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The perfect diet is an elusive target
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DEAR DR. ROACH: In a recent column, you recommended “a diet based mostly on plants and legumes, with nuts, some fruits, whole grains and almost no refined sugars and starches.” By “some fruits,” are you suggesting not eating certain fruits, or just a limited amount of fruit overall? I ask because my cardiologist has recommended an Atkins-type diet with a heavy emphasis on meat -- with full fat -- while limiting carbs and not eating fruit, because it turns to sugar, he claimed.

I prefer a diet of fruit and vegetables, with a limited amount of meat and few carbs. I do love fish and shrimp. My wife can’t tolerate sugar, so I never have sugar or sweets of any kind. I never add sugar or sweeteners of any kind to any food or beverage.

I’m 70 years old and have had a heart catheterization, which indicated clean, clear arteries. However, I have weight gain. I prefer a physically active lifestyle, and canoe on lakes quite often three seasons of the year, for several hours each time.

Please clarify the “some fruits” term, and also what do you think about cutting out fruit entirely, as my cardiologist recommended? I’m concerned that that would lead to serious constipation, which I don’t experience when I have enough fruit in my diet. -- G.H.

ANSWER: There is no agreement on the “best” type of diet, and my use of “some fruits” reflected some current thinking that excess amounts of fruit may not be optimally healthy. Fruits indeed are high in sugar. Although not all fruits are the same, most have fiber, which slows down sugar absorption, while others can be absorbed more quickly. Most data show that the sugars found naturally in fruits have much less (if any) adverse effect on risk of heart disease, and in people with diabetes, two to four servings of fruit do not seem to adversely affect blood sugar. However, most people do not eat enough fruit, so I don’t want to advise against fruit eating: It’s fruit juices and sweetened fruit products that I recommend against consuming in other than modest amounts.

   Although there is good evidence that a high-protein, high-fat diet of the type you describe helps in short-term and medium-term weight loss, I do not recommend large amounts of the saturated fat found in most farm-raised meat. Again, the data are controversial, with one recent review suggesting little or no harm from saturated fat, but the preponderance of the evidence still is concerning, and I think the diet you prefer, of vegetables, fish and fruit, is likely to be healthier in the long term.

   DEAR DR. ROACH: I was very upset about a recent column in which a man thought he got stenosis from implantation of a pacemaker. Your response stated that you had never heard of losing function due to a pacemaker placement and that it is normally a short and straightforward procedure. My mother had the procedure, and they pierced her heart, which resulted in open heart surgery and eventual death. I believe that serious consequences should be explained on any surgical procedure. -- M.C.

   ANSWER: I can understand why you would be upset, and you are right that any procedure has the possibility of harm. About 0.1 to 1 percent of pacemaker placements can have serious complications, including death. It normally is a straightforward procedure, but it certainly can have a bad outcome. Like anything else, the risks must be weighed against the benefits.