Ask Dr. Frita: Questions About High Blood Pressure, Kidney Disease and Diabetes Answered!
Welcome to another edition of Ask Dr. Frita, where today I answer YOUR questions about high blood pressure, kidney disease, and diabetes. These three conditions often go hand in hand and can have a significant impact on one's overall health. As a triple board-certified medical doctor specializing in nephrology, I have seen the effects of these conditions on my patients firsthand. And with over 600,000 followers on YouTube, I understand the importance of education and awareness when it comes to health. So let's dive into some of your questions about high blood pressure, kidney disease, and diabetes.
Questions About High Blood Pressure, Kidney Disease and Diabetes Answered!
High Blood Pressure Questions
The short answer is that for salt, it can take as little as three weeks to stop the cravings. For sugar, it takes about four weeks according to studies. So let's talk about these cravings and why people have them in the first place.
When it comes to salt, you may crave salt if you're sweating and you're losing electrolytes or even if you have a lack of sleep. If you have a lack of sleep or sleep deprivation, then you lose something called leptin. You have a decreased amount of leptin, and leptin is what tells your body to stop craving certain foods. Also, if you're bored, it may be just like a psychological trigger that you want to eat salt. You may associate salty foods with certain activities, like watching a game or hanging out with friends. Also, it could be hormonal. Some ladies during their menstrual cycles happen to crave salt. And for many, it just tastes good and you just want it.
According to the American Heart Association, the average adult should be eating no more than 1,500 milligrams of sodium a day, but the American diet has so much more salt than that. So in order to cut back on salt, you really have to be intentional and you have to understand that if you're used to the taste of salt, then when you start cutting back, it's going to be a sacrifice. There's going to be a change, and initially, you will keep craving it and you'll be tempted to go and add that salt. But if you have a low-sodium diet, it decreases your risk for hypertension, strokes, heart disease, and kidney disease, if you keep your eye on the prize and just hang in there for about three weeks, then the cravings should decrease.
Now, when it comes to sugar, oh my gosh, sugar is everywhere! We have added sugar to cereals, breads, and desserts that we love so much. Sugar actually stimulates the reward centers in your brain. It causes a dopamine release and gives you a bit of a high. That's why a lot of us really just love sugar and crave sugar. But if you cut back and start reading the nutrition facts labels, then you can decrease those cravings.
According to the studies, it should take an average of four weeks if you really cut back. The recommendation is that the average woman should have no more than 25 grams of sugar a day, and the average man, no more than 36 grams of sugar per day. Yet the average American eats over 88 grams of sugar per day. So how long does it take to stop the cravings for salt and sugar? For salt as little as three weeks, sugar, an average of four weeks.
When I tell you this is such a great question because what you're describing is one of the atypical symptoms of a heart attack or one of the symptoms that you may not recognize. A lot of people, especially diabetics, can present with indigestion or what seems like heartburn, or even some nausea, vomiting, or epigastric pain (meaning pain in the upper part of their stomachs). They may never recognize that these can actually be symptoms of a heart attack.
So if you're having indigestion that's not going away, if you're having indigestion that is worse with movement, or indigestion that is worse when you exert yourself, and you have other risk factors for heart disease, then indigestion could very much be your warning sign of a heart attack. And there are other signs as well that I think we are all familiar with such as chest pain, like a big crushing feeling of something like an elephant sitting on your chest.
You can also have jaw pain, shoulder pain, or arm pain as a symptom of a heart attack. You can have sweating, shortness of breath, or fatigue. All of these can be symptoms. The heart is actually located right there next to the esophagus. That tube that connects your mouth to your stomach. And so the reason they call it heartburn when actually you have acid that's refluxing up from the stomach to the esophagus is because it is right near the heart area. So it makes sense that these pains or these symptoms can be confused or overlapping, but definitely, indigestion can be a warning sign of a heart attack. So make sure that you are up to date on your visits with your physician, and if you suspect that you're having a heart attack, don't wait. Don't think about it. Call 911.
Sometimes I forget that 1,500 milligrams doesn't necessarily mean a lot to most people when I mention this in my article and videos. So let me just break this down in a way that everyone can understand. If you are listening to the sound of my voice, or reading this, I want you to go grab a container of table salt if you have it in your house, the table that still has the labels on it. I want you to read the label. The serving size for most table salt is 1/4 of a teaspoon. That's like nothing, right? And in 1/4 of a teaspoon of regular table salt, there are 590 milligrams of sodium.
Now, you will recall that according to the American Heart Association, the average American should have no more than 1,500 milligrams of salt in a day or in 24 hours. Now remember, a 1/4 of a teaspoon is 590 milligrams of salt. So if you multiply that out times four, then you'll see that a full teaspoon of table salt has 2,360 milligrams! So basically, if you have just one teaspoon of salt in a day, then you've already exceeded the daily recommendations for salt intake!
Now some of you are probably thinking, "Oh, but I eat pink Himalayan salt. I don't do regular salt." Okay, 1/4 of a teaspoon of pink Himalayan salt is 560 milligrams.
I know some of you are still listening or reading and you're like, "Well, I don't do that. I just do sea salt. That's healthy." Okay, it's still salt. 1/4 of a teaspoon of sea salt is 530 milligrams.
So I hope that gives you some type of a picture of how much salt you are sprinkling in your food or using for seasoning when you're cooking. It doesn't take much to exceed the daily recommendations of sodium.
If we move into some of the other things such as vegan food and you're trying to be healthy, but you're eating vegan prepackaged foods. Well, if you get a vegan sausage, just three vegan breakfast sausage links have around 390 milligrams of salt!
If you like ketchup, and who doesn't love ketchup? One tablespoon of ketchup has around 197 milligrams of salt, and a lot of us use more than one tablespoon. So yes, please just make sure you are a label watcher and keep that in mind. What is 1,500 milligrams of salt? Well, even if you have just 3/4 of a teaspoon of table salt in 24 hours, you've already exceeded the daily recommendation for salt intake!
When you talk about Edema, it is a medical term for swelling caused by excess fluid trapped in your body's tissues. That swelling or puffiness can happen in your legs and feet and it might make your socks tight and leave an indentation or make some of your shoes tight. Can high blood pressure cause this? The short answer is yes.
High blood pressure can cause swelling in the legs and feet, but health processes that cause edema in the legs and feet can lead to high blood pressure. So what came first, the chicken or the egg, the egg or the chicken? Let's talk about it.
If you have high blood pressure, it can lead to damage to the blood vessel walls. It can lead to a shearing or damage of the endothelial cells. And yes, you could get a leakage or Edema. Also, having high blood pressure can affect your kidneys. High blood pressure is the second leading cause of kidney failure. And so if you have kidney damage or you start to get some signs of kidney disease, this can affect how you metabolize sodium, how you hold onto sodium, or how you excrete sodium. And if you are holding on to too much sodium, this can lead to swelling in your feet and your legs.
So yes, high blood pressure can lead to edema of the feet and legs, but there are also some other disease processes that can cause you to hold onto fluid. When you retain fluid, experience edema, or have increased fluid in your vessels, this excess fluid exerts pressure on the vessel walls. Having high pressure on the vessel walls can lead to hypertension, so the swelling can lead to hypertension as well.
The bottom line, make sure you're seeing your physician regularly, that you understand what your blood pressure is, and that you're getting to the bottom of it and that you're maintaining a healthy blood pressure.
Absolutely. High blood pressure can cause chest pain. High blood pressure is a leading cause of heart disease which is the number one killer of people in the United States. High blood pressure can also cause strokes and it is also the second leading cause of kidney failure. So when I see my patients in the dialysis units, most of them have high blood pressure. It is the high blood pressure that is the problem, so you want to make sure that it is managed.
The other question is about blood pressure medications. Now this is a very good question, because sure, there are certain medications that people can have reactions to. They can have medications that can cause them to have heart palpitations, but by and large, when your physician, especially a physician you trust, gives you a medication, they're giving you that medication for a reason because they have researched it and they know that the benefits of that medication will far outweigh any risks. So if you are concerned that a medication is causing an issue, please don't just stop the medication. Call your physician or go to the emergency room depending on what that issue is, like chest pain, to find out.
Here's something that's very important that I want patients to understand in terms of dealing with high blood pressure medicines. And we as physicians don't always do the best job in explaining, if you have been living with very high blood pressure, and especially if you've gotten to the point where you're not having symptoms, you're not having chest pain, shortness of breath, or nosebleeds, then your body has adjusted to that high blood pressure and has protected you from symptoms, but that's not necessarily a good thing. Because while you're not having symptoms of high blood pressure, your body is still being damaged by the high blood pressure.
So when we start you on a high blood pressure medicine, now we're shifting and we're telling your body to get used to a normal blood pressure. So what your body does as the blood pressure starts to decrease toward normal, your body starts to feel like, oh no, this is not normal for me. Your body may feel lightheaded or nauseated. You may have chest palpitations or even more major problems. And you may tell yourself, "Oh, I'm taking this medication and now that my blood pressure is getting normal, I don't feel good." And you might tell yourself, "Okay, that means that a low blood pressure is not normal for me" or "I'm allergic to the medication."
But that's not necessarily the case. You have to give your body usually two to three weeks to adjust. Your body has gotten used to having high blood pressure. It's going to take time for your body to get used to having normal blood pressure. The truth of the matter is that you may feel sick, tired, or nauseated as your body adjusts.
If you can stick this out for two to three weeks, then usually you will feel better and your body will appreciate the normal blood pressure. When you take medications and your body has to get used to normal blood pressure, you're not going to necessarily feel good at first. That doesn't mean that you're allergic to the medication. Make sure you have very open and direct conversations with your physicians and don't just stop the medication.
Kidney Disease Questions
You must be referring to the fact that I always say if you see bubbles or foam in your urine, that could be a sign of kidney disease. How do you tell the difference? When you urinate with force, or even when you just urinate regularly and look at the toilet, and yes, I want everyone to look back at it, or forward at it, when you urinate, look at what's coming out of your body.
When there are tiny little bubbles that are scant, then yes, that could be normal. Or certainly, if you're urinating with force, then you could have more scant bubbles. When I'm talking about kidney issues, I'm talking about very bubbly urine, like foam. If you think about those beer commercials where they are at the tap with the cold beer and there's a whole lot of white foam that builds up, I'm talking about foam like that. But quite honestly, there's no way to know 100% just by looking. You have to get tested.
When you see your doctor for a routine health physical, or you go in because you're concerned about bubbles in your urine, then you ask them to test your urine. They can spot test urine, meaning just a one-time sample where they can do a urinalysis and it can assess if you have excess protein, one plus, two plus, or three plus. This is just a general screening test. They can also do a more specific test with your urine sample, the one-time urine sample, where they check your urine protein-to-creatinine ratio or your urine albumin-to-creatinine ratio, and that gives also you an idea of whether or not you have excess protein in the urine.
But really, the best way to know for sure is to do a 24-hour urine test where you save every drip drop of urine you make for 24 hours in a container, and the container must be kept cold in the refrigerator, or you can actually get a bucket or a Tupperware of ice and sit it next to the commode and collect the urine. You check how much urine you have in 24 hours, and if the protein in your urine is excessive, that's how you will know. The bubbles or a foam really just give you a hint. But the only way to know definitively is to see your physician and have a laboratory test.
This is a very, very, very important question. As we discussed, having foamy urine can be a sign of having protein, and in your case, you did exactly what you were supposed to do. You got tested in order to confirm that you have protein. But now the question is, is it a significant amount of protein? Is it something worrisome? Or is it just, a little protein, like something called orthostatic proteinuria? Is it no big deal?
Well, now it's time to do the workup. Once you do the workup and know exactly why you have the traces of protein in your urine, then you'll know how to remedy it. So if it's just traces of protein in the urine, it could be a bunch of things. It may be that after you exercise or jog or first thing in the morning, you have heavy amounts of protein. So the first thing you want to do is get that 24-hour urine analysis where you go to your doctor, and at this point, I recommend that you get referred to a nephrologist, someone who specializes in kidney disease, and have them do a 24-hour urine test to find out exactly how much protein you have.
Is it less than 300 milligrams in the 24 hours? If so, that may not be very worrisome, but if it's higher than that, if it's a gram of protein, or certainly, if it's more than three grams or 3,000 milligrams of protein in 24 hours, that could be a sign of very serious kidney disease. It's normal to have zero milligrams of protein in the urine or very, very minimal amounts of protein.
Having protein in your urine is a sign that there is something that is not quite right with the kidneys if it's actually coming from the kidneys, which your kidney doctor will help you figure out. So you do the 24-hour urine analysis to find out exactly how much, and depending upon what your doctor finds, they'll also do blood tests, they'll screen. Do you have lupus? Do you have hepatitis? Do you have rheumatoid arthritis? Do you have diabetes?
Diabetes is actually the most common cause of protein in the urine. Do you have high blood pressure? Is that what's causing protein in the urine? There are lots of possibilities, but it'll be up to your kidney doctor to help pinpoint and figure out why you have the protein in the urine. If your doctor can't figure it out by history, or by blood test alone, and urine test, you may actually have to have a kidney biopsy.
Again, consult with your physician, and get referred to a nephrologist because these are all the things, the wheels that will be turning in the doctors' heads as they try to figure out the cause. You figure out the cause first. That leads to the remedy. One thing you also want to find out is your kidney function. Is that an issue?
Do you have CKD or chronic kidney disease? If you do, and if your EGFR (estimated glomerular filtration rate) is less than 60 milliliters per minute, then having a modest protein restriction in your diet may be a way to help remedy some of the protein that you're spilling out in the urine. Something like 0.6 to 0.8 grams per kilogram or maybe 60 to 80 milligrams of protein in 24 hours.
Consult with your physician, and consult with your registered dietician to find out more. Bottom line, you've done the absolute right thing in going and finding out that you have some protein in the urine, but you need to find out how serious it is, or if it's not serious at all.
Diabetes Questions
The short answer is they are both bad news. So you want to manage them and prevent them if you can. Type 1 diabetes, formerly known as juvenile diabetes, primarily affects younger individuals, often those who are thin or lean. It occurs when the body lacks the necessary insulin-producing cells. Your cells and your pancreas are not making insulin properly, and so you become insulin-dependent. You need to have insulin.
Type 2 diabetes is the one we often hear about. Interestingly, there are a lot of things that you can do potentially to prevent it. Obesity and being overweight can significantly increase the risk of developing type 2 diabetes, especially for people who consume processed foods in excess as they tend to get type 2 diabetes later in life. Even though now we have more and more children living with obesity who are getting type 2 diabetes earlier.
Both of them lead to end organ damage, meaning both type 1 diabetes and type 2 diabetes can lead to kidney failure. In fact, diabetes is the number one cause of kidney failure in the United States. Diabetes can also lead to heart disease. Both type 1 and type 2 diabetes can lead to blindness. You can get diabetic retinopathy in both type 1 diabetes and type 2. Diabetes type 1 and 2 can also lead to an increased risk for strokes and heart attacks. Are you getting the picture?
One challenge associated with type 1 diabetes mellitus is that individuals often receive their diagnosis at a young age. Consequently, their bodies are exposed to the detrimental effects of the disease for a longer span of time. So a lot of times people with diabetes mellitus type 1 will get sicker sooner, be on dialysis sooner, or have eye disease sooner earlier if the diabetes is not managed.
The good news is that we have excellent treatments, therapies, medications, and excellent lifestyle modifications in many cases. So even if you do have diabetes, it is manageable. Make sure you consult with your physicians and your endocrinologists. Also, if you have pre-diabetes, indicating a high risk of developing type 2 diabetes based on your hemoglobin A1C levels, it's important to note that type 2 diabetes can often be prevented. It is possible to manage diabetes through a combination of medication and lifestyle changes. For instance, individuals with obesity can strive to lose weight, which can lead to becoming a diet-controlled diabetic. This means that with proper lifestyle modifications, it may be possible to reduce or even eliminate the need for medications to manage type 2 diabetes.
If you have type 1 diabetes, then you are likely going to be insulin-dependent for life unless you also develop kidney disease and get a kidney, or pancreas transplant. That's a whole nother question for a different day. But the bottom line is regardless of whether it's type 1 or type 2 diabetes, the key is to prioritize effective management. Both types can present similar challenges and complications.
General Health and Wellness Questions
It just so happens that I am taking on new patients. My office is actually located in Atlanta, Georgia, but now I am offering a concierge telehealth consultation service. So no matter where you are located in the world, you can talk to me, we can have medical conversations, and I can give you personalized information. Just make sure that you click this link, and you can set up your appointment today. I will talk to you and take my time and give you world-class health advice, not just generalized advice, but advice that is personal to you. So yes, I am taking on new patients with my VIP concierge telehealth medical service because I believe everyone deserves access to world-class healthcare, and I'm here to give it to you!
Believe it or not, oats can actually be a little controversial. We know that oats can be an excellent source of good grains. They have lots of fiber and minerals. Oats can be healthy, and filling, they can cut your appetite, but they can have some issues as well. To answer this question, the kind of oats that I recommend are steel-cut oats. Steel-cut oats have very little processing, meaning they're holding on to most of their health benefits. They also contain fiber with no added sugar or added salt.
You still want to look at the food labels and make sure that the oats are gluten-free. Oats are gluten-free by nature, but you want to make sure that when they are processed to whatever degree, they're not mixed in with gluten. So look to make sure that they're labeled as being gluten-free and organic.
The way I make my oats into a healthy snack or meal
I like to mix around two cups of oats with two cups of almond milk, in addition, I'll add various fruits. So I'll add blueberries, raspberries, strawberries, or even bananas. I try to stick with fruits that are high in antioxidants, vitamins, minerals, and nutrients. And this is a tasty way that I like to enjoy my oats.
Now, here's the thing to look out for, especially if you have diabetes or if you have pre-diabetes, if you're having a lot of fruit and even with the oats, in some cases this added fruit can increase your blood sugar. So you want to make sure that you consult with your physician and that you do so in moderation. The other tricky thing about oats, we classically think of oats as a breakfast food, right? But one thing that's interesting about oats is that they contain melatonin, and we know that melatonin is something that you can use to help you sleep better. And so having oats in the morning may make you sleepy, so it may not be the best idea.
A good idea might be to have oats later in the day or when you're settling down or even as a snack, maybe a few hours before it's time to go to sleep because that melatonin could actually affect you and make you sleepy.
Oh my gosh, y'all know I love guacamole. Guacamole of course is made with avocados. So you can take your avocado, which is loaded with potassium, and good, healthy fats, and make homemade guacamole. But if you're making homemade guacamole, you want to make sure that you're not adding a lot of salt to it. You don't want to defeat the healthy benefits of the avocado with salt.
Don't add salt, but add other spices. I like to add chili flakes or red pepper or even lemon zest or sometimes I'll just grate a little bit of onion and add it, and I will eat the guacamole that way. Homemade guacamole in and of itself is really not bad for you when you're not adding a bunch of salt and other things.
What makes people get into trouble, it's when they eat guacamole and indulge in the fatty, salty processed tortilla chips. Eating a lot of these salty chips can get you into trouble. I actually like to eat my homemade guacamole just by itself, or maybe even slice up certain vegetables, like sliced carrots, or get some broccoli or celery, and you can eat your guacamole that way.
Now, I haven't tried guacamole with baked chicken. But if you do eat chicken, make sure that you eat the white meat and that you take off the skin so you can eat the chicken in the healthiest way possible and enjoy the benefits of a lean protein.
Well, there you have it. Three common conditions, all closely related, and all in need of proper management. As a nephrologist, I have seen first-hand how high blood pressure, kidney disease, and diabetes can significantly impact a person's health. However, with proper education and awareness, it is possible to prevent and manage these conditions.
If you have questions about high blood pressure kidney disease or diabetes, please feel free to reach out to me by leaving a comment below, on my YouTube channel, or via my concierge telemedicine service. As physicians, we are here to help you live a healthier life. Remember, your health is your wealth!
Stay tuned for more editions of Ask Dr. Frita, where I will be answering more of your pressing questions related to health and wellness. And as always, take care of yourself, inside and out. Let's strive for a healthier future together!
Not only is she the founder and president of a successful nephrology practice (Midtown Atlanta Nephrology, P.C.) and the medical director of a non-profit dialysis unit (DCI), but she has also made it her mission to provide accessible medical advice to everyone. With over half a million subscribers on her YouTube channel, appearances on popular television shows like HLN Weekend Express and Fox News Live, and the Emmy Award Winning Paternity Court, Dr. Frita is dedicated to helping people understand their health with ease.
Additionally, she has been an active board member of the National Kidney Foundation since 2014 and the author of Under Pressure - A Guide to Controlling High Blood Pressure; not to mention her Healthy Happy Life Podcast!
Truly dedicated to helping others learn more about their health, Dr. Frita continues her mission to educate individuals about living their happiest and healthiest lives.
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