High Blood Pressure/ Medication

Dietary Approaches to Stop Hypertension (DASH) diet recommendations: Limit sodium (salt) intake to no more than 2,300 mg a day (a maximum intake of 1,500 mg a

day is an even better goal). Reduce saturated fat to no more than 6% of daily calories and total fat to 27% of daily calories.

(But, include dairy products that are non- or low-fat. Low-fat dairy products appear to be especially beneficial for lowering systolic blood pressure).

When choosing fats, select monounsaturated oils, such as olive or canola oils. Choose whole grains over white flour or pasta products. Choose fresh fruits and vegetables every day. Many of these foods are rich in potassium, fiber,

or both, possibly helping lower blood pressure. Include nuts, seeds, or legumes (dried beans or peas) daily. Choose modest amounts of protein (no more than 18% of total daily calories). Fish, skinless

poultry, and soy products are the best protein sources. Other daily nutrient goals in the DASH diet include limiting carbohydrates to 55% of daily

calories and dietary cholesterol to 150 mg. Patients should try to get at least 30 g of daily fiber.

Restricting Salt and Increasing Potassium

Salt. Some sodium (salt) is necessary for health, but the amount is vastly lower than that found in the average American diet. High salt intake is associated with high blood pressure (hypertension). It is a good idea for everyone to restrict their salt intake to less than 2,300 mg (about 1 teaspoon) a day. Some people over age 50, or who have high blood pressure, may need to reduce sodium intake to less than 1,500 mg daily. This lowering of blood pressure may also help protect against heart failure and heart disease.

Salt substitutes, such as Nusalt and Mrs. Dash, (which contain mixtures of potassium, sodium, and magnesium) are available, but they can be risky for people with kidney disease or those who take blood pressure medication that causes potassium retention.

Potassium. A potassium-rich diet is important for reducing blood pressure. For people without risks for potassium excess, potassium-rich foods can help offset dietary salt intake. These foods include bananas, oranges, pears, prunes, cantaloupes, tomatoes, dried peas and beans, nuts, potatoes, and avocados. For people without risk factors for excess potassium levels, the recommended daily intake of potassium is 3,500 mg a day.

Some patients may need to take potassium supplements. However, people who take medications that limit the kidney's ability to excrete potassium, such as ACE inhibitors, dogixin or potassium-sparing diuretics, should not take potassium supplements and should be aware of excess potassium in their diet.

Other Dietary ConsiderationsFiber. Increasing fiber in the diet may help reduce blood pressure levels.

Fish Oil and Omega 3 Fatty Acids. Omega 3 fatty acids (docosahexaenoic and eicosapentaneoic acids)

are found in oily fish. Studies indicate that they may have specific benefits for many medical conditions, including heart disease and hypertension. They appear to help keep blood vessels flexible and may help protect the nervous system. Fatty acids are also available in supplements, but their long-term effects on blood pressure are unknown.

Calcium. Calcium regulates the tone of the smooth muscles lining blood vessels. Studies have found that people who have sufficient dietary calcium have lower blood pressure than those who do not. Hypertension itself increases calcium loss from the body. The effects of extra calcium on blood pressure, however, are mixed, with some even showing higher pressure.

High-intensity exercise may not lower blood pressure as effectively as moderate intensity exercise and may be dangerous in people with hypertension. Older people and those with uncontrolled hypertension or other serious medical conditions should check with their doctors before starting an exercise program.

Heart Health Nutrients

-Tocotrienols, which belong to the vitamin E family, are powerful antioxidants found in barley, rice bran and wheat germ. By preventing the oxidation of low lipoprotein (LDL) cholesterol, they help in preventing or reversing atherosclerosis. -Important antioxidants such as vitamins A, C (found in fruits such as oranges), E and beta-carotene (found in orange vegetables such as carrots). These antioxidants may be useful in promoting healthy circulation by protecting LDL cholesterol from free radical attack. -Nutrient factors involved in maintaining healthy homocysteine (an amino acid in the blood which can cause problems if it is too high) levels (vitamins B6, B12, folic acid and betaine- available in fortified foods as well as dark green, leafy vegetables). -Important minerals, trace elements, and ultra-trace elements, such as magnesium, selenium, copper, manganese, and vanadium. -Proteolytic enzymes, such as bromelain (an enzyme found in pineapple), papain, trypsin, and chymotrypsin. -Important herbs for support of healthy circulation, such as garlic, hawthorn, ginger, turmeric, Butcher’s Broom, and rosemary. -Gugulipid, an extract of the mukul myrrh tree, has been shown in modern scientific research to significantly help maintain already healthy levels of cholesterol, and to have potent antioxidant activity. -Specific sulfhydryl-containing amino acids (L-cysteine, D,L-methionine and L-taurine) that chelate and help the body remove environmental waste. The heart muscle contains large amounts of the amino acid L-taurine, which specifically supports healthy heart muscle function.- CoEnzyme Q10, or CoQ10, was found in one particular double blind study to help prevent the progression of atherosclerosis after the occurrence of a heart attack. Other possible preventative substances include lipoic acid and resveratrol. Quercetin is yet another nutrient - this time a flavonoid, which offers protection for LDL cholesterol against oxidative damage.

Medications:

DiureticsDiuretics lower blood pressure by causing the body to rid itself of excess fluids and sodium through urination. If diuretics alone don't bring the desired effects, they may be combined with other blood pressure medications. In people with diabetes, diuretic drugs may increase the blood sugar level. A change in drug, diet, insulin or oral antidiabetic dosage corrects this in most cases. Your doctor can change your treatment. Most of the time the degree of increase in blood sugar doesn't change much.Side Effects:

Fatigue Leg cramping Decreased potassium levels

Some commonly prescribed diuretics include:

Amiloride (Midamor)* Bumetanide (Bumex)* Chlorothiazide (Diuril)* Chlorthalidone (Hygroton)* Furosemide (Lasix)* Hydrochlorothiazide (Esidrix, Hydrodiuril)* Indapamide (Lozol)*

Beta BlockersBeta blockers decrease the heart rate and cardiac output, which lowers blood pressure. They're also used with therapy for cardiac arrhythmias and in treating angina pectoris.

For people with diabetes, beta blockers may hide some of the warning signs of low blood sugar. When you take a beta blocker, your heart rate may not increase in response to a low blood sugar level. You will need to check your blood sugar levels carefully after you start taking a beta blocker. If you have low blood sugar often, your doctor may want to change the dosages of your diabetes medicine.

Side effects: Insomnia Cold hands and feet Fatigue Depression Slow heartbeat Symptoms of asthma

Some commonly prescribed medications include:

Atenolol (Tenormin)* Betaxolol (Kerlone)* Bisoprolol/hydrochlorothiazide (Ziac)* Bisoprolol (Zebeta)* Carteolol (Cartrol)* InsoAcebutolol (Sectral)* Metoprolol (Lopressor, Toprol XL)* Nadolol (Corgard)* Propranolol (Inderal)* Sotalol (Betapace)* Timolol (Blocadren)*

Problems with Beta Blockers.

Do not abruptly stop taking these drugs. The sudden withdrawal of beta blockers can rapidly increase heart rate and blood pressure and potentially cause angina or heart attack. If you need to stop your beta blocker, the doctor may want you to slowly decrease the dose before stopping completely.

Beta blockers are categorized as non-selective or selective. Non-selective beta blockers, such as carvedilol and propranolol, may sometimes narrow bronchial airways. Patients with asthma,

emphysema, or chronic bronchitis should not use these medicines. These drugs can hide warning signs of low blood sugar (hypoglycemia) in patients with

diabetes. When combined with a diuretic, the risk of diabetes may increase. They may be less effective than other drugs for preventing stroke.

Calcium Channel BlockersCalcium channel blockers, also known as "calcium antagonists," interrupt the movement of calcium into heart and vessel cells. Besides being used to treat high blood pressure, they're also used to treat angina (chest pain) and/or some arrhythmias (abnormal heart rhythms).

Side effects: Constipation Headache Rapid heartbeat Rash Drowsiness Nausea Swelling in the feet and legs

Some commonly prescribed calcium channel blockers include:

Amlodipine (Norvasc, Lotrel)* Bepridil (Vascor)* Diltiazem (Cardizem, Tiazac)* Felodipine (Plendil)* Nifedipine (Adalat, Procardia)* Nimodipine (Nimotop)* Nisoldipine (Sular)* Verapamil (Calan, Isoptin, Verelan)*

Angiotensin-Converting Enzyme (ACE) InhibitorsThese are often preferred by healthcare providers for people with diabetes, because the medication has fewer side effects, does not affect blood sugar levels and provides additional kidney protection. ACE inhibitors expand blood vessels and decrease resistance, which lets blood flow more easily and makes the heart's work easier or more efficient. ACE inhibitors are used to treat symptoms of heart failure and to lower blood pressure. Your healthcare provider may perform blood tests to make sure there are no effects on your potassium levels or kidneys.Side Effects:

Dry cough Rash or itching Allergy-like symptoms Allergic reaction with generalized swelling (angioedema) Excess potassium in the body (hyperkalemia), especially in people with kidney failure

Commonly prescribed ACE inhibitors include:

Benazepril (Lotensin)* Enalapril (Vasotec)* Fosinopril (Monopril)* Lisinopril (Prinivil, Zestril)*

Moexipril (Univasc)* Perindopril (Aceon)*

Common Side Effects of ACE Inhibitors.

Low blood pressure is the main side effect of ACE inhibitors. This can be severe in some patients, especially at the start of therapy.

Irritating cough is a common side effect, which some people find intolerable. ACE inhibitors can harm a developing fetus and should not be used during pregnancy. Women

who become pregnant should change from ACE inhibitors to another type of blood pressure drug as soon as possible. Women of child-bearing age who are considering becoming pregnant should also discuss other medications with their doctors.

ACE inhibitors can increase potassium levels, particularly in patients with kidney disease.

Uncommon Side Effects of ACE Inhibitors.

ACE inhibitors protect against kidney disease, but they may also increase potassium retention by the kidneys. If potassium levels become extremely high, they can cause the heart to stop beating (cardiac arrest). This side effect is uncommon, except in patients with significant kidney disease. Because of this risk, ACE inhibitors are not usually used in combination with potassium-sparing diuretics or potassium supplements.

A rare but severe side effect is granulocytopenia, an extreme reduction in infection-fighting white blood cells.

In very rare cases, patients suffer a sudden and severe allergic reaction, called angioedema that causes swelling in the eyes and mouth and may close off the throat.

Patients who have difficulty tolerating ACE inhibitor side effects are usually switched to an angiotensin-receptor blocker (ARB).

Angiotensin-2 Receptor AntagonistsAngiotensin-2 (AT-2) receptor antagonists have been shown to produce effects similar to those produced by ACE inhibitors. They may be better tolerated because they produce less cough. Rather than lowering levels of angiotensin II (as ACE inhibitors do), angiotensin II receptor blockers prevent this chemical from having any effects on the heart and blood vessels. This keeps blood pressure from rising.For people with diabetes, this medication is often preferred because of the extra protection for the kidneys.Side effects:

Dizziness/Lightheadedness Decreased kidney function Increased potassium levels

Some common products in this category include:

Candesartan (Atacand)* Eprosartan (Teveten)* Irbesartan (Avapro)* Losartan (Cozaar)* Telmisartan (Micardis)* Valsartan (Diovan)*

Home remedy for Cough- check with doctor before using home remedies Combine ½ tablespoon of ginger paste, and a half tablespoon of pepper powder. Then add equal

amount (one tablespoon) of vinegar and honey into it. Put in 2-3 tablespoon of water and keep it aside. Use this cough syrup 2-3 times a day. This is homemade cough syrup for curing cough.

Mix a small piece of ginger cut in small slices, 1-2 garlic seeds, and small amount of lemon juice into the boiling water. Boil it around 15-20 minutes. Strain the liquid and keep it aside. Add a little amount of honey into the solution and give it to the patient. The lemon juice added to it will loosen the cough and make breath easy.

Nutrition and Dietary Supplements

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider.

For cough from respiratory infections, sinusitis, or allergies:

Honey — A 2007 study found that honey was more effective the over-the-counter cough medicines, including those containing dextromethorphan or DM, at treating cough and easing sore throat. Honey can be mixed with an herbal tea or just warm water. Never give honey to an infant under the age of 1.

Probiotics (Lactobacillus acidophilus) — While probiotics won’t directly relieve your cough, they may help underlying conditions. Some evidence suggests that Lactobacillus may help prevent colds and flu, and possibly reduce allergy to pollen. One study found that children in daycare centers who drank milk fortified with Lactobacillus had fewer and less severe colds. Several studies that examined probiotics combined with vitamins and minerals also found a reduction in the number of colds caught by adults, although it’s not possible to say whether the vitamins, minerals, or probiotics were most responsible for the benefit. One small study suggests that Lactobacillus might help reduce allergic reaction to pollen. More studies are needed to say for sure whether it is effective.

Quercetin — Quercetin is a flavonoid, a plant pigment responsible for the colors found in fruits and vegetables. In test tubes, it inhibits the production and release of histamine, which causes allergy symptoms such as a runny nose and watery eyes. It’s often combined with bromelain, a supplement made from pineapples. However, there is not yet much evidence that quercetin would work the same way in humans. More studies are needed.

Spirulina — Preliminary test tube and animal studies suggest that spirulina, a type of blue-green algae, may help protect against harmful allergic reactions. Spirulina prevents the release of histamines, which contribute to allergic symptoms. Research on people is needed.*Bromelain — Some studies show that bromelain may help reduce symptoms of sinusitis and relieve swelling and inflammation caused by allergies (hay fever). Not all studies show a benefit, however. It is often combined with quercetin. Bromelain may increase the risk of bleeding, so people who take anticoagulants (blood-thinners) should not take bromelain without talking to their doctor first. Taking bromelain with ACE inhibitors may cause a drop in blood pressure (hypotension).

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner.

Peppermint (Mentha x piperita) — Peppermint is widely used to treat cold symptoms. Its main active agent, menthol, is a good decongestant. Menthol also thins mucus and works as an expectorant, meaning that it helps loosen and break up mucus. It is soothing and calming for sore throats and dry coughs as well.

Eucalyptus (Eucalyptus globulus) — Like peppermint, eucalyptus is used in many remedies to treat cold symptoms, particularly cough. It can be found in many lozenges, cough syrups, and vapor baths throughout the United States and Europe. Ointments containing eucalyptus leaves are also applied to the nose and chest to relieve congestion and loosen phlegm.

Marshmallow (Althea officinalis) — Although there isn’t any scientific evidence that it works, marshmallow has been used traditionally to treat sore throat and cough. It contains mucilage, which helps coat the throat and act as a cough suppressant.

Slippery elm (Ulmus fulva) — Slippery elm may help ease sore throat and cough, and has been used traditionally for this purpose, although scientific evidence is lacking. Like marshmallow, it contains mucilage.

Lobelia (Lobelia inflata) — Also called Indian tobacco, lobelia has a long history of use as an herbal remedy for respiratory problems including cough. It is an effective expectorant, meaning that it helps clear mucus from your lungs. However, lobelia can be toxic and should only be used under a doctor’s supervision.

Mullein (Verbascum densiflorum) — Mullein is an expectorant, meaning it helps clear your lungs of mucus. Traditionally, it has been used to treat respiratory illnesses and coughs with lung congestion. However, studies are lacking.

Sundew (Drosera spp.) — Sundew has traditionally been used as a cough suppressant, although scientific studies are lacking. It is often used in Europe to treat dry coughs.

Stinging nettle (Urtica dioica, 600 mg per day for one week) — Stinging nettle has been used traditionally for treating a variety of conditions, including allergies (hay fever). But studies so far are lacking. Only one small study suggested that stinging nettle might help relieve symptoms of hay fever, including cough. Pregnant women and young children should not take stinging nettle. Talk to your doctor before taking stinging nettle if you take blood pressure medication, anticoagulants (blood-thinners), diuretics (water pills), or have diabetes.

Thyme (Thymus vulgaris) — Thyme has traditionally been used to treat respiratory illnesses such as bronchitis and to treat cough. Two preliminary studies indicate that thyme may help treat acute bronchitis and relieve cough, and thyme is approved by the German Commission E to treat those conditions. Thyme oil is considered toxic and should not be taken by mouth.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of coughs based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Aconitum — taken within the first 24 hours of a cough that comes on suddenly, particularly if symptoms develop following exposure to cold weather; this remedy is considered most appropriate for individuals with a hoarse, dry cough who complain of dry mouth, thirst, restlessness, and symptoms

that worsen in the cold or when the individual is lying on his or her side.

Antimonium tartareicum — for wet, rattling cough (although the cough is usually too weak to bring up mucus material from the lungs) that is accompanied by extreme fatigue and difficulty breathing; symptoms usually worsen when the person is lying down; this remedy is generally used during the later stages of a cough and is particularly useful for children and the elderly.

Bryonia — for dry, painful cough that tends to worsen with movement and deep inhalation; this remedy is most appropriate for individuals who are generally thirsty, chilly, and irritable.

Causticum — for laryngitis and a cough that cannot dislodge mucus in the chest and may cause the individual to leak urine during coughing fits; symptoms tend to improve with sips of cold water but worsen with cold air.

Drosera — for dry, spasmodic cough accompanied by sharp chest pain and a tickling sensation in the throat that may cause the individual to gag, choke or vomit; the individual may be hoarse or may perspire in the evenings and symptoms may worsen when the individual is lying down.

Ipecacuanha — for deep, wet cough, often with gagging, nausea, and vomiting; this remedy is especially useful for bronchitis in infants.

Phosphorous — for chest tightness associated with a variety of coughs, particularly a dry, harsh cough with a persistent tickle in the chest and significant chest pain; symptoms tend to worsen in cold air and when the individual is talking; this remedy is most appropriate for individuals who are often worn out and exhausted, suffer from unnecessary anxiety (even fear of death), and require a lot of reassurance.

Rumex — for dry, shallow cough that begins with a tickling sensation in the throat or with the inhalation of cold air.

Spongia — for harsh, barking cough without mucus production; this type of cough is associated with a tickling in the throat or chest; it tends to worsen when the person is lying down and improves when the individual eats or drinks warm liquids; this remedy is often used if a trial of Aconite was not successful.

Warnings and Precautions

Call your doctor right away if you have any of these symptoms accompanying your cough:

Violent cough that begins suddenly

High pitched sound (called stridor) when inhaling

Cough that produces blood

Cough in an infant less than 3 months old

Shortness of breath or difficulty breathing

Abdominal swelling

Unintentional weight loss or Fever

Thick, foul-smelling, green phlegm

Blood Pressure Medication Interactions

Supplements to take: Zinc that contains copper, 300–600 mg per day Magnesium, 400 mcg per day Folic Acid

Supplements to avoid (get these from diet- may want to check levels in blood tests) Potassium may need 4.7 g per day (4700 mg) from diet, Calcium eat green leafy vegetables

Vit. D (get adequate sunshine at least 15 min. per day) Limit Sodium

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor, a family of drugs used to treat high blood pressure and some types of heart failure. Lisinopril is also used in some cases to improve survival after a heart attack.

Summary of Interactions with Vitamins, Herbs, and FoodsIn some cases, an herb or supplement may appear in more than one category, which may seem

contradictory. For clarification, read the full article for details about the summarized interactions.

May Be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.

Zinc*

Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results. Potassium supplements*

Salt substitutes*

Side effect reduction/prevention None known

Supportive interaction None known

Reduced drug absorption/bioavailability None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

PotassiumAn uncommon yet potentially serious side effect of taking ACE inhibitors is increased blood potassium levels. This problem is more likely to occur in people with advanced kidney disease. Taking potassium supplements, potassium-containing salt substitutes (No Salt®, Morton Salt Substitute®, and others), or large amounts of high-potassium foods at the same time as ACE inhibitors could cause life-threatening problems. Therefore, people should consult their healthcare practitioner before supplementing additional potassium and should have their blood levels of potassium checked periodically while taking ACE inhibitors.

ZincIn a study of 34 people with hypertension, six months of captopril or enalapril (ACE inhibitors related to lisinopril) treatment led to decreased zinc levels in certain white blood cells, raising concerns about possible ACE inhibitor–induced zinc depletion.

While zinc depletion has not been reported with lisinopril, until more is known, it makes sense for

people taking lisinopril long term to consider, as a precaution, taking a zinc supplement or a multimineral tablet containing zinc. (Such multiminerals usually contain no more than 99 mg of potassium, probably not enough to trigger the above-mentioned interaction.) Supplements containing zinc should also contain copper, to protect against a zinc-induced copper deficiency.

Interactions with Foods and Other CompoundsLisinopril may be taken with or without food.

Hydrochlorothiazide

Also indexed as: Bendrofluazide, Bendroflumethiazide, Benzthiazide, Chlorothiazide, Chlorthalidone, Cyclopenthiazide, Diucardin, Diuril, Enduron, Esidrix, Exna, HCTZ, Hydrochlorothiazide, HydroDIURIL, Hydroflumethiazide, Hydromox, Hygroton, Indapamide, Lozol, Methyclothiazide, Metolazone, Mykrox, Naqua, Naturetin, Oretic, Polythiazide, Quinethazone, Renese, Trichlormethiazide, Xipamide, Zaroxolyn

Combination drugs: Aldactazide, Aldoclor, Aldoril, Apresazide, Captozide, Co-Tendione, Co-Zidocapt, Combipres, Dyazide, Hyzaar, Inderide, Lopressor HCT, Maxzide, Moduretic, Prinzide, Tenoretic, Timolide, Vaseretic, Zestoretic, Ziac

About thiazide diuretics

Thiazide diuretics are a family of drugs that remove water from the body. They are referred to as potassium-depleting because they cause the body to lose potassium as well as water. Potassium-depleting diuretics also cause the body to lose magnesium. Thiazide diuretics are used to lower blood pressure in people with high blood pressure. Diuretics are also used to reduce water accumulation caused by other diseases.

Helpful Products

Try these helpful products which may be beneficial if taken with this medicine

Potassium To avoid depleting potassium, which can lead to muscle cramps, twitches, and an irregular heartbeat, take a potassium supplement and eat more fruits (especially bananas), vegetables, and juices

Magnesium To avoid depleting magnesium, which can lead to weakness, muscle tremors, twitches, and mental dullness, supplement with 300 to 600 mg per day, or eat more nuts, grains, and beans

Folic acid Preliminary research suggests that this medicine might deplete this nutrient, so supplementing with 400 mcg per day may help improve blood levels

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full article for more information on interactions with vitamins, herbs, and foods.

Thiazide diuretics are also combined with other drugs to treat various conditions.

The information in this article pertains to thiazide diuretics in general. The interactions reported here may not apply to all the Also Indexed As terms. Talk to your doctor or pharmacist if you are taking any of these drugs.

Summary of Interactions with Vitamins, Herbs, and Foods

May Be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.

Folic acid *

Magnesium

Potassium

Zinc

Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.

Alder Buckthorn*

Buchu

Buckthorn*

Cleavers

Dandelion

Digitalis

Ginkgo biloba*

Gravel root

Horsetail

Juniper

Licorice

Uva ursi

Check: Other—Before taking any of these supplements or eating any of these foods with your medication, read this article

Calcium

in full for details. Sodium

Vitamin D

Side effect reduction/prevention None known

Supportive interaction None known

Reduced drug absorption/bioavailability None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

CalciumThiazide diuretics decrease calcium loss in the urine due to actions on the kidneys. As a result, it may be less important for some people taking thiazide diuretics to supplement calcium than it is for other people.

Folic acidOne study showed that people taking diuretics for more than six months had dramatically lower blood levels of folic acid and higher levels of homocysteine compared with individuals not taking diuretics. Homocysteine, a toxic amino acid byproduct, has been associated with atherosclerosis. Until further information is available, people taking diuretics for longer than six months should probably supplement with folic acid.

Magnesium and PotassiumPotassium-depleting diuretics, including thiazide diuretics, cause the body to lose potassium; they may also cause cellular magnesium depletion, although this deficiency may not be reflected by a low blood level of magnesium. Magnesium loss induced by potassium-depleting diuretics can cause additional potassium loss. Until more is known, it has been suggested that people taking potassium-depleting diuretics, including thiazide diuretics, should supplement both potassium and magnesium.

People taking thiazide diuretics should be monitored by their prescribing doctor, who will prescribe potassium supplements if needed. Such supplementation is particularly critical before surgery in patients with a history of heart disease. In a preliminary study, people with low blood levels of potassium (in part related to diuretic use) had a higher incidence of serious problems resulting from surgery (including death) compared with those having normal potassium levels. A double-blind trial showed that thiazide diuretic use led to a reduction in blood levels of potassium in some participants. Those experiencing decreased potassium levels were also more likely to experience cardiovascular events, such as heart attacks, stroke, heart failure, aneurysm, and sudden cardiac death. Fruit is high in potassium, and increasing fruit intake (especially bananas) is another way of supplementing potassium.

Magnesium supplementation for people taking thiazide diuretics is typically 300–600 mg per day, though higher amounts (over 800 mg per day) have been reported in a controlled study to reduce side

effects of thiazides. Combining supplementation of both potassium and magnesium has been reported to correct abnormally low blood levels of potassium and also to protect against excessive loss of magnesium.

Vitamin DThe reduction in urinary calcium loss resulting from treatment with thiazide diuretics is due primarily to changes in kidney function and may also be due, in part, to changes in vitamin D metabolism. However, there is no evidence to suggest that people taking diuretics have different requirements for vitamin D.

ZincThiazide diuretics can increase urinary zinc loss.

SodiumDiuretics, including thiazide diuretics, cause increased loss of sodium in the urine. By removing sodium from the body, diuretics also cause water to leave the body. This reduction of body water is the purpose of taking diuretics. Therefore, there is usually no reason to replace lost sodium, although strict limitation of salt intake in combination with the actions of diuretics can sometimes cause excessive sodium depletion. On the other hand, people who restrict sodium intake, and in the process reduce blood pressure, may need to have their dose of diuretics lowered.

Interactions with Herbs

Herbs that have a diuretic effect should be avoided when taking diuretic medications, as they may enhance the effect of these drugs and lead to possible cardiovascular side effects. These herbs include dandelion, uva ursi, juniper, buchu, cleavers, horsetail, and gravel root.

Alder Buckthorn, Buckthorn(Rhamnus catartica, Rhamnus frangula, Frangula alnus)Use buckthorn or alder buckthorn for more than ten days consecutively may cause a loss of electrolytes (especially the mineral potassium). Medications that also cause potassium loss, such as some diuretics, should be used with caution when taking buckthorn or alder buckthorn.

Digitalis (Digitalis purpurea)Digitalis refers to a family of plants commonly called foxglove, which contains digitalis glycosides, chemicals with actions and toxicities similar to the prescription drug digoxin. Thiazide diuretics can increase the risk of digitalis-induced heart disturbances. Thiazide diuretics and digitalis-containing products should be used only under the direct supervision of a doctor trained in their use.

Ginkgo bilobaOne case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic. Ginkgo was not proven to be the cause of this reaction.

Licorice (Glycyrrhiza glabra)Licorice may increase the side effects of potassium-depleting diuretics, including thiazide diuretics. Thiazide diuretics and licorice should be used together only under careful medical supervision. At the time of this writing, no evidence was found of interactions between deglycyrrhizinated licorice (DGL) and any diuretic was found in the medical literature.

Interactions with Foods and Other CompoundsThiazide diuretics may be taken with food to avoid stomach upset

Atenolol

Also indexed as: Tenormin

Combination drugs: Co-Tendione, Tenoretic

Atenolol is a beta-blocker drug used to treat some heart conditions, reduce the symptoms of angina pectoris (chest pain), lower blood pressure in people with hypertension, and treat people after heart attacks.

Summary of Interactions with Vitamins, Herbs, and FoodsIn some cases, an herb or supplement may appear in more than one category, which may seem

contradictory. For clarification, read the full article for details about the summarized interactions.

Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.

High-potassium foods*

Pleurisy root*

Potassium supplements*

Tobacco

Depletion or interference None known

Side effect reduction/prevention None known

Supportive interaction None known

Reduced drug absorption/bioavailability None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

PotassiumSome beta-adrenergic blockers (called “nonselective” beta blockers) decrease the uptake of potassium from the blood into the cells, leading to excess potassium in the blood, a potentially dangerous condition known as hyperkalemia. People taking beta-blockers should therefore avoid taking potassium supplements, or eating large quantities of fruit (e.g., bananas), unless directed to do so by their doctor.

Interactions with Herbs

Pleurisy rootAs pleurisy root and other plants in the Aesclepius species contain cardiac glycosides, it is best to avoid use of pleurisy root with heart medications such as atenolol.

Interactions with Foods and Other Compounds

FoodAtenolol may be taken with or without food.

AlcoholAtenolol may cause drowsiness, dizziness, lightheadedness, or blurred vision. Alcohol may intensify these effects and increase the risk of accidental injury. To prevent problems, people taking atenolol should avoid alcohol.

TobaccoIn a double-blind study of ten cigarette smokers with angina treated with atenolol for one week, angina episodes were significantly reduced during the nonsmoking phase compared to the smoking phase. People with angina taking atenolol who do not smoke should avoid starting. Those who smoke should consult with their prescribing doctor about quitting.

 CAUSES OF HYPERKALEMIAHigh Potassium

Spurious

Leakage from RBCs if sepearation of serum from clot is delayedThrombocytosis, with release of K from plateletsMarked elevation of white blood cellsRepeateed fist clenching during phlebotomy with release of K from forearm musclesBlood drawn from K infusion

Decreased excretion

Renal failure, acute or chronicSevere oliguria (decreased urine output) from shock or dehydrationRenal secretory defects: SLE, renal transplant, sickle cell disease, obstructive uropathy, amyloidosis, interstitial nephritisHyporeninemic hypoaldosteronism or selective hypoaldosteronism (seen in AIDS)Drugs inhibiting potassium excretion (triamterene, spironolactone, ACE inhibitors, etc)

Shift of Potassium from tissues

Massive release of intracellular potassium (burns, crush inujury, hemolysis, internal bleeding,vigorous exercise, rhabdomyolysisMetabolic acidosisHyperosmolalityInsulin deficiencyHyperkalemic periodic paralysisDrugs: digitalis toxicity, B-adrenergic antagonists, arginine, succinylcholine

Excessive intake of potassium

Excessive K, orally or parenterally

 

 CAUSES OF HYP0KALEMIALow Potassium

Diuretics

• The most common cause of hypokalemia is diuretic therapy. It is the most widely used antihypertensive medication, decreasing blood pressure through decrease of plasma volume by suppressing tubular reabsorption of sodium, and with chronic use, causes a reduction of peripheral vascular resistance.• Of the diuretics, the thiazides are the most widely used. • Used alone, diuretics control blood pressure in about 50% of patients and can be effectively combined with other agents - beta-blockers ,ACE inhibitors, angiotension II blockers.• Low potassium can be minimized or prevented by use of the diuretics in the lowest effective, a high potassium diet, limited salt intake or use of potassium-sparing diuretics, alone or in combination with thiazides.• Caution: Diuretics may increase uric acid and precipitate gout.

Gastrointestinal loss

• Vomiting, diarrhea.• Chronic laxative abuse.

Others

• Antifuncal Amphotericin B.• Excessive sweating and perspiration.• Metabolic acidosis, diabetic ketoacidosis.• Hypomagnesemia which may impair potassium correction.• Other disease states associated with high aldosterone levels that causes hypertension and excessive urinary loss of potassium.• ingestion of glycyrrhizin, which is contained in extract of licorice, found in supplements (see below), candies, etc.• Certain hereditary conditions: renal transport defects, hypokalemic periodic paralysis (muscular ion defect).

 

POTASSIUM CONTENT OF FOODS

DAIRY PRODUCTS PORTIONPOTASSIUM

(mg)

Cheddar cheese 1.5 oz. 42

Cottage cheese 1/2 cup 95

Ice cream, hard 1/2 cup 123

Milk, low fat 2% 1 cup 412

Milk, skim 1 cup 426

Milk, whole 1 cup 370

Yogurt, plain, low fat 1 cup 531

FRUITS & JUICES PORTION POTASSIUM

(mg)

Apple 1 medium 159

Apple juice 6 oz 222

Avocado 1/2 602

Banana 1 medium 451

Blueberries, raw 1/2 cup 65

Cantaloupe 1/2 825

Cherries, sweet, raw 10 152

Grapefruit 1/2 825

Grapefruit juice 6 oz 252

Grapes 10 93

Grape juice, frozen 6 oz 42

Orange 1 237

Orange juice, frozen 6 oz 354

Peach 1 171

Peaches, canned in juice 1/2 cup 158

Pear 1 208

Pineapple, raw 1/2 cup 113

Plum 1 112

Raisins 1/4 cup 553

Strawberries 1/2 cup 123

Watermelon 1/10 560

GRAINS PORTIONPOTASSIUM (mg) 

Bread, white 2 slices 52

Bread, wheat 2 slices 144

Oatmeal, cooked 1 cup 146

Rice, brown 1 cup 41

Shredded wheat 1 cup 87

LEGUMES & NUTS PORTIONPOTASSIUM (mg) 

Almonds, roasted 1 oz 219

Beans, red kidney, cooked 1 cup 629

Beans, white navy, cooked 1 cup 790

Black-eyed peas, cooked 1 cup 573

Peanuts, roasted 1 oz 191

Soybeans, cooked 1 cup 972

Split peas, cooked 1 cup 592

Walnuts, English, shelled 1 oz 128

MEAT, FISH, POULTRY & EGGS  PORTION

POTASSIUM (mg) 

Chicken, dark meat, roasted

4 oz 284

Chicken, light meat, roasted

4 oz 458

Chuck, choice, lean, cooked

4 oz 276

Cod, broiled with butter 4 oz 460

Egg 1 large 65

Flounder, broiled with butter

4 oz 460

Ground beef, lean, cooked 4 oz 305

Halibut, broiled 4 oz 596

Pork, loin chops, lean roasted

4 oz 373

Shad, baked 4 oz 428

Sirloin steak, lean, cooked 4 oz 409

Tuna, in water, chunk 3 oz 257

Turkey, dark meat, roasted 4 oz 450

Turkey, light meat, roasted 4 oz 465

VEGETABLES AND JUICES

PORTIONPOTASSIUM (mg) 

Beet greens, cooked 1 cup 480

Beets, cooked, diced, drained

1 cup 354

Broccoli, cooked 1 cup 414

Brussels sprouts, cooked 1 cup 846

Cabbage, red, raw, shredded

1 cup 240

Carrot, raw 1 246

Cauliflower, cooked 1 cup 240

Celery, raw 1 stalk 136

Coleslaw (w/mayonnaise) 1 cup 239

Collards 1 cup 498

Corn, cooked 1 ear 151

Eggplant, cooked, diced 1 cup 300

Green beans, cooked 1 cup 190

Green pepper 1 349

Lettuce, iceberg 1 cup 96

Lettuce, romaine 1 cup 143

Lima beans, immature, cooked

1 cup 376

Mushrooms, sliced, raw 1 cup 390

Okra, cooked 1 cup 268

Peas, cooked 1 cup 314

Potato, baked 1 long 782

Radishes 1/2 cup 185

Rutabaga, cooked, mashed

1 cup 1.320

Spinach, cooked 1 cup 1,166

Spinach, raw 1 cup 259

Squash, acorn, baked 1 cup 984

Squash, butternut, baked 1 cup 1,248

Sweet potatoes, baked 1 342

Tomato 1 medium 300

Tomato juice, canned 6 oz 413

Turnips, boiled, mashed 1 cup 432

Zucchini, cooked, sliced 1 cup 508

HERBALS THAT PROMOTE POTASSIUM DEPLETION

Herbal supplements that may promote potassium depletion through diuretic or laxative mechanisms include aloe, caraway, castor oil, dandelion, elder flower, flaxseed, figwort, glycerol, licorice, peppermint oil, psyllium, wheat bran, and yarrow.

DAILY POTASSIUM NEEDS

A panel from the Institute of Medicine's Food and Nutrition Board has set the daily adequate intake of potassium for healthy adults at 4.7 g per day to lower blood pressure, counter the effects of salt, and reduce the risk of bone loss and development of kidney stones. The amount corresponds to 10 servings of fruits, vegetables and other foods rich in potassium.

Most American women aged 31-50 years consume no more than half the recommended amount of potassium, 2.2 to 2.4 g of potassium daily; and men's only slightly higher, 2.8-3.3 g daily .

CAUTIONThe panel found no evidence of chronic excess consumption of potassium. However, certain patients - those with renal conditions with impaired ability to excrete potassium and those on certain types of drug therapies such as ACE inhibitors - should be under the care of a physician, who may recommend a daily potassium consumption of less than 4.7 g per day.

Selected Foods with High Potassium Content

Very High (12-20 meq) High (5-12 meq)

BeansGarbanzo beans (half cup)Soy beans (half cup)

Kidney beansLima beansNavy beansPinto beans

Fruit Papaya (medium)Durian

Apricots (1 1/2)Banana (medium)Cantaloupe (1/4 inch slice)Honeydew melon (1/4 inch slice)Orange (3 inch diameter)Orange Juice (half cup)Pear (large)Prunes (4)Prune juiceRhubarb

Vegetables

 

Artichoke (one)Avocado (1/4)Brussels sproutsCarrots (medium)ChardKetchup (tbsp)Potato (one, baked or broiled; 10 fries, half cup mashedPumpkinSpinachTomato (one)Tomato or vegetable juice

Resources

http://www.pccnaturalmarkets.com/health/1421009/

http://www.pccnaturalmarkets.com/health/1517000/

http://www.pccnaturalmarkets.com/health/1089000/

http://www.stuartxchange.com/Potassium.html