DEAR DR. DONOHUE: I am a pre-diabetic. I exercise and try to eat well. What I need is more information about what food I can eat. I baby-sit two great-grandchildren, ages 3 and 1. I get a lot of exercise. If you could give me some advice on the kinds of vegetables and fruits I can and cannot eat, I would appreciate it. – R.B.
ANSWER: Pre-diabetes – also called impaired fasting glucose (blood sugar) – is fasting blood sugar higher than 100 mg/dL (5.6 mmol/L) but not at the diabetes levels of 126 (7). People in this category have to make diet and other lifestyle changes, or they are at risk of coming down with actual diabetes within 10 years or sooner.
Exercise is a most important step. You do get exercise in baby-sitting two youngsters. But you need more. If you take a brisk walk, one where you are not just sauntering but are moving at a decent clip for at least half an hour five or more days a week, that will help lower your blood sugar.
It is imperative to lose weight. Fat blunts the action of insulin.
Sixty percent to 70 percent of your calories should come from carbohydrates. Your diet should be one consisting of lots of whole grains, vegetables and fruits. The fruits and vegetables ought to be of the high-fiber variety. Pears, apples, blueberries, most other berries, oranges, peaches, pineapple and prunes are high-fiber fruits. High-fiber vegetables include beans (like kidney, baked and lima), broccoli, peas, cauliflower and green beans. Put a limit on sweets and desserts, but you don’t have to eliminate them altogether. Cut back on saturated fats – red meats, poultry with skin, full-fat dairy products such as whole milk and cheeses made from whole milk, coconut oil and palm oil. Increase the use of vegetable, corn, soy, safflower and canola oils.
It is far too much to expect you or any reader to master the intricacies of diet without one-on-one help from someone sitting with you in person. Call your local hospital to see if it has a certified diabetes educator, or contact the American Diabetes Association for assistance in finding one.
DEAR DR. DONOHUE: I am the mother of a 5-year-old girl with juvenile rheumatoid arthritis. Currently, a couple of fingers on her left hand are puffy, painful and large. Her rheumatologist wants to start her on methotrexate. I am very reluctant to start her on this medication. I spoke with numerous doctors and with adults who take it, and they swear by it. However, no one can tell me how this drug will affect my child in the future. – A.A.
ANSWER: Methotrexate was first introduced as treatment for some forms of cancer in 1948, so medicine has 57 years of experience with it. Since its introduction, it has been used for many common, noncancerous illnesses, including psoriasis. It is currently being used in about 60 percent of children with juvenile rheumatoid arthritis.
X-rays have demonstrated its value in preventing joint damage in children with this condition, and there is much evidence that it improves arthritic children’s growth and ability to function. Children tolerate it well.
Let me quote from a statement in a recently revised and highly respected pediatric textbook, the Nelson Textbook of Pediatrics (17th edition; 2004): “Methotrexate has become a cornerstone in pediatric rheumatology because of its potential to make significant improvement in joint inflammation and its high patient acceptance.”
Endorsements like this would not be forthcoming if this medicine caused severe problems as children get older.
DEAR DR. DONOHUE: I am 94 years old. A recent ultrasound of my abdominal aorta shows I have calcifications in it. What type of specialist should I consult? – L.R.
ANSWER: Most people your age have calcifications in their aortas. So long as your doctor has not suggested any more tests and has not referred you to another doctor, you don’t need to go any further.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.
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