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Dear Dr. Roach: I had a heart attack a year ago. My wife and other people have told me that I can eat anything I want, as long as I eat in moderation.

What do you say?

C.F.

Dear C.F.: It depends on what you mean by “moderation.” I would recommend that you take up a diet based mostly on plants, with the option of adding whole grains, fish, nuts, fruits and lean meat sources, such as skinless chicken. I would urge moderation (in this case, I mean eaten very rarely) for less-healthy food choices, such as highly processed foods and those with high sugar content.

I would recommend zero intake of trans-saturated fats (which, fortunately, are leaving the food supply, though not quickly enough).

The data on red meat remains mixed, but the preponderance of information shows that commercial red meat should be consumed sparingly (no more than two servings per week appears to give someone the lowest risk for heart disease).

This is the diet I recommend for most people for overall health, but after a heart attack or the diagnosis of blockages in the arteries of the heart or brain even without a heart attack or stroke, this diet is likely to reduce risk of further events.

Dear Dr. Roach: I took your advice on exercising, and switched to lighter weights and more repetitions. I now have no more strains or pulled muscles. I do nine exercises, 30-40 repetitions two to four times a week. My primary doctor won’t prescribe steroids for me.

Are there any over-the-counter artificial steroids available? I would like to add a little bulk. I’ll be 75 next month.

J.B.

Dear J.B.: I agree completely with your primary care doctor, and recommend strongly against the use of anabolic steroids for the purpose of performance enhancement or to gain muscle bulk.

Testosterone and other anabolic steroids are used for men who can’t make adequate amounts, especially those with symptoms. They also are used in cases of muscle wasting from various medical disorders.

Unfortunately, they are used very commonly (6.4 percent of men worldwide have taken steroids, with 18 percent of recreational and 13 percent of professional athletes having done so). They have the potential for serious side effects, and when purchased from Internet suppliers, the quality, amount and even the type of steroids are unknown.

Most of the OTC supplements sold as nonsteroid performance enhancers (there are many) probably are ineffective — with a few exceptions, such as creatine (which has some benefits in men under age 36) and caffeine (which helps a little in endurance events).

If you really want to increase muscle bulk, I suggest you earn it the old-fashioned way: through gradual increase in resistance training. More resistance tends to lead to larger muscles, but it’s important to build up slowly to avoid injury.

Email questions to ToYourGoodHealth@med.cornell.edu.

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