Ask the Doctor: Potassium; Dupuytren’s Contracture; Menopause

Q: I’ve been told that potassium is good for the heart. Should I take a supplement?

A: Potassium is a vital mineral that helps the heart to contract and pump blood and also to maintain a steady rhythm. It’s always best to get needed nutrients from foods whenever possible. Fortunately, potassium can be found in a wide range of foods, making it easy to have some at every meal. Potassium-rich foods include: leafy greens such as spinach and collards, fruits including bananas, grapes, blackberries, oranges and grapefruit, and root vegetables such as carrots and potatoes. Coconut water is also a good and refreshing source that is relatively low in calories and high in potassium. An eight-ounce glass is just 45 calories and supplies 470 milligrams of potassium. Guidelines issued by the Institute of Medicine of the National Academies of Science encourage adults to consume at least 4,700 milligrams of potassium every day. Most people consume only half that amount. But beware of overloading your diet or taking supplements without consulting your doctor. Too much potassium can lead to irregular heartbeats. Likewise, an excess amount can be dangerous to people with kidney disease. On the flipside, people who take diuretics may lose this valuable mineral in urine and should have their potassium levels checked regularly.

Q: I’m a male in my 70s and sometimes my ring finger bends down and I have trouble opening my hand. It doesn’t really hurt but I’m concerned. What’s going on?

A: A lot people have pain and deformity in their hands from arthritic conditions, which can cause knobby knuckles and the fingers to curl slightly. But from what you’re describing, you may have a condition called Dupuytren’s contracture. While both men and women can have this hereditary condition, it tends to be much more common in men of Northern European descent. Cells in the hand start to duplicate and can turn into a thick nodule that pulls the finger down toward the palm. The nodule starts small but can grow into a fibrous band that gets larger and more painful when it’s touched, though this can take a long time. The condition can eventually limit your ability to grip. Typically, a physician will conduct a tabletop test to determine if treatment is needed. If you can lay your hand flat on the table, no treatment is needed. If you can’t, there are several treatment options, including a newer enzyme injection that breaks down the fibers. For more severe contractures, a surgeon can remove the troublesome cord. You’re right to be concerned, as it’s best to have your hand evaluated before the nodules get too large for nonsurgical options.

Q: As a postmenopausal woman, I was told that I’d have to stop taking hormones after five years. They certainly have helped with hot flashes and sleep issues. If hormones are needed for the body, why is it bad to keep taking them?

A: There are many conflicting reports about menopausal hormone therapy. Some have shown an association with serious health risks, such as breast cancer, heart attack and stroke. Those insights first came to light during the large-scale study called the Women’s Health Initiative (WHI), by the National Institutes of Health. The study was halted in 2002 when researchers determined that risks outweighed the benefits. However, three years after stopping the therapy, the increased risk disappeared. Note that the average age of the women in WHI was 63, more than 10 years older than the average age of menopause onset. A 2016 study in the journal Metabolism, reviewed the data in WHI and reported that hormone therapy for relief of moderate-to-severe hot flashes in early menopausal patients who have a favorable coronary profile remains a viable option. Current recommendations are to take hormone therapy for the shortest time and at the lowest effective dose. Ten years is the upper limit. While night sweats can return when therapy stops, symptoms abate with age as the body naturally transitions into the next phase of life.

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