Quick tips: tremors, blood pressure, constipation

Hey, everybody.

Some of my most popular posts are these Quick Tips in which I do relatively brief answers to health topics raised by listeners to the Healthy Matters radio broadcasts.

This time, I’ll cover these three topics from actual listener questions.


Topic 1:  Essential tremors

Question from listener:  “Could you please explain what tremors are?”

I think it odd in medicine whenever we call something “essential.”  There are two big instances of this and one is benign essential tremor.  If you’re interested, the other is essential hypertension which I talk about in the next item.

Let’s break down the terms.

Benign means harmless, which in itself is a poor term since the condition can be more than a little bothersome.  But it is not malignant or ultimately life-threatening.

Essential just means that there is not an identified causative factor. In medicine, essential does not mean required like it might to reasonable people.  But in this case there is nothing essential about it.

Tremor is an uncontrolled shaking of the body and in this case it is usually the hands.

So add them up and you get benign essential tremor = harmless shaking of unknown cause.  I think a better name is totally unnecessary but really annoying hand shaking.

Essential tremor is not Parkinson’s

Many people confuse essential tremor with Parkinson’s.  They are NOT the same thing.  Here’s a quick list of the differences:

Essential tremorParkinson's Disease
Worse when hands are moving and being usedMostly when hands are at rest
Not usually associated with other health problemsOther symptoms may include shuffling gait, stooped posture, flat facial appearance, slow movements, dementia
Tremor usually limited to the hands and possibly head and voiceTremor often starts in the hands but can involve other parts of body including legs

Many of you have probably seen essential tremor or may have it yourself.  It looks like a fine and rather fast frequency shaking of the hands which is especially noticeable when trying to use eating utensils, drinking from a cup, and so forth.  One guy told me that eating peas from a spoon or fork was really hard to do!  Soup can be challenging as well.  When just sitting at rest, the tremor stops.

Here’s two videos to contrast essential tremor from Parkinson’s.   First, here is essential tremor demonstrated in a one-minute clip:


For comparison, have a look at the progression of Parkinson’s in a famous and amazing person, Michael J. Fox.  The beginning shows him before Parkinson’s, then watch as it progresses and how his whole body shakes – unlike the essential tremor.  He is such an example of grace in a person living with Parkinson’s.  It’s worth 5 minutes to watch.

Cause:  Unknown

We don’t know what causes essential tremor, although perhaps there is a familial or genetic connection.  We do know that it usually affects people over age 40. We also have some pretty decent treatments that can help you.   For instance, some medications can really make the difference for some people.

For a good and reliable summary of essential tremor, check out this page from the American Academy of Neurology.


Topic 2:  Variations in high blood pressure during the day

Question from listener:  “My blood pressure is different at different times during the day.  Why is this and should I be worried?”

The short answers to these are “because that is normal” and “no.”

Longer answer.  Your blood pressure varies all the time, day-to-day, hour-to-hour, and even minute-to-minute.   There is actually a daily pattern:  blood pressure is lower while sleeping at night, rises in the pre-waking and early morning hours, remains higher during the day, and comes down in the evening.  Your blood pressure will also go up during exercise, sex, walking, even talking and laughing.  That’s all normal and just means your cardiovascular system is adapting to changing needs in your body.

This is why the best way to check blood pressure is not in the doctor’s office, or even with a single measurement.  Better to check it around the same time on multiple days.  Even better still is 24-hour ambulatory monitoring which is what doctors call the gold standard of blood pressure measurement.  This is done by wearing a blood pressure monitor for a 24-hour period.

I found this video from West Virginia Medicine which explains it well.  Listen for the term “dipping” which is that phenomenon of blood pressure dropping at night.  You want to be a dipper!

24-hour blood pressure monitoring looks like a hassle, but it really is the best way.

What matters is the trend of your blood pressure.  A single reading of 150/90, though elevated, doesn’t matter a whit if it was measured while you are running on a treadmill.  But if you blood pressure on repeated measurements is 150/90, you have hypertension which likely requires medication treatment.  Of course, a single blood pressure reading that is really high, like 220/115, is potentially dangerous so that requires immediate medical attention.

There are new guidelines for high blood pressure which are somewhat controversial.  I covered those new guidelines in a previous post which you can read at New blood pressure guidelines:  130 is the new 140.  I should say that I am ambivalent about the new guidelines in that they may lead too many people to get medication treatment that may not be right for them so be sure to check with your own doctor.

Oh, and back to the word essential.  For a long time, no one knew what causes high blood pressure, and since most people with high blood pressure don’t have any symptoms, the word essential was added to the diagnosis.  It’s a silly name.  Essential hypertension is not essential in the slightest.  A better term is primary or idiopathic hypertension.


Last topic:  Constipation

I’ll end with a glamorous topic – bowel movements.

This tip came from a listener:  “Tell that guy who is constipated to eat refried beans, salads, and dried figs.”

Constipation is not a laughing matter.  People who struggle with regular bowel movements have reported significant quality of life deterioration and it is one of the more common topics I hear about from patients.   Older folks and people on medications are especially prone to slowed bowel function.

I usually tell people to start with these tips for getting bowels moving:

  1. Be more active.  Sedentary lifestyles worsen constipation.
  2. Drink more fluids.  You can tell you’re not getting enough fluids if your urine is darker than pale yellow.
  3. Eat a diet rich in fiber, fewer processed foods, probably less red meat and cheese, less sugar and simple carbohydrates.  Prunes are great.  High-fiber foods are great – bran, anyone?

    By Emőke Dénes via Wikimedia Commons

  4. Consider a gentle laxative.  A daily senna (a plant-based product) can help.  I often tell people to take senna based on your daily bowel movements: you can take 0, 1, 2, or even more tablets a day based on your own needs.   Senna is a type of stimulant laxative which gets your nervous system to energize a bit and move things through your intestines.  For that reason, some people get cramping from these types of laxatives.
  5. There are other laxatives which are not stimulants but work by softening stool and adjusting the water balance in your stool.  An example of this is polyethylene glycol which is a scary-sounding name but is actually pretty darn safe.
  6. There are many more prescription and non-prescription medications to relieve constipation, but if you are not getting relief from #1-5 above, I’d see your doctor for help.

We all know prunes are a good option and they are among my first recommendations.  But what about the suggestions made by the listener in the above question?  What about refried beans, salads, and dried figs?  Here’s what I think on those.  Keep in mind I’m not a nutritional expert!

Refried beans.  Since all beans are high in fiber, they are generally a good choice for constipation.  Refried beans are no exception.  They may lead to gas and bloating, but that is a different problem.  Beans are a winner!

Salads.  The listener suggested salads for constipation but I think what is important is what type of salad.  Iceberg lettuce and ranch dressing is not particularly good for you.  In general, I encourage people to eat really colorful foods – like deep oranges (squash and carrots) and deep greens (kale and spinach).  Adding garbanzo beans and nuts to your salad, or perhaps blueberries – now there’s a colon-healthy salad!

By Chefallen via Wikimedia Commons

Dried figs.  For constipation, dried fruits are a real winner.  So YES to figs, but also to prunes, apples or applesauce, raisins, apricots.  All are great.  The one great thing about figs – dried or fresh – is the large amount of fiber in them, so they are a terrific choice.

Thanks to the listener for your great suggestions!

I hope you will subscribe to MyHealthyMatters.org by entering your e-mail.  Also tune in to my LIVE radio broadcast from Minneapolis, Sunday mornings at 7:30 Central Time on WCCO 830 Radio OR streaming LIVE at WCCO.COM from anywhere in the world.



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2 Responses to Quick tips: tremors, blood pressure, constipation

  1. Mary Edel-Joyce says:

    Thank you for your article on essential tremors. I suffer from them especially when I’m anxious or with a group of people. Particularly, if we are in a restaurant or somewhere that may be serving food which includes soup. I really enjoy receiving your newsletter and listening to your Sunday program on WCCO.

  2. David Hilden, MD MPH says:

    Thanks so much for checking in and being a listener, Mary!

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