Elevated ANA sparks search for associated conditions
DEAR DR. ROACH: I am a 58-year-old healthy female. I am 6 feet tall, and weigh 130 pounds. My last blood pressure reading was 100/58. I have Raynaud’s phenomenon. I exercise every day (walk, bike, snowshoe).
All of my medical laboratory results are within the normal range with the exception of my antinuclear antibody. In 2012, it was at 1:640 titer (speckled pattern). In 2020, it was at 1:1280 titer (speckled pattern). The rheumatologist ordered additional blood tests which showed a strong positive for ANA IgG (95 units) and positive for ANA by HEp-2 titer at 1:160. All other tests were negative.
According to the doctor, the tests determined that I did not have systemic lupus, rheumatoid arthritis or a connective tissue disease. But he could not say why my ANA is elevated, only that I most likely had inflammation somewhere in my body.
My research shows that some normal, healthy people just have elevated ANA, and it does not mean anything is wrong. I would like to know your thoughts on this.
— T.O. ANSWER: The antinuclear antibody is indeed a common finding, and its meaning can sometimes be very confusing. While the majority of people with systemic lupus will have a positive ANA, you are correct that some people will have a positive ANA test without any indication of illness. The pattern of
To Your Good Health
ANA can be helpful, but just “speckled” may or may not be associated with autoimmune diseases. A high titer (1:1280 is high) is more likely to be associated with autoimmune diseases.
Rheumatologists will usually try to get more information, using specific tests in people with such high titers, looking for lupus or rheumatoid arthritis, and it sounds like yours did so and got negative results, which is good news.
Raynaud’s phenomenon is associated with positive ANA titers up to 40% of the time. Raynaud’s may also occur as part of other autoimmune diseases. Since you don’t seem to have any symptoms, and a thorough evaluation was negative, I would not look further unless you develop new issues.
DEAR DR. ROACH: I read your recent column on glaucoma with interest. Can you comment on “low pressure glaucoma?” My intraocular pressure was about 15-16 (normal), but my optic nerve was greatly enlarged. Eyedrops lowered that to about 10, but questions about why the nerve is so enlarged and why lowering the intraocular pressure would help do not elicit much of an answer, just that it might help. My concern is the threat of going blind as the optic nerve “cups out.”
— C.G. ANSWER: Glaucoma is a disease of the retina, diagnosed by an enlargement of the optic cup relative to the optic disc when examining the retina. The vast majority of people with glaucoma have elevated pressures inside the eye, and treatment to lower pressure is effective at slowing or stopping progression of the disease. Without treatment, glaucoma will cause progressive and irreversible loss of vision, starting with peripheral vision.
However, some people will develop the retinopathy of glaucoma with normal pressures. This may be associated with medical conditions such as anemia, arrhythmia, hypothyroidism, autoimmune diseases and migraine headaches. An ophthalmologist will typically do a thorough exam to exclude other causes of retinopathy, but lowering the eye pressure, even if normal to begin with, has been shown to reduce progression of visual loss in glaucoma.
It’s the best treatment we have to prevent blindness.
NEW YORK — Instead of finishing your leftovers, you let them go bad and buy takeout.
It’s a familiar routine for many — and indicative of habits that contribute to a global food waste problem that a new United Nations report says needs to be better measured so that it can be effectively addressed.
The U.N. report estimates 17% of the food produced globally each year is wasted. That amounts to 1.03 billion tons of food.
The waste is far more than previous reports had indicated, though direct comparisons are difficult because of differing methodologies and the lack of strong data from many countries.
“Improved measurement can lead to improved management,” said Brian Roe, a food waste researcher at Ohio State University who was not involved in the report.
Most of the waste — or 61% — happens in households, while food service accounts for 26% and retailers account for 13%, the U.N. found. The U.N. is pushing to reduce food waste globally, and researchers are also working on an assessment of waste that includes the food lost before reaching consumers.
The authors note the report seeks to offer a clearer snapshot of the scale of a problem that has been difficult to assess, in hopes of spurring governments to invest in better tracking.
“Many countries haven’t yet quantified their food waste, so they don’t understand the scale of the problem,” said Clementine O’Connor, of the U.N. Environment Program and co-author of the report.
Food waste has become a growing concern because of the environmental toll of production, including the land required to raise crops and animals and the greenhouse gas emissions produced along the way. Experts say improved waste tracking is key to finding ways to ease the problem, such as programs to divert inedible scraps to use as animal feed or fertilizer.
The report found food waste in homes isn’t limited to higher income countries such as the United States and the United Kingdom.
Roe of Ohio State noted that food sometimes is wasted in poor countries without reliable home refrigeration. In richer countries, people might eat out more, meaning food waste is simply shifted from the home to restaurants.
Roe said cultural norms and policies also could contribute to waste at home — such as massive packaging, “buy one, get one free” deals, or lack of composting programs.
That’s why broader system changes are key to helping reduce waste in households, said Chris Barrett, an agricultural economist at Cornell University.
For example, Barrett said, people might throw away food because of a date on the product — even though such dates don’t always say when a food is unsafe to eat. “Food waste is a consequence of sensible decisions by people acting on the best information available,” he said.
To clarify the meaning of labeling dates,
U.S. regulators have urged food makers to be more consistent in using them. They note that labels like “Sell By”, “Best By” and “Enjoy By” could cause people to throw out food prematurely, even though some labels are intended only to indicate when quality might decline.
The U.S. Department of Agriculture estimates that a family of four wastes about $1,500 in food each year. But accurately measuring food waste is difficult for a variety of reasons including data availability, said USDA food researcher Jean Buzby, adding that improved measurements are part of a government plan to reduce waste.
Richard Swannell, a co-author of the U.N. report, said food was generally more valued even in richer countries just a few generations ago, since people often couldn’t afford to waste it. Now, he said, awareness about the scale of food waste globally could help shift attitudes back to that era.