DEAR DR. ROACH: I have recurring stomach ulcers, so I have been researching acid-alkaline diets to resolve the ulcer problem. I am frustrated, as some research indicates that a food is acid while another source indicates that it is
alkaline. How do I know which is correct? — C.T.

ANSWER: Nearly all ulcers either are caused by an infection with the bacteria Helicobacter pylori or are a side effect of nonsteroidal anti-inflammatory medication. The acidity or alkalinity of the food you eat has very little, if any, effect on developing stomach ulcers. 
The reason you see confusion about whether foods are alkaline or acid has to do with what is being measured. For example, lemons are highly acidic; however, if you burn them, their ash residue is alkaline. While interesting, this has no
net effect on body pH, which is tightly regulated by multiple systems.
DEAR DR. ROACH: I recently was seen by a family practitioner after not
having seen a doctor in 15 years, except at urgent care. I have Type 2 diabetes,
and my recent A1c reading was 7.2. My cholesterol readings, both good and bad,
were average.
The doctor mentioned to me that as soon as I go on Medicare (in 60 days),
she wants me to take a statin drug. She indicates that this is “protocol” now for
diabetes (as a prevention therapy). The side effects of statin drugs seem to me
too dangerous to consider this when my cholesterol levels are good. There is heart
disease (from my father) in the family. Thoughts? — I.M.
ANSWER: Statin drugs reduce the risk of heart attack, and probably stroke, in
people who are at higher-than-average risk for these conditions. The higher the
risk, the more beneficial the medications are. However, the side effects are just as
likely, no matter your risk for vascular disease. So, statin drugs are not recommended for those at low risk, as the benefits are unlikely to outweigh the possible harms.
There are many risk factors for heart disease. High cholesterol is one, but high
blood pressure, smoking, family history and poor diet and exercise also are
important risk factors. Diabetes, both Type 1 and Type 2, increases risk for
heart disease, and so must be considered by your doctor when making the decision to recommend a statin. The risk is largely determined by how long you have had your diabetes and how well it has been controlled.
There are several calculator tools available to estimate an individual’s risk
for heart attack and death based on risk factors, although the most commonly
used one recently has been shown to significantly overestimate risk. In my opinion, this decision needs to be personalized, and protocols — however wellmeaning and well-done — cannot be substituted for individual judgment based on knowing the person, along with his or her risks and fears.
Most people with longstanding diabetes have a high-enough risk that a statin probably makes sense. Nearly everyone with known coronary artery disease should be on a statin, even if the patient’s cholesterol levels are nearly normal.

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 request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.