Lifestyle // Health

Low-salt diet has unexpected risks

Q: I recently was diagnosed with high blood pressure and advised to eliminate salt. My question to you: Is salt substitute (potassium chloride) safe?

A: Ask your physician to review a study that was recently published in The Lancet (online, May 20, 2016). This research showed that a really low-salt diet may be counterproductive and increase the risk of cardiovascular complications. Too much salt also is dangerous for people with hypertension.

Salt substitutes containing potassium chloride are a reasonable approach as long as you are not taking certain blood-pressure pills that preserve potassium. Those could cause a life-threatening potassium overload.

Q: My daughter is allergic to just about everything. I had her on Flonase steroid nose spray, but she absolutely hated taking it.

I looked for an alternative and read about saline nasal spray. I grabbed a bottle, and she tried it. She was totally stuffy, just breathing through her mouth. She used the saline spray, and it cleared her nasal passages.

A: Saline spray is a simple solution that has not been studied very much for nasal allergies. One pilot study of 40 people with this condition found that twice-daily "irrigation" with saline solution (NeilMed) improved their symptoms and quality of life (American Journal of Rhinology and Allergy, July-August 2014). All of these volunteers were using steroid nasal sprays like Flonase in addition to the saline. The study lasted two months, but there was no control group. Sterile, preservative-free saline solutions seem like a reasonable option for people with allergies and congestion.

Q: My husband has been taking Pradaxa for four years. Now he needs a prostate biopsy.

The doctor wants him to stop taking the drug for three days before the procedure and two or three days afterward. Is this safe?

A: Dabigatran (Pradaxa) is an oral anticoagulant medication. It is prescribed to keep blood from clotting and causing trouble in certain situations, to prevent or treat a blood clot in the legs (deep vein thrombosis, or DVT) and to treat nonvalvular atrial fibrillation, or a-fib.

Because the point of this medication is to prevent clotting, it can pose problems when someone needs surgery or a biopsy. Unless the medicine is stopped ahead of time, the biopsy could lead to excessive bleeding. That is why your husband's doctor gave him a window of time in which he should not take the drug.

There is, of course, a small risk that he could suffer a blood clot during that time. Presumably your husband's doctor took that into account. Waiting a couple of days after the biopsy should allow time for healing and reduce the risk of hemorrhage.

Q: When I read about proton-pump inhibitors possibly harming the kidneys, it got my attention. I only have one kidney and want to do all I can to preserve it.

I quit taking Nexium and switched to Zantac. It did not work as well as the PPI, but I managed my heartburn with Tums in the afternoon and evening.

After reading your article on coconut water for heartburn, I started drinking a rather small amount. The results have been excellent. Even after cutting my Zantac dose in half, I have no symptoms.

A: Research linking acid-suppressing drugs (PPIs) to kidney damage has been accumulating (Journal of the American Society of Nephrology online, April 14, 2016). Different heartburn medications (H2 blockers) like cimetidine (Tagamet), famotidine (Pepcid) and ranitidine (Zantac) do not appear to pose the same risk.

Many readers have reported that coconut water seems helpful for indigestion.

Q: Is there a difference between the venoms from yellow jackets, wasps, honeybees and hornets? I have heard that a cut onion might take away the pain from a sting, but I wonder whether it would work equally for different stings.

A: There are substantial differences between the chemical ingredients found in the stings of various insects. No one has done research on the effectiveness of home remedies against various venoms.

Many people report that applying a freshly cut onion helps ease the pain of both wasps and bees. Others insist a paste of meat tenderizer works well for wasps and fire ants. Vinegar also has been reported to be helpful against fire ants.

Q: I get nauseating, throbbing migraines that make it excruciating to bend over, cough or do much of anything. If I quickly eat one bowl of ice cream, the pain is gone. This works faster than taking a pill. In my experience, this remedy that I read about on your website is definitely worth the try.

A: You are not the first person to report that eating ice cream quickly can sometimes ease a migraine headache. One reader wrote: "I have been doing this with milkshakes for years. Coffee/mocha is my favorite."

Research has shown that when something cold (ice cream, ice pop, slushie or Frappuccino) touches the roof of the mouth, it can induce "brain freeze." This induces rapid blood-vessel constriction and then dilation, which may explain why something cold can sometimes stop a migraine before it takes hold. If you want to avoid the extra calories, you might experiment with ice water.


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