Sodium and HCTZ

Hi,
I am wondering if anyone has hit this issue.
I have dropped my weight from 257-190 in a bit under six months. In doing this I have improved my nutrition by orders of magnitude. I am eating a huge amount of veg to get my 38g of fiber a day.
I hit some problems though. I got constipated, had a lot of cramps and get light headed when standing up.
The nurse at my doctors office suggested dehydration (HCTZ is a diuretic) which I had already started to address.
I find that I don't really get thirsty and so wasn't drinking enough. When heavy I use to drink constantly.
So I started drinking more and resolved the constipation issue and reduced the cramps.
There is a warning with the HCTZ medication I take for BP not to use salt substitutes regularly. I traced this to a paper suggesting being on a low sodium diet while on HCTZ causes a bunch of problems. HCTZ causes more sodium excretion. I know that I am in ketosis for much of the day and that in itself also promotes sodium excretion.
I have naturally transitioned to a diet that's much lower in sodium than prior to the diet. I don't eat much processed food now. I was eating some sliced meat (with added salt) but shifted to buying raw meat and cooking myself. I have been seasoning with herbs (Mrs Dash type stuff) and that's likely a mistake.
So I am going to eat a bit of the pre-sliced sliced meat as well as using some MSG etc. I don't want to go mad but keep some of the salty stuff in my diet I had dropped.

Replies

  • xvolution
    xvolution Posts: 721 Member
    Those are classic signs of orthostatic hypotension (low blood pressure when you stand up), which causes dizzy spells when standing and cramping (mainly in the legs and hands). It's caused by an imbalance of electrolytes/lack of water in the system, which is a side effect for almost every powerful diuretic out there (in this case HCTZ creates more urine to create a potential water imbalance). I get it quite often myself ever since I lost about 50 pounds a few months back, usually after exercise. Have you tried checking your blood pressure during the dizzy spells to be sure?

    Also why were you prescribed the HCTZ in the first place? If it was for high blood pressure, then it might be time to work with your doctor to lower/eliminate the dose.
  • psuLemon
    psuLemon Posts: 38,112 MFP Moderator
    To add to the above, are you doing a ketogenic diet while trying to keep sodium low? Because if so, that is a terrible combo. You need electrolytes to maintain body balance.
  • neillc57
    neillc57 Posts: 86 Member
    I have been checking my BP as per my doctors instructions. I have never seen anything but normal values. My values are better than pre-weight loss though. I am to contact them for changes if I drop below some reading they gave me.
    I am on Lisinopril/HCTZ for BP. I have had high BP all my life including times when my weight was much lower than it is right now. So I am not expecting me to come off the meds but maybe the dose may go down. My diet though is so much better than it has ever been I guess there is still some hope.

    I am not on a ketogenic diet. I am eating about ~140g of carbs a day. I am exercising though (weights + low intensity exercise like walking or swimming). This seems to be enough to deplete liver glycogen in me and shift me into ketosis.

    I wasn't specifically trying to eliminate sodium but rather stuff like carbs they put in meat. Or say using Mrs Dash to avoid using dressing at times when I didn't have the calories for dressing or I wanted to consume nuts at night instead to get my fat. Now I really like the herbs + veggies etc. Been using a bit of MSG as well for a couple of days. I am hoping this resolves the issues.
  • psuLemon
    psuLemon Posts: 38,112 MFP Moderator
    neillc57 wrote: »
    I have been checking my BP as per my doctors instructions. I have never seen anything but normal values. My values are better than pre-weight loss though. I am to contact them for changes if I drop below some reading they gave me.
    I am on Lisinopril/HCTZ for BP. I have had high BP all my life including times when my weight was much lower than it is right now. So I am not expecting me to come off the meds but maybe the dose may go down. My diet though is so much better than it has ever been I guess there is still some hope.

    I am not on a ketogenic diet. I am eating about ~140g of carbs a day. I am exercising though (weights + low intensity exercise like walking or swimming). This seems to be enough to deplete liver glycogen in me and shift me into ketosis.

    I wasn't specifically trying to eliminate sodium but rather stuff like carbs they put in meat. Or say using Mrs Dash to avoid using dressing at times when I didn't have the calories for dressing or I wanted to consume nuts at night instead to get my fat. Now I really like the herbs + veggies etc. Been using a bit of MSG as well for a couple of days. I am hoping this resolves the issues.

    If you are in ketosis or trying enough to deplete glycogen, than you need high sodium, like at least 3 to 5k (maybe more). It might be worth increasing salt to see if that allievates the symptoms. Its also possible you might need to look at another medicine.
  • cmtigger
    cmtigger Posts: 1,450 Member
    neillc57 wrote: »
    I have been checking my BP as per my doctors instructions. I have never seen anything but normal values. My values are better than pre-weight loss though. I am to contact them for changes if I drop below some reading they gave me.
    I am on Lisinopril/HCTZ for BP. I have had high BP all my life including times when my weight was much lower than it is right now. So I am not expecting me to come off the meds but maybe the dose may go down. My diet though is so much better than it has ever been I guess there is still some hope.

    I am not on a ketogenic diet. I am eating about ~140g of carbs a day. I am exercising though (weights + low intensity exercise like walking or swimming). This seems to be enough to deplete liver glycogen in me and shift me into ketosis.

    I wasn't specifically trying to eliminate sodium but rather stuff like carbs they put in meat. Or say using Mrs Dash to avoid using dressing at times when I didn't have the calories for dressing or I wanted to consume nuts at night instead to get my fat. Now I really like the herbs + veggies etc. Been using a bit of MSG as well for a couple of days. I am hoping this resolves the issues.

    My doctor told me to eat around 2000 mg of sodium when I started hydrochlorothiazide. It’s for my kidneys more than my blood pressure though.

    He just increased my dose, so I’m watching to see what happens with my blood pressure.
  • cmtigger
    cmtigger Posts: 1,450 Member
    Also, while MSG has less sodium than salt, it’s still pretty high.
  • xvolution
    xvolution Posts: 721 Member
    Are those blood pressures measured while standing? Cause people suffering from orthostatic hypotension often have normal sitting pressures but low standing ones. Sitting mine is usually 125/88 (normal) but once I stand up it can drop up to 40 points (had it drop to 80/55 once).
  • neillc57
    neillc57 Posts: 86 Member
    xvolution wrote: »
    Are those blood pressures measured while standing? Cause people suffering from orthostatic hypotension often have normal sitting pressures but low standing ones. Sitting mine is usually 125/88 (normal) but once I stand up it can drop up to 40 points (had it drop to 80/55 once).

    Yes. Seated. I will test standing.

    cmtigger wrote: »
    Also, while MSG has less sodium than salt, it’s still pretty high.

    I picked this for flavor rather than wanting low sodium. I am currently hooked on this mixture of cooked and raw veg. I take say 5-8oz of mushrooms, 3oz onion, 6oz tomatoes and sometimes 3oz green beans (everything chopped up). Lot's of Mrs Dash and a bit of MSG (I wasn't using this till now) I nuke these in the microwave until the mushrooms go rubbery (that's how I like them). Then I cook say 3oz of chicken breast or more fatty chicken wings/thighs depending on time of day. I dump anywhere from 4-10oz of chopped celery/cucumber on the chicken and then put the mushrooms etc on it.
    For some reason I can't get enough of this at the moment.