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Dear Dr. Roach: I have a strong history of premature heart disease in my family, and I have been having some unpleasant side effects of blood pressure medicine. I decided to try a completely plant-based diet: grains, vegetables, legumes, fruit, seeds and nuts.

After about a month on the new diet, my total cholesterol dropped 44 points to 159, and the other numbers went from borderline to normal, as measured by my cardiologist. My blood pressure, which was often high in the mornings (typically 150+/90), was 118/68 this morning. I’ve only lost about 5 pounds in the past couple of months, and I’m probably still 8-10 pounds overweight.

I am pleased with the results, but why didn’t any of my doctors recommend this?

— J.S.B.

Dear J.S.B.: Diet is a powerful tool for improving overall health, especially heart health. I believe it is underemphasized by most physicians.

Changing from a meat-based diet to a mostly plant-based diet often prompts improvements in blood pressure, cholesterol and weight. Your results are better than most, but by no means unheard of. You haven’t said how you feel, but many people feel more energetic as well. Many others are able to come off of some (occasionally all) of their medications, which of course reduces side effects.

Why don’t physicians recommend it? I think it’s a combination of reasons. Some doctors don’t realize how powerful the effects of dietary change can be. A good deal of patients are highly resistant to making changes, so physicians are used to their dietary advice failing. Also, taking the time to get an accurate diet history is hard, personalizing dietary advice is harder, and writing a prescription is easy.

It is not necessary to have a 100% vegan diet like yours to experience a benefit. A mostly plant-based diet has substantial benefits. It’s easier for some people to make incremental changes.

Dear Dr. Roach: I am a healthy 73-year-old man who has always had a large prostate. Thirty years ago, my urologist described it more like the size of an orange rather than a walnut. Despite its size, it has never given me any problems — no UTIs, sudden urination, poor stream, waking me in the middle of the night, etc. Despite not having symptoms, about 10 years ago I was prescribed finasteride at a dose of 5 milligrams, and Rapaflo to “try to keep it in check.” In 2018 I had an ultrasound done of my prostate, and it was measured at 185 grams. It was measured again recently and is now 232 grams. My PSA is always in the 3.2-3.5 range.

At what point does a prostate get too large? Should I be concerned even without having any symptoms? To his credit, my urologist discussed my surgical options, along with the related side effects. I am reluctant to do anything if it’s not necessary.

— J.J.

Dear J.J.: The normal prostate gland is about 20 grams, and only 4% of men will develop a prostate over 100 grams. Yours is well past that, though far short of the world record of 2,410 grams.

It is striking that the size of the prostate does not well correlate with a man’s symptoms. Since you have no symptoms and a low PSA level (especially considering the size), there is no indication to do anything surgically. The risk of surgical complications is higher in men with very enlarged prostate glands, so I would certainly be cautious about considering surgery.

Readers may email questions to ToYourGoodHealth@med.cornell.edu

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