Reader questions doctor’s advice
Dear Dr. Roach: Iam a 79-year-old woman who weighs 123 pounds. I have been on a low-salt eating program to treat Meniere’s disease for 25 years. My blood pressure is 115/69 mm Hg.
My doctor discovered that I had an estimated glomerular filtration rate (eGFR) of less than 59. The nephrologist said to cut down my total liquid intake to 7-8 cups a day and up my protein to 80100 grams a day.
This seem contrary to everything I have ever heard. Can you explain why I would be directed to drink so little liquid?
C.V.
Answer: This advice is contrary to what I was taught and what is published in the literature.
Protein restriction has been part of the standard of care for decades. For a 56-kilogram woman like yourself, your goal would be 35-45 grams of protein per day.
People with chronic kidney disease are at risk for fluid overload and low sodium levels, which can be dangerous. However, restricting you to 2 liters is not usually necessary, and given your current symptoms, it isn’t the best idea, unless the nephrologist knows something that I don’t.
Dear Dr. Roach: I take 20 mg of famotidine and have for years. Is this safe to take daily?
G.S.
Answer: Reflux disease is very common. Lifestyle changes are the first line of treatment. Avoidance of food triggers, weight loss if appropriate, elevation of the head of your bed, and avoiding eating at least 2 hours before bed are among the most effective. Smoking and excess alcohol use should be stopped.
When lifestyle changes aren’t enough, a histamine-2 blocker like famotidine is a reasonable option, especially for someone with intermittent symptoms. Side effects are rare, and if you haven’t had them yet, you aren’t likely to get them. Proton pump inhibitors like omeprazole have more clearly defined risks with long-term use, so these should be reserved for when they are truly necessary. Famotidine starts working quickly, while omeprazole and similar drugs take days to work.
Readers may email questions to: ToYourGoodHealth@med .cornell.edu or mail questions to 628 Virginia Dr., Orlando, FL 32803.