Friday Q&A: managing low blood pressure; cholesterol and egg intake; hand tremors; & restless leg syndrome
Great questions this week! 👏
ICYMI 👉
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In this week’s reader-submitted Q&A, we’re tackling these questions:
Should I add more salt if I have low blood pressure?
Do eggs really raise cholesterol or can I keep eating them?
When should I worry about fine tremors at 58?
What causes restless leg syndrome, and how do you treat it?
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The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: MANAGING LOW BLOOD PRESSURE
I have low blood pressure and have experienced two vasovagal episodes. Recently, I've been hearing more about the importance of salt and minerals for aging adults. What are your thoughts on this?
-Denise
Hello Denise,
Your question hits on the complex relationship between blood pressure, vasovagal episodes, and our body's need for electrolytes, particularly as we age. Let me help you understand how these pieces fit together.
Vasovagal episodes occur when your nervous system overreacts to certain triggers, causing your heart rate and blood pressure to drop suddenly. This can lead to lightheadedness, nausea, or fainting. When you already have low blood pressure, these episodes can be more frequent or severe because your baseline is already lower than typical.
The conversation about salt and minerals for aging adults isn't just wellness trend—it reflects real physiological changes that occur over time. As we age, our kidneys become less efficient at conserving sodium, and our bodies become less sensitive to thirst cues, making dehydration more common. Additionally, many older adults take medications that can affect electrolyte balance or blood pressure.
However, this doesn't mean everyone should start loading up on salt! For someone with low blood pressure and vasovagal episodes, adequate sodium intake might indeed be beneficial—but this needs to be balanced against your complete health picture, including any medications you're taking and other medical conditions.
The key electrolytes to consider aren't just sodium, but also potassium, magnesium, and calcium. These minerals work together to maintain proper muscle function, nerve signaling, and fluid balance. Dehydration or electrolyte imbalances can definitely contribute to blood pressure fluctuations and increase the likelihood of vasovagal episodes.
Rather than guessing about what your body needs, I'd encourage you to work with your doctor to understand your specific situation. They can review your current medications, check your electrolyte levels, and help you determine whether increasing your salt intake or adjusting your hydration strategy makes sense for your particular circumstances. I hope that helps!
QUESTION #2: CHOLESTEROL & EGG INTAKE
My cholesterol numbers came back high at my last physical, and I've been hearing conflicting advice about eggs. I used to eat them regularly, but now I'm worried they're making my cholesterol worse. Should I avoid or limit them?
-David
Hi David,
Thanks for naming one of the most persistent nutritional myths—that eating cholesterol automatically raises your blood cholesterol. This misconception has sent countless people unnecessarily avoiding eggs, one of nature's most complete protein sources.
Here's what the science actually shows: for most people, dietary cholesterol has minimal impact on blood cholesterol levels. Your liver produces about 75% of the cholesterol in your body, and when you eat more cholesterol-containing foods, your liver typically compensates by producing less. The cholesterol in eggs doesn't directly translate to higher numbers on your lab report.
What matters far more is the overall pattern of your diet and lifestyle. Saturated fat, refined carbohydrates, and trans fats have much greater effects on your cholesterol profile than the cholesterol in eggs.
That said, your individual situation matters enormously. Some people are "hyper-responders" who do see increases in blood cholesterol from dietary cholesterol, though this represents a small percentage of the population. Your family history, genetic factors, other health conditions, and medications all influence how your body handles cholesterol.
Rather than making blanket decisions about eggs, consider the bigger picture. Eggs provide high-quality protein, healthy fats, and nutrients like choline that support brain health. They're also incredibly versatile and satisfying, which can help with weight management—another factor that influences cholesterol levels.
The key is context. If you're eating eggs alongside bacon, buttered toast, and hash browns every morning while living a sedentary lifestyle, that’s not ideal. But if you are eating eggs as part of a diet rich in vegetables, whole grains, and healthy fats while maintaining a healthy weight and staying active, they're likely beneficial rather than harmful. 🍳
QUESTION #3: HAND TREMORS
I am a healthy 58 yr old woman. I have a fine tremor in my hands. When should I be concerned?
-Polly
Great question, Polly.
A fine tremor in the hands can be unsettling, but it's not always a cause for concern. Many tremors are benign, meaning they’re not related to a serious underlying condition. For example, a mild, rhythmic hand tremor that appears when your arms are extended can be due to enhanced physiologic tremor. This can be triggered by things like caffeine, anxiety, fatigue, low blood sugar, certain medications, or even thyroid imbalance. In these cases, the tremor often improves with rest, stress reduction, or changes in medication or lifestyle.
However, there are times when a hand tremor warrants a closer look. If the tremor is progressively getting worse, affecting your daily function, or is associated with other symptoms—such as muscle stiffness, slowness of movement, coordination problems, changes in handwriting, or speech difficulties—it’s important to be evaluated. A family history of tremor (especially essential tremor or Parkinson’s disease) is also relevant. Essential tremor, a common inherited condition, typically worsens with movement and improves at rest. In contrast, tremor from Parkinson’s often appears when the hands are at rest and may be accompanied by other motor changes.
Ultimately, it’s a good idea to check in with your doctor, especially if the tremor is new, worsening, or interfering with your life. A physical exam, medication review, and possibly some basic blood work or neurological assessment can help identify the cause. In many cases, the answer is reassuring—and if not, early evaluation is the best first step toward treatment.
QUESTION #4: RESTLESS LEG SYNDROME
I love reading your newsletter. I feel I have a connection to you that I do not have with my doctor even though we have never met. You answer many of my questions through your posts. Can you please talk a little about restless leg syndrome? Is it treatable without taking medication? What are the underlying causes? It tends to come and go... it is very annoying and makes it difficult to get a good night's sleep.
-Valerie
Greetings Valerie,
Thank you for sharing that! It means everything to me that my newsletter helps you! As for restless leg syndrome (RLS), it is one of those conditions that perfectly illustrates how interconnected our health systems really are. That uncomfortable urge to move your legs, especially at night, isn't just a quirky sleep problem—it's often your body's way of signaling that something deeper needs attention.
The intermittent nature you're describing is actually quite typical. Many people notice their symptoms worsen during times of stress, hormonal changes, or when they're run down. This variability offers important clues about what might be driving your symptoms.
Iron deficiency is one of the most common underlying causes, even when your routine blood work shows "normal" hemoglobin levels. Your brain needs adequate iron to produce dopamine, a neurotransmitter that helps regulate movement. I often check ferritin levels specifically, as these can be low even when other iron markers appear fine. Many of my patients see significant improvement in their RLS symptoms when we address iron deficiency properly.
Other potential contributors include magnesium deficiency, which affects muscle and nerve function, and certain medications like antihistamines or antidepressants. Caffeine intake, especially later in the day, can also worsen symptoms. Even sleep position and circulation issues can play a role.
Before jumping to medication, there are several non-pharmaceutical approaches worth exploring. Regular moderate exercise—but not too close to bedtime—can help. Gentle stretching, warm baths, or massage before bed often provide relief. Some people find compression socks helpful, and maintaining good sleep hygiene can prevent symptoms from worsening.
That said, if lifestyle modifications and addressing nutritional deficiencies don't provide adequate relief, medication can be genuinely transformative. The key is finding the right approach for your specific situation, which might involve both strategies.
I'd encourage you to discuss with your doctor checking your ferritin levels and reviewing any medications or supplements you're taking. Sometimes the solution is surprisingly simple, and sometimes it requires a more comprehensive approach that addresses multiple factors contributing to your symptoms.
Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
ICYMI, check out my recent Q&As on:
As a violinist I was plagued with hand tremor at about age 70. I took Propranolol which helped enough to get through a concert. Age 79 I reduced carbs to about 15% of total calories, in particular no sugar including fruit juices and refined carbs.
the diet achieved its purpose(A!c from 7.0 to 5.3) but a nice side effect was no more tremor( and no more beta blocker) At age 84 I don't have a hint of tremor.