DEAR DR. DONOHUE: I am 59 years and 9 months old, 5 feet 6 inches tall and weigh between 160 and 165 pounds, and I am not happy about my weight. It’s the reason for this letter. I had success with Weight Watchers, and also tried auricular therapy (massage or acupuncture of the ear), which worked for a while. I see an endocrinologist for an underactive thyroid and a gastroenterologist for Crohn’s disease, which I have had since age 23 and which is controlled. I am at my wits’ end. I never feel satisfied after eating and am constantly hungry. I feel like the signal from my stomach to the brain is not working. Help. — A.P.

ANSWER: You’re not alone in that feeling. There are huge gaps in our knowledge of weight and appetite control. Your sentence about a connection between the stomach and brain is quite appropriate. Leptin, a product of fat cells, stops us from overeating when we have taken in all the calories we need. It appears that some overweight people are insensitive to the effect leptin should have. Another body-made appetite-control substance is ghrelin, made by the stomach. It encourages the continued intake of food. Neither of these natural chemicals has immediate bearing on weight control. I mention them only to show you that weight gain and appetite satiety are complicated by the interaction of a variety of body signals. Someday the puzzle will be solved.

I calculated your body mass index, an indicator of how much of our weight is fat. A normal BMI falls between 18.5 and 24.9. Your BMI is 26.3 — overweight, but not by much. The only current way to lose weight is to limit calories and increase the amount of calorie burning through exercise. A diet based on vegetables, fruits and whole grains with restrictions on highly sugared foods and saturated fats is bound to take weight off. You need to lose only a few pounds to attain a normal BMI. Why have you given up on Weight Watchers? I am impressed with the results they achieve.

DEAR DR. DONOHUE: Will you please provide the pros and cons of using salt in the diet? Why is water retention considered so bad? I am an 81-year-old man with stents in five heart arteries and one in the left carotid artery. My blood pressure is controlled with one medicine. — E.W.

ANSWER: What makes salt (sodium, sodium chloride) a danger to health is its tendency to raise blood pressure. We need only 500 mg of salt a day, yet we take in more than five times that amount. Salt’s contribution to the elevation of blood pressure is something that people can alter without resorting to medicines. Salt does contribute to fluid retention. That extra fluid finds its way into the circulation, and blood pressure rises. That’s the condensed version of the salt story. High blood pressure promotes heart attacks and strokes.

The booklet on high blood pressure explains why it is so important to lower elevated pressure and how to go about doing that. Readers can obtain a copy by writing: Dr. Donohue — No. 104, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Will you please explain what a Baker’s cyst is? The doctor told me I have one, and it is painful. — E.M.

ANSWER: A Baker’s cyst is a behind-the-knee swelling. Actually, it’s a bursa filled with fluid. Bursas are thin, pancake-shaped structures placed between tendon and bones to cut down on friction when tendons rub across the bone.

A Baker’s cyst connects to the knee joint by a tunnel with a one-way valve in it. Fluid can pass from the knee into the bursa, but it can’t drain back out of the bursa. The one-way valve prevents it from doing so. Knee trouble usually is the reason why joint fluid increases. A swollen bursa can be tender and painful.

Elevating the leg and wrapping an elastic bandage around the knee and the bursa reduce the swelling. So does taking one of the many NSAID medicines, such as Aleve or Advil. A doctor can drain the fluid with a syringe and needle, but the swelling often returns. Instilling cortisone into the drained bursa helps prevent fluid reaccumulation. A surgeon will remove a persistently swollen and painful bursa.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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