Monday, June 25, 2018

Diamox Depletion, or "Why Can't I Feel My Feet?"

This post ran awhile ago. While I clean some things up and move them around, please enjoy this bit on how to avoid feeling like absolute crap while taking Diamox.

I've talked about acetazolamide before. Namely, my intense love-hate relationship with a medication that's saving my brain and vision while ruining my kidneys and giving me the memory of a coked-up potato beetle. I've even gone a bit into what one can expect when taking it, though everyone's experiences will vary. Now I'd like to go into a little more detail about what I, specifically, do to help deal with it -- especially the nutrient depletion that can result in pain, tingling, numbness, confusion, anxiety, and even death.

So, electrolytes. All foods have them to some degree, but some of those are going to be more useful than others. Most intracranial hypertension patients are told to avoid too much salt (which isn't too surprising -- salt-sensitive high blood pressure doesn't feel too great rocketing through a squeezed brain), but sodium is one of the nutrients that diuretics flush out of the body. Oh, and you also have to worry about keeping your chloride levels low (but not too low) and bicarbonate levels high (but not too high). Your vitamin D levels might be low, but you have to avoid spending too much time in the sun or Diamox'll burn the crap out of your skin. Better not take any vitamin D supplements unless your doctor tells you to, though. Hypervitaminosis of basically any fat-soluble vitamin is a major contributor to IH. You'll need your doctor to give your multivitamins a once-over, too -- too much vitamin A, and you might be told to stop taking them entirely.

If you feel like medical science has basically handed you a letter that says, "GOOD LUCK, SUCKER," I completely empathize.

Still, you've gotta eat to live. To help manage my Diamox depletion side-effects, I:

  • Look for high-potassium foods. Coconut water and avocados are great here -- they're a bit on the pricey side, but one serving of coconut water has 470 mg of potassium. A whole avocado contains 975 mg. Combine them with other fruits, like peaches (at 285 mg potassium for a medium peach) in a smoothie for breakfast. It'll help give you something easy to consume and potassium-rich, which is especially helpful for me on the days when I have no appetite.
    Some health experts recommend avoiding juices and smoothies, since the lack of fiber means they don't fill you up very well and can have a pretty big impact on your blood sugar. I've found them to be helpful for me because I don't have to wait as long for the tingling and anxiety to subside as I do when I eat potassium-rich solids, and choosing low-glycemic fruits and vegetables means I'm not getting a huge sugar hit either way.
    Even if you have to avoid (or just don't like) smoothies, there are plenty of other options. Some plain Greek yogurt (240 mg per average-sized container) and a half a peach (142 mg) is an easy snack that's also rich in protein. A skinless chicken thigh (238 mg per 3.5 ounce serving), spinach salad (167 mg per cup), and some yams (456 mg per a half-cup, boiled) is an easy way to get plenty of potassium in a single meal. If your doctor has ordered you to eat low vitamin A foods, be sure to pick yams over sweet potatoes -- while both are high in potassium and very similar in terms of flavor and appearance, yams contain a fraction of the vitamin A that sweet potatoes do.

  • Keep a careful eye on sodium levels. This means choosing minimally processed and low-sodium foods when I can. Most highly processed foods contain a lot of salt, which isn't necessarily a bad thing if you're deficient in sodium... but it is when you're trying to keep your chlorides down. If you're still feeling weird and tingly even after eating or taking enough potassium, mention it to your doctor. Acetazolamide's side effects feel pretty bizarre even in the absence of a potassium deficiency, but some people find that sodium bicarbonate helps.

  • Drink a lot of water. Like, a lot of water. Getting enough electrolytes is great, but dehydration is pretty miserable. Look for purified drinking water (which is typically water that has undergone reverse osmosis and had some electrolytes added back in). Skip bottled water (which is probably tap water), spring water (which may still contain traces of industrial or agricultural runoff), and distilled water (which contains no electrolytes). If you can filter your own water and avoid disposable bottles, go for it! If not, consider getting a large, reusable water jug that you can refill at a water distiller -- a lot of grocery stores have them, and you can get several gallons at a time for cheap -- and add electrolytes later if needed.

  • Eat regularly. I force myself to sometimes. Set alarms for it, even. Diamox makes it very, very easy to forget that I've missed a meal (or two, or three) because it honestly ruins appetite for some people. In my case, it isn't even that it makes me feel nauseated most of the time -- I'm just honestly not hungry.

  • Carry emergency provisions. For me, this is anything shelf-stable I can stash in a bag just in case I end up all anxious and tingly or lightheaded while I'm out. Things like nuts/seeds, some coconut water, a jar of protein-based baby food, and/or a bottle of Ensure work well here. (I might feel a little weird tucking into a lukewarm jar of turkey and strained peas, but any port in a storm.)

Every body's different, so what I do may not work for you. Talk to your doctor about creating an eating plan that will address your Diamox side effects, appetite loss, and calorie needs. If you need to limit your intake of any specific nutrients (like vitamin A), he or she will be able to point you toward ways to tailor your diet to your specific situation. Nobody's really sure what causes many cases of intracranial hypertension, and it's often found alongside a host of other illnesses and disorders that may have their own particular dietary requirements.

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