pressure, high cholesterol
and diabetes.

 Exercise at least 30 minutes a day on most days of the week.

 Eat a diet that's low in salt and saturated fat.

 Maintain a healthy weight.

 Reduce and manage stress.

 Practice good hygiene.

CANCER
Overview
Cancer refers to any one of a large number of diseases characterized by the
development of abnormal cells that divide uncontrollably and have the ability to
infiltrate and destroy normal body tissue. Cancer often has the ability to spread
throughout your body.
Cancer is the second-leading cause of death in the world. But survival rates are
improving for many types of cancer, thanks to improvements in cancer screening,
treatment and prevention.

Symptoms
Signs and symptoms caused by cancer will vary depending on what part of the body
is affected.

Some general signs and symptoms associated with, but not specific to, cancer,
include:

 Fatigue

 Lump or area of thickening that can be felt under the skin

 Weight changes, including unintended loss or gain

 Skin changes, such as yellowing, darkening or redness of the skin, sores that
won't heal, or changes to existing moles

 Changes in bowel or bladder habits

 Persistent cough or trouble breathing

 Difficulty swallowing

 Hoarseness

 Persistent indigestion or discomfort after eating

 Persistent, unexplained muscle or joint pain

 Persistent, unexplained fevers or night sweats

 Unexplained bleeding or bruising

When to see a doctor

Make an appointment with your doctor if you have any persistent signs or symptoms
that concern you.

If you don't have any signs or symptoms, but are worried about your risk of cancer,
discuss your concerns with your doctor. Ask about which cancer screening tests and
procedures are appropriate for you.
Causes
Cancer is caused by changes (mutations) to the DNA within cells. The DNA inside a
cell is packaged into a large number of individual genes, each of which contains a
set of instructions telling the cell what functions to perform, as well as how to grow
and divide. Errors in the instructions can cause the cell to stop its normal function
and may allow a cell to become cancerous.

Risk factors
While doctors have an idea of what may increase your risk of cancer, the majority of
cancers occur in people who don't have any known risk factors. Factors known to
increase your risk of cancer include:

Your age

Cancer can take decades to develop. That's why most people diagnosed with cancer
are 65 or older. While it's more common in older adults, cancer isn't exclusively an
adult disease — cancer can be diagnosed at any age.

Your habits

Certain lifestyle choices are known to increase your risk of cancer. Smoking, drinking
more than one drink a day for women and up to two drinks a day for men, excessive
exposure to the sun or frequent blistering sunburns, being obese, and having unsafe
sex can contribute to cancer.

You can change these habits to lower your risk of cancer — though some habits are
easier to change than others.

Your family history

Only a small portion of cancers are due to an inherited condition. If cancer is

common in your family, it's possible that mutations are being passed from one
generation to the next. You might be a candidate for genetic testing to see whether
you have inherited mutations that might increase your risk of certain cancers. Keep
in mind that having an inherited genetic mutation doesn't necessarily mean you'll get
cancer.

Your health conditions

Some chronic health conditions, such as ulcerative colitis, can markedly increase
your risk of developing certain cancers. Talk to your doctor about your risk.

Your environment

The environment around you may contain harmful chemicals that can increase your
risk of cancer. Even if you don't smoke, you might inhale secondhand smoke if you
go where people are smoking or if you live with someone who smokes. Chemicals in
your home or workplace, such as asbestos and benzene, also are associated with
an increased risk of cancer.

Complications
Cancer and its treatment can cause several complications, including:

 Pain. Pain can be caused by cancer or by cancer treatment, though not all

cancer is painful. Medications and other approaches can effectively treat
cancer-related pain.

 Fatigue. Fatigue in people with cancer has many causes, but it can often be
managed. Fatigue associated with chemotherapy or radiation therapy
treatments is common, but it's usually temporary.

 Difficulty breathing. Cancer or cancer treatment may cause a feeling of being

short of breath. Treatments may bring relief.

 Nausea. Certain cancers and cancer treatments can cause nausea. Your

doctor can sometimes predict if your treatment is likely to cause nausea.
Medications and other treatments may help you prevent or decrease nausea.

 Diarrhea or constipation. Cancer and cancer treatment can affect your bowels

and cause diarrhea or constipation.

 Weight loss. Cancer and cancer treatment may cause weight loss. Cancer
steals food from normal cells and deprives them of nutrients. This is often not
affected by how many calories or what kind of food is eaten; it's difficult to treat.
 In most cases, using artificial nutrition through tubes into the stomach or vein
does not help change the weight loss.

 Chemical changes in your body. Cancer can upset the normal chemical

balance in your body and increase your risk of serious complications. Signs and
symptoms of chemical imbalances might include excessive thirst, frequent
urination, constipation and confusion.

 Brain and nervous system problems. Cancer can press on nearby nerves

and cause pain and loss of function of one part of your body. Cancer that
involves the brain can cause headaches and stroke-like signs and symptoms,
such as weakness on one side of your body.

 Unusual immune system reactions to cancer. In some cases the body's

immune system may react to the presence of cancer by attacking healthy cells.
Called paraneoplastic syndromes, these very rare reactions can lead to a
variety of signs and symptoms, such as difficulty walking and seizures.

 Cancer that spreads. As cancer advances, it may spread (metastasize) to

other parts of the body. Where cancer spreads depends on the type of cancer.

 Cancer that returns. Cancer survivors have a risk of cancer recurrence. Some

cancers are more likely to recur than others. Ask your doctor about what you
can do to reduce your risk of cancer recurrence. Your doctor may devise a
follow-up care plan for you after treatment. This plan may include periodic
scans and exams in the months and years after your treatment, to look for
cancer recurrence.

Prevention
Doctors have identified several ways to reduce your risk of cancer, such as:

 Stop smoking. If you smoke, quit. If you don't smoke, don't start. Smoking is
linked to several types of cancer — not just lung cancer. Stopping now will
reduce your risk of cancer in the future.

 Avoid excessive sun exposure. Harmful ultraviolet (UV) rays from the sun
can increase your risk of skin cancer. Limit your sun exposure by staying in the
shade, wearing protective clothing or applying sunscreen.

 Eat a healthy diet. Choose a diet rich in fruits and vegetables. Select whole
grains and lean proteins. Limit your intake of processed meats.

 Exercise most days of the week. Regular exercise is linked to a lower risk of

cancer. Aim for at least 30 minutes of exercise most days of the week. If you
 haven't been exercising regularly, start out slowly and work your way up to 30
minutes or longer.

 Maintain a healthy weight. Being overweight or obese may increase your risk

of cancer. Work to achieve and maintain a healthy weight through a
combination of a healthy diet and regular exercise.

 Drink alcohol in moderation, if you choose to drink. If you choose to drink

alcohol, do so in moderation. For healthy adults, that means up to one drink a
day for women and up to two drinks a day for men.

 Schedule cancer screening exams. Talk to your doctor about what types of

cancer screening exams are best for you based on your risk factors.

 Ask your doctor about immunizations. Certain viruses increase your risk of

cancer. Immunizations may help prevent those viruses, including hepatitis B,
which increases the risk of liver cancer, and human papillomavirus (HPV),
which increases the risk of cervical cancer and other cancers. Ask your doctor
whether immunization against these viruses is appropriate for you.

INFERTILITY
Overview
If you and your partner are struggling to have a baby, you're not alone. In the United
States, 10% to 15% of couples are infertile. Infertility is defined as not being able to
get pregnant despite having frequent, unprotected sex for at least a year for most
couples.

Infertility may result from an issue with either you or your partner, or a combination of
factors that prevent pregnancy. Fortunately, there are many safe and effective
therapies that significantly improve your chances of getting pregnant.

Symptoms
The main symptom of infertility is not getting pregnant. There may be no other
obvious symptoms. Sometimes, women with infertility may have irregular or absent
menstrual periods. In some cases, men with infertility may have some signs of
hormonal problems, such as changes in hair growth or sexual function.

When to see a doctor

You probably don't need to see your health care provider about infertility unless you
have been trying regularly to get pregnant for at least one year.

Women should talk with a care provider if they have:

 Are age 35 or older and have been trying to conceive for six months or longer

 Are over age 40

 Have irregular or absent periods

 Have very painful periods

 Have known fertility problems

 Have been diagnosed with endometriosis or pelvic inflammatory disease

 Have had multiple miscarriages

 Have undergone treatment for cancer

Men should talk to a health care provider if they have:

 A low sperm count or other problems with sperm

 A history of testicular, prostate or sexual problems

 Undergone treatment for cancer

 Small testicles or swelling in the scrotum

 Others in your family with infertility problems

Causes
 Fertilization and implantationOpen pop-up dialog box

Male reproductive systemOpen pop-up dialog box

Female reproductive systemOpen pop-up dialog box

All of the steps during ovulation and fertilization need to happen correctly in order to
get pregnant. Sometimes the issues that cause infertility in couples are present at
birth, and sometimes they develop later in life.

Infertility causes can affect one or both partners. Sometimes, no cause can be found.

Causes of male infertility

These may include:

 Abnormal sperm production or function due to undescended testicles,

genetic defects, health problems such as diabetes, or infections such as
chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele)
also can affect the quality of sperm.

 Problems with the delivery of sperm due to sexual problems, such as

premature ejaculation; certain genetic diseases, such as cystic fibrosis;
structural problems, such as a blockage in the testicle; or damage or injury to
the reproductive organs.

 Overexposure to certain environmental factors, such as pesticides and

other chemicals, and radiation. Cigarette smoking, alcohol, marijuana, anabolic
steroids, and taking medications to treat bacterial infections, high blood
 pressure and depression also can affect fertility. Frequent exposure to heat,
such as in saunas or hot tubs, can raise body temperature and may affect
sperm production.

 Damage related to cancer and its treatment, including radiation or

chemotherapy. Treatment for cancer can impair sperm production, sometimes
severely.

Causes of female infertility

Causes of female infertility may include:

 Ovulation disorders, which affect the release of eggs from the ovaries. These
include hormonal disorders such as polycystic ovary syndrome.
Hyperprolactinemia, a condition in which you have too much prolactin — the
hormone that stimulates breast milk production — also may interfere with
ovulation. Either too much thyroid hormone (hyperthyroidism) or too little
(hypothyroidism) can affect the menstrual cycle or cause infertility. Other
underlying causes may include too much exercise, eating disorders or tumors.

 Uterine or cervical abnormalities, including abnormalities with the cervix,

polyps in the uterus or the shape of the uterus. Noncancerous (benign) tumors
in the uterine wall (uterine fibroids) may cause infertility by blocking the fallopian
tubes or stopping a fertilized egg from implanting in the uterus.

 Fallopian tube damage or blockage, often caused by inflammation of the

fallopian tube (salpingitis). This can result from pelvic inflammatory disease,
which is usually caused by a sexually transmitted infection, endometriosis or
adhesions.

 Endometriosis, which occurs when endometrial tissue grows outside of the

uterus, may affect the function of the ovaries, uterus and fallopian tubes.

 Primary ovarian insufficiency (early menopause), when the ovaries stop

working and menstruation ends before age 40. Although the cause is often
unknown, certain factors are associated with early menopause, including
immune system diseases, certain genetic conditions such as Turner syndrome
or carriers of Fragile X syndrome, and radiation or chemotherapy treatment.

 Pelvic adhesions, bands of scar tissue that bind organs that can form after
pelvic infection, appendicitis, endometriosis or abdominal or pelvic surgery.
  Cancer and its treatment. Certain cancers — particularly reproductive cancers
— often impair female fertility. Both radiation and chemotherapy may affect
fertility.

Risk factors
Many of the risk factors for both male and female infertility are the same. They
include:

 Age. Women's fertility gradually declines with age, especially in the mid-30s,

and it drops rapidly after age 37. Infertility in older women is likely due to the
lower number and quality of eggs, and can also be due to health problems that
affect fertility. Men over age 40 may be less fertile than younger men.

 Tobacco use. Smoking tobacco or marijuana by either partner may reduce the

likelihood of pregnancy. Smoking also reduces the possible effectiveness of
fertility treatment. Miscarriages are more frequent in women who smoke.
Smoking can increase the risk of erectile dysfunction and a low sperm count in
men.

 Alcohol use. For women, there's no safe level of alcohol use during conception
or pregnancy. Alcohol use may contribute to infertility. For men, heavy alcohol
use can decrease sperm count and motility.

 Being overweight. Among American women, an inactive lifestyle and being

overweight may increase the risk of infertility. For men, sperm count also may
be affected by being overweight.

 Being underweight. Women at risk of fertility problems include those with

eating disorders, such as anorexia or bulimia, and those who follow a very low-
calorie or restrictive diet.

 Exercise issues. A lack of exercise contributes to obesity, which increases the

risk of infertility. Less often, ovulation problems may be associated with
frequent strenuous, intense exercise in women who are not overweight.

Prevention
Some types of infertility aren't preventable. But several strategies may increase your
chances of pregnancy.

Couples
Have regular intercourse several times around the time of ovulation for the highest
pregnancy rate. Intercourse beginning at least five days before and until a day after
ovulation improves your chances of getting pregnant. Ovulation usually occurs in the
middle of the cycle — halfway between menstrual periods — for most women with
menstrual cycles about 28 days apart.

Men

Although most types of infertility aren't preventable in men, these are some of the
strategies that are discussed to prevent infertility:

 Avoid drug and tobacco use and drinking too much alcohol, which may
contribute to male infertility.

 Avoid high temperatures found in hot tubs and hot baths, as they can
temporarily affect sperm production and motility.

 Avoid exposure to industrial or environmental toxins, which can affect

sperm production.

 Limit medications that may impact fertility, both prescription and

nonprescription drugs. Talk with your doctor about any medications you take
regularly, but don't stop taking prescription medications without medical advice.

 Exercise moderately. Regular exercise may improve sperm quality and

increase the chances for achieving a pregnancy.

Women

For women, a number of strategies may increase the chances of becoming

pregnant:

 Quit smoking. Tobacco has many negative effects on fertility, not to mention

your general health and the health of a foetus. If you smoke and are
considering pregnancy, quit now.

 Avoid alcohol and street drugs. These substances may impair your ability to
conceive and have a healthy pregnancy. Don't drink alcohol or use recreational
drugs, such as marijuana, if you're trying to get pregnant.
 Limit caffeine. Women trying to get pregnant may want to limit caffeine intake.
Ask your doctor for guidance on the safe use of caffeine.

 Exercise moderately. Regular exercise is important, but exercising so

intensely that your periods are infrequent or absent can affect fertility.

 Avoid weight extremes. Being overweight or underweight can affect your

hormone production and cause infertility.