Chris mentions in the exposome unit on HPA axis dysfunction that if a patient is having low blood pressure to consider limiting high-potassium foods. To what extent do you think this is necessary? For example, would a medium banana and half an avocado in one day be too much? If the patient starts taking half to one teaspoon of sea salt in the morning, can they be a little more liberal with the potassium in the foods they’re eating? Lastly should the patient be monitoring blood pressure throughout the day? If so, how often and when?

Dr. Amy Nett: Yeah, so a lot of answers to each of these questions are going to depend to some extent on the symptoms. So is the patient symptomatic from the low blood pressure? What do those symptoms look like? Because depending on the severity of the symptoms, would depend on the restrictions needed. Because you don’t want to be completely potassium free. We need potassium for a number of different processes. So I think half a medium banana and half an avocado should not be too much potassium. So go by symptoms to some extent.

Similarly in terms of blood pressure monitoring, I would have them monitor particularly when they feel symptomatic. So you could either have three set points during the day, like, say, hey, just monitor your blood pressure at these three times; let’s see what it looks like. Or you could just say when you’re symptomatic, do that and what I might do,  you’re having them measure their blood pressure when they’re symptomatic. You might want to have them journal about are they symptomatic around the time of food, are there symptoms when they go from sitting to standing, something like that. But get a little more information there because I don’t know that you want to be too restrictive with potassium, especially for any long period of time. So I would make that determination based mostly on symptoms.