Dear Doctor: We're often told we can consume alcohol, sweets, or burgers and fries "in moderation." My sister and I had a conversation about that sort of recommendation just the other day. What does moderation actually mean? Is it one beer a day? One burger a month? Ten french fries once a week?

Dear Reader: You're right -- moderation is a term that makes a lot of sense in theory but turns out to be somewhat slippery when it comes to actual practice. That's because moderation is relative and varies from person to person. What amounts to a moderate amount of a certain food or beverage for one person may actually be a binge for someone else. And moderation isn't only about the amount or the type of food or beverage -- it's linked to an individual's patterns of consumption as well.

Let's look at alcohol, for example. The current guidelines, put forth by the National Institute of Alcohol Abuse and Alcoholism, define low-risk drinking for women as no more than seven drinks per week, with no more than three drinks on any single day. For men, that number is no more than 14 drinks per week, and no more than four on any one day. (One drink is further defined as 5 ounces of wine, one 12-ounce bottle or can of beer, and 1 ounce of hard liquor.) A man who abstains from drinking during the week, but then downs four drinks per night over the weekend, is technically within the safe drinking guidelines. However, that pattern, which goes from zero to the edge of a binge, doesn't exactly say moderation.

When it comes to sweets, snacks and splurge foods like the burger and fries you mention in your letter, things get a bit murkier. For patients in our practices, we start with the advice to set a baseline with a healthful, balanced diet. In our opinion, that's lean proteins and fish, whole grains and legumes, and a wide variety of fresh fruits and vegetables. When it comes to sweets and treats, whether it's a foray into the potato chip aisle of the grocery store, a visit to the ice cream shop or dinner at your favorite burger joint, make them a fraction of your weekly -- or monthly -- calories. For our patients who are in ideal health, we advise a split of 80 percent being good about diet, and 20 percent "cheat." For those with diabetes, hypertension or any cardiac issues, the ratio changes to 90 percent good and 10 percent cheat.

One of the best guides to figuring out moderation is how the cheat or binge made you feel after it was over. A hangover after a few cocktails or a headache the morning after a chocolate spree, and your body may be asking you to please take a step back and reconsider. That doesn't mean you have to give up on splurges. Indulge in your pleasures, but in quantities and at a frequency that don't require the word "guilty."

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: What is considered a normal blood pressure for a person in their late 70s? My doctor said it should be in area of 120/80. But I have read that older persons' pressure may be higher -- closer to 140/90 -- and that pressure would not be dangerous. Am I the only one confused by the new blood pressure guidelines?

Dear Reader: No, you are not alone in struggling to understand the revised blood pressure guidelines. They were issued in November 2017, and we have been receiving mail about them ever since. The questions aren't limited to the lay public, either. Due to several issues, which we'll address in a moment, these more stringent guidelines are also an ongoing topic of discussion among health care providers. But let's start with your main question.

You're correct that in the past, blood pressure goals for elderly adults were looser. They allowed for a slightly higher range for normal blood pressure compared to younger adults. However, the newest guidelines do not make the same allowances. As your doctor explained, the American College of Cardiology and the American Heart Association now define normal blood pressure for adults as readings less than 120/80. If the top number falls between 120 and 129, even with a lower number of 80 or less, this is considered to be elevated blood pressure. Readings of 130/80 and higher are the threshold for several escalating stages of high blood pressure. At this time, these guidelines apply to all healthy adults, regardless of their age.

By some estimates, the updated guidelines have moved close to half of all adults into the hypertension category, basically overnight. Part of the thinking behind the update was that flagging potential hypertension earlier would encourage patients and their doctors to discuss appropriate lifestyle changes. However, the rigor of the new goals has caused quite a bit of discussion, and even discord.

The updated guidelines are based on results from a study known as the Systolic Blood Pressure Intervention Trial, or SPRINT. In the study, participants rested quietly for five minutes before their blood pressure readings, which were taken with an automated device. Three consecutive readings were then averaged together to arrive at a final number. This is different enough from the way in which blood pressure is typically measured in a doctor's office that many health care professionals have made the argument that the methodology had a statistically significant impact on results. In addition, they address your question, saying it's unreasonable to expect someone in their later years to have the same blood pressure as someone in their 30s.

None of this changes the fact that hypertension is dangerous. Blood pressure that is uncontrolled raises your risk of grave health problems, which include blood clots, stroke, kidney disease, heart disease and heart attack. Not only that, the higher the numbers, the higher the risks. Our advice is to discuss the issue with your primary care physician, who is familiar with your general health, your medical history and any specific risks that you face. He or she will help you set the blood pressure goals that are right for you.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I've been on blood pressure medication for 20 years and am now going through menopause. For me, this includes anxiety attacks. Symptoms of stroke and anxiety attacks seem pretty similar. How can I know for sure if I'm having a stroke versus an anxiety attack?

Dear Reader: It's true that the hormonal changes that take place during menopause, specifically to estrogen and progesterone, can result in feelings of anxiety that range from mild to extreme. And while an anxiety attack is considered a psychological disorder, it causes physical effects that can be distressing. That's because when we become anxious, stressed or panicky, our brains send signals to the body that it should prepare to protect itself, either through fight or flight. Those signals include the release of adrenaline and cortisol, which are often referred to as stress hormones. They cause the heart to race and the blood vessels to constrict, which can result in symptoms like dizziness, nausea, feeling faint, sweating, tingling sensations or numbness in the hands and feet, muscle weakness, heart arrhythmias, sudden headache, and a sense of dislocation or unreality.

Stroke, meanwhile, is a physical event. It occurs when blood flow to the brain is interrupted. A lack of blood means a lack of oxygen, which causes brain cells to begin to die. In a hemorrhagic stroke, a weakened blood vessel either leaks or ruptures. In an ischemic stroke, an obstruction impedes the flow of blood. When the interruption of blood flow is temporary, this is known as a transient ischemic attack, or TIA.

As you say, anxiety attacks and all three types of stroke can share overlapping symptoms. The strokes themselves can vary in the way that they present. However, one thing that all strokes have in common is the sudden onset of symptoms. These include:

-- Sudden numbness or weakness in arms, legs or face, particularly when it affects just one side of the body.

-- Trouble seeing or a loss of vision that affects one or both eyes.

-- A sudden onset of confusion, inability to understand speech or the inability to speak.

-- The instant onset of a massive headache.

-- The abrupt loss of coordination, balance or the ability to walk or move about.

If you do ever experience any of these symptoms, call 911. It's vital to seek medical care immediately. If possible, make note of the time the first symptom appeared, as this is information that may affect treatment decisions. The Centers for Disease Control and Prevention recommend calling 911 over accepting a ride to the hospital. Response times are swift, and paramedics can start life-saving treatment the moment they reach you. This may seem obvious, but never try to drive yourself to an ER if you suspect a stroke. You can become incapacitated while behind the wheel.

Finally, we believe it's wise to talk to your family doctor about the anxiety attacks. Although a certain level of anxiety can accompany menopause, anxiety attacks, particularly if they are ongoing, are unusual. At the very least you can discuss your fears about stroke with your doctor. And it's quite possible she or he can help you with medications or other interventions to lessen the impact of your symptoms.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)