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Dear Dr. Roach: My daughter has been dating a man who is diabetic, but is not diligent about his diet. He is outwardly in good health, in that he runs competitively and bicycles in races, but sometimes he has blood sugar readings of 300 plus. He loves a diet of meat, sauces, and rich and sugary foods, and is trying to cut back, but not very hard. He does seem to think he can change things on his own; he isn’t on insulin. I worry about her being in a long-term relationship with him. He is 47 and already has gout. What do you advise? Is he right that he can change this on his own with a small effort?

K.N.

Dear K.N.: A good diet is important for everybody, but it is critical for someone with diabetes, especially when that person’s blood sugar is out of control. I don’t have enough information to comment much on his diet (sugary foods, however, are clearly not a good idea; that may be the single most important dietary guideline for a person with diabetes), but he should be speaking with his doctor or with an experienced dietician nutritionist for advice.

I sometimes have seen serious and even elite-level athletes feel that their exercise program can compensate for a bad diet. Usually, it doesn’t. You can always out-eat your exercise, and exercise can’t protect you completely from diabetes.

Depending on the details of his diet and how often his sugar is so high, he may indeed be able to get under excellent blood sugar control just by making changes in his diet. However, people with sugar readings of 300-plus often do need insulin. It sounds like he needs a wake-up call.

With excellent blood sugar control, the ability to have a long, healthy life is as good as a person’s without diabetes (or nearly so).

Dear Dr. Roach: Could you explain to me what Ehlers-Danlos syndrome is? My granddaughter has this.

M.M.

Dear M.M.: There are now 13 different recognized types of Ehlers-Danlos syndromes. They run from uncommon to rare and have a genetic cause, so they run in families. All (except for one form) are caused by one of several different mutations in genes coding for connective tissue proteins. By far the most common type is hypermobile EDS syndrome, so let me talk about that one.

Hypermobile EDS is diagnosed clinically, which means it’s diagnosed based on a person’s symptoms and signs of the illness; unlike the other forms, it does not have a defined genetic mutation, so genetic testing is not available. The major organs affected are the skin (soft, velvety and stretchy, prone to scars); abdominal wall (hernias are common); mouth and teeth (high palate and crowded teeth); fingers and arms (long); blood vessels (not as dangerous as other forms of EDS, but still people with hEDS are at risk for valve disease); and joints. The joints are very lax (“double-jointed” is not correct anatomically, but is frequently used to describe the unusual degree of mobility of the joints). This can lead to dislocations and frequently chronic joint pain.

Some people with hEDS develop a type of nerve damage, especially to the nerves that regulate blood pressure and stomach movement, leading to dizziness, “brain fog” and irritable bowel symptoms.

Fortunately, in most people, these symptoms can be managed, and although many people have chronic joint pain, lifespan is not affected.

You can find out more from the National Institutes of Health at tinyurl.com/info-hEDS.

Email questions to ToYourGoodHealth@med.cornell.edu.

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