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Low sodium levels can be life-threatening

September 16, 2018

Q: For years I carefully kept my salt intake as low as possible. At the table and in cooking, I used light salt (only half sodium chloride) from a small shaker.

One day my sodium level dropped to 125 and I started jerking and was near convulsions. After an ambulance ride to the emergency room, I learned how important it is to watch your salt intake. I was told by the hospital doctor to drink less water so as not to lose too much sodium through my urine.

The emergency-room doctor also told me to eat extra table salt. When my sodium finally reached 134, which is only one point lower than the normal range, I started feeling so much better.

I have had three close friends who also were rushed to the hospital because of low sodium. One lady landed in intensive care. She went into convulsions and died with a sodium level of 120. I’d like to warn everyone to be sure to have the doctor check sodium along with your usual blood tests. As long as I keep my sodium level in range I am fine.

A: People have been urged to reduce their salt intake as much as possible, but sodium is essential for health. The normal range is between 135 and 145. When sodium falls too low (hyponatremia), it can be a life-threatening emergency.

Certain medications can deplete the body of this mineral. Some diuretics, SSRI antidepressants, anticonvulsants and proton pump inhibitors can lower sodium levels.

Q: I have been very interested in the messages about using soap containing limonene to help with cramplike pain. I have been plagued with such pain on my face.

I did research on products that contain limonene. Vicks VapoRub is one. I have been using that around my eyebrows and forehead, and it helps relieve pain.

A: We are fascinated by your report. That could help explain why Vicks VapoRub is considered helpful for soothing sore muscles. A chemist who specializes in volatile compounds reported to us that the soaps people find useful against leg cramps usually contain limonene in their fragrance. This compound from essential oils has analgesic effects (Inflammation, April 2017).

We should offer one word of caution: Dermatologists have reported one case of skin depigmentation (vitiligo) triggered by the application of Vicks VapoRub (Journal of Clinical and Aesthetic Dermatology, November 2008). Be alert for any changes in skin tone where you are applying the Vicks.

Anyone who would like to learn about other ways to utilize this common but extremely versatile product may be interested in our “Guide to Unique Uses for Vicks.” It can be downloaded for free from our website: peoplespharmacy.com.

Q: I started having hot flashes at 40 years old and I’m now 55. My hot flashes have become unbearable — 10 or more severe hot flashes with full body sweating every day.

Black cohosh has not been of help, and I do not want to take estrogen. I went searching online for other natural remedies and found maca. It is a root from Peru. After about three days, my hot flashes have been reduced to just one or two a day, with no full body sweating. Can you tell me anything about maca for menopause?

A: Thank you for your testimonial. Many women would prefer not to suffer hot flashes but may be reluctant to use hormone replacement therapy. Some randomized controlled trials have shown that Pycnogenol and maca extract (Lepidium meyenii) can help control hot flashes (Maturitas, February 2014).

There is little, if any, data on the safety of this plant compound, especially taken out of its indigenous context (Journal of Ethnopharmacology, Jan. 30, 2018). It is now being grown in China as well as Peru due to its reputation as an aphrodisiac.

Q: I have read that beets lower blood pressure, but there is controversy about whether only raw ungrated (i.e., not oxidized) beets lower blood pressure or also grated and cooked beets do. Can you clarify this question?

A: Most of the research involves beetroot juice. A meta-analysis of randomized controlled trials concluded that the juice lowers blood pressure (Advances in Nutrition, Nov. 15, 2017).

We have not seen research comparing grated or cooked beets with beetroot juice. One reader offered this testimonial:

“I recently had my blood pressure increase (140 over 90). I started taking beet powder. I add this to food or water. It has a pleasant taste, not very beety. My blood pressure now is in the normal range.”

Q: I recently read that diclofenac can cause atrial fibrillation, heart attacks, heart failure and strokes. I assume that this is from oral diclofenac.

Last year I was diagnosed with an ulcer as a result of taking the NSAID Lodine XL for decades. The ulcer has healed, but I can no longer take any NSAID for my severe arthritis pain.

I have been using diclofenac gel for the inflammatory arthritis in my feet. The route of administration is quite different from diclofenac pills. Does the gel pose the same risk?

A: The study you refer to was published in The BMJ (Sept. 4, 2018). Danish researchers reported that oral diclofenac (Cataflam, Voltaren) increased the risk of the side effects you mention.

Topical diclofenac (patches, spray and gel) appears to offer good pain relief without causing severe digestive irritation or ulcers (British Journal of Sports Medicine, May 2018). The authors of this systematic review are a bit cautious about cardiovascular safety, suggesting that further studies are needed.

The Food and Drug Administration requires a black box in the prescribing information for Voltaren Gel. It warns about the dangers of serious cardiovascular and gastrointestinal reactions in the same language used for diclofenac pills.

You can learn more about topical NSAIDs and other ways to ease joint pain in our “eGuide to Alternatives for Arthritis.” This online resource is available at peoplespharmacy.com.

Q: You have had some people ask questions about dry nasal passages. My father used oxygen for his congestive heart failure, and as a result he, too, struggled with dry nostrils.

His hospice nurse had me use K-Y Jelly in his nose because it is water-soluble. She told me that Vaseline could be inhaled into his lungs and get stuck there with no way to dissolve. Your readers might have an easier time finding K-Y Jelly than the Ayr Saline Nasal Gel you previously suggested.

A: Although many people have written to tell us that they use petroleum jelly in their dry noses, pulmonologists discourage such oil-based lubricants. K-Y Jelly is water-based, as you noted, and should not pose the same hazard.

Contact the Graedons at peoplepharmacy.com.

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