DEAR DR. ROACH: I am 67 years old, weigh 150 pounds and have one kidney; therefore, I am limited in the amount of protein I can have. I also have been trying to limit my carbohydrates to 60 grams per meal. I exercise two hours a day, with an hour walking and the other hour running or weightlifting. I have been running since the age of 25. My blood sugar will not go down to less than 100, regardless of whether it is taken after a 12-hour fast or two hours after eating. I am concerned that I will have to go on prediabetes medicine. What can I do to get my blood sugar down? — G.H.

ANSWER: There remains disagreement among experts on the best diet to reduce risk of progression to diabetes. In a large trial, new cases of diabetes were 40 percent fewer among those following the Mediterranean diet compared with a low-fat-diet group. The Mediterranean diet places an emphasis on fruits and vegetables, whole grains, beans, nuts and seeds, with little red meat but moderate fish and poultry.

You can try further reducing carbohydrates: 60 grams per meal is about 700 calories, or about 30 percent of an average-size person’s calorie needs. Several studies have shown that reducing carbohydrates to 20 percent of calories (about 40 grams carbohydrates per meal) improves blood sugar. Some authorities recommend even lower carbohydrate consumption. However, I am concerned that your blood sugars are high enough that medication may be necessary. Some people need medication even if they do everything they can correctly.

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: A recent column discussed the safety of high heart rates. My exercise partners and I do high-intensity interval training (on a bike) that takes us up to 95 percent of absolute max (160) for intervals of 10 to 60 seconds, six to 10 sets at a time. In light of your comments on enlargement of the aortic root, are we putting ourselves in danger? Suddenly I am interested in all things heart, having had a very unexpected heart attack, resulting in placement of two stents. Not sure I will ever be the same, but I am concerned that my ”road back” regimen may end badly. — C.G.

ANSWER: High-intensity interval training is a great way of improving performance, but for middle-age or older men (especially those with known coronary artery disease), it might not be the best way of staying alive longer. The concern has been that very high levels of exertion could cause a heart attack in those who are at high risk.

Several recent studies have suggested that the risk of HIIT is low, even in people with coronary artery disease (who often have been excluded from previous trials). In a 2012 study in people with CAD, the risk of heart attack during or within one hour of exercise was about 1 in 20,000 hours of exercise, but that was about six times greater risk than in those exercising at moderate levels.

There are two ways to look at this: High-intensity exercise is pretty safe; or high-intensity exercise is much more likely to lead to a heart attack. Both are true.

The studies are hard to translate to real life, since the exercise was done under supervision in a cardiac rehab program. Based on these data, and on many years of epidemiologic data showing a small increase in mortality among men who exercise at very high levels, I recommend moderate- rather than high-intensity exercise among those at highest risk for a heart attack, such as those who have known heart disease. However, this is an individual decision, to be considered with the help of their doctors.

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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.

(c) 2016 North America Syndicate Inc.

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