Sodium, Blood Pressure, and the Russian Nephrologist
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Love the quote @wabmester! Too many freak over the blood pressure when it should just be left alone in some cases. Prescribing of all of the medications has led to worsening symptoms for the patients, imo. The rollercoaster ride of the blood pressure being up and down over time is more stressful for the patient. Usually, upon diagnosis, the patient is asymptomatic anyway. Not that some don't become symptomatic in time, I just feel that immediately prescribing meds isn't proper treatment. I believe it bears watching, taking pressures at different times of the day throughout a month to see fluctuations. One reading in a doctor's office once, or twice, a year isn't enough for proper diagnosis imo. More data helps your physician help you.0
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Yep, JNC8 guidelines actually changed target BP goals for elderly to reflect the J-shape phenomenon. BP control is supposedly most import to control during mid-life as far as mortality goes...40-50yo. Too much orthostasis with these elderly on like 5 different classes of BP meds0
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I believe it bears watching, taking pressures at different times of the day throughout a month to see fluctuations. One reading in a doctor's office once, or twice, a year isn't enough for proper diagnosis imo. More data helps your physician help you.
He loves data. I gave him about 6 months worth of home-collected data. Not just different times of day, but also associations with weight loss, exercise, and other factors.
One of the reasons he says not to worry much about high BP is because of the lack of causality. Yes, there's correlation. But take stroke, for example. Most of it is due to ischemia. How could high BP lead to ischemia?
Variability is more of a concern because he can see both a correlation with events and a mechanism of action.
So the proposed experiment is to increase sodium and measure BP for a few weeks. Daily at the same time, first thing in the morning. High morning BP is the biggest risk factor.
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This is so cool, love this story !0
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My SO's has high blood pressure, in his 20s his Dr put him on 2 different meds for it. I always questioned that because his grandmother also has high bp, she's 84 never goes to the Dr and doesn't take any meds for anything except one aspirin a day. She got pneumonia a couple years ago and was hospitalized, she had to see the Dr then and they tried to force her to take meds for her bp. She did while she was there then stopped again when she got home, her Dr actually yelled at her for not taking it.
It's crazy for my SO they only focus on the family history of those with high bp that also had strokes or heart disease, they pay no mind to the others with high bp that have lived long healthy lives.
He's now down to just one bp med and they lowered his dose so at least they are getting somewhere.0 -
Well it was a high BP reading (just one, I didn't dare get another, so may have not been a real problem at all) at a workplace healthcheck that made me start thinking seriously about the effects of my obesity on my health. It may have all been fine, but rightly or wrongly it, and a few other problems, gave me a wake up call and brought me to ketogenic diet. 40lbs later, I do feel much healthier.
I have to say that learning so much more about nutrition and how the advice we get is wrong, it does make me much more willing to question almost anything that we are "told" about our health and the necessary prerequirements for good health. Unfortunately, unlike @wabmester I have no mental tools/scientific knowledge for thinking about it constructively, just advice from others, research on the web (where there's a lot of chaff you need to wade through to get through to the wheat of good advice - that' s not the best metaphor for LCHF board, is it?!?!?), etc.0 -
By the way, I loved this thread so much that I added it to the launch pad sticky.
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I don't have much of an update yet. I wanted to postpone any radical diet changes until I completed a metabolic analysis for my kidney stone -- that should happen this month.
I did try to clarify if he really wanted me to ramp up to 20g of sodium, so I talked to his nurse, and we both agreed that he must have said 20g of SALT (which is like 8g/d of sodium).
Last week, I did try to increase my salt intake a bit. I added some kimchi and ate a couple pickles a day.
Too soon to tell for sure, but my BP was normal for the few days I checked. And even in a hospital setting, where my BP always takes off, they recorded me at 114/77 mmHg. Perfectly normal.0 -
Interesting experiment going on. I look forward to hearing future developments!1
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But elevated blood pressure is the major cause of stroke. High BP is a sign that perfusion to certain areas is poor; poor blood perfusion means ischemia/lack of O2. The body has to compensate (raise BP) in times of ischemia0
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His argument (to me) was that high variability, not constantly high BP, is possibly a sign of poor perfusion. As you say, it's a sign that the body is trying to compensate.0
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I don't have much of an update yet. I wanted to postpone any radical diet changes until I completed a metabolic analysis for my kidney stone -- that should happen this month.
I did try to clarify if he really wanted me to ramp up to 20g of sodium, so I talked to his nurse, and we both agreed that he must have said 20g of SALT (which is like 8g/d of sodium).
Last week, I did try to increase my salt intake a bit. I added some kimchi and ate a couple pickles a day.
Too soon to tell for sure, but my BP was normal for the few days I checked. And even in a hospital setting, where my BP always takes off, they recorded me at 114/77 mmHg. Perfectly normal.
That's a relief - I just don't know how you could tolerate even 20g of salt in terms of taste - you would have to include salt pills so your mouth doesn't feel revolting.
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His argument (to me) was that high variability, not constantly high BP, is possibly a sign of poor perfusion. As you say, it's a sign that the body is trying to compensate.
That is what I was told too - it wasn't a constant higher than normal that made my docs uncomfortable, it was the spikes - because it is the crazy spikes of high pressure that can highlight and weaken already weakened spots in the vessels.0 -
I had another date meeting with the Russian nephrologist today.
I have been increasing my sodium intake for the last month of so, but not yet to the levels he suggested. 20g of salt is a tough target to reach! It basically means eating salty food at every meal. I've only managed to get about one salty meal a day. Today, for example, I had some lox for breakfast.
The effect is that my blood pressure is a bit more normal. My morning SBP has dropped as low as 107 -- pretty much the lowest I've seen since I've been monitoring.
And in the past, the SBP measured at a doctor's office has been pretty consistently 130+. It's now consistently 120.
So maybe the salt is working. Still too soon to say for sure.
He ordered 3 diagnostic tests at our first visit, and we reviewed the results today:
1) Albumin/Creatinine Ratio
Basically a test of kidney function. Mine is normal.
2) B-type Natriuretic Peptide (BNP)
This is a hormone secreted by the heart to regulate fluid levels. Mine was essentially undetectable, which I thought was a Good Thing. He says it means that my blood volume is consistently too low. Too little sodium!
3) Carotid Intima Media Thickness (CIMT)
This was the big one! It was an ultrasound test of my carotid artery to determine thickness and plaques. If it's thicker than average for my age, that can be a result of high blood pressure.
Mine was normal for my age.
So, in terms of blood pressure, he thinks that I may need meds someday (because both parents are on BP meds), but not yet. Not a diuretic, though. Probably a calcium channel blocker.
And he prescribes more salt!
I'm going to try to increase sodium even more than I have and see what effect it has on BP variability.
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Thanks for the update! Will be interesting to see what your b/p does once you are consistent with the increased sodium (I don't know if I could tolerate that much but would try if I had to)!1
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*hands Wab a salt lick*
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I am following this story too ! I have always been told to cut back on salt! Also told to not eat fat! Everything I have learned in the past 60 something years is just a lie????? Very interesting read.....I will stay tuned for the next chapter!0
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Hi blood pressure in older people (over 70) is actually linked to a longer life span.0
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I am having a lot of trouble swallowing 20 gm sodium a day advice.Is there something about your advisor being russian that is significant? Is he actually a board certified nephrologist? Did he ever give you any references in the scientific literature on which he based his opinion?
I hope you are OK0 -
My dad has a problem with low blood pressure due to low blood volume and drinking too much water, if you can believe it. His doctors could get nowhere with him. He would get really dizzy upon standing and at times can't even walk because of the dizziness and weakness in his legs. I got him some sodium tablets and magnesium and he started feeling better the very next day. He said he still gets dizzy sometimes and I told him to take a second tablet (making it 2000mg) and he's hesitant because "that's a lot of salt". Uh... But didn't you start feeling better? He finally decided to take a second one but at night so he could space them out. It did help and he feels even more stable. He also has a nerve problem, Lambert Eaton Syndrome, associated with cancer, so the fact that sodium offers any help at all is great!1
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@wabmester if you could stop in and answer the questions here, that'd be awesome.1
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Wab seems to be on vacation right now, so I'm going to address some of the points that I can.I am having a lot of trouble swallowing 20 gm sodium a day advice.
Make sure to read through the whole thread, not just the first post. The 20g sodium thing is addressed in a later post, where Wab and the nurse conclude that he said salt, not sodium, putting the sodium intake at 8g.Is there something about your advisor being russian that is significant? Is he actually a board certified nephrologist?
I can't speak for Wab on either of these, but knowing him, I suspect that if the doctor is not board certified, he's likely very highly qualified. Wab's not the kind of person to believe just anyone (as reading his posts in the archives will tell you).
As for him being Russian, I suspect the largest significance is his mannerisms. If you've ever had an Eastern European or Asian doctor (or other service provider) -- and I'm talking "fresh off the boat" immigrant, here, not American with Eastern European or Asian ancestry -- there's a certain demeanor to them that makes them stand out. This isn't a bad thing by any means. It's just something that one happens to notice.Did he ever give you any references in the scientific literature on which he based his opinion?
I can't speak for his references, but I found a few you can start with while we wait to hear back from Wab.
http://healthland.time.com/2011/05/04/low-salt-diets-reduce-heart-disease-risk-right-a-study-disagrees/
http://www.todayifoundout.com/index.php/2013/02/why-does-salt-raise-blood-pressure/
http://www.kevinmd.com/blog/2013/07/salt-diet-high-blood-pressure-evidence.html
http://www.scientificamerican.com/article/what-science-on-hypertension-really-shows/
http://www.scientificamerican.com/article/its-time-to-end-the-war-on-salt/
http://www.aafp.org/afp/2004/0115/p359.html
Unfortunately, certain organizations have done a damn good PR job and it's quite difficult for the layman to find anything that contradicts the conventional wisdom. However, like most of the recommendations, the salt thing is an oversimplification of a more complex thing, and is based off of shoddy science (nutrition -- the only science field where uncontrolled population studies are treated as solid fact and correlation is treated as causation).
What the above links state, at the very least, is that there is no actual correlation in the more strictly-controlled trials between sodium intake and blood pressure. Some of them also mention that increased sodium intake actually helps prevent death.
The thing is, the body regulates sodium concentrations in the blood more tightly than it regulates glucose. As a result, the body will change blood volume and vasoconstriction in order to maintain a certain concentration. This also means that it will deprive the other cells of sodium in order to maintain said concentration.
In other words, it's less about the raw intake numbers and more about the concentration levels in the blood.
Finally, for a quick anecdote regarding blood pressure, I'll share my recent experiences:
I by no means restrict my sodium intake. In fact, I salt damn near everything, in addition to eating a fair amount of cheese, and enjoy the occasional cup of salted broth. Hell, I even add salt to the "energizing hot cocoa" recipe that I recently found (milk of any sort, cocoa, teaspoon or two of coconut oil, dash of cayenne, salt, pinch of cinnamon, and a bit of sweetener of choice, heat, blend, enjoy). Right now, I'm donating plasma twice a week, and I get it measured every time. Yesterday's measurement -- 114/77 A previous measurement -- 114/65 And that's with a shoddy water habit lately (noontime measurements, and the only thing I've had to drink is coffee with a fair bit of cream; yeah...I'm a phlebotamist's worst nightmare, except I still manage to bleed well). Oh, and those numbers are a reduction since going low carb (which is another thing that throws off the studies -- because of the naturetic nature of ketones, our sodium needs -- and therefore intake tolerance -- goes up), my numbers have always been in that 120/80 "perfection" range.0 -
Wab, interestingly, my NP recommended I use Coconut oil (mental health & lipids) as well as blueberries. Coincidentally, this setting has Ukranian & Russian speaking practitioners...interesting how they seem a bit more revolutionary vs. other practitioners. Although they weren't pushing using seemingly absurd amounts of NaCl0
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I drink Kombrucha. Deelish. Also this; low carb high fat dieting; fat does not make you fat. That is proven by everyone who eats this way. It is the opposite. Maybe the same with sodium and blood pressure. I think there is so much we don't know.0
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Hey @wabmester -- now that you're back, care to post a follow-up and answer some of the questions posted here? Thanks!0
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I am having a lot of trouble swallowing 20 gm sodium a day advice.Is there something about your advisor being russian that is significant? Is he actually a board certified nephrologist? Did he ever give you any references in the scientific literature on which he based his opinion?
I hope you are OK
As @dragonwolf mentioned, it turned out to be 20g of salt, or about 8g of sodium. Still high, but not quite as crazy high.
My GP referred me to this particular nephrologist, and when the GP asked me how it went, I told him the guy is either brilliant or a quack, and I couldn't really tell which.
My Yale-educated GP assured me that he wasn't a quack and was good at his specialty, so that reassured me a bit.
And, yeah, he's board certified in nephrology and internal medicine.
His being Russian does influence both his bedside manner and his approach, I think. He's very direct. And he comes from a more homogenous culture, which probably influenced his view. He seems to feel strongly that genetics should be considered both for diet and health. In other words, he thinks it's a mistake to prescribe one diet or one set of guidelines for a mixed culture like the US.
After our first chat, I asked if he was writing a book. He said he was, and he apparently speaks at conferences often about his unconventional approaches.
As I think I mentioned in the thread, my blood pressure has never been better, even in "white coat" situations.
But I recently went on a 3-week vacation to Africa, when I found it difficult to eat a high-sodium diet (and that's a diet that probably doesn't make sense for the Africans). I just measured my BP, and it's higher now, so I'll try to ramp up my sodium intake again and see if my BP stabilizes.
In terms of follow-up, he said I probably don't need meds yet, but I may later since both my parents are on BP meds. I think he's considering a calcium channel blocker rather than a diuretic, since he feels my blood volume is already too low when my sodium intake is insufficient.
And we agreed to do a one-year experiment and follow-up. The experiment was related to my CIMT results, which showed some plaque. We agreed to measure inflammation via CRP. If it was high, I would take a low dose of statins for a year to see if we could reverse the plaque growth. If low, we'd see how my dietary approach worked after a year.
CRP was 0.1 (very low inflammation), so I'll see him again in a year and see how well low-carb and high-sodium works on my health markers in the longer term.
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Soooo...does it matter what source the sodium/salt comes from?0
Your wife sounds awesome. Glad for the good luck with the Russian! You needed it.
