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? — B.D.

ANSWER: 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: I have been suffering for many years from miserable episodes of perineal pain related to my benign, enlarged prostate. My urologist’s recommendation of NSAIDs and sitz baths has afforded very limited relief. I would appreciate any suggestions you have to offer. — J.S.K.

ANSWER: I see a lot of people with benign enlargement of the prostate, and the most common symptoms are inability to empty the bladder easily and having to urinate frequently. Persistent pain would make me concerned that the prostate enlargement is not the cause, or not the only cause, of the pain. I would think carefully about a bladder stone, chronic inflammation of the prostate and interstitial cystitis as a short list.

Chronic pelvic pain is a condition much more frequently encountered in women, and there are specialists in evaluating just that complex problem. Men can get chronic pelvic pain too, and I am concerned that it often is assumed to be due to the prostate, when there are many other possibilities. It’s time for you to be re-evaluated.

The booklet on the prostate gland discusses treatments for enlargement as well as cancer. Readers can obtain a copy by writing: Dr. Roach — No. 1001, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I am a 63-year-old male who had a subarachnoid hemorrhage in 2007. The source of the bleed could not be found, and fortunately I came out of it in good shape, with no adverse effects. My doctor prescribed diclofenac [an NSAID] for joint and muscle pain, and it does help. Do you see a problem with this, considering that it thins the blood? — T.O.M.

ANSWER: Since the aneurism wasn’t repaired, I would not recommend taking the NSAID unless your consulting neurosurgeon has specifically told you that it is safe to do so. I wouldn’t be brave enough to prescribe it without that OK, even though there is some evidence saying it may be safe.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

(c) 2014 North America Syndicate Inc.

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