DEAR DR. DONOHUE: To reduce my husband’s cholesterol, triglycerides and blood pressure, his doctor put him on the DASH diet. Then he developed a blood clot in his leg after a long plane ride and was put on Coumadin. Then he developed gout and was put on a low purine diet. These diets conflict and don’t leave him many healthy choices. Can you suggest what to do? – S.B.

ANSWER: Take heart. Things aren’t as bad as they seem

The DASH (Dietary Approach to Stop Hypertension) brings down blood pressure, cholesterol and triglycerides. It emphasizes whole grains, fruits and vegetables, and de-emphasizes red meat. It requires seven grain-food servings a day, preferably whole grain – grain with its bran intact (unrefined flour). A serving is one slice of bread, an ounce of dry cereal or half a cup of cooked rice, pasta or cereal.

Four or five vegetable servings are called for, and a serving is 1 cup of leafy vegetables, half a cup of cooked vegetables or 6 ounces of vegetable juice. The same numbers of fruit servings are on the diet, and a serving is a quarter-cup of dried fruit, a medium piece of fresh fruit or half a cup of fresh or frozen fruit. Two or three low-fat dairy servings are on the menu, with a serving being 8 ounces of milk or a cup of yogurt. Red meat and poultry are kept to two daily servings, with a serving being 3 ounces. For fats and oils, two or three servings are allowed, and a serving is 1 teaspoon of margarine, 1 teaspoon of vegetable oil or 2 tablespoons of light salad dressing. Every week, four or five servings of nuts and beans are allowed. A serving here is 1.5 ounces of nuts and half a cup of dried beans.

People on Coumadin are told to avoid green leafy vegetables, because those vegetables contain vitamin K, which counteracts the blood-thinning effect of Coumadin.

However, if a person is consistent with the daily intake of these vegetables and if the blood tests indicate good Coumadin control, then the vegetables aren’t banned.

Purine foods are limited for people with gout. Purine foods are metabolized to uric acid, which infiltrates joints to cause a gout attack. Meats – especially organ meats like liver – are the source of purine. The amount of meat on the DASH diet isn’t a threat. All vegetables are permitted, even if they contain purines – mushrooms, spinach, beans and cauliflower. Vegetable purine doesn’t raise blood uric acid.

DEAR DR. DONOHUE: Two years ago, I had a small, quarter-inch round thing above my right breast. The doctor said to leave it alone. It disappeared completely. Now it’s back. Should I leave it alone or have it removed? The doctor said to leave it alone. – P.L.

ANSWER: If the doctor can give the round thing a name and if it’s not an indication of anything serious, I’d leave it alone. If the doctor isn’t sure, I’d have a dermatologist look at it.

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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