DEAR DR. ROACH: My uncle, a retired surgeon, is 90 years old. I visit my uncle periodically to inquire about his health and well-being. He eats, but is a little weak. I suggested to my aunt, a retired obstetrician, to give him a nutritional supplement. I take one myself and found it to be effective if taken regularly. The one I recommended contains only 22 grams of total sugars. My aunt told me that according to a CNN medical correspondent, "Sugar is poison."
I was flabbergasted to hear such an answer from her, a medical doctor! Care to change her mind with a comment about the importance of sugars in our daily lives as it pertains to our physiology and metabolism? My uncle is not a diabetic. — S.F.
ANSWER: When you hear that something is a poison, there are two questions to ask: What is the toxicity, and what is the dose? From the standpoint of sugar, there is no longer any question that large amounts of added sugar increase the risk of heart disease and cancer.
Most experts look at sugars contained within foods such as whole fruits as having less negative health effect than added sugars, such as in a sugar-sweetened beverage. However, the magnitude of the risk is small.
Sugar is not really necessary in the diet. The liver is capable of making all the sugar needed by the body if there are adequate amounts of protein and fat; however, the body converts the complex carbohydrates found in fruits and vegetables into sugar as well. The best scientific data confirms that a diet high in fruits, vegetables, legumes and whole grains is a healthy diet, and also that keeping added sugars down is healthy.
However, the big picture really needs to be kept in mind. A nutritional supplement for a person in his 90s who may not be eating well might indeed improve his energy level, and the benefit of an additional 5 teaspoons of sugar (about half a can of a regular soft drink) a day seems to me to be worth the small downside if it helps him. Unlike a soft drink, nutritional supplements contain protein, healthy fats and other important micronutrients.
DEAR DR. ROACH: When I see dying patients breathing with their mouths wide open, I am concerned for their comfort. Dry mouth and dry throat are both very uncomfortable. Is there anything that can be done to alleviate that? — D.D.
ANSWER: Management of pain and discomfort at the end of life is critically important for patients and their families. I never fail to be impressed with the skill and compassion of hospice nurses, aides, doctors and others who devote themselves to this aspect of medicine. They have all kinds of practical advice and experience for issues like this.
In the case of dry mouth, possible solutions include: ensuring that the nasal passages are open; stopping any medications that dry the mouth, if possible; ensuring adequate hydration; and using humidifiers, mouth/lip moisturizers and saliva substitutes. Having a comfortable head position (sometimes higher or lower, sometimes on the side) often can help with being able to close the mouth, but this isn't always possible. The best solution depends on the individual's unique circumstances.
It's also important to remember that in the case of people who are very near the end of life, what looks like it may be very uncomfortable to a family member is not necessarily so to the person experiencing it. Knowing when to intervene for comfort is where the experience is so helpful.
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 or send mail to 628 Virginia Dr., Orlando, FL 32803.
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