I have diabetes: can I do the fasting diet?

I HAVE type 2 diabetes, weigh 20st and have an infected leg. As well as exercising, I want to go on a ‘semi fast’ diet every second day — i.e. one day at 2,000 calories, the next day at 700 — to reduce my weight and ease my diabetes. Is this possible? I have been told it’s not because of the condition.

Tom Jones, Hayes, Middlesex.

NOT only is it possible for you to follow this plan, it is essential. The two most important steps you can take to protect your future health are to lose weight and take regular exercise — and a rigorous low-calorie regimen like the one you suggest is a good example of what to do.

If you stick at it, the plan cannot fail to be successful. But it will not be a quick fix. You will often feel hungry, you may at times feel depressed at what will seem to be slow progress and you may well need to continue to adhere to the plan for life.

But continued commitment to this will also save your life.

There are so many different types of diet and conflicting ideas about the best way to reduce weight that even dietitians and informed doctors become confused. however, the consensus is that whatever dietary plan you choose, you need to stick to it.

Your suggestion of alternating days with consumption of 2,000 and 700 calories will be effective in the long term, but I do have one concern.

If you’re taking blood sugar-lowering medication for your diabetes (metformin tablets once or twice daily, for example), there is a risk that on the 700-calorie days your blood sugar level may fall too far, causing hypoglycaemia, which can leave you feeling faint.

THEREFORE, it would be advisable to check your blood-sugar level on those days, perhaps twice. You may have been taught how to do this by your practice nurse or a diabetes care nurse. If not, ask your GP to show you how.

If your sugar levels are falling too low, then you will need to take advice about how to modify the medication, or eat snacks to keep your sugar level up: half a handful of sunflower seeds may be all that is necessary.

sunflower seeds are a good choice because they’re widely available and contain plenty of nutrients — and they provide complex carbohydrates, far better for your metabolism than the quick and easy sugar hit of chocolate or biscuits, which can provoke wild swings of bloodsugar levels.

In terms of what you should be eating generally, on both the 2,000 and 700- calorie days, follow the Mediterranean diet, which has been proven to reduce the risk of heart disease, cancer, dementia and other diseases.

It is associated with lower levels of low- density lipoprotein or ‘ bad’ cholesterol, the type that furs up arteries.

The diet is based on plant-based foods, minimising animal fats and avoiding salt, processed foods and ready meals.

If you can master this, it will supply all your nutritional needs.

If exercise is difficult, do at least a 30-minute walk every day, and when you have lost some weight do a little more, but start up a daily habit. Every little helps. IN 2012, I had prostate cancer. I had an operation to remove my prostate followed by radium and hormone treatment. I can no longer get an erection and after three-and-a-half years of no intimacy, my marriage is suffering.

My doctors tell me this happens to everyone but I am getting very depressed. I am 66.

Name and address withheld. THIS must be difficult for you. I am concerned that you may not have been sufficiently warned of the consequences before starting such major treatment.

however, this information can be difficult to take on board when overshadowed by the emotions attached to a cancer diagnosis.

Your treatment has been very thorough. This triple therapy will give you the best chance of survival and minimise the chance of future recurrence.

Unfortunately, these treatments all carry the risk of damaging the mechanisms that make an erection possible. Both the surgery and the radiotherapy can damage the nerves that supply the blood vessels to the genitals.

hormone treatment works by blocking the production of male hormones, or blocking the body’s responses to them. This helps prevent the growth and spread of a tumour (prostate cancer is fuelled by hormones).

This is an essential additional treatment if any cancer cells have already spread beyond the primary tumour. however, these hormones are also necessary for achieving an erection, so blocking them can have an obvious effect.

four years after your operation, there is unlikely to be any recovery of the nerves, and hormone therapy is usually prescribed for life.

As you may have already found, sildenafil (Viagra) and the two similar drugs available are not going to be effective — these drugs work by enhancing the degree of function still present in the blood vessels involved in an erection, and there may be none.

however, you may find a vacuum pump or an implant helpful. I have had patients who have successfully used both.

The pump works by drawing blood into the penis, and is used along with a rubber ring that you apply to keep the blood in place. This can create a reasonable, though not perfect, erection. An

IMPLANT would require an operation. There are two types: a semi- rigid rod, which results in a permanent erection and can be inconvenient; and the inflatable type, which has to be pumped up using a device implanted in the scrotum.

This is a complex system to insert and should be undertaken only by a urologist who specialises in treating impotence — your GP could refer you if the service is available locally.

But the bigger question concerns your libido. You recognise the need for intimacy in your marriage but the suppression of male hormones can make a patient much less interested in sex.

These hormones must remain suppressed to give you the best chance of avoiding recurrence of the cancer. for this reason, supplements of testosterone (the main male hormone), which are sometimes given for erectile dysfunction, would, in your case, not only be of no value but could actually cause harm.

The only other influence on libido is a supportive, loving relationship — which you have — and the recognition that the most important sex organ of all is the brain. I hope this all helps.

WRITE TO DR SCURR

TO CONTACT Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details. Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.