Ask the Doctors: Balance begins to decline as early as 50

Dear Doctors: Can you help with a debate my wife and I are having about good balance? I say it's about staying strong and flexible. She thinks it has to do with your inner ear. We're arguing about this because her dad, who is 75 and in good health, has started to worry about balance.

Dear Reader: For the sake of family harmony, we're glad to be able to say that you are both correct. Your sense of balance is actually quite complex, and the inner ear, as well as strength and flexibility, each play an important role.

Balance begins with a nonstop stream of information gathered by several systems in the body. These include the eyes, which are part of the visual system, and which help you to orient yourself in space. The muscles, joints and tendons, which are part of the musculoskeletal system, contain special sensors that provide something known as proprioceptive input. Sometimes also referred to as kinesthesia, it's the body's ability to sense its own movement, actions and location. The inner ear contains something known as the vestibular system. About the size of a quarter, it's an intricate structure made up of fluid-filled canals, sacs and cavities that are lined with fine hairs and other specialized cells. It provides information about head position, spatial orientation and motion. All three of these systems are continually sending their findings to certain areas of the brain. This flood of data gets processed, and the result is the ability to stand, move and perform tasks and remain balanced.

The other important components of balance are, as you have pointed out, strength and flexibility. Both are required to keep the body upright and under control. Good balance relies on the muscles of the feet, legs, buttocks, abdominals and torso. And, yes, that's basically the entire body.

Resistance training and weightlifting will build strength and stamina, while practices such as yoga, tai chi, Pilates or targeted stretching exercises will help with flexibility. Simple things, such as standing on one foot for a period of time while watching TV or waiting in a line, always rising from a chair without an assist from your arms, practicing walking backward or walking heel-to-toe in a straight line all directly target balance.

And while this may come as a surprise, it's not just older adults, like your father-in-law, who need to think about stability. Researchers have found that balance begins to decline in midlife, starting at about age 50. In one recent study, adults in their 30s and 40s could stand on one foot for a minute or more. At age 50, the time decreased to 45 seconds. At 70, study participants managed 28 seconds. By age 80 and older, they lasted less than 12 seconds standing on one foot. Just as sobering is the fact that one-third of adults 65 and older suffer a fall each year, with outcomes ranging from a bruise or a sprain to broken bones and concussion — or worse. A focus on balance is a great idea for your father-in-law, and for you and your wife, as well.

Dear Doctors: Does Type 2 diabetes run in the family? My dad and sister both have it, and I'm worried I'm next. We are a meat-and-potatoes family, and I've got a sweet tooth. I want to lose weight and eat healthier. Would a more plant-based diet help? What else can I do?

Dear Reader: Yes, Type 2 diabetes can run in families. For those who aren't familiar, Type 2 diabetes is a disease in which the body loses the ability to keep levels of blood glucose, also known as blood sugar, within a healthy range. Having too much glucose in the blood for extended periods of time leads to a range of serious health problems. When it goes untreated, Type 2 diabetes can damage the heart, kidneys and nerves; cause vision problems; and increase risk of stroke.

The reason the disease can run in families is partly due to someone's genetic makeup, which leaves them with a predisposition to the disease. Researchers have identified several genetic mutations that have been linked to Type 2 diabetes. Environmental factors play an important role, as well. Obesity, poor diet, sedentary lifestyle, small or large birth weight and stress all contribute to developing the disease. However, they don't affect all people in the same way. The data shows that when these risk factors are present, people with a family history of Type 2 diabetes are more likely to develop the disease than those with no familial link to the condition.

The lifestyle changes that you are considering — reaching a healthy weight and adopting a healthful and balanced diet — would be important moves toward reducing your risk of developing Type 2 diabetes. Adding regular daily exercise, which helps the body to manage blood glucose levels, would also improve your chances of avoiding the disease. And when it comes to diet, a strong body of research shows that a plantforward diet is associated with a lower risk of Type 2 diabetes.

A recent study, conducted by scientists at Harvard University, examined a vast body of data collected from 10,000 people who had participated in a trio of decadeslong health surveys. The participants were sorted into groups based on the diets they had followed, and their blood plasma samples and long-term health outcomes were analyzed. The researchers found a strong correlation between a healthful diet rich in fresh vegetables, fruits, leafy greens, whole grains, nuts and legumes and a decreased risk of Type 2 diabetes. Study participants with less-healthful diets — which were high in refined grains, sugary beverages, fruit juices, potatoes and sweets and desserts — had a measurably higher incidence of Type 2 diabetes. They were also more likely to be overweight, to have high blood pressure and cholesterol levels, and to use medications to control those conditions. This new study adds to previous research that identify the daily dietary choices that we make as a significant factor in our risk of developing the disease.

Moving forward with your proposed plan, as well as becoming more physically active, will set you on a healthier path.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.