Diet can lower blood pressure

April 22, 2013 By

Q: My husband just returned from his doctor and was told to go on a DASH diet. I guess I should have accompanied him for his visit because I prepare all our meals and don’t have a clue what he is talking about. He’s not overweight so I don’t understand why his doctor might have even suggested this. Can you get me started in the right direction?

A: The DASH (Dietary Approaches to Stop Hypertension) diet was designed to help lower blood pressure readings. In addition, it just may offer additional health benefits by providing protection against stroke, cancer, heart disease, obesity, and more. It focuses on eating foods high in potassium, calcium and magnesium, all nutrients found naturally in fruits, vegetables, seeds, nuts, legumes, and low-fat dairy products. Red meat and fats are allowed in minimal amounts. The diet also endorses fish, poultry and whole grains, but clearly recommends a reduction in sodium intake since salt can contribute to hypertension. Along these lines, there are two versions for a person to consider – a standard DASH diet that allows up to 2,300 mg of sodium daily and a lower sodium version that allows 1,500 mg of sodium per day. While these numbers may appear high, traditional diets are indicative of 3,500 mg or more on a daily basis – levels that far exceed all dietary guidelines.

Except for minimal amounts of red meat and fats, neither diet is restrictive. An individual can have four to five servings of fruit or fruit juice daily; four to five servings of vegetables or vegetable juice; three servings of low-fat dairy; seven to eight servings of grains; and four to five servings of nuts, seeds and legumes each day. The red meat/fish/chicken should be approximately six ounces (about the size of a deck of cards) ; fruit should be medium in size; one fourth cup if dried; one half cup if liquid. Vegetables are a cup if lettuce or raw, leafy varieties; one half cup if chopped or cooked; one half cup if juice. Dairy can be one cup of yogurt, one and one half ounces of cheese; or eight ounces of milk. Grains include one slice of bread; one ounce of dry cereal; and one half cup cooked cereal, rice or pasta. On a weekly basis, nuts are allowed in one third cup servings, seeds two tablespoons, and cooked dried beans or peas.

This regimen may appear daunting but once you get the hang of it, it should be relatively easy to follow. And, it likely won’t happen in your kitchen or mine overnight. Begin slowly. Once a specific phase of the diet is incorporated and becomes routine, proceed with the next step. For example, keep a zip lock bag of raw vegetables in your refrigerator for snacking on. Make up a low-cal, low-sodium dip to enhance their flavor. For desserts, take that yogurt suggestion and add nuts or seeds and fresh fruit as a topping for a satisfying change.

High blood pressure readings can be lowered by behaving prudently, making modest lifestyle changes and, when necessary and at the recommendation of a physician, taking one or more of the many anti-hypertensive drugs available on the market today.

Readers who would like related information can order Dr. Gott’s Health Report “Hypertension” by sending a self-addressed, stamped number 10 envelope and $2 in a US check or money order to Peter H. Gott, M.D. Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

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Man has one kidney and many problems

March 18, 2013 By

Q: My husband has various medical issues that make creating a menu almost impossible. Help is needed for recommendations of what to do and not to do.

He only has one kidney, controls his diabetes with diet (so far), has high blood pressure, gout, plantar fasciitis, and a bad knee and back that make walking/running difficult. What is good for one thing is bad for another. HELP. He is the love of my life and I want him around for decades to come.

A: The kidneys clean waste and extra fluids from the body, help control blood pressure, make red blood cells, maintain a proper balance of minerals in the blood, and even help keep bones healthy. They are located just below the rib cage on each side of the spine and partially protected by the rib cage at the back. You don’t indicate why your husband has only one kidney, but essentially there are three main reasons: he was born that way, one was removed because of injury or disease, or he chose to donate one to someone whose kidney(s) had failed. The body is a truly amazing thing; if only one kidney is present, the body adjusts accordingly and that one kidney functions as two normally would. So, whatever the reason, he can live with only one but must, as you are clearly aware, take some precautions.

Dietary choices should be healthy ones. He should eat fruits, vegetables, grains, and low-fat dairy products. His alcohol and caffeine intake should be rather limited, and his sodium (salt) intake should be 2,000 mg or less daily if he already has a diagnosis of hypertension. Consuming a moderate amount of protein is important for proper nutrition but he should avoid a high-protein diet because of the increased stress placed on the one kidney he has.

While he should avoid contact sports such as boxing, wrestling and football, he can exercise in other ways. For example, he might consider aerobic swimming at a local community center, walking, riding a stationary bicycle in your home, and more. In fact, some health centers offer exercise programs done from a chair and sitting position.

I can understand your husband’s diagnosis of gout because his one kidney may not successfully clear uric acid from his body and gout attacks can precipitate kidney stones that can lead to kidney disease. Generally speaking, however, gout can be controlled with oral medication – specific drugs to prevent attacks, and other meds to reduce the pain and discomfort once an attack has begun.

Plantar fasciitis is inflammation of the tissue on the bottom of the foot. It occurs when this already thick band of tissue is over-used or stretched to excess. It is most common in men between the ages of 40 and 70. Common causes for the condition include being a long-distance runner, obesity, sudden weight gain, having either high arches or flat feet and wearing shoes with poor or no arch supports, and having a tight Achilles tendon. Treatment commonly begins with over-the-counter ibuprofen or acetaminophen, stretching exercises, rest, the application of ice, and more. A splint worn while sleeping might be an option. Unfortunately, treatment can take several months before real progress is seen.

Back and knee pain can have causes too numerous to mention, but I would venture a guess that his immobility might contribute to both issues. Before even making any recommendations, I would feel better if your husband had an examination and possibly X-rays either through his primary care physician or an orthopedic specialist to rule out unknown causes. If no condition or abnormality is found, appropriate suggestions for a reduction of pain can be made.

You’ve got a lot on your plate. Begin with an appointment with your husband’s nephrologist and PCP. Request a recommendation to a top dietitian and physical therapist, both of which will have numerous issues to cover. You should accompany him since you’re the menu planner. With strict adherence, your husband just might be able to keep his sugar levels within control, lower his hypertension, control his gout, reduce his level of pain, and remain in your life for decades to come.

Readers who would like related information can order Dr. Gott’s Health Reports “Hypertension”, Gout,” and “Diabetes” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order to Dr. Gott’s Health Reports, PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) or print an order form from www.AskDrGottMD.com.

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On hypertension and heart disease

March 4, 2013 By

Q: I read your column faithfully and respect your knowledge of medical problems. Would you explain to me the difference between heart disease and hypertension? Are they the same thing? We are asking these questions for my husband so he can see another doctor and are not sure if his high blood pressure is heart disease or not. Thank you for your help.

A: I will explain the two separate conditions that can be related but without knowing your husband’s symptoms and history, I cannot determine his diagnosis. Heart disease covers a wide range of disorders that affect the heart and may include congenital defects, arrhythmias, infection, and coronary artery disease also known as cardiovascular disease. High blood pressure is a common disorder marked by abnormally high readings. When no specific cause can be found, the condition is referred to as essential hypertension. When a specific cause is determined, the condition is referred to as secondary hypertension. Hypertension against arterial walls refers to the arteries that may surround and serve the heart, as well as those that serve the brain, kidney and extremities. I’ll begin by briefly covering heart disease.

Risk factors for heart disease include hypertension that is uncontrolled with medication, a smoking habit that constricts blood vessels, age, family history, diabetes, obesity, and poor diet. Diagnosis can be made through an EKG, Holter monitor, echocardiogram, X-ray,CT, MRI, laboratory testing and numerous other methods.

Congenital heart defects are commonly detected shortly after birth and may include shortness of breath, cyanosis (a pale gray or blue skin tone), and edema of the abdomen and legs. Those defects not diagnosed early on include symptoms of fatigue with activity, edema of the extremities, shortness of breath and a build-up of fluid in the lungs or heart.

An arrhythmia indicates an abnormal heartbeat that can be detected by a physician, physician assistant, nurse, nurse practitioner or other health care provider using a stethoscope. Signs and symptoms include heart flutter, chest pain, fainting, bradycardia (slow beat), tachycardia (rapid beat), chest pain and more. Causes may include high blood pressure, coronary artery disease, diabetes, drug abuse, excessive alcohol consumption, caffeine, and the use of some prescription/over-the-counter/herbals/ dietary supplements.

Infections of the heart that may represent the cause include endocarditis, (inflammation of the inside of the heart), pericarditis (inflammation of the membrane that covers the heart), and myocarditis that affects the middle layer of the walls of the heart. Symptoms include fever, edema of the legs or abdomen, fatigue, shortness of breath, chest pain and more. Causes for infection include viruses or bacteria that enter the bloodstream. Causes unrelated to infection include rare side effects to antibiotics such as penicillin and sulfonamides, having a connective tissue disorder such as lupus, and more.

Coronary artery disease occurs when coronary arteries become damaged or diseased. Plaque on the arteries is commonly to blame for the condition that prevents the heart and all parts of the body from receiving a sufficient supply of blood. Symptoms include angina (chest pain), shortness of breath and more. Causes include hypertension, high cholesterol levels and diabetes.

On to hypertension. There are numerous reasons for a person to have high readings, such as obesity, stress, consuming too much salt, smoking, drinking to excess, family history and diabetes. Many individuals have hypertension without symptoms. In fact the condition is known as the silent killer because with a lack of symptoms, such conditions as heart disease can develop.

If your husband is found to have essential hypertension, medication and lifestyle changes might be sufficient to bring his levels to an acceptable level. If he has secondary hypertension, the cause should be investigated, properly diagnosed, and treated appropriately.

He should see his primary care physician or a cardiologist who can order testing and determine if his hypertension is linked with a heart condition. Some lifestyle changes may be in order initially, such as losing weight, exercising, eating a healthful diet, and taking prescription medication.

Readers who would like related information can order Dr. Gott’s Health Reports “Hypertension” and “Coronary Artery Disease” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

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A “new” old hypertension drug

February 4, 2013 By

Q: At a recent presentation by a local physician, I learned of an old drug that is being “rediscovered” as a miracle for high blood pressure – spironolactone. Specific mention was new research done at the Mayo Clinic.

It’s a low-cost generic so we aren’t going to be seeing advertisements for it by the drug companies but is this a drug I should be considering to control my blood pressure?

A: Spironolactone is a diuretic (water pill) that works in a variety of ways. It is sometimes used in combination with other medications to treat hypertension, congestive heart failure. It prevents a person’s potassium levels from dropping too low, keeps the body from absorbing too much salt, helps control fluid retention in both liver cirrhosis and a kidney disorder known as nephrotic syndrome. It also treats a condition that can result in too much aldosterone in the body. Aldosterone is a hormone produced by the adrenal glands that, when working properly, regulates a person’s salt/water balance efficiently.

There are circumstances in which the drug is ill-advised, such as when a person consumes too much salt or products containing potassium, drinking alcohol, and when becoming dehydrated. The consumption of too much salt will cause the body to retain water. Salt substitutes and low-sodium milk products can cause potassium levels to rise to unsafe levels, a condition known as hyperkalemia. Alcohol can exacerbate the side effects of the drug; and, lastly, drinking too much liquid following periods of excessive sweating or with dehydration can be unsafe.

A patient should take the medication specifically as recommended by his or her physician. Each dose should be taken with a full eight ounce glass of water and the individual should have periodic blood tests to avoid unwanted side effects. Ordinary dosing for hypertension, fluid retention, and hypokalemia is between 25 and 200 mg daily by mouth in one or two divided doses. Doses vary for the treatment of congestive heart failure, hyperaldosteronism and excessive body hair.

Side effects include muscle pain or weakness, decreased urinary output, tremors, confusion, paresthesias, an uneven heart rate, nausea, dry mouth, irregular menses, abnormal hair growth on various parts of the body, vomiting, headache, skin rash and more. As I have stated frequently, some individuals can take a medication and have extremely good results without any side effects, while others may be unable to tolerate a drug – even if it is over-the-counter ibuprofen. It appears you are fortunate and without unwanted issues.

Individuals considering the drug should give their health care providers information on all other drugs they currently take, including prednisone, non-steroidal anti-inflammatories to include ibuprofen, naproxen, numerous prescription drugs, and over-the-counter therapies such as potassium supplements and herbals.

Readers who would like related information can request Dr. Gott’s Health Reports “Hypertension: and “Consumer Tips on Medicine” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order to Peter H. Gott, M.D. Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) when writing or print an order form from www.AskDrGottMD.com.

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Hypertension tough to manage

December 26, 2012 By

Q: I am a male, 79 years of age, in relatively good health. Many are surprised when they become aware of my age, commenting how much younger I appear. I’m 5’11” and weigh 177 pounds stripped. I’m very active, always keeping mentally and physically busy; however, I have suffered with hypertension and cholesterol problems for years. I tried statins for the cholesterol but discontinued them after suffering joint problems. If I watch my intake of sweets, my readings can drop from 240 to possibly 170. I follow a healthy diet, limiting red meat to once a week with a couple of days of fish and chicken. One day may also be meatless.

The primary reason for soliciting your advice is my hypertension problem. During the past three or four years the readings have averaged about 140/75. I’ve been taking hydrochlorothiazide (HCTZ) 25 mg and Diovan 160 mg during that time. My diastolic is almost always in the 60s. I read once in your column [Read more…]

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Chronic cough may be due to meds

October 19, 2012 By

DEAR DR. GOTT: I am 68-year-old woman who suffers from high blood pressure and diabetes. I take a 25 mg Carvedilol tablet as well as a 25 mg hydrochlorothiazide pill; each twice a day. I am continually stricken with severe spasms in my rib cage area, not to mention a dry hacking cough that just won’t go away. My physician as well as several pharmacists are perplexed since my potassium levels are normal. Your advice is greatly needed and appreciated.

DEAR READER: Chronic cough can have many causes from acid reflux to a medication side effect to lung tumors with more benign causes being the most common. In your case, I believe the most likely culprit is one or more of your medications. Your rib cage muscle spasms may be the result of a vitamin or mineral imbalance or simply the result of constantly coughing.
[Read more…]

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Hypertensive drug to blame for weight gain

August 7, 2012 By

DEAR DR. GOTT: I am a female with ESRD, stage 4. My doctor prescribed 100 mg metoprolol approximately 2 ½ years ago. Before that he had prescribed another high blood pressure medicine. My problem is that I am slowly gaining weight, over 20 pounds in two years, and lately I have frequent diarrhea. I am also tired most of the time. I am an older woman and realize that my metabolism is slower and may be contributing to my weight gain. However, I try to stay away from fried foods and processed foods. I exercise about three to four times a week for 30 minutes. Could the metoprolol be causing weight gain and is there a better blood pressure medicine that my doctor could prescribe? Thank you.

DEAR READER: For other readers who may be unaware, ESRD stands for end-stage renal disease, a condition that signifies the almost complete failure of the kidneys to work efficiently. It is likely your kidneys may have begun slowing down 10 or even 20 years before you entered this stage. [Read more…]

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When the numbers are too high

July 28, 2012 By

DEAR DR. GOTT: I’m a 42-year-old male diagnosed with pre-hypertension. My blood pressure was running 150/90 so my doctor put me on Micardis (telemisartan/hydrochlorothiazide 80/1.25 mg). My question is, why is he putting me on such a high dose? Should I go to another doctor and get a second opinion?

DEAR READER: By my standards, pre-hypertension is a systolic pressure between 120 and 139, with a diastolic pressure between 80 and 89. I don’t know if your physician has given you the benefit of the doubt with one reading only and is leaning toward the diagnosis or if you have been seeing him or her for quite some time and your numbers have been steadily creeping up. I consider you to be beyond pre-hypertension. You are a stage 1 hypertensive. As you are likely aware, the first number reported (the systolic) is the pressure exerted against your arteries during the beat of your heart. [Read more…]

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Hypertensive patient wants off Cozaar

July 5, 2012 By

DEAR DR. GOTT: I’m a 54-year-old black female in good health. My only med is Cozaar 100 mg for hypertension. I walk 3 or 4 times a week for at least 40 minutes or more, eat lots of fresh fruits and veggies, and maintain a healthy weight. My height is 5’5”, my weight 149 pounds.

What can I do to safely wean myself off this medication? What are some natural supplements I can use instead of medication?

DEAR READER: Cozaar is in a group of drugs known as angiotension II receptor antagonists. This drug prevents helps keep blood vessels from contracting which, in turn, lowers blood pressure and improves the flow of blood throughout the body. [Read more…]

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Diet causes blood pressure changes

April 18, 2012 By

DEAR DR. GOTT: I have been on your diet since February and have lost 10-15 pounds. I didn’t realize that it could lower my blood pressure in addition to the weight loss. I began noticing dizziness periodically during the day so my cardiologist reduced my blood pressure medicine. Recently I noticed I was still having some dizziness and got winded with little exertion so my doctor had me hospitalized where I was diagnosed with hypotension. All’s well now but I suggest that you make it clear that your diet can also cause lowered blood pressure so that those on medication can be alert to the problem of hypotension. Thanks.

DEAR READER: I do specifically mention that weight loss in general as well as from my diet, can reduce blood pressure (as well as cholesterol, blood sugar, and more) in my book “Dr. Gott’s No Flour, No Sugar Diet”. I have also recommended weight loss as an aid to [Read more…]

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