Diabetes Archive

Ask the doctor

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Q. I'm an 87-year-old man. Over the past year I've lost considerable weight, and I didn't have that much to lose. My doctor can't find any reason for my weight loss and is advising me to eat ice cream. But isn't that risky for my heart?

A. I smiled when I read your letter, because I've occasionally said that if I were to develop a terminal condition, the silver lining on that cloud would be that I could finally eat all the hot fudge sundaes I wanted.

News briefs

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Exercise is considered the most effective pill-free treatment to cope with the pain and stiffness of arthritis. And more people are getting advice from their health care providers about how to stay active, according to a study published online Jan. 5, 2018, by the CDC's Morbidity and Mortality Weekly Report. Researchers looked at national health surveys gathered from 2002 to 2014. In that period, there was an increase in the proportion of people with arthritis (osteoarthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia) who said their clinician suggested physical activity to help reduce symptoms — from 52% in 2002 to about 60% in 2014. But by 2014, about 40% of arthritis sufferers still said they weren't getting exercise counseling. That's significant, considering that 91 million people ages 18 or older are affected by arthritis, according to a study published online Nov. 27, 2017, by Arthritis & Rheumatology. You don't have to wait for a doctor to suggest exercise as an arthritis treatment. Try something gentle, like walking, tai chi, or modified yoga. For more ideas, check out the Harvard Special Health Report The Joint Pain Relief Workout (www.health.harvard.edu/jprw).

On call

Q. There has been a lot of talk about the severity of this flu season, and I recently heard that influenza also can trigger a heart attack. Should I worry?

A. Influenza is responsible for about 10,000 to 20,000 annual deaths, mostly from pneumonia or internal organ failure. In other situations, influenza infection strains a person's health, which can worsen underlying conditions, such as heart disease.

In the journals

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Migraine sufferers may be able to prevent future attacks with a new medication called galcanezumab, suggests a study published online Dec. 18, 2017, by JAMA Neurology. Currently, there are five FDA-approved drugs for migraines, but none were designed specifically for treating attacks or addressing the mechanisms at work.

In comparison, galcanezumab works to suppress the activity of calcitonin gene–related peptide (CGRP) in people. That molecule is believed to play an integral role in migraines and cluster headaches.

Ask the doctor

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Q. My doctor said I "almost" have an underactive thyroid, which puzzled me. Then she said I might benefit from treatment, which puzzled me more. How can you "almost" have a disease, and how can treatment be useful if you don't have the disease?

A. I can see how that might have been confusing. In fairness, it's a confusing situation, even for doctors. Let's take this in two parts. First, what's an "underactive thyroid"? The thyroid gland in our neck makes a hormone, called thyroid hormone, that travels throughout the body and affects every cell. If it is making the right amount of the hormone — if the blood levels are normal — then there's no problem. If it's making too much (an overactive thyroid), or if it's making too little (an underactive thyroid), those are problems that require treatment.

News briefs

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Past studies have suggested that drinking coffee is associated with many health benefits, such as added longevity, lower blood pressure, less weight gain with aging, and a reduced risk of many diseases, including type 2 diabetes, liver disease, cardiovascular disease, several degenerative neurological diseases (like Parkinson's disease), and cancer. Now a massive review of more than 200 large studies, published Nov. 22, 2017, in The BMJ, backs up many of those links. The largest health benefits were associated with drinking three to four cups of coffee per day: drinking more than four cups per day did not bring additional benefits. It's not all good news, however; the study found that women who drank coffee had greater risks for fracture and pregnancy complications. But over all, the researchers say, coffee drinking appears to be safe. They caution that the findings are all based on observational studies, not randomized controlled trials — the gold standard of research.

Symptoms of dry skin, eczema, contact dermatitis, and psoriasis can overlap.

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It's easy to overlook dry skin during the winter, when indoor heating and dry air pull moisture from the skin. But sometimes it's tough to tell if dry skin is a consequence of the season or a sign of a serious condition. "I see a fair number of people who come in with psoriasis or eczema and had just assumed it was dry skin," says Dr. Jason Frangos, a dermatologist at Harvard-affiliated Brigham and Women's Hospital.

Why does skin dry out?

It's not just winter conditions that lead to dry skin; it's also a change in our skin's top layer, or epidermis. This layer is normally thick with naturally occurring fats and oils that act as a barrier to help retain moisture and prevent irritants from entering the skin.

There's an upswing in cases of chlamydia, gonorrhea, and syphilis in the United States, and it includes older adults.

For as long as humans have engaged in sex, there have been sexually transmitted diseases (STDs). The term STD (which has replaced the older "venereal disease") generally refers to infections that can be transmitted by vaginal, anal, or oral sex. Among them are genital herpes, human papillomavirus, chlamydia, gonorrhea, syphilis, and human immunodeficiency virus (HIV). The CDC estimates there are about 20 million new STD cases every year, but only a fraction of them get reported.

STDs are on the rise in people of all ages. There were more than two million reported cases of chlamydia, gonorrhea, and syphilis in 2016. While the vast majority occurred in teenagers and young adults, there also were significant increases in cases among middle-aged and older adults (see "STDs reported among older adults").

Lifestyle changes are vital, but new medications may help.

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Two of the most prevalent health problems in this country — type 2 diabetes and heart disease — are closely linked. People with diabetes are more than twice as likely to die from heart disease than those without diabetes. An array of overlapping risk factors (such as being overweight and having high blood pressure and cholesterol levels) probably explains part of this association.

On the plus side, a diet that emphasizes vegetables, fruits, whole grains, lean protein, and healthy fats, coupled with regular moderate exercise (at least 30 minutes daily, most days of the week) can help people dodge the dangers associated with both heart disease and type 2 diabetes. Even so, most people with type 2 diabetes must also take the drug metformin (or other medications) to help reduce their high blood sugar levels, the hallmark of the disease.