DEAR DR. ROACH: I am a 50-year-old overweight woman (5 feet, 6 inches tall at 240 pounds). So far, I am not diabetic, but my A1C has been creeping upward. In an effort to control my weight and reap the benefits of fasting, I have been engaging in 36-hour fasts.

Although I have lost about 1 pound per week since embarking on this endeavor, I am also aiming to enhance my cellular repair and metabolic response, as well as decrease inflammation.

I have been frustrated that the urine strips I have used at the end of my fast have been negative for ketones. Should I believe the strips? Am I getting any of the benefits of fasting if I never reach ketosis? — J.H.

ANSWER: Intermittent fasting has become increasingly used as a strategy for weight loss and also has been shown to improve markers of inflammation in the blood. It is absolutely not necessary to have measurable ketones in the blood to get the benefits of fasting.

I do not often recommend intermittent fasting as the benefits of this approach are relatively modest, and I prefer to recommend an evidence-based dietary intervention, such as a Mediterranean-style diet, which has shown many benefits. A Mediterranean-style diet also has benefits in metabolism, including anti-inflammatory and cardiovascular benefits.

However, my colleagues who specialize in weight loss find that intermittent fasting is an effective tool for some of their patients. You might also have not done well on a Mediterranean-style diet.

I am concerned about the data showing that there is an increased risk of eating disorders in some people who intermittently fast. Adolescents and young adults, as well as those with a history of depression, are at a higher risk for eating disorders, especially when they are on a rigid diet or when they are dieting in order to look better.

This is another reason why I am hesitant to prescribe this type of diet in people who are at risk, and I try to make my dietary advice more about improving health, rather than losing weight as the primary goal.

DEAR DR. ROACH: I’m a 95-year-old male in good health. I started to have moderate-level roaring in my ears (tinnitus) at around age 60. The roaring in my ears was bothersome but not overwhelming. When I took an aspirin on occasion, the noise level increased.

While visiting my parents, my mother was taking niacin. I decided to try it, and the level of roaring in my ears increased to the point that it became overbearing. I had been taking vitamin C and E, plus a multivitamin. Taking into consideration my reaction to niacin, I decided to stop taking vitamins C and E to see if these vitamins had any effect on my tinnitus. The result was that the roaring in my ears stopped within a few days.

This was about 40 years ago, and I haven’t had a recurrence since. My question is: What is in vitamins C and E and aspirin to have caused the roaring in my ears? — D.H.

ANSWER: Tinnitus is most often associated with hearing loss, but aspirin is another cause. There are several mechanisms to explain the effect of aspirin causing tinnitus. Normally, the tinnitus goes away when stopping aspirin. However, none of the mechanisms through which aspirin causes tinnitus should be triggered by either vitamins C or E.

Zinc and iron supplements did seem to increase the risk of tinnitus, with iron and zinc being associated with greater tinnitus. I couldn’t find case reports to suggest an association between increased doses of these vitamins and tinnitus. Alas, I cannot tell you why stopping the vitamins C and E made your tinnitus go away.

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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