ArcaMax

DEAR DR. ROACH: I am a generally healthy 70-year-old man, and I like to drink orange juice -- the kind that is freshly squeezed with no additives but is pasteurized. I also like to eat strawberries almost every day. My recent A1C and glucose levels were 6% and 110 mg/dL, respectively. My prior year readings were 5.5% and 100 mg/dL.

I've read that ingesting natural sugars is OK because they slow down the absorption and digestion rates, but I wonder what your thoughts are on this. Should I be cutting out strawberries and orange juice altogether? -- M.B.

ANSWER: It is true that eating whole fruit slows the absorption of sugar, so oranges would be much better for your blood sugar than orange juice, no matter how fresh it is or whether it has additives.

Orange juice contains three different sugars: sucrose, glucose and fructose. It is roughly half sucrose and 25% of glucose and fructose each. Your body can't tell a molecule of fructose or sucrose from orange juice apart from those that come from high fructose corn syrup in a can of soda. (For example, Coca-Cola in the United States is a mixture of 55% sucrose and 45% glucose.) These sugars get absorbed quickly -- about twice as quickly as the sugar in whole oranges.

Strawberries are an even better choice than whole oranges. The polyphenols and fiber in strawberries slow sugar absorption, giving your body more time to raise insulin levels to keep your blood sugar under control.

Having other food at the same time can also help. Fats and proteins slow down sugar and other carbohydrate absorption, so I often see people adding some nuts, like almonds or walnuts, to their fruit snack or meal.

I also enjoy a glass of fresh orange juice, but I make it small and occasional, which is good advice for people who are trying to manage their blood sugars, especially when you are trying to prevent prediabetes (an A1C above 5.7% and below 6.5%) from becoming diabetes (6.5% or higher).

DEAR DR. ROACH: I was recently diagnosed with osteoporosis. I am a 67-year-old female, and before this, I was at the osteopenia level for several years. The treatment that is being recommended to me is an IV treatment called Reclast. I have never heard of this before and would like your take on it. -- K.B.

ANSWER: Osteopenia and osteoporosis are both conditions where bones lose minerals and strength. This can be an age-related process in both women and men or may be as a result of an underlying condition. Some medications (especially steroids like prednisone), hormonal abnormalities, nutritional disorders, and bone marrow disease can be underlying causes of osteoporosis and should be considered prior to therapy.

For most women with age-related osteoporosis, the decision to begin therapy starts with the fracture risk, which can be estimated via the FRAX score once the bone density is known. For those who decide on therapy, medications to slow the excess bone reabsorption that is the hallmark of age-related osteoporosis is usually the first-line treatment.

You have probably heard of alendronate (Fosamax) or ibandrobate (Boniva), and zoledronic acid (Reclast) is in the same class called bisphosphonates. It has a major advantage for some people when dosed intravenously (which avoids the possibility of damage to the stomach or esophagus) every year, or sometimes every two years. Bone density is monitored carefully, and most people are on these drugs for three to five years.

Many readers have heard of bad side effects from bisphosphonate drugs, but when used correctly, they reduce the risk of hip and spine fractures, which are life-changing events.

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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.

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