Q: I’m 68 and have been on metformin for almost 25 years. I also have been taking a sulfonylurea for eight years. Recently I have had two scary incidents of low blood sugar. I used to be able to keep everything on a pretty even keel. What’s changed?—Janie P., Lansing, Michigan
A: Time may be the great healer, but it can also be the great troublemaker—at least when it comes to staying on a treatment regimen for years. There’s been such a focus on getting folks on life-saving treatments and increasing their compliance that the whole issue of reducing treatment as a patient gets older has been largely overlooked.
Researchers at Michigan Medicine, the University of Michigan’s academic medical center, and the VA Ann Arbor Healthcare System decided to do the first-ever extensive examination of the effect of sustained routine adult primary care for a whole slew of conditions—looking at meds, scans and screening tests. Their results came out in JAMA Internal Medicine, along with an almost 400-page supplement that a panel of experts produced after reviewing the researchers’ initial findings.
One of their 37 high-priority deintensification recommendations concerns Type 2 diabetes treatments. They found that as people with Type 2 diabetes get older, they don’t need to take multiple medications to lower blood sugar. Not only does that increase the incidence of hypoglycemia (low blood sugar) and associated risks, from falling to death, the “evidence that supports those low targets comes from studies that focused on preventing diabetes-related problems decades in the future.”
So, Janie—and anyone else who’s been getting treatment or tests that haven’t varied in years—ask your doc to look at the study in JAMA and supplemental info and consider if you really need to maintain treatment or testing at your current level. But never—and we mean never—stop or reduce your current medical treatment without permission from your doctor. You don’t want to cause a risky rebound reaction.
Q: I’m not overweight, but my doctor keeps telling me I have to pay more attention to what I eat because I’m going to end up with plaque buildup in my arteries. Seems to me I’ve eliminated the biggest risk factor—obesity—so why should I worry?—Carl D., Indianapolis
A: It’s true that most folks who are obese —or even overweight—have elevated lousy LDL cholesterol and plaque buildup in their cardiovascular system. That’s because of bodywide inflammation associated with excess and visceral (belly) body fat, the difficulty of exercising with extra weight and the fact that excess pounds usually come from eating metabolism-destroying, ultraprocessed and sugar-added foods.
But you don’t have to be obese to have heart disease. Even if you’re not, consuming excess calories, eating artery-clogging foods like red and processed meats, simple sugars, syrups and processed carbohydrates, as well as not getting enough fiber and nutrient-rich fruits and vegetables, can do a lot of damage.
A new study published in PLOS Medicine proves that. Over 21 years of followup, researchers found that folks with a normal body weight index who did not eat a Mediterranean-style diet were 75 percent more likely to die from cardiovascular disease than normal-weight folks who ate Mediterranean. The Med diet was defined as getting 35 percent of calories from fat —22 percent from monounsaturated fats like olive oil—and less than 50 percent of calories from carbs.
If that isn’t proof enough that the Mediterranean diet is life-extending, dig this: Obese study participants who ate a very robust Mediterranean-style diet were not at a higher risk of death from cardiovascular disease than normal-weight folks who also ate a very healthy Med diet.
Clearly you—and you and you—should avoid red meats; enjoy fish, like salmon; make your diet plant-centered, but not refined-carb-heavy; and embrace healthy oils like olive oil. Your heart and brain will thank you with a longer, healthier life.
Mehmet Oz, M.D. is host of “The Dr. Oz Show,” and Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. Email your health and wellness questions to Dr. Oz and Dr. Roizen at firstname.lastname@example.org.
(c)2020 Michael Roizen, M.D. and Mehmet Oz, M.D. Distributed by King Features Syndicate, Inc.