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Your Good Health: Advice to drink less liquid doesn't make sense

Also, suggestion to increase protein intake seems contrary to standard practice.
Dr. Keith Roach

Dear Dr. Roach: I am a 79-year-old woman who weighs 123 pounds and exercises with Zumba, yoga and cardio drumming. I feel well and have plenty of energy, friends, support and family. I have been on a low-salt eating program to treat Meniere’s disease for 25 years. My blood pressure is 115/69 mm Hg.

My doctor recently retired, so my new doctor took blood tests and discovered that I had an estimated glomerular filtration rate (eGFR) of less than 59. They sent me to a nephrologist, and the nephrologist said to cut down my total liquid intake to 7-8 cups a day and up my protein to 80-100 grams a day.

This seem contrary to everything I have ever heard. Eating more protein is not hard, but I’m feeling tired, deprived and constipated from such little liquid. Can you explain why I would be directed to drink so little liquid? Can I find a dietary plan to help with this variety of ailments?


This advice is contrary to what I was taught and what is published in the literature — so much so that I wonder if there wasn’t a miscommunication.

Protein restriction has been part of the standard of care for decades, and its benefit in preventing progression to dialysis or a transplant has been shown in many studies. For a 56-kilogram woman like yourself, your goal would be 35-45 grams of protein per day. Some studies have also shown that plant-based protein may have benefits over animal protein.

People with chronic kidney disease are at risk for fluid overload and low sodium levels, which can be dangerous. However, restricting you to 2 litres is not usually necessary, and given your current symptoms, it isn’t the best idea, unless the nephrologist knows something that I don’t. (For example, if you already had a low sodium level, modest fluid restriction would be appropriate.)

Dear Dr. Roach: I take 20 mg of famotidine and have for years. Is this safe to take daily? I’ve tried looking up the answer online and get a lot of conflicting results.


In an ideal world, it would be great if you didn’t have to take any medications. However, reflux disease is very common; about 20% of the North American population has this symptomatic disease, with an even higher prevalence in older ages.

Lifestyle changes are the first line of treatment. Avoidance of food triggers, weight loss if appropriate, elevation of the head of your bed, and avoiding eating at least 2 hours before bed are among the most effective. Smoking and excess alcohol use should be stopped.

When lifestyle changes aren’t enough, a histamine-2 blocker like famotidine is a reasonable option, especially for someone with intermittent symptoms. Side effects are rare, and if you haven’t had them yet, you aren’t likely to get them. Proton pump inhibitors like omeprazole have more clearly defined risks with long-term use, so these should be reserved for when they are truly necessary. Famotidine starts working quickly, while omeprazole and similar drugs take days to work.

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 [email protected]