Dr. Roach: Diet, exercise are first prescription to try for prediabetes

Keith Roach
To Your Health

Dear Dr. Roach: My husband is a 50-year-old prediabetic who has recently experienced burning feet. He refuses to think it’s his high-carb diet (bread three times a day, chips, ice cream) and instead thinks he just needs some vitamins for foot pain. Could you please explain why and how what he eats affects everything he’s experiencing?

— Anon.

Dear Anon.: Diabetic neuropathy is a condition found in people who have had diabetes for years. It causes different symptoms in different people, but pain (often burning in character) and numbness are most common. The underlying cause is uncertain, but seems to be a combination of factors leading to nerve damage.

Prediabetes, often along with the other components of metabolic syndrome — including high blood pressure, excess abdominal fat and high cholesterol or triglycerides — may also bring on a neuropathy with very similar symptoms. Other causes, especially vitamin B12 deficiency, are appropriate to evaluate before determining the condition is most likely due to diabetes or prediabetes.

There are no specific treatments for the neuropathy, although there are medications to ease symptoms. Treatment of the underlying metabolic syndrome is therefore of the utmost importance, and the two most important treatments are diet and exercise. Avoiding simple carbohydrates, such as found in bread and chips, or the sugars in ice cream, is paramount. Regular exercise has an independent effect that adds to the effectiveness of the dietary changes.

Your husband is at risk, and the fact that the symptoms are recent means he should look at this as a wake-up call. Changing his lifestyle dramatically now can lead not only to improvement in symptoms (or at least they won’t get worse), but it will also reduce his risk of heart attack and stroke.

There are many places to get help: His doctor, a registered dietitian nutritionist and a diabetes nurse educator all are excellent potential sources of information, but he has to make the decision to start the lifestyle change. Vitamins do not help diabetic neuropathy. If he can start making the changes, I hope he will find, as most people have, that his quality of life and sense of well-being are so much better that he will not want to stop his healthier lifestyle. Medications may be helpful, but the primary treatment is diet and exercise.

Dear Dr. Roach: My wife smoked for many years and finally quit with the help of nicotine gum that is 4 milligrams each. Since quitting almost 20 years ago, she continues to use about 12 pieces of nicotine gum per day. Does ingesting this much nicotine in this manner put her at risk for developing some type of cancer from the nicotine?

— T.D.

Dear T.D.: No, nicotine is not carcinogenic, that is to say cancer-causing. In large doses, it is dangerous, but the doses she is taking are not — at least, for a person used to them. Early signs of nicotine toxicity are excess salivation, nausea and vomiting.

There are many toxic substances in tobacco, some of which are cancer-causing. The tobacco does not need to be burned; chewing tobacco and snuff increase the risk of oral cancer. About half of all people who smoke will die because of smoking-related illness. Even one cigarette a day has significant long-term health risks.

Although it’s not ideal that she continues to use nicotine gum (and it’s not cheap), there is no doubt that the gum is much, much safer for her than continuing to smoke.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.