Dear Doctor: I'm a firefighter and in pretty good physical shape, even though I have Type 1 diabetes -- but my body doesn't show it. Specifically, I have flabby abs and man boobs. I walk, run, do push-ups and crunches, and I think I eat pretty well. What else can I do?

Dear Reader: First, I have some questions for you: How long has this been going on? Is the fat around the belly something new or something gradual over many years? Is the gynecomastia ("man boobs") something you have been dealing with since adolescence, or is it something you have only noticed recently?

Let us begin with gynecomastia. Gynecomastia occurs in adolescence due to a relative imbalance of estrogen and testosterone. The relatively elevated levels of estrogen compared to testosterone stimulate breast tissue in adolescent boys, leading to breast enlargement. The majority of adolescent boys will lose this breast tissue, but in 20 percent the enlarged breast tissue will persist into adulthood. In adult men, some estrogen is produced directly by the testes, but most is produced from the breakdown of testosterone and the adrenal hormone androstenedione. As in adolescent boys, adult men can develop gynecomastia if there is an imbalance between estrogen and testosterone levels.

Then, of course, there's obesity, which leads to increased fat in breast tissue. This can give the appearance of increased breast tissue, which is termed pseudo-gynecomastia. Because the fat in the breast tissue carries the enzyme that converts testosterone and androstenedione to estrogen, breast fat may actually increase estrogen levels and stimulate the formation of breast glands.

Because breast fat and the fat in your abdomen are related, the fundamental question is likely: Why are you storing fat?

First, blame the diabetes -- and the connection between the disease and your diet. As a Type 1 diabetic, you've probably been on insulin for many years. Insulin inhibits the breakdown of fat, but also stimulates the creation of fat. The higher your body's insulin level, the more your body will store fat. The more insulin you inject, the more fat you will store.

The higher your calorie intake and the higher your carbohydrate intake, the more insulin you will require to keep your blood sugar low. This will lead to a greater storage of fat. Look for foods that are low in glycemic index, meaning low in the food's ability to raise the blood sugar. Avoid high-sugar foods such as cookies, candies, cakes, sodas, ice cream and juices. These foods may no longer be part of your diet. But if they still are, and if your sincere desire is to remove the fat from your body, then eliminating these foods will help. I would also recommend limiting the amount of high-glycemic carbohydrates, such as bread, pasta, rice, corn and potatoes. Increasing fiber in your diet will also decrease your insulin requirements.

Then there's aerobic exercise. Walking, running, biking, rollerblading, hiking, swimming, using an elliptical machine -- all of these will help you lose and maintain a lower weight.

Of course, even with a good diet and exercise, you may have difficulty totally losing this unwanted fat. The important point is to be patient, diligent and more obsessive about your diet. This will decrease your insulin requirements, help control your diabetes and help you lose the fat.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: It seems like if you just wait long enough, everything about nutrition gets contradicted. So now fat is good, carbs are bad, and we don't really need more than 4 servings of vegetables a day? Really? Is everything we've been taught wrong?

Dear Reader: We hear this same frustration from many of our patients, and honestly, we're right there with you. Healthful eating is an important goal, but how are we supposed to achieve it if the rules keep changing?

When it comes to why nutrition advice keeps changing, several factors come into play: science, media and marketing.

Conclusions regarding diet and nutrition are frequently drawn from observational and epidemiological studies. Unlike in a clinical trial, where a single variable, such as a medication or a treatment approach, is scrutinized repeatedly in a randomized and rigidly controlled environment, observational and epidemiological studies draw conclusions by identifying and analyzing trends within large population groups.

Well-designed observational studies can provide valid results. But it's important to understand that the data they use include multiple variables that can't be controlled. Eggs and coffee are two culprit foods that have gone through the "it's bad"/"no, it's good" whiplash. Each of those foods was the focus as researchers combed through piles of data. However, the people in those studies were eating and drinking many more things. Add in variables like lifestyle and environment, and isolating the effect of eating any one specific food becomes challenging.

When researchers publish results that suggest a causal link between a certain food and a particular outcome, they acknowledge that it's just one single data point in an ongoing analysis. It takes time and repetition to reach a reliable conclusion. But scientific rigor pretty much flies out the window when it comes to how the emerging studies get publicized, which leads us to the second factor -- the media.

While scientists are saying, "In this one study, we see a link between eggs and heart disease," in the hands of over-eager newscasters, this is translated as "Eggs will kill you!" Meanwhile, time goes on. Many more studies are conducted. A decade or so later, armed with a wealth of data points collected over the years, the original thesis doesn't hold up. For the scientists, it's the nature of research -- precision and repetition over time. For the rest of us, it's a new -- and contradictory -- headline. "Eggs are good!"

Which brings us to marketing. Diet and nutrition are multibillion-dollar industries in the United States. That means that as food recommendations are crafted, a good bit of lobbying takes place. When new dietary guidelines were released in 2015, a number of nutrition experts, including Dr. David Heber, founding director of the Center for Human Nutrition at UCLA, bemoaned the influence of the food industry in the process.

We need to be savvy consumers of dietary information. And when it comes down to healthful eating, we recommend that our patients stick with the tried-and-true basics. That is, eat fish and lean meats, grains and legumes. Limit or cut out processed foods, and eat a wide variety of fruits and vegetables, especially leafy greens. Limit sugar and alcohol. When you're thirsty, reach for a glass of water.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My eyes are so dry, they often feel as if I have sand in them. I use drops, but they don't always work. Is there anything else I can do? And will this hurt my vision over time?

Dear Reader: No doubt you're frustrated. If it's any comfort, your doctor probably is too. People suffering from dry eyes are frustrated because of the constant irritation; doctors are frustrated because they don't have a miracle cure. The symptoms of dry eyes vary. Like you, many patients complain of a gritty or sandy sensation. Some also report red or watery eyes, a burning feeling, light sensitivity, blurred vision or a combination of these symptoms. Paradoxically, excessive tearing can also be a sign of dry eyes. Rarely, however, does prolonged dry eyes lead to scarring of the cornea or permanently altered vision.

That's fortunate, because 14.5 percent of Americans report having regular dry eye problems, and the likelihood increases with age. The condition is more common in women, especially those undergoing menopause, as well as in people with certain chronic illnesses such as diabetes and Parkinson's disease. People who have had laser eye surgery, wear contacts or use medicated eye drops also have a greater rate of dry eyes, as do people who have allergies.

As for treatment, it's important to look at the possible cause. Some medications, such as antihistamines, antidepressants, niacin, estrogens and the arrhythmia drug amiodarone can cause dry eyes. So can the autoimmune disease Sjogren's syndrome, which leads to inflammation of tear ducts, death of cells in the ducts and decreased formation of tears. Sjogren's, which is accompanied by dry mouth, can be diagnosed with blood tests and other screenings that evaluate production of tears and saliva. Other conditions can affect the tear ducts as well, such as sarcoidosis, lymphoma and diabetes.

Eyelid health is also important. Normally, Meibomian glands in the eyelid produce an oily substance that prevents tear evaporation and helps trap tears upon the eyeball. Inflammation of the lid margin, termed blepharitis, causes these glands to malfunction, leading to dry eyes. Treatment of blepharitis includes lid scrubs (using baby shampoo and a warm wet cloth), lid massage, warm compresses and artificial tears.

Speaking of artificial tears, these drops add viscosity to the fluid surrounding the eye and thus maintain a natural tear covering the eye. Adding one drop to each eye three to four times per day will improve symptoms. Note that some people have sensitivity to the preservatives in artificial tears, so using preservative-free tears may be helpful.

For people with inflammatory conditions such as Sjogren's syndrome or blepharitis, the immunosuppressive eye drop cyclosporine, applied twice a day, can significantly improve the symptoms of dry eyes.

A newer eye drop, lifitegrast, decreases inflammation in the eye, with twice-a-day application leading to significant improvement of symptoms. Note, however, that the medication can also cause eye irritation and taste abnormalities.

Not all treatments are drug-related. Omega-3 fatty acids with EPA, DHA and flaxseed oil can enhance tear production, decrease tear evaporation and improve overall symptoms. Similarly, diets deficient in omega-3 fatty acids have been linked to increased rates of dry eyes.

In summary, give artificial tears a try, and increase your intake of omega-3 fatty acids. Also, please see an ophthalmologist. He or she can determine whether an inflammatory disorder, such as blepharitis or Sjogren's, is the cause of your symptoms.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)