So I recently started a combo of drugs for my hypertension. One is a potassium sparing diuretic, the other is a thiazide diuretic.
I had my electrolytes tested. My potassium is fine and didn’t drop too low, but my sodium is almost at the cutoff for low at 136 mEq/L. The cutoff is 135.
My diet is not good, I get plenty of sodium. My question is, is there any benefit for people eating a low sodium diet vs taking a diuretic pill?
I know someone with a health condition where they both have to limit their sodium intake as well as take a diuretic. Isn’t there a risk thats going to cause their sodium to get too low? Also why is a sodium limited diet + a diuretic pill superior to a normal sodium diet + 2 diuretic pills?
I get the impression that there is a strong strain of puritanism in medicine. That people believe illness is due to moral failure (sloth, laziness, gluttony, lust) and if people use their moral fiber to engage in morally superior behavior, they will be healthy. Eat this food, avoid this food, being hungry is good, exercise a lot, etc. A hundred years ago telling people to not masturbate was considered health advice, and sadly its come back as the nofap movement.
So my question is, is there a medical benefit of a low sodium diet vs just taking a pill that removes sodium in the kidneys?
Off the top of my head, yes. Because of what is required to achieve a low sodium diet. You cannot achieve a low sodium diet and eat lots of processed crap. If you eat a diet aimed at low sodium you will also be eating fairly little highly processed and junk foods and eating more vegetables and fruits. The model dietary approach to stop hypertension is the DASH eating plan, and while its focus is on hypertension it has a host of other benefits as well. A diuretic alone - does not.
ETA With or without sodium restriction thiazides do run a defined risk of making sodium go too low (hyponatremia). Dietary restriction alone does not.
That leads me to a question. (Not for you!)
Is the sodium level detected in blood work the number that counts?
(I eat way too much salt, but my sodium levels are always in the ‘green zone’. So when doctors tell me to cut back on salt my only thought is ‘But my sodium levels are perfect!’)
Not for the purposes of blood pressure control. Total body sodium is. Your body will work hard to keep the concentration within a narrow range. That’s what that number is, its concentration. More sodium in there will result in more water in the vessels to dilute it, to keep the concentration in that range. More water in same vessels means it is under higher pressure. Same concentration but more absolute amount.
As already mentioned, there are many benefits switching over to a healthy low sodium diet that you’ll never get just taking a diuretic pill. It’s never too late to switch to eating healthy and avoiding processed and window (fast food) eating.
When you buy packaged food at the grocery store make sure you read the label and avoid ultra-processed foods as much as possible. If you can switch to a whole-food diet with lots of veggies, fruits, nuts, and healthy proteins, like eggs, chicken, and seafood, you can reduce you hypertension naturally. But changing your diet is hard, so make changes gradually over time.
In my experience, doctors rarely, if ever, talk about diet and nutrition since it’s much easier to prescribe a medication than suggesting someone change their lifestyle choices.
My doctors have always talked to me about diet and nutrition. In fact my current doctor put me into a nutrition support group run by a registered dietitian. It’s an online session and I find it quite helpful. I have had high blood pressure all my life and have to maintain a healthy weight, or it becomes hard to control even with medication. I’ve been on blood pressure meds since my mid twenties when I was 5’10” and 140 lbs. When I’m at 200 lbs the drugs I need to take require me to have bloodwork every three weeks. On a scale of 1-100, I’m probably a 95 in motivation. And it’s hard for me.
So have my brother’s doctors. He also is overweight (actually obese) and suffers from metabolic impacts of it. But less urgent and severe. He can’t walk two miles, but his blood pressure is fine. His cholesterol and A1C not so good.
But the reality is that most people do not respond to this coaching. And if you’re seeing your doctor once or twice a year, the message doesn’t stick with you at every meal choice.
My brother is constantly traveling. It’s very hard to maintain a healthy diet and exercise regimen, unless you’re highly motivated. I changed jobs ten years ago because I couldn’t manage it with the extensive travel. Setback in my career for sure. I will not consider jobs with more than 10% travel (5 trips per year)
So in terms of patient outcomes “prescribing diet and exercise changes” is not effective for the overwhelming majority of patients. At least not without investing 50 hours a year in provider time (not necessarily a doctor, but dietician and nurse).
Which of course quickly becomes very discouraging for the providers who do invest the effort.
And let’s be real. The vast majority of patients already know the information. A provider telling them that a diet high in vegetables and fruits, high in real foods rich in fiber, low in highly processed crap, is not going to be a big reveal. They know this. The provider can reemphasize how important it is. They can be a cheerleader reinforcing the positive steps the person is making. They can coach a bit and connect to others who can spend more time and energy coaching. But the guidance itself is for most involved a “no duh doc.”
I have never had a doctor ask me about my diet or nutrition, let alone offer me any advice in that regard, and I’m 70 years old and have had a number of very good PCPs.
Perhaps it’s because I never had metabolic issues. While I was overweight for much of my adult life, at least as far as my BMI was concerned, I had never been obese.
The only advise from a doctor I ever got regarding my weight was the offhand comment “you could lose a few pounds” as he was wrapping up my visit. No discussion about what I was eating or how I suppose to “lose a few pounds” because my blood values were always good. At that point I had never dieted in my life.
When I decided it was time to clean up my diet and lose the weight I did the research myself since I only see my PCP once a year and I wasn’t going to wait around for eight months until my next visit. It all worked out for me, I just wish I had done it 30 years earlier.
Thing is that you don’t have to have hypertension, hypercholesterolemia, obesity, or other identifiable conditions for healthy nutrition and exercise habits to be important. Not waiting until then is definitely preferred!
That said some primary care providers are more into preventation than others. And some are more effective at it than others.
Doctors have a hard enough time getting people who do have these issues to change their diet. I mean, we all know people who are overweight and ate a meat and potatoes diet their whole lives but live into their 80s or 90s. The odds are not in their favor, but people don’t think like that.
Doctors practicing prevention at “retail” is not efficient. There just isn’t enough doctor time per patient.
A year and a half ago I saw my PCP for a check up and she said, “your blood pressure is getting high, let me prescribe something.”
I’d put on some weight (thanks, lockdowns!) and wasn’t exercising up to my usual standards, so I said, “I don’t want medication just yet, let me try to bring it down with healthier habits.” She looked doubtful but said, “okay, I’ll see you in 6 months.”
I came back in 6 months, after having lost my “Covid 15” and having resumed my normal exercise routine. BP was fine and dandy!
The doctor admitted she was surprised - “I know you said you could do it with lifestyle changes, but most people don’t.”
Of course, I had something of an advantage; my weight gain and lack of exercise were the aberrations, not my slimmer, daily-5k self. Still, it was interesting to see her attitude. It may be not so much that it is “easier” to prescribe medication than to counsel on lifestyle modification (though it probably is), but that most doctors have had little success getting their patients to make long term healthy adjustments.
I think everyone knows poor lifestyle is bad for your health, but not everyone feels the tradeoff of improved health is worth the effort of changed lifestyle.
Its no different than people who like to ride motorcycles. Its bad for your health, but a lot of people accept the risks.
I think this is key. Taking a pill is a lot easier than dieting or exercising, and doctors know that most people won’t keep up with their lifestyle changes over the long run while they will continue taking their medication since it’s relatively “painless”. Congratulations on doing the right thing and not going for the easy med fix. Let’s hope you can keep up your lifestyle changes for as long as you need to.
Patients, and to some degree providers, get myopic. The issue is the cholesterol number or the blood pressure number or the number on the scale … and “success” of lifestyle choices is hitting some target on that number. A target that a medication can hit more reliably and with less work for all involved. Going on the medication to hit that number (say after diet and exercise have not hit the number for whatever reason) then obviates any need to keep up with healthier lifestyle choices. The number is okay, goal!
Then there’s people like me who genetically or who knows what just naturally run a little hot in the blood pressure department. I had never seen 120/80 or below until my doctor put me on 5/20 amlodopine/benazapril. I had been running 40+ miles a week at an average intensity of 7:30/mile for several years, not eating processed foods for the most part (maybe 10% of my diet – I cook for myself and my family), and I still was clocking in at 160/95, sometimes higher. As soon as I took that pill, that was the first time I saw my blood pressure recorded at “normal” levels. Even in high school running track and at 16 years old, it was like 135-140/85-90 on average. For me, there really was no lifestyle to change unless I became an Olympic athlete and, I don’t know, hunted and foraged my own food.
That’s me with cholesterol. I was training for my first marathon, thin, fit, eating very healthily, and was still high LDL. A whiff of Lipitor and my LDL was lower than my HDL and generally has been ever since.
The point though is that your exercise was still important to maintain even though your blood pressure control was achieved with medication. And my lifestyle choices were as well even though my cholesterol was only treatable with medication.
That said without Lipitor I might have had a first heart attack by now, no matter how much I exercise and eat right.
Yes, a good friend of mine who was probably one of the healthiest and fittest people I knew (his wife was a dietician, so he had help) had high cholesterol as a genetic “gift.” He had to take that pill or potentially stroke out at a youngish age as his dad did.