Dear Dr. Roach: I have peripheral neuropathy symptoms in my feet. I am borderline diabetic and keep it under control by eating right. Also, my legs are weak, and I am doing exercises. I was taking the drug Reglan for a couple of months. During the time I was taking it was when I started to have these leg problems. Could this be a side effect of the Reglan?
G.D.
Diabetic neuropathy is a complication of long-standing diabetes, especially if it has been poorly controlled. Occasionally, it can show up seemingly early in the course of Type 2 diabetes, but this is thought to represent a delay in diagnosis in otherwise asymptomatic disease or in those who have ignored symptoms. The symptoms of diabetic neuropathy usually begin with numbness, and later on pain and tingling of the feet. Weakness, when it happens, generally comes later on.
Metoclopramide (Reglan) is used for nausea and vomiting, especially after chemotherapy, and is used to stimulate the stomach emptying in people with diabetic gastroparesis, which is a type of neuropathy of the nerves to the stomach and intestines. Many or most diabetics with gastroparesis also have diabetic neuropathy. However, metoclopramide should not be given for more than eight weeks due to the risk of tardive dyskinesia, a serious disease of motor control, especially in the facial muscles. Although tardive dyskinesia can cause symptoms in the limbs, weakness would be unusual, and tardive dyskinesia would be very unusual if you took the Reglan only for two months and have stopped.
I think it is unlikely that either diabetic neuropathy or the Reglan are causing the muscle weakness. There are many kinds of neuropathies, and all (or nearly all) are more common in people with diabetes. I would revisit your doctor to try to find out more about why you are having leg weakness.
Dear Dr. Roach: I’m a 77-year-old man in good health except for irritable bowel syndrome for 35 years. Six months ago, I started taking two low-dose aspirins daily as a preventive, and since then all IBS symptoms have disappeared. Stools and frequency are now normal and without any intense cramping, gas or urgency, which I had for all those years. Frankly, I’m pleasantly shocked, since I thought IBS had no cure. I take no other medications or supplements, so it seems likely that the aspirin has alleviated or maybe cured my IBS. I thought other readers might be interested. Any thoughts?
B.C.
Yours is a very unusual but not unheard of response to aspirin. Most people with IBS find that aspirin and other anti-inflammatories worsen IBS symptoms. I have read of others who have the same response you seem to, however.
Aspirin remains controversial as a preventive in people without heart disease, but I believe the benefits outweigh the risks in people at high risk for heart disease, even if they are undiagnosed. Always speak with your doctor before beginning a course of aspirin, even if it’s low-dose.
Dear Dr. Roach: There is much controversy circulating about the healthiest choices available today for butter and margarine spreads made with canola oil, coconut oil, flaxseed oil, grapeseed oil and olive oil.
There are so many choices that it is almost mind-boggling to the average consumer. I keep receiving emails from friends and relatives with articles that state margarine was developed to fatten up turkeys, and when that did not fly, it was marketed to people as a healthy substitute for butter. Yet, I read labels on products claiming much lower saturated fat than real butter contains.
Many articles forwarded to me have a product to sell, and so their claims are used to push these products, whether valid or not.M.P.
Today’s margarine is not the margarine of the 1950s. Margarines with plant sterols and stanols (sold as Benecol and Smart Balance) reduce LDL cholesterol, although it’s not clear whether they reduce the risk of heart disease.
The advice I give is to avoid trans-saturated fatty acids (shown on food labels as “trans fat”). Most food companies have received that message, and it’s easy to find high-quality margarine. The vast preponderance of the evidence is that margarines are healthier for you than butter.
That doesn’t mean you can’t have butter ever. We all make choices that affect our health. The harm you do from a little butter is small.
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