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Dear Dr. Roach: I am a 62-year-old female in excellent health. I eat right, exercise and have a great genetic history. I have no high blood pressure. For about four years I have been taking two Sudafed pills, 30 mg per tablet, on average every other day, to alleviate morning headaches and congestion. Is there any long-term danger to taking Sudafed like this?

R.R.

Dear R.R.: Pseudoephedrine is a decongestant. It works by constricting blood vessels, such as those in the nose, making it easier to breathe. However, it constricts blood vessels everywhere, and in some people, especially those with existing high blood pressure, pseudoephedrine can raise the blood pressure to dangerous levels. People with high blood pressure should avoid Sudafed or any over-the-counter cold remedy that contains pseudoephedrine.

Older men have another reason to worry about using Sudafed. It works in the body is by activating receptors on the blood vessels, called alpha receptors. These cause the blood vessels to tighten up. Those same receptors exist in a man’s prostate gland. Drugs like Flomax are alpha blockers and are given to relax muscles in the prostate and allow the urine to flow. Urine goes through the urethra, which runs right through the prostate. So, Sudafed has the opposite effect and can cause the sudden inability to urinate at all, in men with enlarged prostates.

For women and younger men without high blood pressure, occasional Sudafed is safe.

Dear Dr. Roach: I am a tall, slim, active woman of 67 who doesn’t drink or smoke, and eats clean (“eating clean” means I have very little processed foods and eat mostly organic foods). A couple of years ago, my A1C tested at 6, in the “prediabetes” category. For the past seven months I have been following the keto diet, and a recent blood test showed that my A1C has dropped to 5.5, back into the “normal” range. Unfortunately, my blood sugar consistently remains in the 90s and low 100s throughout the day, including upon rising. Any ideas of where I should go from here?

J.A.O.

Dear J.A.O.: Nowadays, diabetes is diagnosed at a hemoglobin A1c level above 6.5 percent. That corresponds to an average blood sugar of 140. An A1c of 5.5 percent is normal, and corresponds to an average blood sugar level of about 112, so it seems that your diet and activity are doing the job at keeping diabetes away.

I don’t recommend a strict ketogenic diet for long-term use, but some components of the keto diet are okay for people wanting to avoid diabetes. This includes very low amounts of starches. However, most vegetables — especially green, leafy vegetables — are healthy and don’t increase diabetes risk, despite being nearly all carbohydrate.

Continue to avoid simple sugars and starches, but allow more vegetables and some, but not excess, fruits. Some people will develop diabetes despite being slim, eating well and exercising regularly, so if you need medication, you shouldn’t look at it as a reflection of yourself.

There is no evidence that organic food consumption leads to lower risk of diabetes, nor to any health benefits.

Email questions to ToYourGoodHealth@med.cornell.edu.

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