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Making Lifestyle Changes Is a Good Move for Prediabetics

Dear Dr. Roach: I’m prediabetic. I have known you and others to say not to eat any grain that is not whole wheat. Based on that, I leave off white rice, pasta and white rolls. I eat two whole-wheat rolls most days. Does that sound right? I am underweight. — S.R.

Answer: It is much better and easier to prevent diabetes than it is to treat it. Diet and exercise are proven to help prevent diabetes in everyone, even your less-common situation of being normal or underweight and at risk for diabetes.

The most important part of diet is to avoid simple sugars. Processed grains are converted extremely rapidly to sugar in the body. The added fiber and protein of whole grains slows this process down somewhat; however, I still would recommend having your grains with some healthy fat and protein. Nuts, olive oil and healthy vegetable spreads go great with whole-grain rolls and slow down absorption. By having foods in combination, you can reduce diabetes risk.

Don’t forget about exercise, the other key to preventing diabetes. Any exercise is better than none. Walking is a great form of exercise that takes no special equipment and can be done anywhere. At 10,000 steps a day, which is not very hard to build up to, the risk of diabetes is significantly decreased. An inexpensive pedometer can keep track of your steps and may motivate you to reach your goal.

Dear Dr. Roach: I’m a 44-year-old male. I had aortic valve repair surgery in 2008. I also had a cardiac ablation for ventricular tachycardia in 2009. I had a normal heart catheterization in 2011. However, in 2013, I had a cardiac CT, which showed “mild stenosis of the distal left circumflex artery,” but the “left anterior descending and the right circumflex arteries were normal. There was myocardial bridging of the mid ramus branch without appreciable stenosis.”

I was told that this is nothing to worry about. There was nothing mentioned about bridging on my catheterization two years earlier. Should I be concerned about this, and should I have the catheterization repeated? — D.G.B.

Answer: You have had quite a few issues with your heart. Normally, the left main artery splits into the left anterior descending (LAD) and the circumflex artery, but in some people, there is a third branch, called the ramus. You have a ramus artery.

You also have myocardial bridging, which happens to only some people. In most cases, the arteries of the heart sit right on top of the heart muscle. In about 2 percent of people, the heart muscle goes over a part of the blood vessel. This is called myocardial bridging, and it is present from birth. The CT scans of the heart have such high resolution that they are very good at spotting this variation.

A small amount of bridging does not seem to cause any increased risk of heart disease. However, long segments may increase risk of heart attack. The segment that is within the muscle can be completely closed when the heart squeezes, which stops blood flow and may predispose a person to clots.

The report mentions some stenosis (narrowing) of the circumflex artery. If your cardiologist thinks it is significant, I would guess that you would be on appropriate medication, including a statin, aspirin and beta blocker. These would reduce any possible risk from the myocardial bridging, even though most people with bridging don’t need specific treatment.

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 write to P.O. Box 536475, Orlando, FL 32853-6475.