Dr. Keith Roach

DEAR DR. ROACH: I have read that dietary potassium is very important in reducing heart disease risk, along with reducing sodium. I use a potassium-based salt replacement at home. Is there a maximum amount I should use? Why don’t restaurants offer salt substitutes for people who want to reduce sodium and heart risk? — T.S.
ANSWER: I think you are on to something here, although there are some concerns. Most people aren’t using salt substitutes simply because they don’t know salt substitutes exist or that they have the potential to reduce heart attack and stroke.
As you say, more dietary potassium is generally better for blood pressure (and for heart disease). A review of many studies found that salt substitutes reduce blood pressure by about six points systolic (top number) and three points diastolic (bottom number), which may not sound like much, but is about the same that we see with some blood pressure medicines. Across a population, this would result in far fewer heart attacks and strokes. Some countries have already started promoting high-potassium salt substitutes to markets and restaurants, with documented improvements in blood pressures.
The concerns include: the greater cost of salt substitutes, that some people don’t like the taste, and safety. Too high a level of blood potassium is very dangerous. Fortunately, there were no serious side effects found in a study of over 20,000 healthy participants. However, the study excluded the people that should be most concerned about excess potassium: people with chronic kidney disease, who cannot get rid of potassium well, and people who are taking medication that increase blood potassium levels (such as ACE inhibitors, potassium supplements, and some diuretics).
One expert group recommended a warning on salt substitutes in restaurants such as: “This product contains potassium, a necessary nutrient. If you have been told to limit potassium in your diet, please consult your doctor before use.”
You don’t need supplements to get more potassium in your diet. Most fruits are high in potassium. Along with cutting down on sodium, eating more fruits, vegetables, and legumes and less processed foods (especially less processed meat) reduces risk of many diseases.
DEAR DR. ROACH: I am a 68-year-old male diagnosed with a 4.9 ascending thoracic aortic root aneurysm. I take metoprolol, valsartan, an aspirin and rosuvastatin. The medical system treating me is excellent (Cleveland Clinic), yet I have found published material from them that is conflicting. Some doctors say singles tennis and golf is fine, while others note an increased chance of rupture due to the rapid trunk rotation involved in these two sports.
I certainly do not want to cause dissection, and I’m fine giving up these two sports if advisable. However, I do not want to give up anything prematurely at my age! — D.W.
ANSWER: The doctors at the Cleveland Clinic are among the best in the world, and you should listen to their counsel. But in general, the type of exercises that put people with ascending thoracic aneurysms most at risk are those that involve increasing pressure inside the body (such as heavy lifting) and those that involve contact. Rapid trunk rotation is less of a concern in the type of aneurysm you have.
You are on the medicines that are best shown to help, and normally, surgery is recommended at a level of 5.5 cm, but your doctor may adjust that based on additional characteristics of your anatomy.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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