Dear Dr. Roach: Is prediabetes reversible, and if not, is it permissible to eat sweets and starches in moderation if you have it?
In many cases, prediabetes can be reversed. In North America, by far the most common type of diabetes is Type 2, and a major risk factor is being overweight.
As a rule, our diets include far too much refined starch (such as white bread, pasta and rice) and simple sugars, and our lives are far too sedentary. Addressing any of these risk factors can have a significant effect on the complex metabolic condition that, left unchecked, will eventually become diabetes. Addressing all of them has a more than additive effect. The majority of my patients diagnosed with prediabetes are able to get to normal blood sugar levels with modest or moderate changes in their lifestyle.
People with Type 1 diabetes have a different issue. Type 1 is an autoimmune disorder that attacks the insulin-making cells of the pancreas. A proper diet and exercise will also help people with Type 1 diabetes, but they absolutely need insulin.
Having diabetes does not mean that you can never eat sweets again, but “in moderation” might mean different things to different people. The right amount of sugars and starches depends on your size and activity level. A diabetes provider, educator or dietitian nutritionist can make personalized recommendations. I am fortunate to work in a practice where all of these resources are immediately available to our patients.
Dear Dr. Roach: I drink a large amount of water, black tea and green tea. Can a person drink too much? Does it wash out electrolytes or water-soluble vitamins, or create another type of imbalance?
It is possible to drink too much water. As a physician who takes care of many older adults, I see problems with excess water more often than I see problems with not enough water. Vitamins are not the concern. It is indeed the electrolytes that are the problem, specifically one electrolyte, sodium, most often.
When we lose fluid — through sweat especially now as the weather is warm — we lose both water and sodium. Replacing that fluid with plain water can cause the body to become deficient in sodium. This develops a problem, especially for people exercising in the heat or people who are working in hot environments all day.
Older adults, with older kidneys, might not be able to hold on to sodium well. This becomes much more of an issue in people who are taking diuretics, such as hydrochlorothiazide, furosemide or chlorthalidone.
Low blood sodium levels are very common in older adults, especially on these “water pills.”
I often see the advice to drink eight (or more!) glasses of water daily. This might be appropriate for some people, but is not necessary for most and downright harmful to some. A much better rule of thumb is to drink when you are thirsty.
It is true that some people do not have a good thirst mechanism, but overall thirst is a better guide than an arbitrary number of glasses.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu