By Beth Piraino, MD
A few years ago, I diagnosed myself with hypertension. I ‘inherited’ a blood pressure from my mother, who was hypertensive and religious about monitoring her own blood pressure twice a day, so one day I decided to check my blood pressure. To my horror it was 180/110 mm Hg. I rechecked it and got the same reading. I should not have been surprised as both my parents had hypertension that came with increasing age, and I had also gained considerable weight over the preceding several years. As a nephrologist, I am very aware that hypertension is one of the leading causes of kidney disease.
Furthermore, around the same time, I was the counseling physician for a kidney health screening program, and during a lull in the action, I myself went through the program (qualifying due to a history of chronic kidney disease in my diabetic father). I subsequently received in the mail my urine albumin to creatinine ratio which was positive. Fortunately, my estimated GFR was normal.
These findings led me to take action. I immediately changed my diet to one that was restricted in sodium. My goal was 1500 calories per day, which would also allow me to gradually lose the extra weight I had gained. This meant an entire change in the foods I ate. I changed to a diet rich in fresh fruit and vegetables and non-fat, low sodium dairy products especially yogurt. I found the diet to be very pleasurable so it was not very difficult to maintain. My blood pressure within weeks was 130/80 without anti-hypertensive medication and with Losartan 25 mg each day, 114/75. My weight gradually decreased so that I achieved a normal body mass index, and my urine albumin/creatinine ratio on repeat was no longer elevated.
This experience made me a more effective physician for my patients, for whom almost all I recommend a sodium restricted diet. I was able to give my patients practical tips to help them achieve a reasonable sodium restriction. This included reading the labels for sodium content of all foods bought in the store, buying as often as possible canned foods with no sodium added (possible with canned tomatoes as well as beans and frozen vegetables). I warned my patients of the hazards of eating frequently in restaurants (lots of sodium in most foods) and fast food. I encouraged them not to consider this a punishment but a way to enjoy one’s food separate from the sodium which may override the flavor when used in excess. Other seasonings are available and are delicious. As I point out to my patients, this is not a ‘no sodium diet’ but a ‘low sodium diet.’ Following such a diet, for me and many of my patients, leads to a decreased need for medicine and better blood pressure control.
All of us need to be in charge of our own health and work with our health care team to achieve our goals. This involves paying attention to what we eat, exercising and not smoking. You can improve your health just as I did.
Dr. Beth Piraino is the President of the National Kidney Foundation.