People’s Pharmacy: Hydration plus medication led to life-threatening complication

Q. I just got out of the hospital. The doctors discovered that my sodium level was dangerously low. That explained why I was troubled with headaches, insomnia, muscle cramps, dizziness and severe fatigue.

Why do we get such conflicting messages about salt? I have been told for years to avoid sodium. During hot weather, we are also told to stay well hydrated. I try to drink eight glasses of water daily.

Now I’ve learned from my hospital stay that too much water on a low-salt diet in combination with the HCTZ I take to control my blood pressure could be a big mistake. The doctors in the hospital actually told me to eat more salt! Go figure.

A. We are glad to hear that you have recovered from an extremely serious complication. Low sodium, also called hyponatremia, can lead to brain swelling, seizures, coma or even death if it is not corrected promptly.

Thiazide diuretics such as hydrochlorothiazide (HCT or HCTZ) can deplete the body of crucial minerals such as magnesium, potassium, sodium and zinc. Your health care provider should be monitoring these electrolytes, especially during hot weather.

While hydration is critically important when temperatures soar, you can overdo it. Instead of plain water, you should include a solution containing electrolytes as part of your liquid intake.

Scientists discovered decades ago that a low-salt diet could interfere with normal sleep (Journal of Clinical Endocrinology, March 1983). We fear this consequence of a low-sodium regimen has been overlooked.

Q. I have a bad family history of cardiovascular disease. My brother died at age 45 of a heart attack. Consequently, I have tried to lower my own risk.

A preventive cardiologist who I consulted prescribed statins, which gave me terrible leg cramps and brain fog. After a few years of that, I gave up on those drugs. I was still struggling with the low-fat, high-carb diet the dietician recommended. On it, I gained weight and felt tired. Eventually, I quit that, too.

A diet with good-quality fats helped me lose 15 pounds. Even better, my Lp(a) levels dropped significantly and are no longer too high. I get my fats from grass-fed meats, free-range eggs, avocados, olive and avocado oil, though I sometimes cheat with a little peanut butter or chocolate. Reading actual medical research on Lp(a) has been enlightening.

A. High levels of lipoprotein(a) or Lp(a) are now considered a major risk factor for atherosclerosis, heart attacks, strokes and heart valve calcification. Statins lower LDL cholesterol, but there is growing evidence that these medications may increase Lp(a) levels. A study involving over 42,000 patients found that: “The use of statins was associated with an increased risk of Lp(a) elevation compared with non-statin use counterparts” (European Journal of Medical Research, July 1, 2023).

Diet is not supposed to lower Lp(a) levels, but a study in the American Journal of Clinical Nutrition (Sept. 28, 2021) suggests that a low-carb diet can be helpful. You can learn much more about Lp(a) and other strategies to lower this often-ignored risk factor for heart disease in our “eGuide to Cholesterol Control and Heart Health.” This online resource may be found under the Health eGuides tab at www.PeoplesPharmacy.com.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla., 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”