Eating better, losing weight, being physically active and reducing stress are the hallmark of healthy living. For those affected by primary aldosteronism, they are not an option — they are a lifeline. Because of the various symptoms and comorbidities associated with the disease, patients who adopt these lifestyle changes usually see their quality of life improve.
Food is fuel, and the type and quality of the food we eat have a direct impact on our health.
Since primary aldosteronism is a salt-sensitive form of hypertension, limiting sodium intake can be of benefit to patients. Some not only experience a significant improvement in symptoms such as headaches and myalgia, but can also reduce the dose of their blood pressure medications and avoid potassium supplements all together.
Dietary Approaches to Stop Hypertension (DASH), is an eating plan based on 2,000 calories per day. Rich in fruits and vegetables, it is also low in saturated fat, total fat, and cholesterol. Recommended sodium levels are between 1,500 and 2,300 mg per day. The recommended potassium level is 4,700 mg per day.
Some patients with PA further reduce sodium, and increase their potassium intake beyond 4,700 mg. You should discuss the value of DASH and plant-based eating plans with your physician prior to adopting them.
Sodium is a ubiquitous molecule that is found in every food. Patients who have primary aldosteronism find online applications and analytical tools helpful to manage their eating plan.
To help validate your daily sodium and potassium intake, your physician can order a “sleep urine” test. Urine is collected from the time of retiring to bed until the first voiding the next morning. Sodium and potassium are measured, and a sodium/potassium ratio < 1 indicates that the DASH target has been reached. The lower the ratio, the lower the sodium level, and the higher the potassium intake were the day before.
(weight in pounds) x 703
(height in inches) x (height in inches)
Someone who is 5’5” tall and weighs 135 lbs. has a BMI of:
135 x 703 / (65 x 65) = 94,905/4,225 = 22.5
18.5 - 24.9
25.0 - 29.9
Blood pressure increases with weight, and those who have hypertension benefit the most from weight loss. Excess weight is also associated with dyslipidemia and diabetes, two comorbidities often found in patients who have primary aldosteronism.
Body Mass Index (BMI), a person’s weight relative to his/her height, is used with waist measurement to assess obesity. A BMI between 25 and 30 is considered overweight. A waist circumference above 35 inches for women and 40 inches for men is considered high.
Weight loss is achieved by reducing calorie intake and increasing physical activity. A pound equals 3,500 calories, and the recommended daily calorie intake is 2,000 for women and 2,500 for men. Eating plans should be discussed with your physician.
Being Physically Active
A minimum of 30 minutes of moderate-level physical activity on most days of the week lowers hypertension and the risk of heart disease. It also helps maintain endurance, and mitigate muscle and bone damage caused by excess aldosterone.
Brisk walking, bicycling, and performing chores such as washing a car or gardening, are considered physical activities of moderate level.
If too challenging, the 30 minutes can be broken down in shorter 10-minute segments. If feasible, being active for longer periods of time or performing more vigorous activities bring added benefit. Exercise plans should be discussed with your physician.
Because they are prone to sleep disorders, patients with PA must ensure they get enough rest. Adopting a few simple techniques also helps reducing the anxiety and depression caused by excess aldosterone:
- Accepting events that are beyond our control;
- Asserting our feelings to prevent anger and aggressiveness;
- Setting limits and saying no to requests that create excessive stress;
- Managing our time effectively;
- Making time for hobbies and interests;
- Learning and practicing relaxation techniques;
- Seeking out social support; and
- Seeking counseling in times of crisis and to learn from professionals trained in stress management.
- Appel, L. J., Brands, M. W., Daniels, S. R., Karanja, N., Elmer, P. J., Sacks, F. M., & American Heart Association (2006). Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension (Dallas, Tex. : 1979), 47(2), 296–308. DOI: 10.1161/01.HYP.0000202568.01167.B6
- Grim, C. E. (2017). Potassium and Blood Pressure: How to Test the Effects of DASH Diet in your Patient with Hypertension? Hypertension Journal, 3(1), 37-41. DOI: 10.5005/jp-journals-10043-0068