Dear Dr. Roach: In your recent answer to a question from "P.H.," you replied, "For many people, that (the release of sugars, from digestion of carbohydrates) increases the risk of diabetes." Your predecessor, Dr. Donohue, commented less than a year ago (and sounding as if he had made the point multiple times, previously), that sugar does not cause diabetes and the use of the term "sugar diabetes" gives the people the impression that sugar itself constitutes the cause of the condition. Please clarify this matter, as you understand the nexus. - J.M.
Answer: I'm going to limit my discussion to type II diabetes, which accounts for more than 90 percent of the diabetes cases in North America.
There are numerous important risk factors for diabetes. The most important is genetic predisposition. Several genes are involved, but a strong history of diabetes in the family is a powerful risk. Other risk factors are increased weight and poor physical activity. Thus, for a person at risk for diabetes, the most significant ways to reduce diabetes risk are keeping weight under control and regular exercise.
What about dietary sugar? Recent evidence shows an association between sugar intake and diabetes risk. Sugar doesn't cause diabetes, but in a person at risk, increased sugar intake certainly is associated with a higher diabetes risk. Also, sugar intake tends to promote weight gain, which also leads to resistance to the effects of insulin and the development of diabetes.
Dear Dr. Roach: I'm an almost 90-year-old lady who has received Reclast IV annually for a number of years. I've been advised that I need to take 1,500 mg of calcium daily. Should I be taking calcium carbonate or calcium citrate? - H.L.
Answer: Calcium is necessary when taking medications like Reclast or Fosamax. Diet is one way to get all the calcium you need. However, if you can't get enough through diet, then both calcium carbonate and calcium citrate are good choices. Calcium carbonate should be taken with food, since it is absorbed better with food. Calcium citrate is absorbed well with or without food.
More people have side effects, especially constipation or nausea, with calcium carbonate, in my experience. In both cases, you need to look at the amount of elemental calcium in order to get the 1,500 mg. You also should be getting vitamin D - I recommend 1,000 to 2,000 units daily.
Calcium supplements increase the risk of kidney stones, and may cause a small increase in heart disease risk. However, the risk for fracture in someone with osteoporosis is so much higher than these risks that I recommend supplementation for anyone who doesn't get enough dietary calcium.
Dear Dr. Roach: I have not had a menstrual cycle for around four years. In the past two weeks I have had breast tenderness, bloating, weight gain and ovulation signs. It's just like when I was flowing, and any day I will be starting my period. I have had these symptoms before, since the onset of menopause, but it's been a while. Is this normal? - S.K.
Answer: These are symptoms of increased levels of estrogen. Estrogen levels continue to fluctuate in the years after menopause. It's normal. They tend to go down in the first few years after menopause, but individual women can vary a great deal.
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