DEAR DR. ROACH: I read your recent column on pulmonary fibrosis. I especially appreciate knowing that there are medications known to slow progression of lung disease, reduce exacerbations and reduce mortality. With a 20-year-old diagnosis of COPD and having been prescribed medications to reduce exacerbations, you might imagine my interest in your article.

I’m wondering how pulmonary fibrosis differs from COPD and if the two medications that you mention (pirfenidone and nintedanib) might be helpful in slowing the progression of lung disease in patients such as myself. Have any studies been completed using these medications on patients with COPD?

— S.A.

ANSWER: Chronic obstructive pulmonary disease — its two main forms are emphysema and chronic bronchitis — usually, but not invariably, is a result of long-term exposure to lung toxins, especially smoke. In the most common case of COPD, due to cigarette smoking (at least, that’s the most common in North America and Europe: cooking fires are still a common cause in less developed countries), stopping the exposure will dramatically slow down further damage. Unfortunately, there are no established treatments that can restore lung function in people with moderate to advanced COPD.

Pulmonary fibrosis is, by contrast, a rare disease; about 30,000 people in the U.S. are diagnosed each year (compare that with the 9 million people in the U.S. diagnosed with chronic bronchitis last year).
The exact mechanism of action of pirfenidone and nintedanib is not known, but they are not thought to be effective in COPD. Surprisingly, I did not find a published trial looking at whether these drugs might be effective. The need for new therapies to treat COPD is so great that I would have thought some researcher might have tried it, despite the long odds.

DEAR DR. ROACH: I have a friend who recently found out that she’s prediabetic. She’s also very obese. She has started juicing her fruits and vegetables in order to lose weight and get healthier. Isn’t it just healthier to eat produce whole as opposed to making juice out of it?

— N.F.E.

ANSWER: Eating more vegetables and fewer simple sugars and processed starches is a good idea for nearly all people who want to eat healthier, and it may help people lose weight. Fruits are also an important part of diet, but for people with or at high risk for diabetes, I recommend no more than one or two fruits with meals, and that the fruits be whole. Fruit juice is absorbed much more rapidly into the blood, so excess fruit juice can actually precipitate diabetes or worsen diabetes control.

Juicing makes it easy to consume vegetables and fruits, but in addition to the problem with faster sugar absorption, taking food in liquid form usually isn’t as satisfying. That’s not true for everyone, but since reducing calories is essential for weight loss in nearly everybody, juicing may have the opposite effect, unfortunately, and I don’t recommend it in general.

Of course, what doesn’t work for one person may work great for someone else. If she is able to change her diet, reduce unhealthy choices and lose some weight, then juicing may be just right for her. I would still recommend against too much fruit juice, and to have fruits mixed in with vegetables, preferably taken with some protein and healthy fat.

Never forget that exercise is the other critical intervention for diabetes prevention or control.

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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 send mail to 628 Virginia Dr., Orlando, FL 32803.