DEAR DR. ROACH: I am 55 years old, take no medication and am in good health. However, I’m about 25 pounds overweight. Starting four months ago, I eliminated most carbohydrates from my diet — no pasta, potatoes, rice, flour, bread or sweets. I have always eaten many vegetables and fish, but have increased my vegetable, fish and cheese intake to make up for the lack of those other foods. And I have successfully lost nine pounds without really trying. My friend, upon hearing that I eliminated those carbohydrates, was horrified, stating that this is very bad for my health. I explained that I have not increased my red meat consumption, but she’s adamant. Can you comment? Thank you. — P.H.

ANSWER: There remains a great deal of controversy about the topic of low-fat diets versus low-carbohydrate diets. There is evidence on both sides. But what you are doing isn’t too controversial — and it’s almost all good. Pasta, potatoes, rice, flour and bread are all starches, a type of complex carbohydrate, and are all turned into sugar in your bloodstream. Sweets are directly absorbed as sugar. For many people, that increases risk of diabetes as well as predisposing them toward weight gain. Perhaps most importantly, those calories aren’t as filling as calories from protein, fiber or fat.

Taking in more vegetables and fish is also a great idea. Although vegetables are essentially 100 percent carbohydrates, they aren’t changed to sugar nearly as quickly as the starches. Having a little protein or healthy fat, such as olive oil or nuts, also slows down absorption and conversion to blood sugar. Whole grains have more fiber, which slows down their absorption and provides more micronutrients than bleached versions of the starches. Your fish is providing protein and essential fatty acids.

The only concern is cheese, much of which is saturated fat, and that isn’t so good for you, so go easy on it. But the fact that you have lost nine pounds easily, and made dramatic improvements in your diet, means I can safely reassure your horrified friend.

HELLO, DR. ROACH: I have not seen this particular concern of mine addressed by any of the doctors’ columns. Perhaps you can find an answer for me, which will be very much appreciated. My question is whether Coumadin (warfarin) is a lifetime drug. I had triple bypass heart surgery in 1997. I contracted atrial fibrillation about five years thereafter, when I was put on warfarin. For the past 10 years, I have had a regular heartbeat. This being the case, is it possible for me to discontinue this drug? — T.P.

ANSWER: Atrial fibrillation is a chaotic, uncoordinated movement of the atria, the top chambers of the heart. It puts people at high risk for stroke, but the anticoagulant warfarin reduces the risk of stroke. Some people are in atrial fibrillation all the time; others go in and out of it, which we call paroxysmal atrial fibrillation. Some people can feel when they go into the abnormal rhythm; others can’t.

People with paroxysmal atrial fibrillation still need anticoagulation. Your doctor may want to be sure you aren’t going in and out of atrial fibrillation without knowing it before considering taking you off warfarin. This usually is proven by wearing a Holter monitor, which measures your heart rhythm for 24 or 48 hours. Talk to your doctor. It’s worth doing, because warfarin has the possibility of significant side effects, and it would be great to remove those risks if you no longer need the medication.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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