DEAR DR. ROACH: My husband and I are at odds about sugar and other carbohydrates as a cause of diabetes. I say it’s sugar; he says carbohydrates. Why not just eliminate all sugars, I say to myself? We live in the good ol’ South — the diabetes belt of the U.S. — where sugar exists in all foods. Soon someone shall start injecting sugar into carrots and green beans. — M. and G.S.

ANSWER: There are two major forms of diabetes, Type 1 and Type 2. Type 1 most commonly occurs in children and adolescents, and is related to an autoimmune destruction of the cells in the pancreas that secrete insulin. People with Type 1 diabetes almost always need insulin injections. Excess sugar intake probably has no bearing on the development of Type 1 diabetes.

Type 2 diabetes is epidemic not only in the Southern U.S., but also in Mexico and increasingly in all industrialized countries. The exact reason for Type 2 diabetes remains incompletely understood, but certainly it has to do with resistance to insulin. Insulin levels in Type 2 diabetics usually are higher than they are in people without diabetes. However, the body has a decreased ability to secrete large amounts of insulin in response to sugar intake than normal people, which is why high blood sugar after ingesting sugar is a way of diagnosing the condition early.

Sugar is a simple carbohydrate, and refined carbohydrates or starches, such as pasta and potatoes, are chemically long strings of sugar molecules, which the body can rapidly turn into sugar. So, you and your husband are both partially right. When combined with protein (as in whole grains) or eaten with fat, complex carbohydrates like starches are absorbed more slowly and are less likely to cause stress to the pancreas. It is thought that reducing insulin requirements from the pancreas by eating less simple and refined carbohydrates reduces the likelihood of developing diabetes, even in someone who has a genetic predisposition. It is critical to keep weight in a normal range, since obesity itself causes insulin resistance and predisposes a person to diabetes.

Carrots and green beans do have natural sugar, but they also contain fiber. They have a minimal effect on raising blood sugar. Some fruits are so high in sugar that they should be eaten only in moderation. These include figs, mangoes, grapes and dates.

Diabetes has become epidemic in North America. The booklet on it provides insight on its diagnosis and treatment. Readers can order a copy by writing: Dr. Roach Book No. 402, 628 Virginia Dr., Orlando, FL 32803. 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: My friend got trichomonas. She doesn’t know from whom she got it. We know it is sexually transmitted, but what is it? Where did it come from?

Her doctor put her on Flagyl 500, then tinidazole, but they didn’t seem to work. Do you have any advice? — R.R.

ANSWER: Trichomonas is a very common sexually transmitted infection. Worldwide, there are over 50 million cases per year. Trichomonas is a protozoan, a parasite related to an amoeba. The only known place it lives is in the human genital tract. It is spread sexually. Most people have no symptoms, but if symptoms are present, they usually include pain, itching and burning. Women may have a vaginal discharge.

If untreated, trichomonas can persist for years, so your friend may have acquired it a long time ago. The most common treatment is metronidazole (Flagyl), 2,000 mg as a single dose. Resistance has been described, but only 1 percent of trichomonas is resistant to tinidazole. If your friend is having persistent symptoms, making certain of the diagnosis with new laboratory techniques and referral to a specialist may be necessary.

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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 ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

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