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 Considerations
Fiber. 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:
Diuretics
Diuretics 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 Blockers
Beta 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 Blockers

Calcium 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) Inhibitors

These 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 Antagonists

Angiotensin-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 Foods
In 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 Zinc*

medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help
replenish them.
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

Potassium
An 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.
Zinc
In 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 Compounds
Lisinopril 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 Folic acid *

medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help Magnesium
replenish them.
Potassium

Zinc

Avoid: Adverse interaction—Avoid these supplements when Alder Buckthorn*

taking this medication because taking them together may cause
undesirable or dangerous results. Buchu

Buckthorn*

Cleavers

Dandelion

Digitalis

Ginkgo biloba*

Gravel root

Horsetail

Juniper
 Licorice

Uva ursi

Check: Other—Before taking any of these supplements or Calcium

eating any of these foods with your medication, read this article
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

Calcium
Thiazide 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 acid
One 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 Potassium
Potassium-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 D
The 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.
Zinc
Thiazide diuretics can increase urinary zinc loss.
Sodium
Diuretics, 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 biloba
One 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 Compounds
Thiazide 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 Foods

In 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 High-potassium foods*

taking this medication because taking them together may cause
undesirable or dangerous results. 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

Potassium
Some 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 root
As 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

Food
Atenolol may be taken with or without food.
Alcohol
Atenolol 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.
Tobacco
In 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 HYPERKALEMIA
High Potassium
Spurious
Leakage from RBCs if sepearation of serum from clot is delayed
Thrombocytosis, with release of K from platelets
Marked elevation of white blood cells
Repeateed fist clenching during phlebotomy with release of K from
forearm muscles
Blood drawn from K infusion
Decreased excretion
Renal failure, acute or chronic
Severe oliguria (decreased urine output) from shock or dehydration
Renal secretory defects: SLE, renal transplant, sickle cell disease,
obstructive uropathy,
amyloidosis, interstitial nephritis
Hyporeninemic 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, rhabdomyolysis
Metabolic acidosis
Hyperosmolality
Insulin deficiency
Hyperkalemic periodic paralysis
Drugs: digitalis toxicity, B-adrenergic antagonists, arginine,
succinylcholine
Excessive intake of potassium
Excessive K, orally or parenterally

CAUSES OF HYP0KALEMIA
Low 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.
Other s
• 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

POTASSIUM
DAIRY PRODUCTS PORTION
(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

PORTIO POTASSIUM
FRUITS & JUICES
N (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

PORTIO POTASSIUM
GRAINS
N (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

PORTIO POTASSIUM
LEGUMES & NUTS
N (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, PORTIO POTASSIUM

POULTRY & EGGS N (mg)
Chicken, dark meat,
4 oz 284
roasted
Chicken, light meat,
4 oz 458
roasted
Chuck, choice, lean,
4 oz 276
cooked
Cod, broiled with butter 4 oz 460
Egg 1 large 65
Flounder, broiled with
4 oz 460
butter
Ground beef, lean, cooked 4 oz 305
Halibut, broiled 4 oz 596
Pork, loin chops, lean
4 oz 373
roasted
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 PORTIO POTASSIUM

JUICES N (mg)
Beet greens, cooked 1 cup 480
Beets, cooked, diced, 1 cup 354
 drained
Broccoli, cooked 1 cup 414
Brussels sprouts, cooked 1 cup 846
Cabbage, red, raw,
1 cup 240
shredded
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,
1 cup 376
cooked
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,
1 cup 1.320
mashed
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 .

CAUTION
The 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)
Garbanzo beans (half Kidney beans
Beans
cup) Lima beans
Soy beans (half cup) Navy beans
Pinto beans
Apricots (1 1/2)
Fruit Papaya (medium) Banana (medium)
Durian Cantaloupe (1/4 inch slice)
Honeydew melon (1/4 inch slice)
Orange (3 inch diameter)
Orange Juice (half cup)
Pear (large)
Prunes (4)
Prune juice
Rhubarb
Vegetables Artichoke (one)
Avocado (1/4)
 Brussels sprouts
Carrots (medium)
Chard
Ketchup (tbsp)
Potato (one, baked or broiled; 10 fries, half cup mashed
Pumpkin
Spinach
Tomato (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