Men Have Greater Self-Esteem Than Women, Especially in Developed Nations

MONDAY, Jan. 4, 2016 (HealthDay News) — Self-esteem increases as people grow older, and men tend to have higher levels of it than women do, a new international study finds.

The gender gap in self-esteem was found worldwide. But the research revealed this self-esteem gender gap is widest in Western nations.

The researchers examined data collected from more than 985,000 people. The information came from 48 countries between 1999 and 2009. Study participants were between the ages of 16 and 45.

Overall, self-esteem tended to increase with age, the researchers found. Men at every age tended to have higher levels of self-esteem than women, they said.

But there were notable differences between nations.

Wealthier, developed nations with higher gender equality had larger gender gaps in self-esteem than poorer, developing nations with greater gender inequality, said the study’s lead author Wiebke Bleidorn, from the University of California, Davis.

“This is likely the result of specific cultural influences that guide self-esteem development in men and women,” she said in an American Psychological Association news release.

For example, gender differences in self-esteem levels were small in Asian countries such as India, Indonesia and Thailand. But these differences were larger in countries such as the Netherlands and the United Kingdom, the study showed.

While there are cultural differences, the most surprising finding is that gender and age affect the self-esteem of people worldwide, the researchers said.

“This remarkable degree of similarity implies that gender and age differences in self-esteem are partly driven by universal mechanisms; these can either be universal biological mechanisms such as hormonal influences or universal cultural mechanisms such as universal gender roles. However, universal influences do not tell the whole story,” Bleidorn said.

“The differences in magnitude and shape of gender and age differences in various countries provide strong evidence for culture-specific influences on the development of self-esteem in men and women,” she added.

Until now, most research on self-esteem has been limited to Western nations, Bleidorn noted.

She said the new research adds to the understanding of how culture may shape self-esteem. And, with further study, this information may help lead to better ways to “promote or protect self-esteem.”

The study was published recently in the Journal of Personality and Social Psychology.

More information

The National Association for Self-Esteem has more on boosting self-esteem.

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College Football Player’s Autopsy May Offer Clues to Brain Trauma

By Alan Mozes
HealthDay Reporter

MONDAY, Jan. 4, 2016 (HealthDay News) — Former Missouri State linebacker Michael Keck quit football after three years of Division 1 play and might have faded into obscurity.

But his death at age 25, in 2013, has opened a window on a poorly understood but increasingly scrutinized brain disorder.

In death, Keck joined a tragic gridiron group, including once-great pro players Mike Webster and Junior Seau, all of whom developed chronic traumatic encephalopathy (CTE) — a devastating disease caused by repeated blows to the head.

“This is a relatively understudied disease,” said Dr. Ann McKee, a professor of pathology at Boston University School of Medicine. “But the loss of memory, the behavioral problems, the depression, the difficulties with learning and planning can and do affect all kinds of athletes, both professional and amateur.”

McKee is co-author of a new case study, based on Keck’s experience, published online Jan. 4 in JAMA Neurology.

Keck was knocked unconscious during fall practice in 2009. “After that, things changed for him,” his wife, Cassandra Keck, later told the Associated Press.

Keck’s memory, vision and ability to sleep suffered, she said, adding that he started taking medication for head pain. He became moody and, later, prone to bouts of violent behavior, she told the news service.

“He told one of the trainers there’s something wrong with his head. They gave him a concussion test and told him to count backward from 20 by threes,” Cassandra Keck said in the interview. “Some other players couldn’t do it, either. So they just said football players are dumb.”

But debilitating headaches and falling grades caused Keck to leave school in his junior year.

Keck’s death several years later was originally attributed to an unrelated heart condition, but post-mortem testing revealed CTE.

Although the disease is known to result from repeated head injuries, CTE confirmation can only come upon examination of a patient’s brain after death.

Suspecting CTE, Keck volunteered to undergo neuropsychological evaluation at age 24.

“His wife will tell you that he thought he had CTE,” said McKee. “It turns out he was right.”

Results of the neuropsychological tests documented a list of mental health struggles that had long plagued the athlete who had suffered more than 10 concussions.

This provided researchers a rare chance to stack symptoms alongside actual brain pathology. More research is essential to gain a better understanding of CTE, McKee said, noting “this will certainly help.”

Keck started playing football at age 6, and suffered his first concussion two years later. But even without concussions, athletes are at risk of CTE, McKee said.

“It’s a widespread misperception that CTE is about concussions,” said McKee. “About 20 percent of patients have no history of concussion at all. A lot of the time it’s really about exposure to sub-concussive routine hits that don’t give rise to any immediate symptoms.”

Such hits occur hundreds, even thousands, of times in the course of a year of football. “It’s about long-term exposure to repeated head trauma,” she said.

Investigators are approaching Keck’s case cautiously, hoping to learn what they can from the information he left behind, while acknowledging that the early onset of symptoms could mean his experience was not the norm.

Dr. James Noble, an assistant professor of neurology at Columbia University Medical Center in New York City, said the Keck case should serve as “a call to responsibility, concerning everybody involved in sports, to better understand this disease.”

Parents, players, sports leagues, schools, and conferences — “everybody who has an interest in the academic, mental and physical health of these players” — must take an interest in their neurological health, said Noble, author of an accompanying journal editorial.

Noble pointed out that the first case of football-associated CTE appeared only about 10 years ago.

That was when Pittsburgh forensic pathologist Dr. Bennet Omalu autopsied the brain of “Iron Mike” Webster, the star center for the Pittsburgh Steelers of the 1970s who died at age 50 after years of dementia had left him penniless and intermittently homeless. Omalu — portrayed by Will Smith in the movie “Concussion” — discovered that Webster’s brain was riddled with large clumps of tau protein, which generally is considered a hallmark of Alzheimer’s disease. Omalu published his findings in the journal Neurosurgery in 2005.

And 12-time Pro Bowl NFL linebacker Junior Seau, who died by suicide at age 43 two years after leaving the league following the 2009 season, was also subsequently diagnosed with CTE. He was inducted into the NFL Hall of Fame last summer.

Greater awareness has brought scrutiny and improved safety provisions to football, but much is still unknown, Noble said.

“While it’s encouraging that awareness about the dangers of head trauma has increased over the last 10 years, there are still so many unresolved questions in this field,” he added.

More information

There’s more on CTE at Boston University.

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Could Higher Vitamin D Doses Harm Seniors Prone to Falls?

By Randy Dotinga
HealthDay Reporter

MONDAY, Jan. 4, 2016 (HealthDay News) — Higher doses of vitamin D don’t improve mobility for the elderly, and may actually raise the risk for falls among certain seniors, a new study suggests.

The small Swiss study, published in the Jan. 4 issue of JAMA Internal Medicine, doesn’t say that vitamin D is harmful in routine doses. And, the researchers say seniors should continue to follow guidelines and make sure they get recommended amounts of the nutrient naturally.

However, “don’t assume that because something is called a ‘vitamin’ it means that it is safe,” cautioned Dr. Steven Cummings, research scientist with California Pacific Medical Center Research Institute in San Francisco.

Cummings is co-author, along with Dr. Douglas Kiel, of a commentary accompanying the study.

Vitamin D supplements have been suggested as a way to build muscle strength and thus prevent falls among the elderly, according to background information with the study.

Many older adults get too little vitamin D in their diet and don’t spend enough time outside to get it through sun exposure, said Kiel, director of musculoskeletal research at the Institute for Aging Research at Hebrew SeniorLife in Boston, and professor of medicine at Harvard Medical School. Low levels are most common in the frailest individuals, he noted.

Inexpensive vitamin D supplements, often recommended for boosting levels of vitamin D, are widely available in the United States.

For the study, the researchers recruited 200 people in Switzerland age 70 and older — average age 78 — who’d fallen over the previous year. Two-thirds were female and almost 60 percent had low levels of vitamin D, the researchers said.

Participants were divided into three groups and given a form of the vitamin called D3, which is commonly available via over-the-counter supplements.

One group received the equivalent of 800 International Units (IU) a day. Another group took that dose plus a vitamin D product called calcifediol (also known as calcidiol). The third group consumed the equivalent of 2,000 IU of vitamin D3 a day.

The researchers tracked the participants for a year. They expected to see fewer falls because previous research had shown vitamin D to benefit mobility, said study lead author Dr. Heike Bischoff-Ferrari, chair of geriatrics and aging research at the University of Zurich in Switzerland.

Instead, two-thirds of those taking the higher dose of vitamin D and vitamin D plus calcifediol experienced falls compared to 48 percent of those on the lower dose. The lower-dose group also had the best improvement in leg function among the three groups, the study found.

One explanation, Bischoff-Ferrari said, is that there’s an ideal range for vitamin D in seniors who’ve fallen before, with higher levels possibly translating into more falls. Another possibility, Bischoff-Ferrari said, is that seniors become more physically active when taking higher doses of vitamin D, which puts them at risk of more falls.

Cummings, however, said the theory about increased activity seems unlikely. Kiel, meanwhile, said another possibility is that high doses of vitamin D might disrupt muscle activity, leading to falls that way.

Also, the study doesn’t establish a direct cause-and-effect relationship between higher doses of vitamin D and more falls.

Still, if you’re healthy and not confined to bed, “there is no evidence that you need or will benefit from any vitamin D supplementation,” said Cummings.

“The Institute of Medicine recommended that older adults should get about 800 IU per day, and diet and sun are the best ways to do that,” Cummings said. “There is no good evidence yet that taking even 800 IU per day as supplements will reduce your risk of diseases or prolong your mobility or your life.”

Kiel agreed. “Until the safety of larger doses of vitamin D is established, it is better to either get enough vitamin D from diet or take more modest daily supplements if there is a deficiency,” he said.

More information

For more about vitamin D, see the U.S. Office of Dietary Supplements.

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New School Lunch Program Lets Kids Select More Nutritious Meals

MONDAY, Jan. 4, 2016 (HealthDay News) — Move over, mystery meat — students are choosing more nutritious school lunches under the Healthy Hunger-Free Kids Act, new research suggests.

“We found that the implementation of the new meal standards was associated with the improved nutritional quality of meals selected by students,” according to study author Donna Johnson, from the University of Washington’s Nutritional Sciences Program.

“These changes appeared to be driven primarily by the increase in variety, portion size and the number of servings of fruits and vegetables,” the researchers wrote in a report published Jan. 4 in JAMA Pediatrics.

The 2010 Healthy Hunger-Free Kids Act updated nutritional standards for the National School Lunch Program and the School Breakfast Program. The revised guidelines took effect for the 2012-13 school year. They increased the availability of whole grains, fruits and vegetables, and created other food requirements. The national lunch program serves more than 31 million students daily, the researchers said in a journal news release.

The updated nutritional standards appeared to have no negative effects on kids’ participation in school meal programs, Johnson’s team said.

The study looked at the nutritional quality of the foods students chose. The investigators also looked at how many kids ate school meals before and after implementation of the new regulations.

Overall, the research team examined changes in more than 1.7 million lunches at three middle school and three high schools in an urban school district in Washington state from 2011 to 2014.

The nutritional quality of the foods was estimated using a measure that included calcium, vitamin A, vitamin C, iron, fiber and protein. The researchers also looked at the energy density of foods. Items with lower energy density have fewer calories per gram, the researchers said.

The study found a significant increase in the nutritional quality of the foods. And, the energy density of foods decreased, the study revealed.

Meal participation was 47 percent before the updated guidelines and 46 percent after the changes were made, the research showed. However, the researchers said their findings only showed what foods were selected by students, not necessarily what they ate.

The study authors also pointed out that because the study only included one urban school district, the results may not apply to schools in other areas.

More information

The U.S. Centers for Disease Control and Prevention has more about students’ nutritional needs.

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Newer Blood Pressure Drugs as Good as Older Ones: Study

MONDAY, Jan. 4, 2016 (HealthDay News) — Newer blood pressure drugs are as safe and effective as older medications, new research suggests.

Scientists at the NYU Langone Medical Center in New York City said their findings settle a longstanding debate about which of two types blood-pressure lowering medications studied are better.

An analysis of 106 randomized trials involving more than 250,000 patients examined the effects of newer angiotensin receptor blockers (ARBs) and older angiotensin-converting enzyme (ACE) inhibitors. Although ACE inhibitors were developed 10 years earlier, both types of drugs showed similar effects in the analysis, challenging previous findings that suggest ACE inhibitors have greater benefits.

According to the new analysis, published online Jan. 4 in the Mayo Clinic Proceedings, the only difference between the medications is that ARBs are more easily tolerated.

“There has been debate for many years over the safety and efficacy of ACE inhibitors compared to ARBs, with many of them using an ‘ACE inhibitor-first’ approach, with ARBs regarded as less effective,” study author Dr. Sripal Bangalore said in a medical center news release.

“We believe that our study ends the debate and gives physicians the option to prescribe either drug for their patients,” added Bangalore, an associate professor in the division of cardiology, in the department of medicine at NYU Langone.

Both ARBs and ACE inhibitors interfere with the function of a hormone called angiotensin II, which regulates blood pressure, but they do this in different ways, the study authors said.

Angiotensin II restricts blood flow through vessels, raising blood pressure. ACE inhibitors prevent the body from making angiotensin II, while ARBs prevent the hormone from doing its job by taking its place on the surface of blood vessels, the researchers explained.

Previous studies have suggested that older ACE inhibitors are more effective than ARBs. But, this latest analysis attributed that difference to changes in the standard of care over the decade between trials of the two types of drugs, greater emphasis on quitting smoking, and wider use of cholesterol-lowering drugs called statins.

However, when trials were conducted at similar times, one drug was not more effective than the other, the findings showed.

“This is the first time that we have a clear and consistent message from the three buckets of trials of ACE inhibitors and ARBs, all of which show that there is no outcome difference between the two agents, except for better tolerability of ARBs,” Bangalore said.

“The results of our analysis are especially important for patients, given that many ARBs are now also generic, which reduces their costs,” he added.

More information

For more about blood pressure drugs, visit the American Heart Association.

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Newer Blood Pressure Drugs as Good as Older Ones: Study

MONDAY, Jan. 4, 2016 (HealthDay News) — Newer blood pressure drugs are as safe and effective as older medications, new research suggests.

Scientists at the NYU Langone Medical Center in New York City said their findings settle a longstanding debate about which of two types blood-pressure lowering medications studied are better.

An analysis of 106 randomized trials involving more than 250,000 patients examined the effects of newer angiotensin receptor blockers (ARBs) and older angiotensin-converting enzyme (ACE) inhibitors. Although ACE inhibitors were developed 10 years earlier, both types of drugs showed similar effects in the analysis, challenging previous findings that suggest ACE inhibitors have greater benefits.

According to the new analysis, published online Jan. 4 in the Mayo Clinic Proceedings, the only difference between the medications is that ARBs are more easily tolerated.

“There has been debate for many years over the safety and efficacy of ACE inhibitors compared to ARBs, with many of them using an ‘ACE inhibitor-first’ approach, with ARBs regarded as less effective,” study author Dr. Sripal Bangalore said in a medical center news release.

“We believe that our study ends the debate and gives physicians the option to prescribe either drug for their patients,” added Bangalore, an associate professor in the division of cardiology, in the department of medicine at NYU Langone.

Both ARBs and ACE inhibitors interfere with the function of a hormone called angiotensin II, which regulates blood pressure, but they do this in different ways, the study authors said.

Angiotensin II restricts blood flow through vessels, raising blood pressure. ACE inhibitors prevent the body from making angiotensin II, while ARBs prevent the hormone from doing its job by taking its place on the surface of blood vessels, the researchers explained.

Previous studies have suggested that older ACE inhibitors are more effective than ARBs. But, this latest analysis attributed that difference to changes in the standard of care over the decade between trials of the two types of drugs, greater emphasis on quitting smoking, and wider use of cholesterol-lowering drugs called statins.

However, when trials were conducted at similar times, one drug was not more effective than the other, the findings showed.

“This is the first time that we have a clear and consistent message from the three buckets of trials of ACE inhibitors and ARBs, all of which show that there is no outcome difference between the two agents, except for better tolerability of ARBs,” Bangalore said.

“The results of our analysis are especially important for patients, given that many ARBs are now also generic, which reduces their costs,” he added.

More information

For more about blood pressure drugs, visit the American Heart Association.

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Kids Born Through IVF Show No Higher Risk for Developmental Delays: Study

By Amy Norton
HealthDay Reporter

MONDAY, Jan. 4, 2016 (HealthDay News) — Preschoolers who were conceived through fertility treatments don’t seem to have any special risk of developmental delays, a new study suggests.

The researchers said the findings, published online Jan. 4 in the journal JAMA Pediatrics, should be reassuring to the growing number of U.S. couples seeking help with infertility.

There have long been lingering concerns about the development of children conceived through infertility treatment, explained study author Edwina Yeung, a researcher at the U.S. National Institute of Child Health and Human Development.

That’s partly based on animal research, Yeung said, and partly because of conflicting findings from studies of children.

A few studies of children have suggested there might be developmental effects, at least with certain types of fertility treatment. But many others have found no such link, the researchers noted.

For the study, Yeung’s team followed over 5,800 children born in New York state between 2008 and 2010. They included 1,830 children conceived through various forms of infertility treatment — including fertility drugs and more extensive treatments such as in-vitro fertilization (IVF).

Overall, children conceived with the help of fertility drugs were no more likely to show developmental delays at the age of 3 than their peers whose parents conceived naturally.

That was true whether the treatment involved intrauterine insemination or not, Yeung said. Insemination means that sperm are placed in the uterus during ovulation.

The study did find signs of slower development among children conceived through more complicated fertility treatments — including IVF, intracytoplasmic sperm injection and other techniques that fall under the umbrella of “assisted reproductive technology,” or ART.

However, Yeung said, that was explained by the “much higher rate of twinning” in the ART group — 34 percent, versus 19 percent among children conceived naturally. Twins are often born prematurely and at low weights, which raises the risk of developmental problems, according to the March of Dimes.

There was no evidence that fertility treatment, itself, affected the children’s development. Twins conceived by ART had no greater risk of delays than twins conceived naturally, the study found.

Dr. Norbert Gleicher, medical director of the Center for Human Reproduction, in New York City, said that couples commonly worry about the potential effects of fertility treatment on child development.

“I hear these questions all the time,” Gleicher said.

For researchers, he added, it’s a difficult issue to study. “Patients with infertility are often older, and may have medical conditions,” Gleicher pointed out. “You have to be able to differentiate those potential effects from any effects of the fertility treatment, per se.”

The new study accounted for factors such as parents’ age, education levels and mothers’ smoking and drinking habits during pregnancy — along with the effects of “twinning.”

The results, Gleicher said, “should be reassuring” to couples considering fertility treatment.

For the study, parents periodically completed standard questionnaires used to screen infants and young children for delays in movement, language, social development and problem-solving.

At each screening, anywhere from 6 percent to 10 percent of the children showed delays in at least one of those areas. Children who’d been conceived with ART were about twice as likely to show a delay, versus children conceived naturally.

But the difference evaporated once the researchers accounted for the effects of twin births.

Yeung said there was further reassurance in another study finding: Children who’d been conceived through infertility treatment seemed to have no higher risk of being diagnosed with a full-blown developmental disability — such as a learning disability, speech or language disorder, or autism.

Over 400 children in the study had a formal evaluation at the age of 3 or 4, based on their screening results. In that group, 13 percent of children conceived through infertility treatment were diagnosed with a disability, versus 18 percent of children conceived naturally.

Dr. Siobhan Dolan, medical advisor to the March of Dimes, agreed that the results are reassuring.

“It’s always good to have more data on longer-term outcomes, and it’s great to see that kids are doing well,” said Dolan, who is also a professor of obstetrics and gynecology at Albert Einstein College of Medicine, in New York City.

But, Dolan added, there is still some concern in the fact that ART often results in twins. “It is a higher-risk situation,” she said.

There are professional guidelines, Dolan noted, that encourage using just one embryo during ART, to minimize the chances of having twins (though it can still happen).

According to the guidelines, that approach should be considered when women have a good chance of becoming pregnant — which usually means women age 35 or younger who have “good quality” eggs or embryos.

More information

Read more on female infertility treatments at the U.S. National Institute of Child Health and Human Development.

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Families Like Looser ICU Visitation Policies

MONDAY, Jan. 4, 2016 (HealthDay News) — Many hospitals still restrict who can visit critically ill patients and when. But new survey results suggest that lifting such restrictions can improve family satisfaction and patient well-being.

“The term ‘visiting hours’ is obsolete due to the growing evidence related to the wide-ranging benefits of open access for ICU [intensive-care unit] families,” said senior study author Dr. Samuel Brown. He is director of the Center for Humanizing Critical Care at Intermountain Medical Center in Murray, Utah.

The study involved 103 family members visiting patients in the intensive care unit and 128 ICU nurses. About half were surveyed before an unrestricted patient visitation policy was implemented at the medical center and half were questioned after.

With the new policy, visitors are allowed at all times, if patients agree and are well enough. Previously, visits were restricted to 90 minutes each morning and evening.

The new policy dramatically improved family satisfaction with the ICU visitation hours and waiting room atmosphere, the study found. Nurses also perceived higher visitor satisfaction with the updated visitation policy, the researchers noted.

The study results were published Jan. 4 in the American Journal of Critical Care.

A growing number of hospitals have developed more open ICU visitation policies following a 2010 presidential memorandum and new regulations from the U.S. Centers for Medicare and Medicaid Services, the researchers said in background notes.

“Numerous studies have shown that more liberal visitation policies lead to improved family, patient and nurse satisfaction without representing a safety risk,” Brown said in a journal news release. “In fact, studies have suggested that patients do better medically when their families are free to accompany them during their ICU stay.”

More information

The Institute for Patient-and-Family-Centered Care provides more on family presence in the ICU.

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Pediatricians’ Group Says U.S. Lacks Resources to Treat Kids in Disasters

MONDAY, Jan. 4, 2016 (HealthDay News) — When a major public health emergency, disaster or act of terrorism occurs, the United States may lack adequate resources to treat children who are affected, according to a new statement from the American Academy of Pediatrics.

The medical requirements of children — for example, drug formulations or dosing — would often be very different from those needed by adults when or if a chemical, biological, radiation or nuclear disaster strikes.

The AAP’s Disaster Preparedness Advisory Council says that while “significant strides” have been made over the past couple of decades in helping stockpile disaster supplies that are specific to children, more must be done.

“Many vaccines and pharmaceuticals approved for use by adults as medical countermeasures [in disaster situations] do not yet have pediatric formulations, dosing information or safety information” aimed at children, the council explained.

“As a result, the nation’s stockpiles … are less prepared to address the needs of children compared with those of adults in the event of a disaster,” the council stated.

Also, there’s not enough research “to assure effectiveness and safety [of these medicines] and to identify evidence-based dosing guidelines for children,” the council added in a news release.

In many cases, drugs meant to counter a biological or other threat have only been developed and tested on military personnel, the council said.

The U.S. Food and Drug Administration should begin to address this situation “by taking full advantage of all pathways currently available to ensure that products can be tested in pediatric populations,” the experts suggested.

Then there are practical concerns: Kids often balk at swallowing pills or drinking liquid medications with a “yucky” taste. Reformulating emergency medicines to make them more palatable to children could help speed care in a crisis, the AAP advisors added.

Another idea: Store caches of emergency supplies near places where children congregate, such as schools or child care centers. The council also said that devising easy-to-understand instructions for parents or caregivers on how to give a specific drug to children would prevent a lot of stress and error if or when disaster strikes.

All of this will cost money, but cost “is not an appropriate rationale to limit or exclude [children] from such research,” the council said.

“Children represent nearly a quarter of the U.S. population, but they are affected disproportionately by most disasters and public health emergencies,” the AAP team said. “The recommendations outlined in this statement should be used to guide pediatricians; federal, state, and local government agencies; and others in addressing this need.”

The statement was published online Jan. 4 and will appear in the February print issue of the journal Pediatrics.

More information

There’s more on the unique pharmaceutical needs of children at the U.S. Food and Drug Administration.

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What Going Gray Early Can Tell You About Your Health

Photo: Getty Images

Does going gray earlier mean I’m aging more quickly?

Silvery strands are one of the more conspicuous signs of aging. That said, getting gray hair doesn’t necessarily mean that you’re closer to the end of your life span than anyone else your age. Gray hair occurs when the hair follicles produce less melanin, the pigment that gives hair its color. It’s most common for graying to begin in your 30s, though some women spot a few grays in their 20s. Your graying age is related to your ethnicity (Caucasians tend to go gray earlier than Asians and African-Americans), as well as your family history, so you may want to ask your parents and grandparents when they noticed their first grays.

RELATED: 13 Everyday Habits That Are Aging You

If you think you’re going gray unusually early, there are a number of possible reasons why. Smoking, for one, has been linked to the early onset of gray hair. Environmental factors—like ultraviolet rays and air pollutants—may also be partially to blame. In rare cases, premature graying can be a sign of a medical issue, such as vitiligo (a condition that causes skin to lose its pigmentation), pernicious anemia (in which the body has difficulty absorbing vitamin B12) or problems involving your pituitary or thyroid glands.

Health’s medical editor, Roshini Rajapaksa, MD, is associate professor of medicine at the NYU School of Medicine and co-founder of Tula Skincare.

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