DEAR DR. ROACH: I am a 68-year-old man, 5-feet-10-inches tall and weighing 223 pounds. Last January, my weight was up to 247, so I decided to diet and exercise in order to lose the excess. My goal is to get below 200.

In a recent visit to my physician, I told him that I was losing weight by restricting my total calories to 1,700 per day on a seven-day running average (so I can go out to eat once in a while). I am trying to keep my fats below 30 percent on a seven-day calorie basis, and I am trying to keep total carbs to 50 percent or so.

My physician told me that my diet plan was “old-school.” He said that I should eliminate all sugars and all grains. I should eat a couple of ounces of meat and/or eggs. And I should eat as many fruits and vegetables as I want without worrying about calories.

In your opinion, should I follow his advice, or should I continue with what has been working for me? — J.B.

ANSWER: Your physician is right that counting calories is “old-school.” However, if you can stay with it, it will work. If you expend more calories than you take in, you will lose weight. That is the energy balance equation, and there are no exceptions.

However, the issue isn’t so straightforward as you might think from that statement. Fat and protein make almost everybody feel more full and satisfied, comparing meals of the same calories, than a high-carbohydrate meal. Plain, fresh fruits and vegetables, absent of dips or sauces that load on the calories, are low in calories, in most cases, and can be eaten in relatively large amounts without slowing weight loss much. I also agree with your physician that simple sugars and processed grains add calories without a lot of real nutrition and don’t fill you up much (and may even make you hungrier later). I don’t think all grains need to be avoided: The fiber present in whole grains also improves satiety, and I recommend that all grains be whole grains. However, some people find that eliminating grain entirely helps them.

By all means, you can stick with what works for you. That being said, most people find that by adding a little healthy protein and fat, you can stick with your eating plan with less hunger or discomfort. Losing weight can make people feel a little uncomfortable. But I think you will find that the eating plan he outlined, while still keeping an eye on calories, will allow you to reach your weight goals and keep you on track while still feeling well.

DEAR DR. ROACH: Due to cancer, my prostate was removed about seven years ago. My PSA reading has increased since 2012 from 0.09 to 0.304. Should I be concerned? I am 78 years old and in relative good health. — B.D.

ANSWER: PSA readings can go up and down, but a threefold increase could mean that the cancer is coming back, and you should see the specialist taking care of your prostate cancer to discuss getting additional testing.

Not having disease for seven years after treatment is a good sign, but the PSA test is pretty specific for cancer recurrence if two separate readings are above 0.2. You may need additional therapy, but only further investigation will show how concerned you need to be.

The booklet on the prostate gland discusses enlargement and cancer. Readers can obtain a copy by writing: Dr. Roach — No. 1001, 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.

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 [email protected] or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from

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