DEAR DR. ROACH: I’m a 67-year-old healthy male, but I do take Humira for rheumatoid arthritis (RA). It does a wonderful job for me with no side effects. It does such a good job that I can periodically extend the time between injections, such as one every three weeks instead of the recommended dose every two weeks. I can even go as long as six months between injections without noticing much of the RA symptoms.

My rheumatologist is aware of this and encourages me to use the lesser amount if I still get relief. My quandary is that I was recently talking to my gastroenterologist about Humira, and he said that they use a very similar drug for gastrointestinal issues. But apparently, you aren’t supposed to stop taking it consecutively because the body will become immune to the drug, and the drug can lose its effectiveness.

Naturally, I don’t want to lose the great relief I am lucky to be getting, but I also know it’s a strong drug. It seems the less I take of it, the better. — J.C.

ANSWER: I share your gastroenterologist’s concern. He may be thinking of a similar medication, vedolizumab (Entyvio). When this drug is stopped in someone with Crohn’s disease, it will cause a flare-up of the disease in about half of the cases within six months. In a third of them, the medication will no longer be effective.

The situation is similar with adalimumab (Humira), as there is the possibility of a relapse if you stop it entirely. Taking it every three weeks led to a flare-up in 36% of people who had the disease well-controlled for years. The researchers were unable to identify any way to predict who would flare up. Restarting Humira regained control for over half of the study participants, but not everybody.

I do understand that these are powerful medicines with side effects. Even if you aren’t noticing any, many people will, and there can be very serious side effects to many organs. Fortunately, these are uncommon, and in most cases, it is far better to stay on the medicine, as long as you are being monitored.

As a medical student, I remember seeing what RA looked like before we had effective medications, such as methotrexate and TNF inhibitors like Humira. Years of inflammation caused terrible hand deformities, mostly in the women I saw. Since you aren’t having any side effects, and it is working well, I don’t recommend the three-week dosing — and certainly not six months between doses.

DR. ROACH WRITES: A recent column on hair loss and thyroid disease prompted many readers to write me with their experiences. One reader noted that increasing protein in their diet seemed to slow down hair loss and even cause some regrowth.

Another reader recommended biotin. I often recommend this as a trial, despite a lack of good evidence that it works. Biotin is a B-type vitamin that is very safe, although it can interfere with a lab assay on thyroid and other hormone levels.

I need to note that both hair loss and thyroid disease are very common, and it is not always the case that thyroid disease causes hair loss.

DEAR DR. ROACH: My mom was feeling awful and went to the doctor. The doctor did lab work and concluded that my mom’s A1C was 8.5% — and that she was diabetic. My mom told her doctor that she had been eating a lot of sweets every day. The doctor put her on metformin, but my mom said that the medicine made her feel worse.

So, the doctor told her she could stop taking it and quit eating desserts to see if her A1C would come down on its own. Three months later, my mom repeated her lab work, and her A1C was down to 6.4%. The doctor said, “You are no longer diabetic and don’t need any medicine. Just watch what you eat.”

Well, my mom is a dessert-aholic and still eats whatever she wants, just in moderation, but she is not scheduled to go back to the doctor. I tried to explain to her that when she eats a lot of sugar or starch, her glucose level can still skyrocket and cause damage to her kidneys and other organs. I told her it is very unhealthy for her glucose levels to go up and down, but she just repeats what her doctor said about no longer being diabetic and just having to watch what she eats. Is this correct? I am worried about her health. — K.C.

ANSWER: Congratulations to your mom for getting her blood sugar back down to the near-normal range. That’s an impressive achievement by just changing her diet in a very short time. I am sorry to disagree with her doctor, but she still has diabetes.

Once the diagnosis of diabetes has been made, it is a “stable” diagnosis, and her blood sugar will hopefully stay controlled with her diet. However, if she changes her diet back to what it was when her A1C was 8.5% (not well-controlled), it’s likely that her A1C will go back up there.

Her doctor may be absolutely correct that with a careful diet (and hopefully a good amount of moderate exercise), she may remain well-controlled without medicine, but I strongly disagree about not having her back for regular checkups.

My experience is that many people initially do a great job with their diet but slowly go back to their less-healthy ways, and maintaining good behaviors often requires frequent reminders. The fact that your mom seems to be slipping on her healthy eating is concerning. You are quite right that starches are rapidly turned into sugar by the body. Repeat visits every three months are a minimum, in my opinion, for a person recently diagnosed with diabetes.

Although metformin is often the first medicine we use for people with Type 2 diabetes, especially those who are overweight, it is not the only treatment. Other oral medications are also effective at keeping blood sugar levels down. Some of these also help with weight loss and protecting the heart and kidneys. Side effects vary, and we are usually able to find a well-tolerated medicine when needed.

Finally, let me once again put in a recommendation that diabetes educators and registered dieticians have a great deal of expertise in helping patients learn healthy behaviors. Her doctor may not have enough time to really break down her diet and give her the personalized advice that she needs.

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