DEAR DR. DONOHUE: My son, at 40, was found to have dangerously high blood pressure. My husband died at age 41 of a heart attack. He also had very high blood pressure. It is a family condition. My son was told to cut out all salt. Is that necessary? Is it possible? His doctor says no salt is allowed. How many milligrams is it reasonable to eat in a day? There’s almost no food without some salt in it. – J.B.

ANSWER: A low-salt diet is difficult for most people. A no-salt diet is impossible. I’m sure your son’s doctor wants him on a low-salt diet with no salt added to his food. Salt is necessary for life. The salt issue is confusing, because sometimes doctors talk about sodium, sometimes sodium chloride and sometimes salt. Salt and sodium chloride are the same. Sodium is only 40 percent of salt. I’ll give my numbers as sodium chloride (salt) and put the sodium value in parentheses.

The recommended daily allowance for salt has been 6,000 mg – 6 grams – (2,400 mg sodium, or 2.4 grams). New recommendations have lowered it to 3,750 mg salt (1,500 mg sodium). That’s a pretty low-salt diet, one that can aid in decreasing blood pressure. One teaspoon of salt is 6,000 mg. You should eat only half a teaspoon. That’s the total salt intake – including the hidden salt in foods like bacon, sausage, ham, potato chips, pretzels, pickles, olives, sauerkraut, frozen dinners, canned soups, many canned vegetables, bakery products and on and on. Don’t add salt in cooking or at the table.

People’s taste gradually comes around to enjoying food without salt. If your son doesn’t reach that point ever, he can use salt substitutes. They replace sodium with potassium. Some examples are AlsoSalt, Nu-Salt and Morton’s Salt Substitute.

His daily diet should include seven servings of whole grains (bread, pasta, cereal), five servings of vegetables, five fruit servings, a reduction in meat intake and consumption of low-fat or fat-free dairy products.

The booklet on hypertension provides more details on this epidemic illness. People can order a copy by writing: Dr. Donohue – No. 104, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: What is bigeminy? I have it. My doctor wants me to see a heart doctor, but I feel fine. I am active, have normal blood pressure and am not overweight. Both my parents are alive at 87. – R.F.

ANSWER: Bigeminy (by-JIM-uh-nee) is a heart rhythm in which every normal beat is followed by an extra beat. The extra beat is a premature ventricular beat, a beat that originates in the lower heart chambers – the ventricles – and that comes before it should.

If you have sustained bigeminy all day long, that’s a large number of premature beats, and it should be investigated. If it’s something that happens only for short periods, then serious heart disease is less likely, especially if there are no other indications of heart problems.

The doctor will most likely want you to wear a monitor for at least 24 hours. The monitor will capture all the heartbeats that transpire during that period. That information is important in estimating the need for treatment.

If the number of extra beats is large, then the doctor might prescribe medicines that suppress those beats.

DEAR DR. DONOHUE: I am 65. I had hernia surgery 11 months ago. Three hours after surgery I was back in the operating room because I had a huge hematoma – not exactly a marvelous memory. For the past four months I’ve felt a small, hard protrusion on the left side (my hernia was on the right). It is sometimes mildly painful when walking more than 30 minutes. My doctor says there is no cause for alarm. What abdominal exercises can I safely do? – G.P.

ANSWER: Only if your surgeon gives his approval, you can do sit-ups. Do them with your lower legs resting on the seat of a chair. If you raise your shoulder blades off the floor, that’s high enough to benefit your abdominal muscles. The hard protrusion might be scar tissue.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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