Doc: Limiting carbs one way to reduce risk of diabetes

Dear Dr. Roach: I am 67 years old, weigh 150 pounds and have one kidney; therefore, I am limited in the amount of protein I can have. I also have been trying to limit my carbohydrates to 60 grams per meal. I exercise two hours a day, with an hour walking and the other hour running or weightlifting. I have been running since the age of 25. My blood sugar will not go down to less than 100, regardless of whether it is taken after a 12-hour fast or two hours after eating. I am concerned that I will have to go on prediabetes medicine. What can I do to get my blood sugar down?

G.H.

Dear G.H.: There remains disagreement among experts on the best diet to reduce risk of progression to diabetes. In a large trial, new cases of diabetes were 40 percent fewer among those following the Mediterranean diet compared with a low-fat-diet group. The Mediterranean diet places an emphasis on fruits and vegetables, whole grains, beans, nuts and seeds, with little red meat, but moderate fish and poultry.

You can try further reducing carbohydrates: 60 grams per meal is about 700 calories, or about 30 percent of an average-size person’s calorie needs. Several studies have shown that reducing carbohydrates to 20 percent of calories (about 40 grams carbohydrates per meal) improves blood sugar. Some authorities recommend even lower carbohydrate consumption. However, I am concerned that your blood sugars are high enough that medication may be necessary. Some people need medication even if they do everything they can correctly.

Dear Dr. Roach: I saw your column on strontium, and it raised a question for me. My raw water contains strontium in large amounts, 15,500 ug/L. Do I need to be worried about consuming this water?

D.R.

Dear D.R.: There are two reasons to be concerned about strontium in the environment. The first is that there is a radioactive isotope of strontium, strontium-90, which is man made and exists in and around hazardous waste sites and gets into the water as dust (still leftover from atomic bomb testing and nuclear reactors). Levels of radioactive strontium are very low in most areas of the country, but I would find out what radioactivity level the strontium in your area is. It should be in the same analysis where you found out about the level in your drinking water.

I am surprised at the level you report, since the Environmental Protection Agency recommends no more than 4,000 micrograms per liter. Yours is nearly four times that. High levels of strontium can cause a bone disease, osteomalacia. You should check with public-health officials and, if confirmed, I would consider supplemental calcium and vitamin D, which minimize the deleterious effects of strontium.

Email questions to ToYourGoodHealth@med.cornell.edu.