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To Your Good Health: Which Diet Is the Right Diet

Dear Dr. Roach: I am taking Zetia and niacin for extremely high cholesterol and triglycerides. Exactly what type of diet should I be on to lower my cholesterol and triglycerides?

Many of the processed (cheese, ice cream, cookies, etc.) fat-free, cholesterol-free foods are high in sugar. Should I be on the South Beach Diet or a strictly vegetarian diet?

How many calories, carbohydrates and fat grams should I consume daily to lose weight?

I am a 5-feet-4-inch-tall female who weighs 160 pounds. When I was on the Atkins diet for more than 20 years, I was always slim and had no health problems. Thank you. — J.D.

Answer: You are asking how to lower cholesterol, but I think what you really want to know is what diet reduces risk of heart disease. The right question is: What diet should you be on that will help you be healthier in the long term?

All of the diets you mention have their strengths and weaknesses. Almost everyone agrees that avoiding sugar and processed grains is a key factor in reducing heart disease risk, but, despite decades of research and controversy, there isn’t agreement on the best diet for overall health.

I think it’s possible to take some wisdom from all the diets you mention, and to avoid some of their potential pitfalls.

Both the Atkins and South Beach plans avoid simple sugars and excess carbohydrates, and I would emphasize that red meat and saturated fats should be kept at reasonable levels.

A vegetarian diet emphasizes vegetables and fruits, but some people will gain weight on this diet, especially if they aren’t careful to choose good sources of protein and healthy fat, or choose refined carbohydrate sources like the cookies you mention.

I have often recommended the Mediterranean diet, since there is high-quality evidence that it reduces heart disease risk. This diet calls for lots of vegetables and fruits, lean proteins such as fish, healthy fat such as from olive oil and nuts, and whole grains.

The medications you are taking, ezetimibe (Zetia) and niacin, do lower cholesterol, but it isn’t certain whether either of them really reduces risk of heart disease. The statin class of drugs is best shown to reduce heart disease risk in people of above-average risk.

Dear Dr. Roach: Nine weeks ago, my 76-year-old dad went to Punta Cana in the Dominic Republic for a two-week vacation. On the second day there, he began having diarrhea, and it has persisted since then. He has lost 15 pounds (and was not overweight to start). He went to a GI doctor, who ordered a single stool culture for ova and parasites, giardia, shiga, campylobacter, salmonella, shigella and C diff (toxin B screen cytotoxin), which all were negative.

He will occasionally vomit. He has not had a fever or abdominal pain. Many foods cause violent symptoms, something that never happened before.

The GI doctor recommended probiotics, which is being followed. The GI doctor says he is stumped, and has now started him on a lactose-free diet. We need some resolution to this.

What are your thoughts? What else can be done to find out what is wrong? Any help would be greatly appreciated. — B.I.

Answer: Normally, we would repeat the stool cultures, since ova and parasites especially can be missed on one. Most specialists recommend three cultures.

I agree with the lactose-free diet and probiotics for now. If it persists, he should probably get an upper and lower endoscopy as well.

Dear Dr. Roach: My brother-in-law was prescribed warfarin several years ago after a stroke. He claimed that it was made from rat poison and refused to take it. Is it, in fact, made from rat poison? — D.K.

Answer: Yes, warfarin (Coumadin) was used as rat poison. Some rat poisons are still relatives of warfarin.

However, that doesn’t mean he shouldn’t take it. The difference between a medicine and a poison is often one of dosing. Warfarin is reasonably safe when used correctly, and it can significantly reduce the risk of a second stroke. There are also some newer options, such as Pradaxa and Xarelto. Your brother should reconsider the risks and benefits.

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.