Question: I’m 63 years old and in fine health as far as I know. For years my blood pressure has been in the neighborhood of 118/85, which I understand is quite good. If my blood pressure stays down, am I unlikely to experience a heart attack or stroke?
Answer: Normal blood pressure is definitely an advantage, but it won’t protect you completely. High blood pressure is only one of several risk factors for cardiovascular disease. Others include smoking, high blood cholesterol, lack of exercise, heredity, and diabetes. Nevertheless, recent studies have suggested that even mild elevations of blood pressure increase your risk of problems. That’s why it’s important to keep track of your pressure, even if it hasn’t been high to date.
THE OTHER HYPERTENSION
Question: What would cause an increase in a 70-year-old’s sys-tolic, or upper, blood-pressure reading while the diastolic pressure remains normal? How serious a problem is this?
Answer: The stiffening of the arteries that typically occurs with advancing age can cause systolic blood pressure (the pressure in the arteries when the heart contracts) to rise above normal without affecting diastolic pressure (the pressure between contractions). An overactive thyroid or anemia can often produce the same effect. Temporary systolic blood-pressure hikes may result from exercise, stress, or excitement.
Until recently, doctors paid little attention to systolic blood pressure. But recent studies have clearly shown that for middle-aged and older people, any increase in systolic blood pressure over 140 mm Hg needs to be controlled.
KIDNEY STONES AND CALCIUM
Question: My 27-year-old daughter has had surgery twice for kidney stones. Her doctor told her to eliminate high-calcium foods from her diet. My concern is that a low-calcium diet will put her at high risk for osteoporosis. Would you comment?
Answer: A low-calcium diet can increase the risk of osteoporosis, an abnormal loss of bone that can lead to fractures in later years. Your daughter’s chances of avoiding osteoporosis will improve if she exercises regularly, doesn’t smoke, and avoids heavy intake of alcohol and caffeine. There is new evidence that low-calcium diets can increase the frequency of kidney stones whereas high-calcium diets can do the opposite. This seeming paradox may have to do with the effect of dietary calcium in preventing the absorption of oxalates from the intestine. However, calcium supplements should be avoided.
TUMS FOR THE BONES
Question: My doctor told me to take Tums, which is calcium carbonate, as an inexpensive alternative to calcium pills. However, the bottle warns against taking the maximum dose for more than two weeks. Is it safe to take Tums indefinitely?
Answer: Yes, if you’re just taking the modest dose needed as a supplement. The warning on the Tums bottle refers to its use as an antacid: Prolonged need for antacids should be evaluated by a doctor. Moreover, large amounts of supplemental calcium—such as the maximum dosage of 16 tablets a day for indigestion—can cause constipation, abdominal pain, and kidney stones if taken over a long period.
An adequate calcium intake is essential for warding off the fragile-bone disease osteoporosis. It’s a good idea to get as much of that calcium as you can from dietary sources—primarily reduced-fat dairy products and calcium-fortified products such as orange juice. But many people will also need to turn to supplements, which can be a bewildering task. Here are answers to some of the most commonly asked questions about calcium supplements.
How much should I take? Postmenopausal women who are receiving any kind of bone therapy, including estrogen, nasal calcitonin (Miacalcin Nasal Spray), and alendronate (Fosamax), should get 1,200 milligrams of calcium a day; those who aren’t should aim for 1,500 milligrams. Other adults need about 1,000 milligrams up to age 50, 1,200 milligrams from age 50 to 65, and 1,500 milligrams over 65. If you need sup-plements, take only the amount of calcium required to reach the recommended level. For best absorption, don’t take more than 500 milligrams at a time; if you need to take more than that, split up your dose.
How can I tell how much calcium is in a certain supplement? Read the label very carefully. Calcium comes in various compounds, such as calcium carbonate, calcium citrate, calcium gluconate, and others. But only the calcium element itself counts. So ignore how much of the total calcium compound is in each pill; instead, look for the amount of “elemental” calcium.
Which calcium compound is best? The various compounds differ mainly in the amount of elemental calcium they supply. The more calcium you get from a particular compound, the fewer pills you’ll have to take. Calcium carbonate—which is also the active ingredient in certain antacid tablets, such as Tums and Rolaids Calcium Rich—is the most concentrated form of calcium and usually the cheapest, so it’s generally the best choice.
When should I take calcium pills? Calcium-carbonate supplements are generally somewhat better absorbed when they’re taken with a meal or shortly afterward.
Should I be concerned about potential drug interactions? Calcium pills may interfere with the absorption of various medications—including iron supplements as well as certain prescription drugs, such as thyroid hormone, tetracycline antibiotics and the osteoporosis medication alendronate (Fosamax). Check with your doctor or pharmacist. If a medication you’re taking is affected by calcium supplements, you’ll probably need to put at least two hours between the drug and the calcium.
Conversely, certain other medications such as corticosteroids tend to impair the absorption of calcium, whether from pills or from food. People who are taking an extended course of such treatment are therefore at increased risk of developing osteoporosis and should consult their physician about appropriate treatment options. They may need to take more calcium than is normally recommended for someone their age, or their doctor may prescribe medication to counter bone loss.
What about the risk of food interactions? The substances known as phytates, which are found in wheat bran, soybeans, and legumes, can inhibit the absorption of calcium from supplements. If you’re eating a meal rich in those foods, take your calcium supplements at a different time—or take a little extra calcium to compensate. The oxalates found in certain green leafy vegetables, including rhubarb, spinach, and Swiss chard, tend to block the absorption of calcium from those foods, whether cooked or raw, but they won’t affect the amount absorbed from other foods or from supplements.
Should I take other nutrients with my calcium? Your body needs vitamin D to maximize calcium absorption. If you’re over 50, you may need a daily vitamin-D supplement—especially if you don’t drink fortified milk or eat fatty fish, and you seldom get out in the sun. (If you’re at high risk for osteoporosis, talk to your doctor about being tested for a low level of vitamin D.)
Small quantities of the trace minerals magnesium, manganese, and zinc also help the body utilize calcium. But the average American diet provides sufficient amounts for that purpose.
What’s the risk of lead contamination? While calcium supplements can contain traces of lead, the risk is low and outweighed by the clear benefit against osteoporosis in people who need extra calcium. Still, the less lead the better, which is why Consumers Union has urged the FDA to require manufacturers to minimize the lead content of their calcium pills.
No one type of calcium compound appears to have a con-sistently higher lead level than the others. However, natural sources of calcium, such as bonemeal and dolomite, are subject to unpredictable environmental contamination, so they’re best avoided.
CALCIUM AND LACTOSE
Question: I’m a 33-year-old man who can’t digest lactose. Since I can’t drink milk, I’m concerned that I don’t get enough cal-cium in my diet. So I take a 500-milligram supplement twice a day. Is that necessary?
Answer: At your age, it’s a good idea to get 1,000 milligrams of calcium every day, but you should be able to get that without supplements. One way is to consume milk products with the help of pills containing the digestive enzyme lactase, such as LactAid or Lactrase. Or you could drink a lactose-reduced milk. Buttermilk and yogurt probably wouldn’t trouble you either. Nondairy sources of calcium include broccoli, greens (except spinach), kale, legumes (dried beans, peas, and lentils), and canned sardines and salmon.
If you’re eating a meal rich in those foods, take your calcium supplements at a different time—or take a little extra calcium to compensate.
Health handbook introducing you to read the article: Bladder And Yurinary Problems
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