Guest guest Posted May 17, 2005 Report Share Posted May 17, 2005 Dear Dr. Grim and All I had a pretty typical day today, in terms of diet. I thought I would post what I've eaten and my sodium intake for discussion or suggestions. I really think I have a pretty low sodium intake, but perhaps I'm missing something. I'm afraid I can't afford a book to learn the DASH diet; I use online sources for sodium information. Breakfast Yogurt, 1/2 C. 46 mg Strawberries, five medium sized 1 mg Honey, 1/2 tsp 5 mg Lunch Garden Salad--Lettuce, one grape tomato, red onion 10 mg Mustard honey dressing, 1/2 tsp. on the side 150 mg 1/2 hoagy roll 200 mg Iced tea, unsweetened 0 mg 1 1/2 meatballs, no sauce 120 mg 1/2 slice provolone cheese 75 mg 1/2 serving cream cake, cream cheese icing scraped off 300 mg Dinner 6-oz. strip steak, unsalted 120 mg hash browns 6 mg 2 eggs, unsalted 148 mg 1 slice toast, buttered 200 mg Unless I miscalculated, this is 1280 mg so far. I expect if I have a snack later, it will consist of strawberries, bananas, or grapes. This is pretty typical; some days are worse, and as you can see, eating out at lunch was the worst part of the day. Baked goods like bread or cake are real trouble-makers. I am going to look into low-sodium bread as Dave suggested before. Any suggestions are welcome. Blood pressure is hovering between 148/91 and 159/96 on 200 mg Spironolactone (100 mg twice daily) and 2.5 mg Lisinopril every other day. Warmly, Pam " I'd rather learn from one bird how to sing, than to teach ten thousand stars how not to dance. " __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2005 Report Share Posted May 20, 2005 Raw (as salad with low Na ranch dressing, diluted with milk) or steamed veggies would help this, and if you like the salty taste for them you could use one of those DASH seasonings. I really like meatball sandwiches too. But when you have more than 300-500mg sodium at one meal, it is not good, according to AHA. That lunch is almost 1 gram. This BP is too high Pam. I worry about you. You seem to have tried everything, but no soap. That crack about the LVH may have grounds in a stats model, but your answer is profound. Has Dr Grim recommended anything? Dave On May 17, 2005, at 3:33 PM, Pamela s wrote: > Dear Dr. Grim and All > > I had a pretty typical day today, in terms of diet. > > I thought I would post what I've eaten and my sodium > intake for discussion or suggestions. I really think > I have a pretty low sodium intake, but perhaps I'm > missing something. I'm afraid I can't afford a book > to learn the DASH diet; I use online sources for > sodium information. > > Breakfast > > Yogurt, 1/2 C. 46 mg > Strawberries, five medium sized 1 mg > Honey, 1/2 tsp 5 mg > > Lunch > > Garden Salad--Lettuce, one grape tomato, red onion > 10 mg > Mustard honey dressing, 1/2 tsp. on the side > 150 mg > 1/2 hoagy roll 200 mg > Iced tea, unsweetened 0 mg > 1 1/2 meatballs, no sauce 120 mg > 1/2 slice provolone cheese 75 mg > 1/2 serving cream cake, cream cheese icing scraped off > 300 mg > > Dinner > > 6-oz. strip steak, unsalted 120 mg > hash browns 6 mg > 2 eggs, unsalted 148 mg > 1 slice toast, buttered 200 mg > > Unless I miscalculated, this is 1280 mg so far. > > I expect if I have a snack later, it will consist of > strawberries, bananas, or grapes. > > This is pretty typical; some days are worse, and as > you can see, eating out at lunch was the worst part of > the day. Baked goods like bread or cake are real > trouble-makers. I am going to look into low-sodium > bread as Dave suggested before. > > Any suggestions are welcome. Blood pressure is > hovering between 148/91 and 159/96 on 200 mg > Spironolactone (100 mg twice daily) and 2.5 mg > Lisinopril every other day. > > Warmly, > > Pam > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2005 Report Share Posted May 20, 2005 This is not a DASH diet as there is not enought K or fruits and vets and too much protein and fat. For DASH think "give me 5" as in 5 fruits AND 5 veggies a day. Again the DASH book costs only $8. I would get it and follow the 14 day challenge diet like your life depended on it and see what happens. If BP does not budge then you will need to either try the rice diet or your team needs to think about adding more meds. What I would do now if this is not possible is to have you collect a 24 hr urine to see if Na in not sneaking in somehow. I strongly recommend the 14 day DASH challenge-at 1200-1800 calories. Keep us posted. May your pressure be low!CE Grim MDClinical Professor of Internal MedicineProfessor of EpidemiologyBoard Certified in Internal Medicine, Geriatrics and Hypertension Re: Low-Sodium Diet Sample Raw (as salad with low Na ranch dressing, diluted with milk) or steamed veggies would help this, and if you like the salty taste for them you could use one of those DASH seasonings. I really like meatball sandwiches too. But when you have more than 300-500mg sodium at one meal, it is not good, according to AHA. That lunch is almost 1 gram. This BP is too high Pam. I worry about you. You seem to have tried everything, but no soap. That crack about the LVH may have grounds in a stats model, but your answer is profound. Has Dr Grim recommended anything? Dave On May 17, 2005, at 3:33 PM, Pamela s wrote: > Dear Dr. Grim and All > > I had a pretty typical day today, in terms of diet. > > I thought I would post what I've eaten and my sodium > intake for discussion or suggestions. I really think > I have a pretty low sodium intake, but perhaps I'm > missing something. I'm afraid I can't afford a book > to learn the DASH diet; I use online sources for > sodium information. > > Breakfast > > Yogurt, 1/2 C. 46 mg > Strawberries, five medium sized 1 mg > Honey, 1/2 tsp 5 mg > > Lunch > > Garden Salad--Lettuce, one grape tomato, red onion > 10 mg > Mustard honey dressing, 1/2 tsp. on the side > 150 mg > 1/2 hoagy roll 200 mg > Iced tea, unsweetened 0 mg > 1 1/2 meatballs, no sauce 120 mg > 1/2 slice provolone cheese 75 mg > 1/2 serving cream cake, cream cheese icing scraped off > 300 mg > > Dinner > > 6-oz. strip steak, unsalted 120 mg > hash browns 6 mg > 2 eggs, unsalted 148 mg > 1 slice toast, buttered 200 mg > > Unless I miscalculated, this is 1280 mg so far. > > I expect if I have a snack later, it will consist of > strawberries, bananas, or grapes. > > This is pretty typical; some days are worse, and as > you can see, eating out at lunch was the worst part of > the day. Baked goods like bread or cake are real > trouble-makers. I am going to look into low-sodium > bread as Dave suggested before. > > Any suggestions are welcome. Blood pressure is > hovering between 148/91 and 159/96 on 200 mg > Spironolactone (100 mg twice daily) and 2.5 mg > Lisinopril every other day. > > Warmly, > > Pam > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2005 Report Share Posted May 20, 2005 In a message dated 5/20/05 6:30:33 PM, spirlhelix@... writes: Hi, Dave I will be asking my nephrologist to give me a K update. I am one of those who has had a pretty low K in the past (2.6). Diet was not able to touch it when it was that low. I was on K supplements (40 MEq a day) while on diuretics and even after I stopped them. Note the DASH diet contains 130 mEq and is cheaper than taking K and less likely to give you GI upset which K tabs can do. I have been going without supplementation while on Spironolactone, but now I need to know exactly what my K looks like on this high a dose. And although I eat potatoes and bananas without hesitation, I hesitate to stress the dietary K too much without knowing my K just now. Yes this is the need to check it but the cramps may be a built in bioassay for low K in you. Keep us posted. I have been getting cramps in my lower legs lately, and the occaisional charlie horse at night. I wonder how my K could possibly be low on this much Spiro, or if the same symptoms are possibly due to high K--or something else entirely. In short, I just need a test. Warmly, Pam May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2005 Report Share Posted May 20, 2005 In a message dated 5/20/05 6:22:49 PM, dave@... writes: Pam, the other thing I was wondering is about potassium. Do you eat bananas, OJ, potatoes, etc. to get the 4500mg Dr Grim suggests, alongside the 1500mg sodium? CAN you on such a high does of spiro? Dave This depends on how much aldo your body is making and how much K and Na you are eating. High aldo takes Na out of the urine into the blood in exchange for putting K in the urine. Thus PA classically has high blood Na and low K. High diet Na will increase K in the urine and lower K in the blood-the higher the aldo the higher the effect of diet Na. This is the reason DASH or Rice helps excess aldo_it is low Na and high K. May your pressure be low! Clarence E. Grim, BS (Chem/Math), MS (Biochem), MD, FACP, FACC, FAHS Clinical Professor of Medicine and Epidemiology Director, Hypertension Diagnosis and Treatment Center Board Certified in Internal Medicine, Geriatrics and Hypertension Published over 220 scientific papers, book chapters and 220 abstracts in the area of high blood pressure epidemiology, physiology, endocrinology measurement, treatment and how to detect curable causes. Listed in Best Doctors in America Specializing in Difficult to Control High Blood Pressure and the History and Physiology of High Blood pressure in the African Diaspora Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2005 Report Share Posted May 20, 2005 In a message dated 5/20/05 6:11:35 PM, spirlhelix@... writes: Hi, Dave Thanks for your concern. I am still striving to maintain an improved diet. Sometimes it just requires some planning to go out to eat. I think I ought to consider picking up a menu or two from some of the places my parents like to eat, since I normally take them out to eat once or twice a week to help them get some fresh air. Then I can know what to order before I get there and have to make a decision on the spot. For example, halfway through a meal out with my parents today, I thought of a great idea for lunch. Too late! I was already eating. "I could have had. . .." a grilled chicken salad with a side order of kid's spaghetti, plain. salad is likley high in salt from the chicken if it was treated with salt as in McDs or some frozen stuff. Then I would have transferred the chicken to the spaghetti and added some fresh lemon juice and parmesean cheese for flavor. Sounds pretty good, huh? My father (age 79) is not driving anymore, since his vascular parkinsonism symptoms have gotten worse. He is having a lot of trouble getting around; I think he will be using a wheelchair regularly soon. Vascular Parkinsonism is caused by multiple strokes. I may joke about my preference for sudden death and LVH, but I know from experience that is really not the worst thing that can happen with uncontrolled hypertension and low K. I live with the effects of stroke (on my father) everyday. Most of these strokes come from poorly treated HTN. Everyones BP should be below 140 and 120 is the best way to grow old without these problems. Even when having some taking diuretics will reduce stroke by up to 70% esp if there is a touch of Diabetes. Check out his BP and be sure it is below 135 (at home 140 in dr office assuming they are measureing it well). Check you Moms also. Recall that all the good effects of diuretics can likely be acheived by DASHing without the bad effects from diuretics-but even if you get DM when you get older and when you are taking Diuretics you are have fewer strokes etc than those who develop DM without diuretics. There is good evidence that lowering BP in the elderly slows the rate of mental decline and mini strokes. We suspect DASHing will do the same if it lowers BP as well. Dash works better in older folks as well.   Since you asked, I also wrote to my nephrologist, who responds by email about my blood pressure. Dr. Grim, do you have any ideas about the blood pressure? I will be sure to ask my nephrologist about a 24-hour urine test for sodium. > > Any suggestions are welcome. Blood pressure is > > hovering between 148/91 and 159/96 on 200 mg > > Spironolactone (100 mg twice daily) and 2.5 mg > > Lisinopril every other day. Thanks! Warmly, Pam --- Dave <dave@...> wrote: > Raw (as salad with low Na ranch dressing, diluted > with milk) or steamed > veggies would help this, and if you like the salty > taste for them you > could use one of those DASH seasonings. I really > like meatball > sandwiches too. But when you have more than > 300-500mg sodium at one > meal, it is not good, according to AHA. That lunch > is almost 1 gram. > > This BP is too high Pam. I worry about you. You > seem to have tried > everything, but no soap. That crack about the LVH > may have grounds in > a stats model, but your answer is profound. Has Dr > Grim recommended > anything? > > Dave > > On May 17, 2005, at 3:33 PM, Pamela s wrote: > > > Dear Dr. Grim and All > > > > I had a pretty typical day today, in terms of > diet. > > > > I thought I would post what I've eaten and my > sodium > > intake for discussion or suggestions.  I really > think > > I have a pretty low sodium intake, but perhaps I'm > > missing something. I'm afraid I can't afford a > book > > to learn the DASH diet; I use online sources for > > sodium information. > > > > Breakfast > > > > Yogurt, 1/2 C.         46 mg > > Strawberries, five medium sized 1 mg > > Honey, 1/2 tsp         5 mg > > > > Lunch > > > > Garden Salad--Lettuce, one grape tomato, red onion > >           10 mg > > Mustard honey dressing, 1/2 tsp. on the side > >                150 mg > > 1/2 hoagy roll        200 mg > > Iced tea, unsweetened      0 mg > > 1 1/2 meatballs, no sauce   120 mg > > 1/2 slice provolone cheese   75 mg > > 1/2 serving cream cake, cream cheese icing scraped > off > >              300 mg > > > > Dinner > > > > 6-oz. strip steak, unsalted  120 mg > > hash browns           6 mg > > 2 eggs, unsalted        148 mg > > 1 slice toast, buttered    200 mg > > > > Unless I miscalculated, this is 1280 mg so far. > > > > I expect if I have a snack later, it will consist > of > > strawberries, bananas, or grapes. > > > > This is pretty typical; some days are worse, and > as > > you can see, eating out at lunch was the worst > part of > > the day. Baked goods like bread or cake are real > > trouble-makers. I am going to look into > low-sodium > > bread as Dave suggested before. > > > > Any suggestions are welcome. Blood pressure is > > hovering between 148/91 and 159/96 on 200 mg > > Spironolactone (100 mg twice daily) and 2.5 mg > > Lisinopril every other day. > > > > Warmly, > > > > Pam > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2005 Report Share Posted May 20, 2005 Hi, Dave Thanks for your concern. I am still striving to maintain an improved diet. Sometimes it just requires some planning to go out to eat. I think I ought to consider picking up a menu or two from some of the places my parents like to eat, since I normally take them out to eat once or twice a week to help them get some fresh air. Then I can know what to order before I get there and have to make a decision on the spot. For example, halfway through a meal out with my parents today, I thought of a great idea for lunch. Too late! I was already eating. " I could have had. . .. " a grilled chicken salad with a side order of kid's spaghetti, plain. Then I would have transferred the chicken to the spaghetti and added some fresh lemon juice and parmesean cheese for flavor. Sounds pretty good, huh? My father (age 79) is not driving anymore, since his vascular parkinsonism symptoms have gotten worse. He is having a lot of trouble getting around; I think he will be using a wheelchair regularly soon. Vascular Parkinsonism is caused by multiple strokes. I may joke about my preference for sudden death and LVH, but I know from experience that is really not the worst thing that can happen with uncontrolled hypertension and low K. I live with the effects of stroke (on my father) everyday. Since you asked, I also wrote to my nephrologist, who responds by email about my blood pressure. Dr. Grim, do you have any ideas about the blood pressure? I will be sure to ask my nephrologist about a 24-hour urine test for sodium. > > Any suggestions are welcome. Blood pressure is > > hovering between 148/91 and 159/96 on 200 mg > > Spironolactone (100 mg twice daily) and 2.5 mg > > Lisinopril every other day. Thanks! Warmly, Pam --- Dave <dave@...> wrote: > Raw (as salad with low Na ranch dressing, diluted > with milk) or steamed > veggies would help this, and if you like the salty > taste for them you > could use one of those DASH seasonings. I really > like meatball > sandwiches too. But when you have more than > 300-500mg sodium at one > meal, it is not good, according to AHA. That lunch > is almost 1 gram. > > This BP is too high Pam. I worry about you. You > seem to have tried > everything, but no soap. That crack about the LVH > may have grounds in > a stats model, but your answer is profound. Has Dr > Grim recommended > anything? > > Dave > > On May 17, 2005, at 3:33 PM, Pamela s wrote: > > > Dear Dr. Grim and All > > > > I had a pretty typical day today, in terms of > diet. > > > > I thought I would post what I've eaten and my > sodium > > intake for discussion or suggestions. I really > think > > I have a pretty low sodium intake, but perhaps I'm > > missing something. I'm afraid I can't afford a > book > > to learn the DASH diet; I use online sources for > > sodium information. > > > > Breakfast > > > > Yogurt, 1/2 C. 46 mg > > Strawberries, five medium sized 1 mg > > Honey, 1/2 tsp 5 mg > > > > Lunch > > > > Garden Salad--Lettuce, one grape tomato, red onion > > 10 mg > > Mustard honey dressing, 1/2 tsp. on the side > > 150 mg > > 1/2 hoagy roll 200 mg > > Iced tea, unsweetened 0 mg > > 1 1/2 meatballs, no sauce 120 mg > > 1/2 slice provolone cheese 75 mg > > 1/2 serving cream cake, cream cheese icing scraped > off > > 300 mg > > > > Dinner > > > > 6-oz. strip steak, unsalted 120 mg > > hash browns 6 mg > > 2 eggs, unsalted 148 mg > > 1 slice toast, buttered 200 mg > > > > Unless I miscalculated, this is 1280 mg so far. > > > > I expect if I have a snack later, it will consist > of > > strawberries, bananas, or grapes. > > > > This is pretty typical; some days are worse, and > as > > you can see, eating out at lunch was the worst > part of > > the day. Baked goods like bread or cake are real > > trouble-makers. I am going to look into > low-sodium > > bread as Dave suggested before. > > > > Any suggestions are welcome. Blood pressure is > > hovering between 148/91 and 159/96 on 200 mg > > Spironolactone (100 mg twice daily) and 2.5 mg > > Lisinopril every other day. > > > > Warmly, > > > > Pam > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2005 Report Share Posted May 20, 2005 Pam, the other thing I was wondering is about potassium. Do you eat bananas, OJ, potatoes, etc. to get the 4500mg Dr Grim suggests, alongside the 1500mg sodium? CAN you on such a high does of spiro? Dave On May 20, 2005, at 4:08 PM, Pamela s wrote: > Hi, Dave > > Thanks for your concern. I am still striving to > maintain an improved diet. Sometimes it just requires > some planning to go out to eat. I think I ought to > consider picking up a menu or two from some of the > places my parents like to eat, since I normally take > them out to eat once or twice a week to help them get > some fresh air. Then I can know what to order before > I get there and have to make a decision on the spot. > > For example, halfway through a meal out with my > parents today, I thought of a great idea for lunch. > Too late! I was already eating. " I could have had. . > . " a grilled chicken salad with a side order of kid's > spaghetti, plain. Then I would have transferred the > chicken to the spaghetti and added some fresh lemon > juice and parmesean cheese for flavor. Sounds pretty > good, huh? > > My father (age 79) is not driving anymore, since his > vascular parkinsonism symptoms have gotten worse. He > is having a lot of trouble getting around; I think he > will be using a wheelchair regularly soon. Vascular > Parkinsonism is caused by multiple strokes. I may > joke about my preference for sudden death and LVH, but > I know from experience that is really not the worst > thing that can happen with uncontrolled hypertension > and low K. I live with the effects of stroke (on my > father) everyday. > > Since you asked, I also wrote to my nephrologist, who > responds by email about my blood pressure. > > Dr. Grim, do you have any ideas about the blood > pressure? I will be sure to ask my nephrologist about > a 24-hour urine test for sodium. > >>> Any suggestions are welcome. Blood pressure is >>> hovering between 148/91 and 159/96 on 200 mg >>> Spironolactone (100 mg twice daily) and 2.5 mg >>> Lisinopril every other day. > > Thanks! > > Warmly, > > Pam Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2005 Report Share Posted May 20, 2005 Hi, Dave I will be asking my nephrologist to give me a K update. I am one of those who has had a pretty low K in the past (2.6). Diet was not able to touch it when it was that low. I was on K supplements (40 MEq a day) while on diuretics and even after I stopped them. I have been going without supplementation while on Spironolactone, but now I need to know exactly what my K looks like on this high a dose. And although I eat potatoes and bananas without hesitation, I hesitate to stress the dietary K too much without knowing my K just now. I have been getting cramps in my lower legs lately, and the occaisional charlie horse at night. I wonder how my K could possibly be low on this much Spiro, or if the same symptoms are possibly due to high K--or something else entirely. In short, I just need a test. Warmly, Pam --- Dave <dave@...> wrote: > Pam, the other thing I was wondering is about > potassium. Do you eat > bananas, OJ, potatoes, etc. to get the 4500mg Dr > Grim suggests, > alongside the 1500mg sodium? CAN you on such a high > does of spiro? > > Dave > > On May 20, 2005, at 4:08 PM, Pamela s wrote: > > > Hi, Dave > > > > Thanks for your concern. I am still striving to > > maintain an improved diet. Sometimes it just > requires > > some planning to go out to eat. I think I ought > to > > consider picking up a menu or two from some of the > > places my parents like to eat, since I normally > take > > them out to eat once or twice a week to help them > get > > some fresh air. Then I can know what to order > before > > I get there and have to make a decision on the > spot. > > > > For example, halfway through a meal out with my > > parents today, I thought of a great idea for > lunch. > > Too late! I was already eating. " I could have > had. . > > . " a grilled chicken salad with a side order of > kid's > > spaghetti, plain. Then I would have transferred > the > > chicken to the spaghetti and added some fresh > lemon > > juice and parmesean cheese for flavor. Sounds > pretty > > good, huh? > > > > My father (age 79) is not driving anymore, since > his > > vascular parkinsonism symptoms have gotten worse. > He > > is having a lot of trouble getting around; I think > he > > will be using a wheelchair regularly soon. > Vascular > > Parkinsonism is caused by multiple strokes. I may > > joke about my preference for sudden death and LVH, > but > > I know from experience that is really not the > worst > > thing that can happen with uncontrolled > hypertension > > and low K. I live with the effects of stroke (on > my > > father) everyday. > > > > Since you asked, I also wrote to my nephrologist, > who > > responds by email about my blood pressure. > > > > Dr. Grim, do you have any ideas about the blood > > pressure? I will be sure to ask my nephrologist > about > > a 24-hour urine test for sodium. > > > >>> Any suggestions are welcome. Blood pressure is > >>> hovering between 148/91 and 159/96 on 200 mg > >>> Spironolactone (100 mg twice daily) and 2.5 mg > >>> Lisinopril every other day. > > > > Thanks! > > > > Warmly, > > > > Pam > > > > Quote Link to comment Share on other sites More sharing options...
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