June 30, 2014 at 1:00 am

Prediabetic should cut sugars, sugar alcohols

Dear Dr. Roach: I recently was diagnosed as being prediabetic and told to watch my sugar intake. So I now read the nutrition facts on packages. However, I am confused about the listed sugars. Sometimes the label includes both “sugar” and “sugar alcohols.” For instance, a package can read “sugars 1 g” and “sugar alcohols 11 g.” Would my sugar intake be 1 g or 12 g? What is the difference, and what should I avoid/limit?


Dear B.D.: First, congratulations on reading labels. There is a lot of good information to be found that can help you decide whether something is a healthy food for you. That being said, sugar alcohols are confusing.

Sugar alcohols have nothing to do with the type of alcohol in beer, wine or spirits, and they aren’t sugars either. A sugar alcohol, such as sorbitol or xylitol, is an incompletely absorbed carbohydrate. Since they are incompletely absorbed, you get only some of the calories, and your blood sugar goes up less than if you had had the same amount of sweetness with regular sugar. A rough but reasonable rule of thumb is to count about half the grams of sugar alcohol as sugar, for the purposes of counting sugar grams. So in your example, it would be about 6.5 grams of sugar.

You might wonder what happens to the unabsorbed sugar alcohol. It continues through your GI tract and acts as a laxative. Some people are very sensitive and will have diarrhea with just a little sugar alcohol; others tolerate more.

Dear Dr. Roach: Some time ago, you wrote an article on trig­ger finger. I have two on my left hand and one on my right. I’m 94 and work an eight-hour day, four days per week.

Dear A.M.: Tendons, which attach muscle to bone, travel in the finger in a sheath, which protects and lubricates the tendon. Sometimes, the sheath can become inflamed and the tendon sticks there — which leaves your finger in a bent position, sometimes painfully. Trigger finger is when the tendon to the finger is stuck in its sheath. It is not related to carpal tunnel or arthritis.

It helps to rest the hand. Your doctor may have you wear a splint to really rest the finger. (I think you’ve earned some time off.) The doctor also might inject the finger with a steroid anti-inflammatory, though this may take up to three times to work.

Dear Dr. Roach: My brother-in-law was prescribed warfarin several years ago after a stroke. He claimed that it was made from rat poison and refused to take it. Is it?


D.K.: Yes, warfarin (Coumadin) was used as rat poison. Some rat poisons are still relatives of warfarin.

That doesn’t mean he shouldn’t take it. The difference between a medicine and a poison is often one of dosing. Warfarin is reasonably safe when used correctly, and it can significantly reduce the risk of a second stroke.

Email questions to ToYourGoodHealth@med.cornell.edu.