The only way to ‘reverse’ Type 2 diabetes is to control it
Q: Any suggestions on how to reverse Type 2 diabetes?
A: Strictly speaking, once you have diabetes, you always have diabetes, as the diagnosis is considered “stable,” or lifelong. However, many people can get diabetes under control without medications so that the blood sugar is always in the normal range, which is pretty close to reversing diabetes.
The three most important areas of controlling diabetes are diet, exercise and weight. While there is much information I can give on diet, the most important single factor is reducing sugar and starches (which rapidly turn into sugar). It’s not all carbohydrates that are bad — vegetables and legumes, which are mostly carbohydrates, have very little starch and sugar and high amounts of fiber, forming one of the bases of a healthy diet for diabetes, along with healthy protein sources. A registered dietitian or nutritionist is an essential partner in diabetes care. Entirely (or nearly) cutting out breads, pastas and rice makes an enormous difference in blood sugar.
The body makes its own sugar, and regular exercise not only uses up blood sugar, but it also trains the muscles to use sugar more efficiently. Exercise alone will not reverse diabetes in people who have a poor diet, but the combination of a good diet and regular exercise is better than either alone.
Weight has an independent effect on blood sugar control, as a higher weight usually correlates to more resistance to insulin. However, a person can have Type 2 diabetes and be very thin, and most people who are overweight do not have diabetes. For most people, a diabetic-friendly diet and regular exercise will end up leading to weight loss, but it will always lead to improved health, even without losing a pound.
Q: Lately, I’ve been hearing about a relationship between the COVID vaccines and a significant increase in heart-related deaths. Please review the latest information on this subject, and your recommendations.
A: While there are multiple studies published and, unfortunately, misleading conclusions on social media based on faulty analyses, the best data come from the U.K., where all-cause mortality is very significantly reduced in people who have had the COVID vaccine, compared to unvaccinated people.
A separate analysis from the Florida Department of Health also found lower all-cause mortality in all age groups among vaccinated compared to unvaccinated. This is likely due to the fact that getting COVID is a major risk in multiple types of death, and the vaccine is effective at preventing serious COVID.
Certainly, in high-risk groups, such as people with heart failure, the vaccine prevents death very powerfully. Unvaccinated people are three times more likely to die from any cause than those who have been fully vaccinated.
My recommendation remains consistent. Everyone who can get the vaccine should get the vaccine, and it’s more important for people who have more risk factors. Older people, those with heart or lung problems, and those with problems in their immune system due to a medical condition, or its treatment, are at a particularly high risk and should ensure that they are fully boosted with the vaccine.
Q: I am having trouble finding a reliable recommendation for the daily supplement zinc. I purchased 50-mg pills, but I think this may be too much. I am 74 and female, and I would like to include zinc in my daily supplements, as my hair has begun thinning quite a bit, straight down the top of my head.
A: Zinc is an important nutrient, and it is certainly true that zinc deficiency may lead to hair loss. However, most people with hair loss do not have a zinc deficiency, and there are no convincing data that giving extra zinc to a person with normal zinc levels will help with hair loss. Hair loss along the midline is consistent with female pattern hair loss, which is very common among women in their 70s and usually has nothing to do with zinc.
Very high amounts of zinc supplementation can be dangerous (and impair your body’s ability to absorb other trace metals such as copper), but 50 mg is a safe amount. Still, the most effective therapies for female pattern hair loss include minoxidil (usually topical, but low-dose oral is increasingly used), spironolactone and finasteride. A dermatologist is the expert on hair loss and can give you a better diagnosis by exam than I can by your description.
Q: My youngest son has to have both of his hips replaced. He is only 37 but is in a very strenuous job of being a boilermaker in an oil refinery. This is the hardest job in a heavy industry. His doctors are telling me that his hips deteriorated due to alcohol consumption — is this even possible? Even if he can get through this ordeal, he is still locked into this physical type of work.
The doctors say he will need another hip replacement in 10 to 15 years if he stays in this line of work. Do you agree with these statements?
A: Let’s take them one by one.
The most common cause of hip disease requiring hip replacement is osteoarthritis of the hips, but it is quite unusual to see someone of your son’s age require a hip replacement. Alcohol is not a recognized risk factor for osteoarthritis of the hips, but alcohol is a known underlying cause of a much less-common condition: osteonecrosis of the hips, also called avascular necrosis.
The more a person drinks, the more likely they are to get this rare condition, even though most heavy drinkers will never get this condition. Not every person with osteonecrosis of the hip will require a hip replacement. It is frequent to have both sides of the hip with disease.
Untreated congenital hip dysplasia may also lead to severe hip damage requiring a total hip replacement, and it is also one cause I see in a person of your son’s age.
Prognosis after a modern hip replacement is very good. More than 90 percent of people are doing well, pain-free and without complications 15 years after surgery. Of course, some kinds of activities, such as heavy lifting and high-impact movements, could make the surgical prosthetics wear out faster, but regular activities, such as walking, stair climbing and most sports that are not high-intensity or high-impact, can be done without damage to the prosthetic.
Although further alcohol use will not affect the prosthetic hips or other bones, many other body systems are very much affected by alcohol. So, if he has been a heavy drinker, it is time to stop. His doctors can help him find many of the available resources.
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 Drive, Orlando, FL 32803.