Trending
DEAR DR. ROACH: I’m a 79-year-old woman who’s trying her best to stay strong physically with daily exercise, eating right, and successfully living independently after the death of my husband. Other than taking one 20-mg benazepril tablet daily for high blood pressure, I’m in pretty good health.
Recently, several friends who are close to my age have been diagnosed with low blood sodium levels. One landed in the ICU for several days, while others had problems with falls, swollen ankles and legs, slurred speech, and difficulty thinking and problem-solving, among other symptoms. I’m shocked to find out that so many others who are my age have also suffered from low blood sodium, because it was something that I wasn’t aware of.
What can I do to protect and prevent myself from becoming just another older woman who gets diagnosed with this malady? When I asked a doctor who was making his rounds at the hospital, he said that I should just eat lots of protein-rich foods. Is this really all I and others in my age group should be doing? Protein seems to be the new magic cure for almost everything today, much like vitamin C was Linus Pauling’s answer for so many things in the ’70s and ’80s. -- J.E.K.
ANSWER: Hyponatremia, aka low blood sodium, is a common problem in older men and women (approximately 10% of adults, but much higher among those who are in a nursing facility). A common definition is a sodium level below 135 mEq/L. Although the sodium level is low, the problem usually isn’t from a lack of salt -- it’s from an excess of water.
There are many causes. High blood pressure medicines in the diuretic class, especially chlorthalidone but also HCTZ, are extremely common causes. It’s possible to drink enough water to lower the blood sodium, but it isn’t easy. Some kidney, liver and heart diseases frequently cause low sodium.
The syndrome of inappropriate antidiuretic hormone is another common cause. While this can occur by itself, it’s often associated with lung and brain conditions. It can also be triggered by common medications, and some common antidepressants may be particularly prone to do so in older adults. Another common way to get low blood sodium is by exercising and replacing sweat loss with plain water.
A high-fluid, low-protein diet is a cause of hyponatremia. An adequate protein intake is important for older adults, but most people get plenty of protein. I agree with you that protein may be overemphasized at the current time. Although Linus Pauling was a positively brilliant chemist and won a Nobel Prize for his work on the chemical bond, he was wrong about vitamin C being a cure for all medical problems.
The prevention of hyponatremia in healthy older adults means being careful about prescribing medications that predispose people to it. (Benazepril isn’t one that’s commonly associated with hyponatremia.) It also means advising people against excess water drinking. (I see people in my office with enormous water bottles with encouraging remarks on the side to drink more; this is often a bad idea.)
Getting adequate protein is important, as well as using sports drinks or medical electrolyte-replacement drinks rather than water when exercising intensively (or with a diarrheal illness).
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.
All Rights Reserved