Q My husband has "white-coat hypertension" in the form of highly elevated blood pressure whenever he goes to the doctor for his routine checkups. He has a blood pressure monitor at home and checks his blood pressure at least once a day. The machine was calibrated twice by the doctor and was found to be accurate. My husband's readings at home are always 120 or less systolic over 80 or less diastolic with the home machine, but can be 160 systolic at the doctor's office. Does he need additional medication for his blood pressure?
A Reactive hypertension -- high blood pressure resulting from a situational rather than a medical source -- is very common. When it's the result of seeing the doctor -- the "white coat" part -- it can lead to overtreatment if not recognized.
You and your husband have done exactly the right thing -- bought and tested a home machine, and your husband regularly tests his blood pressure at home.
If the readings at home are consistently good and there are no other signs of poorly controlled blood pressure -- the doctor may look at the back of the eyes, listen to the heart, check kidney tests or even get an echocardiogram to look for signs of damage from high blood pressure -- I would not recommend additional medication.
For others in the market for a home machine, home blood pressure cuffs that go around the upper arm, not the wrist or a finger, tend to be the most accurate. Definitely take the machine to the doctor so it can
be checked for accuracy. More blood pressure measurements mean better information for you and your doctor to decide about treatment.Q I have always known that fish oil is beneficial for its omega-3 content. Now, I see krill oil is being sold, claiming to have the same beneficial properties. But krill are high in cholesterol. How can that be beneficial?
A The benefits of omega-3 fatty acids have been extremely controversial in the past few years, with studies showing conflicting results and a recent study concluding that omega-3 has only a small effect.
My take, after reading all this data, is that omega-3- containing foods, such as fatty fish like salmon, have a modest benefit in reducing heart disease. Fish-oil supplements may be of benefit, especially for people with high cholesterol or heart disease.
One study showed that krill oil supplements reduced cholesterol levels, but I would not recommend taking a supplement until there is clear data not only that blood numbers improve but also that people live longer or are healthier taking a supplement compared with not doing so. We don't yet have that certainty with krill oil.
Finally, the big effect on your blood cholesterol comes from the cholesterol your body makes, not from the cholesterol you eat. Fish oil and, it appears, krill oil seem to affect the way your body makes cholesterol.
Q I have a male relative with diabetes. He takes diabetes medicine, but he eats five or more servings of fruit per day. Should he be restricting his daily fruit intake? Is there too much sugar in five or more fruits per day?
A Sugar from whole fruits acts differently in your body than the way added table sugar or even fruit juice does. Sugar from fruit is absorbed more slowly due to the fiber of whole fruit.
Most diabetes authorities recommend two to four servings of fruit daily. However, each person may react a little differently, and it is pretty easy to check blood sugar before and after eating fruit to see what the effect is on an individual's blood sugar.
Some fruits may be better than others. Many diabetics find apples, which have more fiber and less sugar than some others, to have little effect on their blood sugar.
Q Does a heart murmur cause atrial fibrillation? I have had a heart murmur for years.
A A heart murmur is an abnormal sound heard by your doctor or nurse with a stethoscope. There are many kinds of heart murmurs, and although some of them represent serious disease, many are benign and don't need any testing.
However, one cause of a heart murmur is a defective heart valve. One of these valves, the mitral valve, prevents blood from leaking back into the left atrium from the left ventricle. If this valve is partially blocked -- we use the term "stenotic," and it can be from calcification, rheumatic heart disease or some other cause -- it may lead to enlargement of the left atrium. If the atrium is too big for too long, it can cause atrial fibrillation, which is an abnormal, irregular heartbeat.
In other words, there is one kind of heart murmur that can lead to atrial fibrillation, but it's one of many. Ask your doctor for the cause of your murmur.
Q I am 89. My memory isn't good. I take coconut oil, hoping to improve it. What is your opinion on that?
A Coconut oil has a high concentration of saturated fat. Saturated fat is a factor in raising cholesterol and clogging arteries. However, the effect of coconut oil in those regards isn't as bad as was once believed.
Coconut oil also contains medium chain triglycerides. They have been suggested as a preventative for Alzheimer's disease with its loss of memory.
Personally, I would wait until there is more evidence that coconut oil wards off Alzheimer's disease before using it on a regular basis.
Write to Drs. Donohue and Roach at P.O. Box 536475, Orlando, FL 32853-6475.
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