It all started with a horrible case of mono.

That’s what Kristen Towery, 46, thinks now when she looks back on her symptoms and the nearly two decades it took to get a proper diagnosis.

During her junior year of college, the bout of mono was so bad that she had to miss a semester of classes.

“I never felt like I got fully better,” she says. “I really still struggled with the fatigue. That was something that stuck with me throughout my early twenties.”

For the first few years, Towery visited different doctors, mentioning the fatigue to see if anyone could suggest a solution. “Could I have this chronic fatigue syndrome I keep hearing about?” she would ask, explaining that she just couldn’t get back to normal energy levels.

The fatigue wasn’t completely debilitating at that point. “But I knew that I didn’t really have enough energy to go to work and come home and be the other things that I needed to be,” says Towery, who at the time was working in the corporate buying offices of Neiman Marcus in Dallas. “It was exactly like The Devil Wears Prada. Super super stressful and that took a lot out of me, and not feeling like I had the energy on top of it made it much worse.”

Most doctors blew her off. Chronic fatigue syndrome doesn’t really exist, they would tell her. “You just need to exercise.” “Work less.” “Get more sleep.”

The Pain Starts to Creep In

Throughout her twenties, Kristen endured other seemingly random symptoms here and there. She had pain in her neck that she saw a chiropractor for. She recalls going to several dermatologists for mysterious rashes — “I’d break out in hives from time to time.”

There was one instance with hip pain so piercing that it sent her to the emergency room, but then it went away.

In Kristen’s early thirties she started noticing some pain in her hands and she saw a couple of different doctors. But “it wasn’t enough to drive me crazy,” she says, and she didn’t push.

The First Flare: Could It Be Lupus or RA?

Kristen, who now lives Tampa, Florida with her husband and two Chihuahuas, hadn’t given much thought to the idea that she could have an autoimmune disease. It was the early nineties when she graduated college, and you couldn’t exactly look up your symptoms online.

But then, around seven or eight years ago, she got hit with a bad flu-like illness. “In retrospect, I think it was a horrible flare,” she says. Sick, hot, feverish, with rashes that kept breaking out across her chest, shakiness and loss of balance. “Weird things,” she says.

It was at this point that other people started to suggest to Kristen that she might have lupus. Enter Google — and conviction.

“I started researching it and thought, ‘oh, it has to be lupus,’” says Kristen.

She ruled out RA because “I thought you have to be screaming in pain, that it has to be super bad. I felt like my symptoms leaned more toward fatigue.” The lupus signs, for Kristen, were adding up: hair loss, rashes, brain fog, anxiety issues.

Her primary care doctor had run a slew of RA and Lupus blood tests, found nothing, and told her the five words no chronic illness patient ever wants to hear: “It’s all in your head.”

She pushed for a referral to a rheumatologist.

The rheumatologist agreed that Kristen’s symptoms sounded like they could be lupus, and he ran more tests. Everything, she says, came back negative. Tests that look for certain antibodies in the blood — rheumatoid factor and antinuclear antibody (ANA) — were both negative. (More than 95 percent of people with lupus will test positive for ANA.) Her sedimentation rate, which measures levels of inflammation in the body, was normal.

“You don’t have RA. You don’t lupus,” the doctor told her.

Trying to Get Back on Track

Kristen, who by now had quit her job as a high school English and history teacher because it was way too taxing, was defeated and confused. “I felt half dead,” she says. The brain fog was making it impossible for her to think straight. “I couldn’t get up in front of the class and remember how to spell basic words.”

After taking a break from work, she gradually started feeling better. She went back and got a different teaching job, which was going well… and then she got hit with another flare.

This time, Raynaud’s, a condition in which blood circulation to your extremities becomes limited, started popping up and turned Kristen’s fingers purple. Her back and hips were throbbing.

“I was waking up in the morning with my hands in little claws, and my feet hurt really badly,” says Kristen, who by this time found out that her grandmother had had rheumatoid arthritis.

She felt something shift in her gut — and somehow just knew she had RA too, even if blood tests wouldn’t confirm it. She sought out a different rheumatologist.

Getting Diagnosed: “I Was Almost Giddy”

Kristen told the rheumatologist (who she still treats her today), all about her complicated medical history. This time, though, the radiographic imaging finally caught it. “They X-rayed every bit of me,” Kristen says.

Based on the X-rays, the doctor told her she likely had about five years of damage to her joints. It was rheumatoid arthritis.

Kristen’s reaction to learning she had RA was probably different than the average patient’s. “I was smiling,” she remembers. She was just so relieved to have a name for what she’d been experiencing for almost 20 years — nearly her entire adult life.

What’s more, Kristen’s husband had been living with psoriatic arthritis for 10 years, and was managing it well on a TNF inhibitor biologic. Kristen assumed she too would get on a treatment and start feeling fine.

Adjusting to RA

It wasn’t quite that simple. Now on her fourth biologic, Kristen is finally starting to feel like maybe everything’s under control.

“It’s been a roller coaster up and down, an emotional journey,” she says. “It hasn’t been super easy, but I feel better than a lot of people do and I finally feel like I’m in a place where I’m better able to balance my time and feeling better. I’m getting there. I’m the best I’ve been in a long time.”

As for having a husband who also has inflammatory arthritis? “It was actually a little harder for me in the beginning,” Kristen says. “Because his has been quite well controlled, I think he expected mine to be right off the bat. And mine has been a lot more difficult to control.”

Even while on treatment that controls her pain symptoms well, she still struggles with fatigue, which he husband typically doesn’t.

“I think he expected me to be better sooner,” Kristen says. But over time they’ve seen that their diseases are very different from one another’s and have learned to adjust to it. “And he gives me my shots, so that’s a good thing.”

From Patient to Advocate

“When I was diagnosed I knew pretty quickly that I wanted to get involved in shaping the conversation and the process, beyond the level that was just stuffing envelopes,” says Kristen. “I had been living so long undiagnosed and I wanted to take steps to make sure that doesn’t happen to other people, or lessen the degree to which it does.”

She saw online that CreakyJoints had put out a call for people with RA who would be interested in sitting on a patient council and to fill out an application. “I thought, there’s no way they’re going to pick me — I’m newly diagnosed, I haven’t done any other advocacy work yet. But I filled it out and I got a phone call not too long after.”

Kristen joined our Patient Council for people living with inflammatory arthritis, and has been actively involved ever since.

As a member, Kristen helps inform and shape patient-centered communication and educational materials. For example, she was involved with the development of our Rheumatoid Arthritis Patient Guidelines.

“Education is empowering,” she says. “I’ve had friends who have been diagnosed with diseases like this and not really even take much of an effort to learn themselves about the disease. That surprises me because the more you know, the better your treatment outcome can be. You have to educate yourself and not just rely on what the doctors say. Don’t just trust everything you read online. Read journal articles, read abstracts. Stay up to date on what’s happening and what the different treatment options are.”

“Work with your doctor but don’t necessarily rely 100 percent on them,” she says firmly. “We’re the patient, we have to live with this, and it’s important to take as much of it into our own hands as we can.”

Being part of CreakyJoints has also helped Kristen find the peer support she didn’t know how badly she needed.

“It’s so easy to get in your head and feel like this is only happening to me,” she says. “I didn’t know how to live with this unpredictability or this pain, but when you start to meet other people who do, that’s empowering. Just to know that you’re not the only one.”

If you’ve been having symptoms that you suspect are lupus, or your doctor thinks you might have lupus, you might be Googling like crazy or your mind may spinning with questions: What does this mean for your future? How will you be treated? Will you ever feel healthy/normal again? And just what is lupus, anyway?

Here, we address your basic questions and more.

1. Lupus is an autoimmune condition

No one is sure what causes lupus, but doctors do know that the symptoms emerge when your immune system isn’t working as it should. Your immune system cells that are supposed to protect the body from different germs start treating normal, healthy cells like invaders, attacking them and causing flare-ups that can affect the joints, kidneys, and almost any other system in the body.

2. The symptoms of lupus are vague

Symptoms of lupus vary from person to person, from severity to the body parts affected. Some of the most common signs of lupus are a rash and joint pain, says Konstantinos Loupasakis, MD, a rheumatologist with MedStar Washington Hospital Center, but symptoms can also include fatigue, hair loss, mouth sores, and fever. “There’s a great range of manifestations we see with lupus,” he says.

3. Lupus can be diagnosed at any age

Women at childbearing age (between 15 and 44) are at the highest risk of lupus, according to the Centers for Disease Control and Prevention (CDC), but the disease isn’t limited to younger adults. Between 10 and 20 percent of people with systemic lupus are diagnosed before age 18, according to a study in Nature Reviews Rheumatology, and adults can also have “late-onset” lupus that is diagnosed after age 50.

4. Race is a risk factor

People of color — particularly African Americans — are at a higher risk of lupus than white people are, and the disease tends to affect populations differently. Native American and black patients tend to have higher mortality rates than white patients, while Hispanic and Asian patients have a lower risk of lupus, according to a study of 42,000 lupus cases. (Read more about stroke risk in black and hispanic lupus patients.) There seems to be a genetic component to the disease, but researchers are investigating how socioeconomics and other factors play into the discrepancies.

5. Women are at a higher risk

Most studies find that about 90 percent of lupus patients are women, according to a review in Seminars in Arthritis and Rheumatism. The study also found that men tend to have more damage earlier in the disease and have lower survival rates. Hormones might play a role in the sex differences, but studies haven’t found a conclusive answer, says Dr. Loupasakis.

6. You’ll want to enlist a specialist

The symptoms of lupus are vague and the condition requires regular follow-ups, so a general practitioner will need to refer you to a specialist if he or she suspects an autoimmune problem like lupus. “When there is concern [that you could have] lupus, a rheumatologist should be involved in evaluating this diagnosis,” says Jason Liebowitz, MD, a rheumatology fellow with Johns Hopkins Bayview Medical Center. Once they have a confirmed diagnosis, lupus patients will likely visit their rheumatologist every three months or so, adds Dr. Loupasakis.

7. A blood test can help, but it isn’t a surefire diagnosis

Because lupus is caused by activity in the immune system, doctors will want to test for certain antibodies to find out what’s happening on a cellular level. Antinuclear antibody (ANA) levels tend to be high in people with autoimmune problems, and about 98 percent of people with systemic lupus test positive to the ANA blood test.

But that doesn’t mean every person with a positive ANA has lupus. With or without lupus, about 14 percent of the general U.S. population shows positive ANA tests, according to a 2012 study, so doctors can’t rely on a single test to diagnose lupus.

8. A lupus diagnosis is based on symptoms and tests

Without a single blood test clinch a lupus diagnosis, rheumatologists need to look at the whole picture. “There is no single finding that defines the diagnosis of lupus,” says Dr. Liebowitz. “It is a condition that can affect the body in many different ways, and thus diagnosis requires putting together the entire clinical picture.”

When rheumatologists suspect an autoimmune problem, they will take your symptoms into account while looking at X-rays, blood tests, and biopsies to see if results match what they’d expect from lupus, or if it is more likely a different disease.

9. Lupus can look like other conditions

Other conditions like rheumatoid arthritis, fibromyalgia, and Lyme disease share symptoms with lupus. Without a specific blood test pointing to lupus or other autoimmune conditions, it can sometimes take trial and error for rheumatologists to pin down the right diagnosis.

10. There is no cure for lupus

At this point, scientists haven’t found a cure for lupus. That said, the chronic disease is not a death sentence. With new medications, lupus mortality rates have improved over time, and the life expectancy for women with lupus-related kidney inflammation is almost on par with women of similar age groups in the general population, according to a study in the Internal Journal of Immunopathology and Pharmacology.

11. Medications can help

Drugs can’t cure lupus, but they can prevent flare-ups. Available medications can suppress the immune system, holding back the antibodies that would otherwise be triggering inflammation. “The most important treatment for lupus is a medication called Plaquenil [hydroxychloroquine]. Essentially all patients with lupus should be on this medication,” says Dr. Liebowitz. “The other medications used in lupus — which may include mycophenolate mofetil, cyclophosphamide, and other immunosuppressive medications — depend on the symptoms of lupus and the parts of the body that have been affected.” A rheumatologist will be able to recommend the best treatment plan for a particular patient.

12. Systemic lupus is the most common form

There are several types of lupus, but most people refer to the most common form: systemic lupus erythematosus, also known as SLE or systemic lupus. About 70 percent of people with lupus have SLE, according to the Lupus Foundation of America. Compared to other types of lupus, it tends to be more severe and is more likely to affect a major organ, such as the kidneys, lungs, or heart.

13. Sometimes, lupus is just limited to the skin

Patients with systemic lupus can have rashes, but some patients have discoid lupus, which means they might only get rashes and skin lesions, rather than joint pain, kidney problems, and other symptoms seen in SLE. About 17 patients with discoid lupus will see their disease turn systemic later, according to a Swedish study in the British Journal of Dermatology, but “most of the time, it will never progress,” says Dr. Loupasakis.

14. Certain drugs might trigger lupus symptoms

When some people take certain medications, including isoniazid, hydralazine, and procainamide, their bodies can overreact and start showing lupus-like symptoms. Typically, they’ll have symptoms like low-grade fever, aching and swelling joints, or occasionally rashes, but the more serious aspects like kidney inflammation don’t tend to show up, says Dr. Loupasakis.

The condition is separate from “true” systemic lupus because it isn’t chronic. “In the majority of these patients, once they stop the medication, the symptoms will go away in a few weeks,” Dr. Loupasakis says.

15. Some babies are born with lupus

Sometimes, a mother with lupus or antibodies related to it can pass those antibodies to her newborn, causing a form of lupus called neonatal lupus. “‘Bad’ antibodies are transferred from the mother to the baby along with ‘good’ antibodies that are supposed to protect the baby in the first months of their life,” says Dr. Loupasakis.

Typically, the result is lupus-like skin lesions that go away after a few months, when the babies start to make their own antibodies, he says. In rare cases, the child of a mother with those antibodies will develop a condition known as congenital heart block, but moms-to-be with lupus shouldn’t stress. Only 2 to 5 percent of babies whose mothers have those antibodies will develop congenital heart block, according to a study in Arthritis & Rheumatology. These problems can be detected during ultrasound during pregnancy and babies can be treated immediately after being born by getting a pacemaker implanted to help regulate the electrical activity of the heart.

16. Lupus can damage the kidneys

Left unchecked, inflammation running rampant in the body can lead to serious complications. For lupus, damage to the kidneys is a big concern. About 40 to 70 percent of lupus patients have kidney inflammation, according to a study in Nature Reviews Nephrology, making renal failure one of the main comorbidities.

“Unfortunately we see that quite often, especially in patients that did not present to us early enough,” says Dr. Loupasakis. The life expectancy of lupus patients with renal disease or failure is three to ten years lower than that of a lupus patient without kidney problems, according to a study of 700 Hong Kong patients.

17. Lupus also increases cardiovascular risk

Indirectly, lupus can lead to cardiovascular problems. Lupus doesn’t directly affect the heart, but the inflammation the disease causes can speed up the formation of blood clots, says Dr. Loupasakis. Cardiovascular disease is the leading cause of death in people who have had lupus for more than five years, according to a study in Current Cardiology Reviews. One thing you can do to help reduce your risk of heart disease is to eat a healthy, Mediterranean-style diet that focuses on healthy vegetables and seafood while avoiding red meat, recommends Dr. Loupasakis.

Imagine your body is a castle and your immune system is an army fighting off invaders like germs. If the army malfunctions and attacks the castle itself, you may have an autoimmune disease. There’s no cure for autoimmune diseases, but your healthcare provider will help you find treatments that manage the symptoms you experience.

What are autoimmune diseases?

Autoimmune diseases are health conditions that happen when your immune system attacks your body instead of defending it. Healthcare providers sometimes call them autoimmune disorders.

Usually, your immune system is like your body’s built-in security system. It automatically detects substances that shouldn’t be in your body (like viruses, bacteria or toxins) and sends out white blood cells to eliminate them before they can damage your body or make your sick.

If you have an autoimmune disease, your immune system is more active than it should be. Because there aren’t invaders to attack, your immune system turns on your body and damages healthy tissue.

Autoimmune diseases are chronic conditions. This means if you have an autoimmune disease, you’ll probably have to manage it and the symptoms it causes for the rest of your life.

Types of autoimmune diseases

There are more than 100 different autoimmune diseases. They can affect almost any tissue or organ in your body, depending on where your immune system malfunctions, including your:

• Joints.
• Muscles.
• Skin.
• Blood vessels.
• Digestive system.
• Endocrine system.
• Nervous system.

This isn’t a complete list of autoimmune diseases, but some examples of conditions (and where they affect you) include:

Joints and muscles

• Rheumatoid arthritis (RA).
• Lupus.
• Myositis.

Skin and blood vessels

• Sjögren’s syndrome.
• Psoriasis.
• Psoriatic arthritis.
• Dermatomyositis.
• Scleroderma.
• Vasculitis.
• Rheumatoid vasculitis.
• Urticarial vasculitis.
• Vitiligo.

Digestive system

• Crohn’s disease.
• Celiac disease.
• Ulcerative colitis.
• Autoimmune gastritis.

Endocrine system

• Type 1 diabetes.
• Addison’s disease.
• Hashimoto’s thyroiditis.
• Graves’ disease.

Nervous system

• Multiple sclerosis (MS).
• Myasthenia gravis (MG).
• Guillain-Barré syndrome.
• Chronic inflammatory demyelinating polyneuropathy (CIPD).

How common are autoimmune diseases?

Autoimmune diseases are common, especially because there are so many different types. Experts estimate that around 1 in 15 people in the U.S. has an autoimmune disease.

What are autoimmune disease symptoms?

Autoimmune diseases can cause a wide range of symptoms. They can affect your body almost literally from head to toe.

For example, conditions that affect your muscles can cause muscle weakness. You might also have joint pain, swelling or feel stiffness if you have a condition like rheumatoid arthritis. Type 1 diabetes causes high blood sugar (hyperglycemia). Some autoimmune conditions affect your vision.

Many autoimmune diseases cause inflammation, which can include:

• A feeling of warmth or heat.
• Discoloration or redness on your skin.
• Swelling.
• Pain.

Lots of autoimmune diseases cause symptoms that come and go (recur). These episodes of more noticeable or more severe symptoms are called flares or attacks. Tell your provider if you experience symptoms that seem to recur — especially if certain physical activities, times of day, foods or drinks, or anything else makes them noticeably better or worse.

Trust your gut. Nobody knows what’s normal for your body better than you. Visit a healthcare provider if you notice any new symptoms you can’t explain, especially if you don’t feel like yourself more often than usual.

What causes autoimmune diseases?

Experts don’t know for certain what causes autoimmune diseases. We know your immune system mistakenly damaging your body instead of protecting it causes the symptoms of an autoimmune disease you experience. But researchers are still studying what makes your immune system start hurting you in the first place.

What are the risk factors?

Some studies have found that certain factors (triggers) might increase your risk of developing an autoimmune disease. Some triggers may include:

• Viral infections, including COVID-19 and Epstein-Barr virus.
• Your sex. Women are more likely to have autoimmune conditions.
• Having biological relatives with autoimmune diseases. Some autoimmune conditions are genetic conditions and pass through generations of a biological family.
• Having one autoimmune disease can increase the odds of developing another one (multiple autoimmune syndrome).
• Exposure to chemicals or other environmental factors (aspects of where you live or work that impact your health) might trigger autoimmune diseases.
• Smoking and using other types of tobacco can cause many health issues, including potentially triggering autoimmune diseases.

How do healthcare providers diagnose autoimmune diseases?

Healthcare providers diagnose autoimmune diseases with a physical exam and by discussing your health history. You might also need some tests.

Your provider will examine your body, especially if you’re experiencing symptoms in a specific area. They’ll ask about the symptoms you’re experiencing and when you first noticed them. Tell your provider if you know any of your biological family members have an autoimmune disease.

Diagnosing an autoimmune disease is often a differential diagnosis. This means your provider will test you for several different conditions that can cause the symptoms you’re experiencing until they find the cause.

Your provider might order blood tests to look for specific signs (markers) of autoimmune diseases. These markers are like clues your immune system leaves behind after it damages your body or causes specific issues.

You might need some imaging tests to take pictures of the insides of your body, including:

• X-rays.
• MRI (magnetic resonance imaging).
• CT scan (computed tomography scan).
• Ultrasound.

What are autoimmune disease treatments?

Autoimmune diseases can need a variety of treatments. Just like the wide variety of symptoms they cause, which treatments you’ll need depends on which condition you have. Everyone’s immune system, genetics and environment are different. That means the treatments that work for you will be unique.

Some common treatments to manage autoimmune disease symptoms include:

• Pain relievers.
• Anti-inflammatory medication like NSAIDs or corticosteroids.
• Immunosuppressants.
• Physical therapy.
• Occupational therapy.
• IVIG infusions.

You might need specific treatments based on the condition you have. For example, people with Type 1 diabetes need insulin therapy and people with celiac disease need to eat a gluten-free diet.

Can autoimmune diseases be cured?

There’s no cure for autoimmune diseases. They’re chronic (long-term) conditions that usually last your whole life. Some autoimmune diseases enter remission, a long period of time between symptom flares. This isn’t the same as a cure, but it might mean the symptoms impact your daily routine less often.

Can you prevent autoimmune diseases?

There might not be any way to prevent autoimmune diseases because experts aren’t sure what causes them.

How do I take care of myself?

Everyone’s body and journey with an autoimmune disease is different. Talk to your healthcare provider about the best ways to manage the symptoms you experience. You might need to adjust the kinds of physical activities you do, the foods and drinks you consume or make other tweaks to your day-to-day routine.

Is an autoimmune disease serious?

Living with an autoimmune disease like lupus, rheumatoid arthritis and multiple sclerosis can be complex and serious. Although there are no cures for these diseases, many of their symptoms can be treated, and sometimes they go into remission. Stay in touch with your healthcare provider about any advances in understanding and treating autoimmune diseases.

What is the life expectancy of someone with an autoimmune disease?

It’s hard to give an estimate of how an autoimmune disease will affect your lifespan (how long you live). Some conditions are more serious than others, and can cause fatal complications.

Conditions like multiple sclerosis and myositis are more likely to be fatal than many autoimmune diseases, but that doesn’t mean they always are. Similarly, Type 1 diabetes can be fatal if it’s not managed.

Talk to your healthcare provider. They’ll explain how an autoimmune disease will affect your lifespan (if at all).

When should I see my healthcare provider?

Visit a healthcare provider if you’re experiencing new or worsening symptoms you can’t explain — especially if they affect your ability to do all your usual activities.

If you’ve already been diagnosed with an autoimmune disease, tell your provider if it feels like your treatments aren’t working as well as they used to or if the symptoms are recurring more often.

When should I go to the emergency room?

Go to the ER or call 911 (or your local emergency services number) if you experience any of the following severe symptoms:

• Trouble breathing or shortness of breath (dyspnea).
• Severe chest pain or pressure in your chest.
• A headache that starts suddenly and feels unusually serious or intense.
• Sudden weakness, especially if you can’t move.
• Dizziness that doesn’t stop.
• Pain so severe that you can’t stand it.

Which questions should I ask my provider?

You may want to ask your provider:

• Which tests will I need?
• Is this condition genetic?
• What kinds of treatments will manage my symptoms?
• How will I need to change my daily routine?

A note from Cleveland Clinic

Finding out you have a health condition that you’ll have to manage for the rest of your life can be overwhelming and scary. It might seem even more unfair if your healthcare providers can’t say what caused it.

Having an autoimmune disease can be hard. And it can be tough for others to understand how much effort it can take you just to move through the world on a day-to-day basis. Give yourself credit for how strong you are. Celebrate small victories, and don’t be afraid to feel frustrated or ask for support from your loved ones and providers.

Autoimmune diseases come in all shapes and sizes. Your healthcare providers will help you find treatments that manage the symptoms you experience. You’re not defined by a condition you have, it’s just a part of your health journey.

Broadway is a major east-west thoroughfare in the city of Vancouver, British Columbia, Canada. In Vancouver’s numbered avenue grid system, it runs in place of a 9th Avenue, between 8th and 10th. The street has six lanes for most of its course. Portions of the street carry the British Columbia Highway 7 designation.

The route begins as “West Broadway” at the intersection of Wallace Crescent and 8th Avenue, in the affluent residential neighbourhood of West Point Grey, a few kilometres east of the University of British Columbia (UBC). Past Alma Street, Broadway takes over from 10th Avenue as one of Vancouver’s major thoroughfares, as it enters Greek West Broadway (or Greektown) section of Vancouver’s Kitsilano district. East of here are several blocks of generally trendy, upscale shops interspersed with low-rise apartment blocks and small supermarkets. The surrounding neighbourhoods generally consist of large, older homes dating from the early twentieth century, many of which have been subdivided into rental suites.

As Broadway approaches Arbutus Street, the commercial establishments become larger before transitioning into a mix of small to mid-size apartment blocks. East of Burrard Street, the apartment blocks get progressively taller, and commercial establishments larger and busier. Between Burrard and Main Street, Broadway can be considerably congested by vehicular traffic. Past Granville Street, Broadway yields completely to medium-to-large commercial structures and high-rise apartments and condominiums. Between Cambie and Main, the commercial establishments become smaller and somewhat more downscale.

At Ontario Street, two blocks west of Main, the route becomes “East Broadway.” After bisecting Main and Kingsway, traffic on Broadway eases somewhat, and the character returns to a mix of small-to-medium apartment buildings and commercial establishments, interspersed with older homes – all considerably less affluent than those to the west. At Commercial Drive, Broadway passes by the Commercial–Broadway SkyTrain Station. Past here for several blocks, the neighbourhood consists predominantly of older residential homes.

As Broadway travels east of Renfrew Street, the neighbourhood once again becomes mixed, with older homes to the north and larger industrial, commercial, and warehouse establishments to the south. Broadway finally ends at Cassiar Street, just short of the Vancouver-Burnaby boundary, where it becomes the Lougheed Highway.

Broadway was created at the turn of the 20th century, along with other gridded roads south of False Creek, to meet the needs of an expanding population in Vancouver. The name of the route was changed from 9th Avenue to Broadway in 1909, at the behest of merchants around Main Street (at that time the hub of Vancouver commerce), who felt that it bestowed a more cosmopolitan air. Commercial establishments originally spread out around the intersections of Cambie and Main Streets, while the character of the rest of the route remained predominantly single-family dwellings.

By the 1970s, the length of Broadway had become a major arterial route in Vancouver, conveying commuters from downtown to the neighbourhoods of the west and east sides. With the growth of UBC and the expansion of the Vancouver General Hospital (one block south of Broadway between approximately Oak and Cambie), traffic demands accelerated. In the 1990s, the agency then responsible for public transit in Greater Vancouver — BC Transit — introduced an express bus route, the 99 B-Line, to help reduce congestion. The Vancouver transportation plan for Broadway notes that congestion is such that the bus service is at capacity, and will not be eased until a new rapid transit line is built paralleling the street. It is anticipated that the SkyTrain’s Millennium Line will be extended to Central Broadway by 2021; the extension is expected to connect with Canada Line at Broadway-City Hall Station, at the intersection of Broadway and Cambie Street.

Biotin, also known as Vitamin B7, is a vital nutrient that plays a key role in energy production, metabolism, and maintaining healthy hair, skin, and nails. A biotin deficiency disease can manifest through subtle but impactful signs, often mistaken for other health concerns. Understanding the symptoms and causes of biotin deficiency is crucial to preventing its adverse effects and restoring optimal health.

What is Biotin Deficiency Disease?

Biotin deficiency disease occurs when the body lacks sufficient biotin levels to perform essential functions. While biotin is naturally produced in small amounts by gut bacteria, dietary intake remains the primary source. Deficiency can occur due to poor diet, digestive disorders, or prolonged antibiotic use, leading to a wide range of health problems.

Signs of Biotin Deficiency Disease

1. Hair Loss and Thinning

Hair loss, brittle strands, and a receding hairline are among the most common indicators of biotin deficiency disease. Biotin helps in keratin production, which is the building block of hair structure. A lack of biotin weakens hair follicles, causing breakage and slow regrowth.

• Slow Hair Growth: Without sufficient biotin, new hair growth slows down, and existing hair becomes prone to splitting and shedding.
• Hair Texture Changes: Deficiency can also alter hair texture, making it dry, coarse, or less manageable.
• Eyebrows and Eyelashes: Thinning or sparse eyebrows and eyelashes can occur alongside scalp hair loss.

When experiencing hair loss, it’s natural to wonder, which nutrient deficiency causes hair fall? In many cases, deficiencies in biotin or other essential nutrients are the culprits.

2. Skin Problems

Biotin plays a crucial role in maintaining skin health. Dry, scaly, or red patches, especially around the nose, mouth, and eyes, can signal low biotin levels. Persistent skin issues often require deeper examination of nutrient intake, including biotin.

• Rashes and Itchiness: Biotin deficiency can lead to dermatitis-like symptoms, including itchy, inflamed patches on the face and body.
• Premature Wrinkles: Lack of biotin can accelerate skin aging, causing fine lines and dullness.
• Seborrheic Dermatitis: In some cases, biotin deficiency contributes to greasy, flaky skin on the scalp and face.

3. Brittle Nails

Weak, splitting, or thin nails often accompany a biotin deficiency disease. Biotin strengthens nail beds and promotes growth, which is why its absence directly affects nail quality.

• Frequent Breakage: Biotin deficiency weakens the nail structure, leading to cracking or peeling.
• Discoloration: Nails may develop a pale or yellowish tint, signaling poor keratin production.
• Slow Nail Growth: The growth rate of nails decreases, making recovery from damage slower.

4. Fatigue and Lethargy

Biotin contributes to energy production by breaking down fats, carbohydrates, and proteins. Without adequate biotin, individuals may experience chronic fatigue, muscle weakness, and overall sluggishness. This can sometimes overlap with protein deficiency, amplifying the feeling of exhaustion.

• Brain Fog: Deficiency can lead to difficulty concentrating, forgetfulness, or mental fatigue.
• Physical Exhaustion: Even minor activities may leave you feeling overly tired or drained.
• Sleep Disruptions: Fatigue from biotin deficiency may disrupt natural sleep patterns, further worsening energy levels.

5. Neurological Symptoms

Severe cases of biotin deficiency disease can cause neurological issues such as depression, tingling sensations in the limbs, or cognitive impairments. Biotin’s role in nerve signaling makes it essential for maintaining brain health.

• Mood Swings: Low biotin levels may trigger mood disturbances like irritability, anxiety, or mild depression.
• Nerve Damage: Tingling or numbness, particularly in hands and feet, can indicate biotin’s role in nerve health.
• Focus and Coordination Issues: Biotin deficiency can impair motor coordination and mental focus, causing clumsiness or cognitive fog.

6. Muscle Pain and Cramps

Muscle pain, aches, or cramps are other signs of biotin deficiency. This occurs when the body struggles to metabolize nutrients for muscle function, often linked to insufficient energy production.

• Muscle Weakness: Biotin deficiency reduces energy availability, making muscles feel weak or shaky during activity.
• Frequent Cramps: Poor nutrient metabolism can lead to sudden and painful muscle cramps, especially in the legs.
• Delayed Recovery: Post-exercise recovery slows down, causing soreness to linger longer than usual.

Causes of Biotin Deficiency Disease

Several factors can trigger biotin deficiency disease:

• Poor Diet: Lack of biotin-rich foods like nuts, seeds, eggs, and leafy greens can deplete biotin levels.
• Digestive Disorders: Conditions like Crohn’s disease or leaky gut syndrome can impair nutrient absorption.
• Prolonged Antibiotic Use: Antibiotics disturb gut bacteria that naturally produce biotin.
• Excessive Alcohol Consumption: Alcohol interferes with nutrient absorption, including biotin.

How to Prevent Biotin Deficiency

1. Include Biotin-Rich Foods in Your Diet

To prevent biotin deficiency disease, prioritize biotin rich foods such as:

• Eggs (cooked)
• Almonds, walnuts, and peanuts
• Sunflower seeds
• Sweet potatoes
• Spinach and Kale

Incorporating these foods not only helps maintain biotin levels but also supports overall health. A balanced diet rich in vitamins and minerals is key to preventing deficiencies.

2. Support Gut Health

Healthy gut bacteria naturally produce biotin, so supporting digestion is crucial. Probiotics, prebiotic-rich foods like bananas and garlic, and fermented foods can improve gut flora and boost biotin levels.

3. Address Nutrient Imbalances

Since biotin works with other nutrients like protein, ensure you’re not facing a protein deficiency. Consuming sufficient protein through natural sources or plant based protein powder can complement biotin’s role in energy metabolism and tissue repair.

4. Improve Nutrient Absorption

Focus on how to increase biotin absorption by addressing factors like hydration, gut health, and avoiding nutrient blockers such as excessive alcohol or smoking. Proper lifestyle choices play a significant role in preventing deficiencies.

5. Balance Diet for Long-Term Health

A well-rounded approach, including nutrient-dense foods and mindful eating habits, can provide sufficient biotin levels. In cases where dietary gaps exist, options like a Plant Based Biotin Supplement can help ensure the body gets the support it needs.

Conclusion

Biotin is an essential nutrient that supports multiple bodily functions, from maintaining vibrant hair and skin to enabling energy production. Recognizing the signs of biotin deficiency disease—like hair loss, skin issues, and fatigue—allows for early intervention and prevention. Prioritizing a diet with biotin-rich foods, maintaining gut health, and addressing nutrient imbalances are the first steps in avoiding this deficiency.

With a balanced lifestyle and mindful dietary habits, you can effectively prevent biotin deficiency and enjoy long-term health benefits.

Tyrosine is a supplement that may help improve alertness, attention, and focus. Depending on the dose, it may help boost physical and mental performance. But, not all research is conclusive, and there may be side effects.

Tyrosine produces important brain chemicals that help nerve cells communicate and may even regulate mood.

Despite these benefits, supplementing with tyrosine can have side effects and interact with medications.

This article tells you all you need to know about tyrosine, including its benefits, side effects, and recommended dosages.

Tyrosine is an amino acid that is naturally produced in the body from another amino acid called phenylalanine.

It’s found in many foods, especially in cheese, where it was first discovered. In fact, “tyros” means “cheese” in Greek.

It is also found in chicken, turkey, fish, dairy products and most other high-protein foods.

Tyrosine helps make several important substances, including:

• Dopamine: Dopamine regulates your reward and pleasure centers. This important brain chemical is also important for memory and motor skills.
• Adrenaline and noradrenaline: These hormones are responsible for the fight-or-flight response to stressful situations. They prepare the body to “fight” or “flee” from a perceived attack or harm.
• Thyroid hormones: Thyroid hormones are produced by the thyroid gland and primarily responsible for regulating metabolism.
• Melanin: This pigment gives your skin, hair and eyes their color. Dark-skinned people have more melanin in their skin than light-skinned people.

It’s also available as a dietary supplement. You can purchase it alone or blended with other ingredients, such as in a pre-workout supplement.

Supplementing with tyrosine is thought to increase levels of the neurotransmitters dopamine, adrenaline and norepinephrine.

By increasing these neurotransmitters, it may help improve memory and performance in stressful situations.

Stress is something that everyone experiences.

This stress can negatively affect your reasoning, memory, attention and knowledge by decreasing neurotransmitters.

For example, rodents who were exposed to cold (an environmental stressor) had impaired memory due to a decline in neurotransmitters.

However, when these rodents were given a tyrosine supplement, the decline in neurotransmitters was reversed and their memory was restored.

While rodent data does not necessarily translate to humans, human studies have found similar results.

In one study in 22 women, tyrosine significantly improved working memory during a mentally demanding task, compared to a placebo. Working memory plays an important role in concentration and following instructions.

In a similar study, 22 participants were given either a tyrosine supplement or placebo before completing a test used to measure cognitive flexibility. Compared to the placebo, tyrosine was found to improve cognitive flexibility.

Cognitive flexibility is the ability to switch between tasks or thoughts. The quicker a person can switch tasks, the greater their cognitive flexibility.

Additionally, supplementing with tyrosine has been shown to benefit those who are sleep deprived. A single dose of it helped people who lost a night’s sleep stay alert for three hours longer than they otherwise would.

What’s more, two reviews concluded that supplementing with tyrosine can reverse mental decline and improve cognition in short-term, stressful or mentally demanding situations.

And while tyrosine may provide cognitive benefits, no evidence has suggested that it enhances physical performance in humans.

Lastly, no research suggests that supplementing with tyrosine in the absence of a stressor can improve mental performance. In other words, it won’t increase your brainpower.

Phenylketonuria (PKU) is a rare genetic condition caused by a defect in the gene that helps create the enzyme phenylalanine hydroxylase.

Your body uses this enzyme to convert phenylalanine into tyrosine, which is used to create neurotransmitters.

However, without this enzyme, your body cannot break down phenylalanine, causing it to build up in the body.

The primary way to treat PKU is to follow a special diet that limits foods containing phenylalanine.

However, because tyrosine is made from phenylalanine, people with PKU can become deficient in tyrosine, which can contribute to behavioral problems.

Supplementing with tyrosine may be a viable option for alleviating these symptoms, but the evidence is mixed.

In one review, researchers investigated the effects of tyrosine supplementation alongside or in place of a phenylalanine-restricted diet on intelligence, growth, nutritional status, mortality rates and quality of life.

The researchers analyzed two studies including 47 people but found no difference between supplementing with tyrosine and a placebo.

A review of three studies including 56 people also found no significant differences between supplementing with tyrosine and a placebo on the outcomes measured.

The researchers concluded that no recommendations could be made about whether tyrosine supplements are effective for the treatment of PKU.

Tyrosine has also been said to help with depression.

Depression is thought to occur when the neurotransmitters in your brain become unbalanced. Antidepressants are commonly prescribed to help realign and balance them.

Because tyrosine can increase the production of neurotransmitters, it’s claimed to act as an antidepressant.

However, early research doesn’t support this claim.

In one study, 65 people with depression received either 100 mg/kg of tyrosine, 2.5 mg/kg of a common antidepressant or a placebo each day for four weeks. Tyrosine was found to have no antidepressant effects.

Depression is a complex and varied disorder. This is likely why a food supplement like tyrosine is ineffective at combating its symptoms.

Nevertheless, depressed individuals with low levels of dopamine, adrenaline or noradrenaline may benefit from supplementing with tyrosine.

In fact, one study among individuals with dopamine-deficient depression noted that tyrosine provided clinically significant benefits.

Dopamine-dependent depression is characterized by low energy and a lack of motivation.

Until more research is available, the current evidence does not support supplementing with tyrosine to treat symptoms of depression.

Tyrosine is “generally recognized as safe” (GRAS) by the Food and Drug Administration.

It has been supplemented safely at a dose of 68 mg per pound (150 mg per kg) of body weight per day for up to three months.

While tyrosine is safe for most people, it can cause side effects and interact with medications.

Tyramine is an amino acid that helps regulate blood pressure and is produced by the breakdown of tyrosine.

Tyramine accumulates in foods when tyrosine and phenylalanine are converted to tyramine by an enzyme in microorganisms.

Cheeses like cheddar and blue cheese, cured or smoked meats, soy products and beer contain high levels of tyramine.

Antidepressant medications known as monoamine oxidase inhibitors (MAOIs) block the enzyme monoamine oxidase, which breaks down excess tyramine in the body.

Combining MAOIs with high-tyramine foods can increase blood pressure to a dangerous level.

However, it is unknown if supplementing with tyrosine may lead to a buildup of tyramine in the body, so caution is necessary for those taking MAOIs.

The thyroid hormones triiodothyronine (T3) and thyroxine (T4) help regulate growth and metabolism in the body.

It’s important that T3 and T4 levels are neither too high nor too low.

Supplementing with tyrosine may influence these hormones.

This is because tyrosine is a building block for the thyroid hormones, so supplementing with it might raise their levels too high.

Therefore, people who are taking thyroid medications or have an overactive thyroid should be cautious when supplementing with tyrosine.

Levodopa (L-dopa) is a medication commonly used to treat Parkinson’s disease.

In the body, L-dopa and tyrosine compete for absorption in the small intestine, which can interfere with the drug’s effectiveness.

Thus, doses of these two drugs should be separated by several hours to avoid this.

Interestingly, tyrosine is being investigated for alleviating some of the symptoms associated with cognitive decline in older adults.

As a supplement, tyrosine is available as a free-form amino acid or N-acetyl L-tyrosine (NALT).

NALT is more water-soluble than its free-form counterpart, but it has a low conversion rate to tyrosine in the body.

This means that you would need a larger dose of NALT than tyrosine to get the same effect, making the free-form the preferred choice.

Tyrosine is commonly taken in doses of 500–2,000 mg 30–60 minutes before exercise, even though its benefits on exercise performance remains inconclusive.

It does seem to be effective for preserving mental performance during physically stressful situations or periods of sleep deprivation when taken in doses ranging from 45–68 mg per pound (100–150 mg per kg) of body weight.

This would be 7–10 grams for a 150-pound (68.2-kg) person.

These higher doses may cause gastrointestinal upset and be split into two separate doses, taken 30 and 60 minutes prior to a stressful event.

Tyrosine is a popular dietary supplement used for a variety of reasons.

In the body, it’s used to make neurotransmitters, which tend to decrease under periods of stressful or mentally demanding situations.

There is good evidence that supplementing with tyrosine replenishes these important neurotransmitters and improves mental function, compared to a placebo.

Supplementing with it has been shown to be safe, even in high doses, but has the potential to interact with certain medications, warranting caution.

While tyrosine has many benefits, their significance remains unclear until more evidence is available.

4.5/5 (Very Good)

Anders Bodelsen’s Freezing Down (1969, trans. 1971) is a harrowing collision of SF tropes and the emotional landscape of Scandinavian noir. Bodelsen, “primarily associated with 1960s New-Realism in Danish literature,” might be best known to English-speaking audiences for writing the source material for the 1978 heist film The Silent Partner, starring Christopher Plummer and Elliott Gould.

Freezing Down, Bodelsen’s lone SF work, is an icy and complex (despite its brief length) speculation on the promise of immortality.

A forgotten masterpiece.

Brief Analysis/Summary

1973. Bruno is an editor. He’s constantly on the phone with his writers plying them with plots and themes, “he was the man with the most ideas” (5). He doesn’t write himself, but he has grand plans! He’s single. One day he meets a dancer named Jenny, who seems like one of his characters, distant, remote…. Ostensibly to gather ideas, he arrives at her house and discusses her goals, her desires, her drive for her art. While Bruno never implements his plans, Jenny gives all for hers. There’s a connection but Bruno cannot communicate his secret–his incurable illness and decision to wake up in another time through the process of “freezing down.”

1995. Bruno, after doctors discover a cure for his illness, emerges from his icy interlude, without his own kidneys. A new world order promises greatness, but beneath the veneer of immortality and progress, the limbs propping up humankind have rotted. Those that want immortality are forced to work to pay for their treatments. Those who decide to live out their natural lives, try whatever means possible to forget that death i.e. a preventable moment in life, is near. Not all are happy. Bruno observes agitators interrupting the infrequent flow of cars, only owned by doctors, outside the hospital. Bruno discovers a world where his talents seem useless, and Jenny, still alive but in a state of “freezing down,” has decades to wait until her own injuries can be cured. Bruno decides to re-enter his frozen state.

2022. The language has changed. The agitators grow in strength, but what they’re agitating for remains elusive. Connections are increasingly impossible to achieve—the anti-aging processes appear to introduce senility. Communication is fragmented and the events of the world outside of the hospital, a windowless environment of flickering lights, remains unknown: ‘Who ruled the world outside this building he was in? […] Did people read in this world?” (165). Bruno meets a thawed Jenny. Brunno tries to make connections. Jenny tries to dance: “Why does she keep falling?” (167). Bruno’s body deteriorates as restorative processes are interrupted by power cuts.

Freezing Down ends in a grotesque danse macabre of physical and intellectual decay. Immortality as an act of fragmentation….

Final Thoughts

Freezing Down is an unnerving exercise in physical and mental discomfort. A particular scene exemplifies my point. In 2022, the following tableau unfolds: Bruno, missing hair and fingernails, finally meets Jenny, recently thawed with a new spine installed. The hospital lights flicker in and out. A newly “young” Dr. Ackermann, who originally froze Bruno, periodically interrupts the emotion-drenched exchange, bewildered at the hospital’s flickering lights: “‘Don’t ask me […] No one tells me anything nowadays” (152). The poignant and aching moment is littered with Ackermann’s repetitive comments about Bruno’s missing body parts, and the candle in his pocket in case the lights go out… Ackermann confesses that “[He’s] long since given up trying to understand” (158).

Adding to the growing nightmare, Bodelsen deploys spatial constriction in each successive age. In 1973, Bruno moves in and out of the hospital if he needs to before the final countdown to his procedure. In 1995, only as his depression grows do the doctors move him to a new location as therapy. In 2022, the hospital no longer has windows, and the outside world is a great unknown.

Bruno’s increasingly restrictive perspective through which he views the world, is foreshadowed by the dominate image that begins and ends and is referenced throughout the text:

“[Bruno] wants to look at the thermometer outside the window, but he cannot because of the ice crystals. Still only half awake, he remembers how as a child he had put a coin on the radiator and then pressed it against the ice crystals to give himself a little hole he could peep through, out into a dark winter’s morning like this”.

And as time progresses, it becomes more and more difficult to see through the ice. The ice is no longer a barrier but a tomb. Bodelsen’s prose is characterized by an intensity made more and more unnerving as the ability to communicate and connect decays. Bodies might be resurrected in the semblance of earlier vitality but the future is not full of hope, the future is an alien landscape.

Find a copy.