How far is too far in salt restriction?

Ask Dr. Keith Roach M.D

How far is too far in salt restriction?

DEAR DR. ROACH: I'm 74 years old and have been very healthy. I take only Synthroid. My cholesterol and blood pressure were high, but I didn't want to take medication for fear of side effects. Last July, I had a stroke, leaving me with mouth and leg numbness. My neurologist told me not to eat salt. I started having cramps in my fingers and toes, and my general doctor said I need 1,400 mg of sodium a day.

Some doctors tell you not to eat salt, but I understand that we need a certain amount. It's very confusing. — P.J.R.

ANSWER: We certainly do need a small amount of sodium for normal function. Back in the middle ages, 'salt famines' were a serious problem. However, this has not been a significant public health issue for centuries — indeed, the converse is true. In North America, most of us get far excessive amounts of salt, not only exceeding requirements (minimum requirement may be as little as 200 mg daily), but at a level where it raises blood pressure in a great proportion of people; I have seen people whose daily sodium intake is in excess of 25,000 mg. (Note that I am talking about sodium intake. To convert to how much table salt that is, multiply by 2.5.) Different groups have different recommendations, but reducing salt intake is likely to reduce risk of high blood pressure and of stroke. The Centers for Disease Control and Prevention recommends a diet with less than 2,300 mg of sodium daily – that's less than a teaspoon. Most of the salt in our diet (75 percent) comes from processed and restaurant foods, not from adding salt at the table.

In my experience, cramping comes from low potassium, and not low sodium intake. Plenty of fruits will ensure good potassium intake, which is important, as it helps to minimize the effects of sodium (but people with kidney disease may need to watch potassium intake).

If you can get your blood pressure and cholesterol down with diet, that's great. If not, medication can reduce risk of a second stroke.

DEAR DR. ROACH: You recently wrote about nasal polyps, and seemed to recommend against surgery. My husband had surgery for nasal polyps years ago. They never returned. Do they not do that procedure now? — F.S.

ANSWER: Surgery can be effective treatment for nasal polyps, which can cause symptoms of nasal congestion and difficult sleeping. However, medication treatment often is successful and can prevent the need for surgery. It's sometimes necessary even after surgery. For this reason, I recommend a trial of medication, usually nasal steroids, prior to considering surgery. Some people benefit from washing the inside of the nose with saline and treating any underlying allergies. A few people have sensitivity to aspirin and NSAIDs, like ibuprofen, and avoiding these can improve symptoms.

I value my surgical colleagues, but want to be sure I am sending them appropriate candidates for surgery.

DR. ROACH WRITES: One of the most common questions I receive is about how to find prescription medications for less money. I recently have found two resources that appear to reduce the prices for medications — often dramatically, and occasionally to less than the insurance co-payment that many people have. Both of these are websites -www.blinkhealth.com and w w w . g o o d r x . c o m . Unfortunately, the most expensive, name-brand medications still are not affected. I'd like to hear from readers about their experiences. *** 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 request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.