Dear Dr. Roach: I am 61 years old and in good shape. I have Crohn’s disease, which makes eating a good diet difficult. Fruit and fresh vegetables go right through me. I can digest a banana. My doctor just told me that my total cholesterol is 215, HDL 45 and LDL 146. Should I consider medication? He also said that I need to watch my sugar and not eat so many carbs. My fasting glucose is 100, and triglycerides were 105. I am worried because my dad had a heart attack at 49 and a five-way bypass at 70, but he ate terribly and was overweight. He lived until 90. Diabetes does run in my family.

I am 5 feet, 9 inches tall and weigh only 150 pounds. Can you please tell me what I can eat to stay healthy? I live on lean meat, chicken, turkey and bread.


Dear G.G.: Nearly everyone I see would benefit from eating less meat, less processed carbohydrates (I mean starches, like bread and pasta) and more vegetables and fruits. However, because of your Crohn’s disease, you have to balance a healthy diet for your heart (and to reduce diabetes risk, given your family history and your labs) with what your digestive system will tolerate.

First, I would try slowly expanding your diet and using a food diary (a registered dietitian nutritionist may be an invaluable investment). Try some fruits that you haven’t had before. Mangoes, peeled pears and avocados are well-tolerated by many people with Crohn’s disease, but only a trial will tell you for sure. Similarly, legumes, like lentils and chickpeas, may be better tolerated. Butter lettuce and roasted peppers are good choices for many with Crohn’s. Nuts and nut butters are great sources of protein and healthy fats. Breads should be enjoyed less often; choose breads with whole grains if you can tolerate those.

As far as medicine for heart disease goes, it seems unlikely that you are at high enough risk to meet the guidelines for treatment (unless your blood pressure is quite elevated). However, given that your fasting blood glucose is 100, you just qualify for a diagnosis of prediabetes. Your family history makes the advice your doctor gave you about simple sugars and processed carbohydrates very important.

Along with diet, exercise is the other key factor in avoiding diabetes, so I would advocate a half-hour or more daily of moderate exercise.

Dear Dr. Roach: What is your opinion of Neti pots? I use one as a preventive measure once a week, and if I have any symptoms of a cold or a stuffy head, I’ll use it more often. I haven’t had a cold or any bronchial problems in seven years. I’m 68 years old.


Dear F.: It’s hard to argue with success, but you may be breaking out the Neti pot more than you need to. A Neti pot uses saline solution (made with sterile — distilled or boiled — water) to irrigate the nasal passages. The fluid gets rid of allergens, bacteria and mucus. Some people don’t mind the fluid sensation; others cannot tolerate it.

Using a Neti pot at the onset of congestion makes sense. I’m not sure you need to use it as a preventive, but if you have symptoms when you don’t use it, it’s perfectly reasonable. The side effects usually are local and mild, such as nasal irritation and occasional nosebleeds.

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