Dear Dr. Gott: I am an active 71-year-old woman with a cholesterol reading of 258, which I know is high.

I do not want to go on medication, and my doctor seems to feel that since I am not heavy, exercise regularly and my HDL is excellent, I shouldn't be concerned.

I don't eat meat or fats and watch what I do eat. I also read that taking flaxseed is good for lowering cholesterol levels, so I take a tablespoon of flaxseed meal each morning.

Is my doctor correct in advising me that I shouldn't be concerned? Is there anything else I should be doing to lower the numbers since I really do not want to take statins? I would appreciate hearing your opinion on this.

Dear reader: More and more emphasis is being placed today on lowering total cholesterol levels. Excessive amounts of cholesterol in the blood have been linked to plaque developing in blood vessels.

Over time, plaque build-up can lead to inadequate amounts of blood travelling through the arteries.

This, in turn, can cause coronary-artery disease, heart attack and stroke.

Optimal values for total cholesterol are below 200 mg/dL. With a level of 258, you are above the normal range and are at an increased risk for related medical issues.

I fully appreciate your reluctance to go on statin drugs. There are a number of medications in the category that work by blocking a substance the liver requires to make cholesterol.

While some people can take statins without experiencing any side effects, others have reported cramping, nausea and diarrhoea. Follow-up laboratory blood testing is vital to be assured there is no liver damage, another common side effect.

You already watch your diet, exercise and take flaxseed. If you smoke, which I doubt, you should discontinue the habit.

Alcohol can be consumed in modest amounts. Excessive amounts can lead to liver, heart and other organ damage.

My guess is that your problem may be genetic, so you could have higher-than-normal levels despite all your efforts.

Consider eating oatmeal for breakfast and salmon once or twice weekly for dinner.

Try adding cinnamon to breakfast cereals and other food items. Over-the-counter niacin can lower triglycerides by limiting the liver's ability to produce low-density lipoprotein (LDL or "bad") cholesterol. A recommended initial dose is 250 milligrams daily with incremental increases to 1,000 milligrams daily.

Niacin can cause flushing and itching that can be counteracted by taking an antihistamine or an 81-milligram aspirin about 15 minutes prior to taking the niacin.

There are several other drugs available without prescription that might be a good first step.

They generally contain plant sterols that have been reported to lower levels.

Speak with your physician regarding your concerns about being placed on a statin drug and discuss options.

I'm inclined to agree that you needn't worry, but he or she just might have some alternative suggestions.

To give you related information, I am sending you a copy of my newly revised Health Report "Understanding Cholesterol".

Other readers who would like a copy should send a self-addressed, stamped, No. 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Doctor Gott is a retired physician and the author of the book "Dr. Gott's No Flour, No Sugar Diet," available at most chain and independent bookstores, and the recently published "Dr. Gott's No Flour, No Sugar Cookbook." Write directly to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, NY 10016.