RE: spiro

[Guest guest]

Natalia, When I reported to my doc my agonizing nights that I could not breathe and no matter how much I washed and blow out my nose some nights I had no sleep and following day I was tired, all that he could advise was prescribing Vaseline for me to rub inside my nose…it worked but then I noticed whenever I stay at my cousins out of the town no matter how many times I get up at night rubbing Vaseline it does not properly open my nose…and once I noticed they added a lot of salt to their food for cooking…and later when Vaseline did not work I tried other nasal sprays and liquids to no avail until once I could not sleep at night and after all these nasal cures that did not work I took a glass of K-citrate and in 10 minutes I went to sleep and had no trouble breathing…and gradually with all the emphasis of Dr. Grim to avoid salt and problems that salt causes I reached the conclusion of keeping my K/Na at a level that I can breathe at night.My guess based on a recent publication on problems of reducing salt intake is that we need some amount of salt to keep our chemistry in proper balance…so no longer I am afraid of salt but rather I keep it to minimum level slightly above craving level and then adjust my K-supp high enough in order to stay in normal condition.Max.62M L adenoma by NP59 scan. High aldos not low renin. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet, heat intolerance, insulin resistance} Max, There are two new thoughts in your posting.1. How did you figure out the connection between nasal inflammation and K/Na ratio? Only intuitively or you had done some research on it? Do you have cramps when you have low K or your nasal inflammation is the main symptom of low K? Do you start to feel badly when your K is low? 2. About salt craving and the amount of salt that we eat. Likely you are right. I noticed the same thing. Now, when I cook everything by myself and put a little bit of salt, my craving is getting much better. Also, it might be that we are getting used to small amount of salt, you don't think so? I am also lazy and I didn't count my salt daily either, but I approximate that. I know that I have to eat about 500 mg with every main meal and I try not to exceed this amount every time. My snacks are usually fruit, vegetables and Swiss cheese, that don't contain much sodium. Many thanks, very interesting. Natalia

[Guest guest]

Max- u and ur team understand that BB and CCBS may not work well in PA? While Dashing well and MCBS may be all I need. As K corrects need for DM meds will likely go away?May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Natalia, When I reported to my doc my agonizing nights that I could not breathe and no matter how much I washed and blow out my nose some nights I had no sleep and following day I was tired, all that he could advise was prescribing Vaseline for me to rub inside my nose…it worked but then I noticed whenever I stay at my cousins out of the town no matter how many times I get up at night rubbing Vaseline it does not properly open my nose…and once I noticed they added a lot of salt to their food for cooking…and later when Vaseline did not work I tried other nasal sprays and liquids to no avail until once I could not sleep at night and after all these nasal cures that did not work I took a glass of K-citrate and in 10 minutes I went to sleep and had no trouble breathing…and gradually with all the emphasis of Dr. Grim to avoid salt and problems that salt causes I reached the conclusion of keeping my K/Na at a level that I can breathe at night.My guess based on a recent publication on problems of reducing salt intake is that we need some amount of salt to keep our chemistry in proper balance…so no longer I am afraid of salt but rather I keep it to minimum level slightly above craving level and then adjust my K-supp high enough in order to stay in normal condition.Max.62M L adenoma by NP59 scan. High aldos not low renin. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet, heat intolerance, insulin resistance} Max, There are two new thoughts in your posting.1. How did you figure out the connection between nasal inflammation and K/Na ratio? Only intuitively or you had done some research on it? Do you have cramps when you have low K or your nasal inflammation is the main symptom of low K? Do you start to feel badly when your K is low? 2. About salt craving and the amount of salt that we eat. Likely you are right. I noticed the same thing. Now, when I cook everything by myself and put a little bit of salt, my craving is getting much better. Also, it might be that we are getting used to small amount of salt, you don't think so? I am also lazy and I didn't count my salt daily either, but I approximate that. I know that I have to eat about 500 mg with every main meal and I try not to exceed this amount every time. My snacks are usually fruit, vegetables and Swiss cheese, that don't contain much sodium. Many thanks, very interesting. Natalia

[Guest guest]

Please look at the Na in your Swiss cheeseMay your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Max,There are two new thoughts in your posting.1. How did you figure out the connection between nasal inflammation and K/Na ratio? Only intuitively or you had done some research on it? Do you have cramps when you have low K or your nasal inflammation is the main symptom of low K? Do you start to feel badly when your K is low? 2. About salt craving and the amount of salt that we eat. Likely you are right. I noticed the same thing. Now, when I cook everything by myself and put a little bit of salt, my craving is getting much better. Also, it might be that we are getting used to small amount of salt, you don't think so? I am also lazy and I didn't count my

salt daily either, but I approximate that. I know that I have to eat about 500 mg with every main meal and I try not to exceed this amount every time. My snacks are usually fruit, vegetables and Swiss cheese, that don't contain much sodium.Many thanks, very interesting.Natalia To: hyperaldosteronism Sent: Saturday, November 19, 2011 12:44

AMSubject: RE: spiro

Natalia, I am lazier than what you think to count my salt daily intake…but then I listened to a famous psychologist on radio speaking of OCD and laughing at those who waste their life in measuring daily calories and food measurements…and that gave me the necessary good excuse to just add minimum amount of salt such that I do not crave for salt…so when I crave for salt I know that I have not taken enough salt…and consequently, I don’t mind to add to my K sup if needed especially before bed time if I take a snack then I also drink 25 mEq K-citrate sup otherwise during sleep I get nasal inflammation preventing breathing smoothly and I

realize that my K/Na ratio has been low that day and I try to adjust it the following day. Summary: I keep my salt to minimum just slightly above salt craving level and keep K/Na ratio such that at night I can breathe…and this gives me normal daily BP too with Spiro=100 mg! …of course without calculations (don’t tell this to Dr. Grim!) Max.62M L adenoma by NP59 scan. High aldos not low renin. med combo

#76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet, heat intolerance, insulin resistance} So, Max, what do you think now, how much sodium is optimal for you? My guess is that there is some optimum and it's probably somewhere between 1500 and 2000 mg :-) Natalia

[Guest guest]

Max. You say high also not low renin can u refer me to details. Unless did renin and also at same time and on no meds it will not be clear what u mean by high also but not low renin??May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Natalia, When I reported to my doc my agonizing nights that I could not breathe and no matter how much I washed and blow out my nose some nights I had no sleep and following day I was tired, all that he could advise was prescribing Vaseline for me to rub inside my nose…it worked but then I noticed whenever I stay at my cousins out of the town no matter how many times I get up at night rubbing Vaseline it does not properly open my nose…and once I noticed they added a lot of salt to their food for cooking…and later when Vaseline did not work I tried other nasal sprays and liquids to no avail until once I could not sleep at night and after all these nasal cures that did not work I took a glass of K-citrate and in 10 minutes I went to sleep and had no trouble breathing…and gradually with all the emphasis of Dr. Grim to avoid salt and problems that salt causes I reached the conclusion of keeping my K/Na at a level that I can breathe at night.My guess based on a recent publication on problems of reducing salt intake is that we need some amount of salt to keep our chemistry in proper balance…so no longer I am afraid of salt but rather I keep it to minimum level slightly above craving level and then adjust my K-supp high enough in order to stay in normal condition.Max.62M L adenoma by NP59 scan. High aldos not low renin. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet, heat intolerance, insulin resistance} Max, There are two new thoughts in your posting.1. How did you figure out the connection between nasal inflammation and K/Na ratio? Only intuitively or you had done some research on it? Do you have cramps when you have low K or your nasal inflammation is the main symptom of low K? Do you start to feel badly when your K is low? 2. About salt craving and the amount of salt that we eat. Likely you are right. I noticed the same thing. Now, when I cook everything by myself and put a little bit of salt, my craving is getting much better. Also, it might be that we are getting used to small amount of salt, you don't think so? I am also lazy and I didn't count my salt daily either, but I approximate that. I know that I have to eat about 500 mg with every main meal and I try not to exceed this amount every time. My snacks are usually fruit, vegetables and Swiss cheese, that don't contain much sodium. Many thanks, very interesting. Natalia

[Guest guest]

Information on low sodium cheese also should be able to look at other links.

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Tuesday, January 29, 2008

Low Sodium Cheese

Finding low sodium cheeses is quite difficult. They are not readily available at most local grocery stores. Of course, you can always order them from a low sodium online source, but I don't like the idea of plunking down a bunch of money for a product & its shipping, only to discover that it tastes yucky. My local grocery stores all carry Alpine Lace Reduced Sodium Muenster Cheese (1 slice = 85 mg. sodium) in the self-service section of their delis. The cheese tastes OK (muenster is rather bland to start with), but is very soft and almost impossible to separate. I don't buy it very often as a result.My local Safeway carries its house brand of sliced Primo Taglio Reduced Fat Low Sodium Lacy Swiss (1 slice = 35 mg. sodium). It's usually pretty easy to separate the slices, so I buy it often and use it in sandwiches.I've found that Swiss cheese has the lowest sodium content of any regular type cheese; most regular cheese has 170 mg. sodium per oz. or even more. You have to check the labels, of course, but most blocks of Swiss cheese have a sodium content similar to the Tilamook Swiss Cheese (1 oz. = 60 mg.) I often purchase. I'll even buy sliced Swiss from the deli counter after I ask about its sodium content.Our favorite cheese is Tilamook Sharp Cheddar (1 oz. = 170 mg. sodium). Obviously, I have to be careful using it, and I've developed a "work around." When I shred cheese, I use half sharp cheddar & half block Swiss. Doing it that way, I lower the sodium content considerably and the flavor is as good or even better.I've discovered that fresh mozzarella cheese is naturally low in sodium. My local grocery stores carry Mozzarella Fresca (1 oz. = 95 mg. sodium) and Smoked Mozzarella Fresca (1 oz. = 25 mg. sodium). The fresh mozzarella is quite soft, so before I slice it for pizza, I usually stick it in the freezer for about 15 minutes. This stiffens it up enough so I can slice it fairly easily.Safeway carries an unsalted cottage cheese. Unfortunately, it tastes like chalk! However, there are two "work around" options if you're a cottage cheese lover. OPTION #1: Buy one container of the Lucerne No Salt Added 1% Cottage Cheese (1/2 cup = 45 mg. sodium) and one container of Lucerne 2% Cottage Cheese (1/2 cup = 410 mg. sodium). Combine the two containers and re-pack. Now you'll have a lower sodium cottage cheese (1/2 cup = 228 mg. sodium) that has some flavor. Not a perfect solution, but the no salt alternative is inedible in my estimation. OPTION #2: Buy one container of the Lucerne No Salt Added 1% Cottage Cheese (1/2 cup = 45 mg. sodium) and add 1/2 tsp. of Kosher salt; mix well. This will also give you a lower sodium content (1/2 c. = 180 mg. sodium). Again, not a perfect low salt solution, but, take my word for it, the no salt cottage cheese is dreadful.

Posted by shambo at 3:42 PM

Labels: Cheese

10 comments:

Anonymous said...

THANK YOU for your advice and sharing what you have discovered. My husband has to be on low sodium and we were wondering what sort of cheese to choose. Your site has given us very useful information. Thanks again - Ross & Micky

February 3, 2009 11:14 PM

Anonymous said...

Thank you so much for posting this information. My four-year-old granddaughter recently had to start taking prednisone and we are struggling to find ways to include her favorite meals (ie: pizza!)in our low sodium diet for her. The shredded cheese combo you mentioned sounds tasty! Thanks Again, Carolyn and Savannah

March 5, 2009 7:42 PM

TheMachine1 said...

You can dramatically reduce the sodium in shredded cheese by a quick soak in water. It does tend to get water logged though. I cooked a pizza and it had a puddle of water. So it needs to be dried some how.

January 4, 2010 12:29 AM

shambo said...

I've found that using a combination of fresh mozzarella and Swiss cheese along with some regular mozzarella works really well for pizza. You end up with less sodium than if you used all regular mozzarella.

January 4, 2010 11:18 PM

scrapper al said...

Thank you for this information. I already cook (relatively) low sodium, but now need to learn how to cook even lower sodium for my FIL. I was trying to figure out what to do about cheese since FIL is Italian. It looks like I can still make him lasagne if I'm careful.

March 26, 2010 7:00 PM

Anonymous said...

Lorraine Swiss, and Reduced Fat Lorraine Swiss sodium is 75 mg per ounce, which equals to one deli slice. One slice is big enough to cut in half lowering it to around 35-40 mg. I sell this in my low sodium section of my deli. Very strong taste also.

August 29, 2010 6:42 PM

Cheese said...

Thank you so much for posting this Article.My wife like this.

March 8, 2011 11:14 AM

said...

Thank you for sharing your research. I was looking for a low sodium cheese. As a former grocery cashier, I have seen many fresh mozzarella go through and now I know why. In my dieting I wanted to keep my salt down and every time cheese and processed meats seemed to defeat me.

May 5, 2011 12:09 PM

nicholas said...

THANKS FOR POSTING THIS HELPFUL INFORMATION. LOW SODIUM IS NOT EASY TO FIND ANYWHERE!

May 19, 2011 6:10 AM

Liz said...

Thank You So much for posting this, it is so difficult to find cheeses and now I know what I can look for. I really appreciate it!

July 4, 2011 2:03 PM

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Why low sodium?

Several years ago my husband was diagnosed with congestive heart failure and high blood pressure. He was put on a low sodium diet. He's done very well with it, but it has been a tremendous challenge for me. If I hadn't been a good cook to start with, familiar with all kinds of spices & herbs, and always interested in experimenting with inventive techniques or borrowing them from others, the meals would have been far too boring for him to live with.

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> > > Max,> > > > There are two new thoughts in your posting.> > 1. How did you figure out the connection between nasal inflammation and K/Na ratio? Only intuitively or you had done some research on it? Do you have cramps when you have low K or your nasal inflammation is the main symptom of low K? Do you start to feel badly when your K is low? > > 2. About salt craving and the amount of salt that we eat. Likely you are right. I noticed the same thing. Now, when I cook everything by myself and put a little bit of salt, my craving is getting much better. Also, it might be that we are getting used to small amount of salt, you don't think so? > > > > I am also lazy and I didn't count my salt daily either, but I approximate that. I know that I have to eat about 500 mg with every main meal and I try not to exceed this amount every time. My snacks are usually fruit, vegetables and Swiss cheese, that don't contain much sodium.> > > > Many thanks, very interesting.> > > > Natalia> > > > > > > > > > > To: hyperaldosteronism > > Sent: Saturday, November 19, 2011 12:44 AM> > Subject: RE: spiro> > > > > > Natalia,> > > > I am lazier than what you think to count my salt daily intake…but then I listened to a famous psychologist on radio speaking of OCD and laughing at those who waste their life in measuring daily calories and food measurements…and that gave me the necessary good excuse to just add minimum amount of salt such that I do not crave for salt…so when I crave for salt I know that I have not taken enough salt…and consequently, I don’t mind to add to my K sup if needed especially before bed time if I take a snack then I also drink 25 mEq K-citrate sup otherwise during sleep I get nasal inflammation preventing breathing smoothly and I realize that my K/Na ratio has been low that day and I try to adjust it the following day.> > > > Summary: I keep my salt to minimum just slightly above salt craving level and keep K/Na ratio such that at night I can breathe…and this gives me normal daily BP too with Spiro=100 mg! …of course without calculations (don’t tell this to Dr. Grim!)> > > > Max.> > 62M L adenoma by NP59 scan. High aldos not low renin. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet, heat intolerance, insulin resistance}> > > > > > So, Max, what do you think now, how much sodium is optimal for you?> > My guess is that there is some optimum and it's probably somewhere between 1500 and 2000 mg :-)> > > > Natalia> > > > > >>

[Guest guest]

Dr. Grim, Twice before, based on your recommendations, I asked my doc to eliminate those extra drugs…but if you remember, this is the same doc who admitted before my case he had never had any PA case…and he seems too timid to change my combo while my BP looks normal… Prior to Spiro, I noticed CCB had greatest BP lowering effect on me… When doc added Spiro and found out about PA, I was already on CCB+ACE+Indap and doc just increased Spiro fron 25 to 50 to 75 to 100 and did not change previous combo elements. My other restriction is DASHing: I wish there was a DASH restaurant around here rather than I be in charge of making DASH foods! Max.62M L adenoma by NP59 scan. High aldos not low renin. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet, heat intolerance, insulin resistance} Max- u and ur team understand that BB and CCBS may not work well in PA? While Dashing well and MCBS may be all I need. As K corrects need for DM meds will likely go away? May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension

[Guest guest]

Thanks Dr. Grim, The wordings “High aldos not low renin.†In my thumbnail were originally suggested by you based on my test results. My Aldos-Renin Test: 2009-10-22 08:20 [stopped Spiro=50 since 2009-09-25, Combo=(Indap=2.5)+(Amlo=10)+(Ramip=5)+(Fenof=67)+(KCl=75mEq)]Aldos = 1065 High  [28 – 860] pmol/LRenin = 6  [<30] ng/L 2009-10-26 07:44 Aldos = 1516 High [28 – 860] pmol/L2009-10-27 07:36 Aldos = 2056 High [28 - 860] pmol/L No renin was measured for last two dates…and the Aldos 2nd & 3rd tests were just my own decision as I was learning that Aldos variations might be too large day to day. I appreciate your further thoughts and recommendations. Max.62M L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance} Max. You say high also not low renin can u refer me to details. Unless did renin and also at same time and on no meds it will not be clear what u mean by high also but not low renin?? May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension

[Guest guest]

Trust u have taken your Dr the evolution article so he can evolve. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Dr. Grim, Twice before, based on your recommendations, I asked my doc to eliminate those extra drugs…but if you remember, this is the same doc who admitted before my case he had never had any PA case…and he seems too timid to change my combo while my BP looks normal… Prior to Spiro, I noticed CCB had greatest BP lowering effect on me… When doc added Spiro and found out about PA, I was already on CCB+ACE+Indap and doc just increased Spiro fron 25 to 50 to 75 to 100 and did not change previous combo elements. My other restriction is DASHing: I wish there was a DASH restaurant around here rather than I be in charge of making DASH foods! Max.62M L adenoma by NP59 scan. High aldos not low renin. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet, heat intolerance, insulin resistance} Max- u and ur team understand that BB and CCBS may not work well in PA? While Dashing well and MCBS may be all I need. As K corrects need for DM meds will likely go away? May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension

[Guest guest]

Hokay. The meds u were on makes it impossible to interpret the renin and also. Note lab has no lower limit for renin. Very curious. Do they have normals for A/R?Finally (and we have been stressing for at least since reni. And also were first measured): ONE CANNOT INTERPRET A Renin or an also without a simultaneous 24 hr urine for NA K and creatinine. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Thanks Dr. Grim, The wordings “High aldos not low renin.†In my thumbnail were originally suggested by you based on my test results. My Aldos-Renin Test: 2009-10-22 08:20 [stopped Spiro=50 since 2009-09-25, Combo=(Indap=2.5)+(Amlo=10)+(Ramip=5)+(Fenof=67)+(KCl=75mEq)]Aldos = 1065 High [28 – 860] pmol/LRenin = 6 [<30] ng/L 2009-10-26 07:44 Aldos = 1516 High [28 – 860] pmol/L2009-10-27 07:36 Aldos = 2056 High [28 - 860] pmol/L No renin was measured for last two dates…and the Aldos 2nd & 3rd tests were just my own decision as I was learning that Aldos variations might be too large day to day. I appreciate your further thoughts and recommendations. Max.62M L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance} Max. You say high also not low renin can u refer me to details. Unless did renin and also at same time and on no meds it will not be clear what u mean by high also but not low renin?? May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension

[Guest guest]

But for u the proof of an excess salt/Aldo problem is the excellent response to DASH and MCB. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Thanks Dr. Grim, The wordings “High aldos not low renin.†In my thumbnail were originally suggested by you based on my test results. My Aldos-Renin Test: 2009-10-22 08:20 [stopped Spiro=50 since 2009-09-25, Combo=(Indap=2.5)+(Amlo=10)+(Ramip=5)+(Fenof=67)+(KCl=75mEq)]Aldos = 1065 High [28 – 860] pmol/LRenin = 6 [<30] ng/L 2009-10-26 07:44 Aldos = 1516 High [28 – 860] pmol/L2009-10-27 07:36 Aldos = 2056 High [28 - 860] pmol/L No renin was measured for last two dates…and the Aldos 2nd & 3rd tests were just my own decision as I was learning that Aldos variations might be too large day to day. I appreciate your further thoughts and recommendations. Max.62M L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance} Max. You say high also not low renin can u refer me to details. Unless did renin and also at same time and on no meds it will not be clear what u mean by high also but not low renin?? May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension

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My lab normal ranges (based on more recent lab details): Renin:Age>51    Standing: [3.5-29.0]  Supine:[3.5-14.5] ng/LAldos:Age >=10  Resting:[28-444]   Ambulatory:[110-860] pmol/L Stopping Spiro for 4-weeks & continuing Amlo+Indap+KCl+Fenof was decided by PA specialist University Prof…should I add title dumb for her too? Max.62M L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance} Hokay. The meds u were on makes it impossible to interpret the renin and also. Note lab has no lower limit for renin. Very curious. Do they have normals for A/R? Finally (and we have been stressing for at least since reni. And also were first measured): ONE CANNOT INTERPRET A Renin or an also without a simultaneous 24 hr urine for NA K and creatinine. May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension Thanks Dr. Grim, The wordings “High aldos not low renin.†In my thumbnail were originally suggested by you based on my test results. My Aldos-Renin Test: 2009-10-22 08:20 [stopped Spiro=50 since 2009-09-25, Combo=(Indap=2.5)+(Amlo=10)+(Ramip=5)+(Fenof=67)+(KCl=75mEq)]Aldos = 1065 High [28 – 860] pmol/LRenin = 6 [<30] ng/L 2009-10-26 07:44 Aldos = 1516 High [28 – 860] pmol/L2009-10-27 07:36 Aldos = 2056 High [28 - 860] pmol/L No renin was measured for last two dates…and the Aldos 2nd & 3rd tests were just my own decision as I was learning that Aldos variations might be too large day to day. I appreciate your further thoughts and recommendations. Max.62M L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance} Max. You say high also not low renin can u refer me to details. Unless did renin and also at same time and on no meds it will not be clear what u mean by high also but not low renin?? May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension

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Maybe her lab hAs normals or at least HTN she has studied on and off your combo of meds. And of she does not order a simultaneous 24 hr urine u can label her as inexperienced I would think. But we are here to help. So call and see if it is OK TO start and bring in a 24 hr urine for Na K creat and also. Start in am before clinic visit so it can finish the 24 hr period before u see her. Or at same time. If she says no I would still do it and bring it in anyway. Most believe pts can't do this correctly. We have directions in our files. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

My lab normal ranges (based on more recent lab details): Renin:Age>51 Standing: [3.5-29.0] Supine:[3.5-14.5] ng/LAldos:Age >=10 Resting:[28-444] Ambulatory:[110-860] pmol/L Stopping Spiro for 4-weeks & continuing Amlo+Indap+KCl+Fenof was decided by PA specialist University Prof…should I add title dumb for her too? Max.62M L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance} Hokay. The meds u were on makes it impossible to interpret the renin and also. Note lab has no lower limit for renin. Very curious. Do they have normals for A/R? Finally (and we have been stressing for at least since reni. And also were first measured): ONE CANNOT INTERPRET A Renin or an also without a simultaneous 24 hr urine for NA K and creatinine. May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension Thanks Dr. Grim, The wordings “High aldos not low renin.†In my thumbnail were originally suggested by you based on my test results. My Aldos-Renin Test: 2009-10-22 08:20 [stopped Spiro=50 since 2009-09-25, Combo=(Indap=2.5)+(Amlo=10)+(Ramip=5)+(Fenof=67)+(KCl=75mEq)]Aldos = 1065 High [28 – 860] pmol/LRenin = 6 [<30] ng/L 2009-10-26 07:44 Aldos = 1516 High [28 – 860] pmol/L2009-10-27 07:36 Aldos = 2056 High [28 - 860] pmol/L No renin was measured for last two dates…and the Aldos 2nd & 3rd tests were just my own decision as I was learning that Aldos variations might be too large day to day. I appreciate your further thoughts and recommendations. Max.62M L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance} Max. You say high also not low renin can u refer me to details. Unless did renin and also at same time and on no meds it will not be clear what u mean by high also but not low renin?? May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension

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R u sure age for Aldo s >= 15. Both renin and also go down with aging. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

My lab normal ranges (based on more recent lab details): Renin:Age>51 Standing: [3.5-29.0] Supine:[3.5-14.5] ng/LAldos:Age >=10 Resting:[28-444] Ambulatory:[110-860] pmol/L Stopping Spiro for 4-weeks & continuing Amlo+Indap+KCl+Fenof was decided by PA specialist University Prof…should I add title dumb for her too? Max.62M L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance} Hokay. The meds u were on makes it impossible to interpret the renin and also. Note lab has no lower limit for renin. Very curious. Do they have normals for A/R? Finally (and we have been stressing for at least since reni. And also were first measured): ONE CANNOT INTERPRET A Renin or an also without a simultaneous 24 hr urine for NA K and creatinine. May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension Thanks Dr. Grim, The wordings “High aldos not low renin.†In my thumbnail were originally suggested by you based on my test results. My Aldos-Renin Test: 2009-10-22 08:20 [stopped Spiro=50 since 2009-09-25, Combo=(Indap=2.5)+(Amlo=10)+(Ramip=5)+(Fenof=67)+(KCl=75mEq)]Aldos = 1065 High [28 – 860] pmol/LRenin = 6 [<30] ng/L 2009-10-26 07:44 Aldos = 1516 High [28 – 860] pmol/L2009-10-27 07:36 Aldos = 2056 High [28 - 860] pmol/L No renin was measured for last two dates…and the Aldos 2nd & 3rd tests were just my own decision as I was learning that Aldos variations might be too large day to day. I appreciate your further thoughts and recommendations. Max.62M L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance} Max. You say high also not low renin can u refer me to details. Unless did renin and also at same time and on no meds it will not be clear what u mean by high also but not low renin?? May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension

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Dr. Grim, 2009-10-22 collect 3.2L 24-hr urine sample…lab rejected claiming high pH. 2009-11-18 collected 1.8L 24-urine sample…lab tested catecholamines as attached test results: (attached & saved in Group’s Attachments Folder) Max.62M L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance} Maybe her lab hAs normals or at least HTN she has studied on and off your combo of meds. And of she does not order a simultaneous 24 hr urine u can label her as inexperienced I would think. But we are here to help. So call and see if it is OK TO start and bring in a 24 hr urine for Na K creat and also. Start in am before clinic visit so it can finish the 24 hr period before u see her. Or at same time. If she says no I would still do it and bring it in anyway. Most believe pts can't do this correctly. We have directions in our files. May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension My lab normal ranges (based on more recent lab details): Renin:Age>51 Standing: [3.5-29.0] Supine:[3.5-14.5] ng/LAldos:Age >=10 Resting:[28-444] Ambulatory:[110-860] pmol/L Stopping Spiro for 4-weeks & continuing Amlo+Indap+KCl+Fenof was decided by PA specialist University Prof…should I add title dumb for her too? Max.62M L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance} Hokay. The meds u were on makes it impossible to interpret the renin and also. Note lab has no lower limit for renin. Very curious. Do they have normals for A/R? Finally (and we have been stressing for at least since reni. And also were first measured): ONE CANNOT INTERPRET A Renin or an also without a simultaneous 24 hr urine for NA K and creatinine. May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension Thanks Dr. Grim, The wordings “High aldos not low renin.†In my thumbnail were originally suggested by you based on my test results. My Aldos-Renin Test: 2009-10-22 08:20 [stopped Spiro=50 since 2009-09-25, Combo=(Indap=2.5)+(Amlo=10)+(Ramip=5)+(Fenof=67)+(KCl=75mEq)]Aldos = 1065 High [28 – 860] pmol/LRenin = 6 [<30] ng/L 2009-10-26 07:44 Aldos = 1516 High [28 – 860] pmol/L2009-10-27 07:36 Aldos = 2056 High [28 - 860] pmol/L No renin was measured for last two dates…and the Aldos 2nd & 3rd tests were just my own decision as I was learning that Aldos variations might be too large day to day. I appreciate your further thoughts and recommendations. Max.62M L adenoma by NP59 scan. Aldos=1065…2056 [28-860] pmol/L, Renin=6 [<30] ng/L. med combo #76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet just slightly above craving while keeping K/Na ratio constant, heat intolerance, insulin resistance} Max. You say high also not low renin can u refer me to details. Unless did renin and also at same time and on no meds it will not be clear what u mean by high also but not low renin?? May your pressure be low! CE Grim MS, MDSpecializing in DifficultHypertension

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I look. Usually Swiss has the lowest Na, around 35 - 55 mg. Natalia To: "hyperaldosteronism " <hyperaldosteronism > Sent: Saturday, November 19, 2011 11:24 PM Subject: Re: spiro

Please look at the Na in your Swiss cheeseMay your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertension

Max,There are two new thoughts in your posting.1. How did you figure out the connection between nasal inflammation and K/Na ratio? Only intuitively or you had done some research on it? Do you have cramps when you have low K or your nasal inflammation is the main symptom of low K? Do you start to feel badly when your K is low? 2. About salt craving and the amount of salt that we eat. Likely you are right. I noticed the same thing. Now, when I cook everything by myself and put a little bit of salt, my craving is getting much better. Also, it might be that we are getting used to small amount of salt, you don't think so? I am also lazy and I

didn't count my

salt daily either, but I approximate that. I know that I have to eat about 500 mg with every main meal and I try not to exceed this amount every time. My snacks are usually fruit, vegetables and Swiss cheese, that don't contain much sodium.Many thanks, very interesting.Natalia To: hyperaldosteronism Sent: Saturday, November 19, 2011 12:44

AMSubject: RE: spiro

Natalia, I am lazier than what you think to count my salt daily intake…but then I listened to a famous psychologist on radio speaking of OCD and laughing at those who waste their life in measuring daily calories and food measurements…and that gave me the necessary good excuse to just add minimum amount of salt such that I do not crave for salt…so when I crave for salt I know that I have not taken enough salt…and consequently, I don’t mind to add to my K sup if needed especially before bed time if I take a snack then I also drink 25 mEq K-citrate sup otherwise during sleep I get nasal inflammation preventing breathing smoothly and I

realize that my K/Na ratio has been low that day and I try to adjust it the following day. Summary: I keep my salt to minimum just slightly above salt craving level and keep K/Na ratio such that at night I can breathe…and this gives me normal daily BP too with Spiro=100 mg! …of course without calculations (don’t tell this to Dr. Grim!) Max.62M L adenoma by NP59 scan. High aldos not low renin. med combo

#76={Spiro=100, Amlo=10, Indap=2.5, Ramip=5, Metf=1000, Crestor=20, Feno=67, K.Cl=120 mEq}{K=4.7}{not DASHing but low-salt diet, heat intolerance, insulin resistance} So, Max, what do you think now, how much sodium is optimal for you? My guess is that there is some optimum and it's probably somewhere between 1500 and 2000 mg :-) Natalia