Dear doctor. cockroach: I have read that dietary potassium is very important in reducing the risk of heart disease, along with reducing sodium. I use a potassium-based salt substitute at home. Is there a maximum I should use? Why don’t restaurants offer salt substitutes for people who want to reduce their sodium and heart risks? – T.S
Answer: I think you’re on to something here, though there are some concerns. Most people do not use salt substitutes simply because they do not know that salt substitutes exist or that they have the potential to reduce heart attacks and strokes.
Like I said, more dietary potassium is generally better for blood pressure (And heart disease). A review of several studies found that salt substitutes reduce blood pressure by about six points systolic (the top number) and three points diastolic (the bottom number), which may not sound like much, but it’s about the same thing we see with some blood pressure medications. Across the population, this would lead to far fewer heart attacks and strokes. Some countries have already begun promoting high-potassium salt substitutes in markets and restaurants, with documented improvements in blood pressure.
Concerns include: the high cost of salt substitutes, the taste of which some people dislike, and their safety. High level of potassium in the blood is very dangerous. Fortunately, no serious side effects were found in a study of over 20,000 healthy participants. However, the study excluded people who should be most concerned about hyperkalemia: people with chronic kidney disease, who can’t get rid of potassium well, and people who take medications that increase potassium levels in the blood (such as ACE inhibitors, potassium supplements, and some diuretics).
One group of experts recommended a warning about salt substitutes in restaurants such as: “This product contains potassium, an essential nutrient. If you are asked to limit potassium in your diet, please consult your physician before use.”
You don’t need a supplement to get more potassium in your diet. Most fruits are rich in potassium. Besides reducing sodium, eating more fruits, vegetables, and legumes and reducing processed foods (especially less processed meats) lowers your risk of many diseases.
Dear doctor. cockroach: I am a 68-year-old male diagnosed with a 4.9 aneurysm of the ascending thoracic aortic root. I take metoprolol, valsartan, aspirin and rosuvastatin. The medical system that treats me is excellent (the Cleveland Clinic), however I found their published material conflicting. Some doctors say tennis and singles golf are good, while others point to an increased chance of tearing due to the rapid rotation of the torso involved in these two sports.
I definitely don’t want to get dissected, and I’m fine with giving up both of those sports if it’s advised. However, I don’t want to give up on anything prematurely at my age! – DW
Answer: The doctors at the Cleveland Clinic are among the best in the world, and you should listen to their advice. But in general, the type of exercises that put people with an ascending thoracic aneurysm at greater risk are those that involve increasing pressure within the body (such as lifting weights) and those that involve contact. Rapid rotation of the trunk is not a concern in the type of aneurysm you have.
You are taking medications that would best help, and a 5.5cm level surgery is usually recommended, but your doctor may adjust this based on additional characteristics of your anatomy.