Dear Dr. Roach: I have been told that vinegar diluted with water and taken prior to a meal is an effective way to reduce one鈥檚 blood glucose level.
Is this accurate? If so, how much vinegar and how much water? Is there a difference between apple cider vinegar and white vinegar? Will consuming vinegar on a long-term basis harm the esophagus?
N.J.
There is a fair bit of research showing modest improvements in blood sugar levels by taking vinegar. One study showed that two tablespoons of apple cider vinegar at night with a snack (the study used one ounce of cheese) reduced blood sugar about four per cent.
Some people noted stomach upset, so the author of the study suggested using the vinegar in a salad dressing or over steamed vegetables.
The acid level of vinegar, called pH, is about 2.8 (the lower the pH, the stronger the acid). This makes it less acidic than lemonade (2.6) or a cola beverage (2.4), so I don鈥檛 think you need to worry about damage to the esophagus.
Four per cent is a significant drop, but it is very unlikely that apple-cider vinegar by itself will be sufficient to control diabetes. However, it may make enough of a difference, along with a healthy diet and regular exercise, to keep some people with diabetes from using a new medication, all of which have the potential for side-effects.
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Dear Dr. Roach: My eight-year-old granddaughter is quite tall for her age and can wear some women鈥檚-size clothes. She has small breasts and pubic hair, but still wets the bed occasionally. Her mother says it鈥檚 normal, but I don鈥檛 think so. What do you think?
Anon.
Although she is starting to show some signs of puberty at a young age, she still has an eight-year-old鈥檚 nervous system. Even though your granddaughter is getting bigger on the outside, development of the nervous system鈥檚 control of the bladder takes time, and seven per cent of eight-year-old children still have some bedwetting. The most likely outcome is that she eventually will outgrow her bedwetting.
If she is having symptoms of a urine infection or diabetes, such as burning with urination, extreme thirst and an urgent need for the bathroom during the day, she needs evaluation. Otherwise, your granddaughter, her mother and her pediatrician will discuss any potential medical causes, behavioral treatments (especially avoiding excess fluids in the evening and being sure to void immediately before bed), and possibly a bedwetting alarm if the behavioral treatments have been ineffective after six months or so.
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Dear Dr. Roach: I have production of phlegm from the chest on an almost continuous basis throughout the day and night. The doctors say it is now COPD, and I can handle most aspects, except having to spit every few minutes. Sometimes it brings on a coughing fit. I am seeking new remedies. Do you have any?
S.F.
Maybe not. Treatment of cough in COPD is frustrating and very little has been proven to work. However, many people find that they can more effectively get rid of the mucus by first using their inhalers (usually albuterol) and then using the stomach muscles to make a deep cough.
Drinking plenty of water can help keep the mucus from getting thick and hard to expel. Some people may benefit from inhaled steroids, N-acetyl cysteine (Mucomyst), or the new medication roflumilast. A pulmonologist is your best bet for personalized information on these treatments.
Of course, quitting smoking is critical if you are a smoker.
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Dear Dr. Roach: I have dry macular degeneration and take the AREDS vitamins. Is there anything on the horizon to help?
A.S.
Maybe. Right now, the best treatment for dry-type (the more common) age-related macular degeneration is the vitamin regimen studied in either of the two AREDS trials. However, in the future, we may see stem cells being used as treatment, as shown in a 2015 study from UCLA. It鈥檚 too early to say whether this will live up to its early promise.
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 [email protected].
