Dr. Keith Roach

DEAR DR. ROACH: I read in a health journal that large amounts of sodium are unhealthy for one’s diet. The government standard is no more than 2,300 mg of sodium per day. If one’s health is not so good, some doctors say that their sodium intake shouldn’t be more than 1,500 mg per day. Everything you eat or drink counts.
If consuming sodium is so bad for your health, then why aren’t there limitations in the amount of sodium a company puts into their products? Shouldn’t this be controlled by the federal government, similar to alcohol and numerous other chemicals in food and drinks that we find in cans, boxes and packages?
For instance, why should diet soda have sodium in it? — E.R.
ANSWER: It is true that excess sodium has health risks, and I agree with public health officials in recommending that people consume less sodium. High sodium increases blood pressure levels for most people. Even in people without high blood pressure, a high-sodium diet slightly increases stroke risk and predisposes them to kidney stones.
However, sodium is an essential nutrient, and although sodium deficiency is unheard of now, there are conditions where a high-sodium diet is important. I saw a patient yesterday who had POTS (postural orthostatic tachycardia syndrome) after COVID, and she needs 8-12 grams of sodium daily to keep her blood pressure up.
As a physician, my role is to advise. It’s not for me to dictate public policy, and I worry about the government making regulations about what is a personal choice. Pretzels contain 250-300 mg of sodium in a 1-ounce serving, so a big bag of pretzels might have 5 grams of sodium — two day’s worth. I’m uncomfortable with the government limiting my ability to buy this, even if it isn’t a good idea for me to consume it all in a day.
On the other hand, I think that the decision made by the Food and Drug Administration in 2015 to ban the use of trans fats was correct. Trans fats are exceedingly unhealthy, and manufacturers quickly switched to heathier options. The decision to ban a substance or limit its use must be made wisely.
As far as diet sodas, sodium suppresses the bitter taste that can accompany some artificial sweeteners. A typical diet soda might have 20 mg of sodium (0.02 grams), so those usually aren’t the biggest offenders. On the other hand, a large pizza might have 6-10 grams of sodium.
DEAR DR. ROACH: I am 73 years old with an extremely large prostate. My PSA reading was over 11 ng/mL. I’ve had negative biopsies, and my new urologist put me on finasteride. He told me he had great results with it and could cut my cancer risk by 80%.
I have been taking it for more than six months, and my latest PSA was 4.4 ng/mL. I’m reluctant to keep taking it. What are your thoughts on finasteride? — H.D.
ANSWER: I agree that finasteride decreases the risk of prostate cancer and death due to prostate cancer. Unfortunately, the data show more of a 25% to 30% decreased risk than an 80% risk. If it were 80% successful at stopping prostate cancer, we would be recommending it to all men (in absence of side effects). Still, a decrease in prostate cancer risk is worth considering when it comes to the treatment of symptomatic prostate enlargement.
Finally, finasteride reduces PSA levels by about half, which needs to be taken into account when interpreting the PSA level.
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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 or send mail to 628 Virginia Dr., Orlando, FL 32803.
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