DEAR DR. ROACH: It seems that eating a healthy diet with an emphasis on nuts and seeds, fruits, vegetables and grains is the best choice for anyone. It’s been well-documented that omega-6 is inflammatory, whereas foods containing omega-3 are not. It seems to me that we should be consuming foods that have more omega-3 in them. The only problem is that, from my research, all nuts and seeds with the exception of chia and flaxseeds have a much higher ratio of the omega-6 to the omega-3. This appears to be the case with most foods, no matter which food group they are in. How can any of the healthy foods be beneficial when so much more of the “bad fats” are being ingested?

— Anon.

ANSWER: Dietary fats are categorized into four groups: monounsaturated, polyunsaturated, saturated and trans-saturated. It is accepted that monounsaturated fats have a healthy effect, reducing heart disease risk, while trans-saturated fats are clearly harmful.

The effect of saturated fats on health is mixed, but those that come from processed meat increase heart disease and diabetes risk. Saturated fat overall has little effect on heart disease risk, but swapping saturated fat with unsaturated fats (both polyunsaturated and monounsaturated) appears to reduce heart disease risk.

Polyunsaturated fats are categorized into the omega-3 family and the omega-6 family. I also have read in many places that omega-6 fats are “bad fats,” causing inflammation. The best evidence, a 2014 review of all controlled trials published, showed that omega-6 fats are NOT inflammatory and that they DECREASE risk of heart disease compared with meat-based saturated fats.

We should be consuming both omega-3 and omega-6 polyunsaturated fats, mostly from plant sources. The data support that nuts and seeds are foods we should be eating more of, but we also should be eating good sources of omega-3, including fatty fish, the chia and flaxseeds you mentioned, as well as walnuts and canola oil. Most people have to work harder to get omega-3 oils but get plenty of omega-6.

DEAR DR. ROACH: Hi. I’m a very healthy, 68-year-old male. My only issue is almost nonexistent testosterone. What type of doctor should I see? It seems to be a problem for many senior men.

— A.

ANSWER: Low testosterone is a concern for many men as they get older. In some cases, the concern is justified. Some men may have a problem making testosterone due to a condition in the brain (the hypothalamus and pituitary gland both need to be working properly for testosterone production) or in the testes, where testosterone is actually made. In these cases, testosterone replacement therapy is clearly indicated.

What is still controversial is whether to treat healthy older men who have a low testosterone level and no symptoms. It’s not clear that treatment of low testosterone will prevent problems in the future. It’s possible that’s the case, but I am very cautious about prescribing a drug with potential harms for someone without symptoms, when it has not been proven to be of benefit.

However, men with symptoms of low testosterone, such as low sex drive, depressed mood and loss of body hair, and who have clearly low testosterone levels may benefit from treatment, and a trial of testosterone treatment is appropriate. Men should learn about potential risk (prostate cancer remains a concern despite reassuring early studies) and have regular laboratory evaluation.

Low energy by itself is not clearly a symptom of low testosterone and may not improve with testosterone treatment.

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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 send mail to 628 Virginia Dr., Orlando, FL 32803.

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