The Dr. Hyman Show - How To Treat High Blood Pressure And What Causes It?

Episode Date: September 11, 2023

This episode is brought to you by Rupa Health, AG1, Beekeepers, and Super Simple Grassfed Protein.  Blood pressure is one of the key markers of metabolic health, yet high blood pressure is very common—and the numbers are growing. Moreover, 93 percent of Americans are metabolically unhealthy. In fact, high blood pressure is often called a silent killer as it can lead to conditions such as heart disease, kidney failure, and stroke, and many people don’t even know they have it. In today’s episode, I talk with Dr. George Papanicolaou and Dr. Cindy Geyer about the seriousness of high blood pressure, the misconceptions around salt intake and blood pressure, what foods and supplements support healthy blood pressure, and overall metabolic health. Dr. George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is board certified in family medicine from Abington Memorial Hospital. He is also an Institute for Functional Medicine practitioner. Upon graduation from his residency, he joined the Indian Health Service. He worked on the Navajo reservation for four years at the Chinle Comprehensive Medical Facility, where he served as the Outpatient Department Coordinator. In 2000, he founded Cornerstone Family Practice in Rowley, MA. He began training in Functional Medicine through the Institute for Functional Medicine. In 2015, he established Cornerstone Personal Health, a practice dedicated entirely to Functional Medicine. Dr. Papanicolaou joined The UltraWellness Center in 2017. Dr. Cindy Geyer received her bachelor of science and her doctor of medicine degrees, with honors, from the Ohio State University. She completed her residency in internal medicine at Strong Memorial Hospital in Rochester, NY, and is triple board certified in internal medicine, integrative medicine, and lifestyle medicine. She joined The Ultrawellness Center in 2021 after practicing and serving as the medical director at Canyon Ranch for 23 years. This episode is brought to you by Rupa Health, AG1, Beekeepers, and Super Simple Grassfed Protein.  Access more than 3,000 specialty lab tests with Rupa Health. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com today. Head to drinkAG1.com/HYMAN to receive 10 FREE travel packs of AG1 with your first purchase. Go to beekeepersnaturals.com/HYMAN and enter code HYMAN to get Beekeeper’s Naturals' exclusive offer of 20% off sitewide. Right now, you can get 10% off Super Simple Grassfed Protein by heading to drhyman.com/protein and using code protein10. Full-length episodes (and corresponding links) of these interviews can be found here: Dr. George Papanicolaou Dr. Cindy Geyer Dr. Mark Hyman

Coming up on this episode of The Doctor's Pharmacy. Anything that causes inflammation or oxidative stress will cause high blood pressure. Hey everyone, it's Dr. Mark. To all the healthcare practitioners out there, let me ask you a question. Would you like to make your life a little easier? I'm sure the answer is yes. As a functional medicine doctor, I know you can relate about how complicated and time-consuming ordering lab tests can be. Thankfully, with Rupa Health, you can easily order lab tests from more than 30 different lab companies such as Dutch, Great Plains, Genova, Access, Medical Laboratories, and many more,

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That's drinkag1.com forward slash hymen. Check it out. And now let's get back to this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Feehan, one of the producers of The Doctor's Pharmacy podcast. About 1 billion people worldwide have high blood pressure, and that number is increasing. High blood pressure can be a driver for heart disease, dementia, kidney disease, and more. But the good news is that there are a lot of things you can do right now to improve your numbers. In today's episode, we feature three conversations from the doctor's pharmacy about why high blood pressure is such a serious condition and how to treat it. Dr. Hyman speaks with Dr. George Papanikolaou about the root causes behind high blood pressure, including inflammation, sleep apnea, and more. With Dr. Cindy Geyer about the

link between high blood pressure and poor metabolic health more, with Dr. Cindy Geyer about the link between high blood pressure and poor metabolic health. And then Dr. Hyman talks about why salt is not the enemy and share some helpful dietary tips and supplement recommendations to improve and maintain healthy blood pressure levels. Let's jump in. So what are the consequences of high blood pressure? Why should we care if our blood pressure is high? Because it's a silent killer, we call it. Yeah, and that's the key. It's a silent killer.

You don't know you have it. People won't know they have it. And what it causes, it's one of the leading causes of heart disease that's considered heart attacks, congestive heart failure, arrhythmias, which is abnormal electrical activity in your heart that can lead to critical events. So big cause of all kinds of heart disease. Yeah, heart disease.

It causes end-stage renal disease. Kidney failure. Yep, kidney failure and stroke. Stroke. And stroke creates a great deal of mortality and morbidity for adult population. Even blindness? Yep. Right?

Hypertensive. Microvascular disease and blindness. Can lead to dementia because of its effects on the vascular system in the brain? Yeah. Right? Hypertensive. Microvascular disease and blindness. It can lead to dementia because of its effects on the vascular system in the brain. And also affects things lower down, right? Like sexual function. Oh yeah. Right. Your blood vessels get problematic in your sexual organs.

You're not doing things normal. Microvascular disease in the penis can definitely result in erect dysfunction, and that's not a good state. Nobody likes that. It also causes stiffening and hardening of your arteries, and you get vascular problems in your legs and blood flow issues. Peripheral artery disease is a major issue, and particularly if you have diabetes, then you have two things that you have to deal with. The diabetic changes that create the peripheral vascular disease and also the hypertension and and you can get literally blood flow issues you need amputations so this is a serious problem serious and a billion people have it in america a lot of people have it yeah right yeah 50 to 75 million americans absolutely and growing and how many people are actually like

treated well it's probably like yeah 14 million out of those yeah as we talked about that treatment is you know is primarily medication it's not always effective it has lots of side effects and it's you know and there's so many other ways to treat hypertension besides just using pharmaceutical agents and you know we we have determined that by treating people's blood pressure with medications that people do reduce their risk of these complications. So it's important to understand that if you have high blood pressure, you need to treat it. Absolutely.

And whether it's with the things we're going to talk about or medication, you can't let it go. And it's something you should do as a preventive strategy. You can go to the drugstore. They have blood pressure machines. You can stick your arm in or you can buy one for next to nothing in the drugstore, $29. And you can monitor your blood pressure. Now, part of the problem with diagnosing blood pressure is that it's often hard to know if you have high blood pressure

because, one, it fluctuates all day long. Two, just getting one blood pressure reading in the doctor's office may not really tell you what's going on. You might have white coat hypertension, meaning you get nervous and stressed, it goes up. I mean, when you exercise, your blood pressure goes up. When you're stressed, your blood... But what's your average blood pressure? So one of the diagnostics we do is a 24-hour blood pressure test, which I found really effective because you can see what is happening when they're sleeping, when they're active, when they're inactive, and you get a really good sense of what their pattern is day, night, and average, and that'll tell you what your real risks are. Right. So doing 24-hour ambulatory monitoring is something that is

really important to do, particularly if you have any concern that the readings you're getting in your office are inappropriate. And you mentioned white coat hypertension, and that is not uncommon. It actually is fairly common common and so we will oftentimes recommend ambulatory blood pressure readings and that gives us the clear clearest picture possible yeah it's true and sometimes you can just get a cuff at home and have people monitor their blood pressure out the day and that that'll help too you know i want to just dig into a little bit before we get talking about the difference with functional medicine right uh and traditional medicine right traditional medicines you check your blood

pressure, it's high, you get medication, you monitor it. We call it essential hypertension. Now, there are other causes of hypertension that we know of that are kidney diseases and other problems. But for the most part, people call it essential hypertension, which I joke and I say it means essentially we have no idea what's causing it. But we know that's not true. We know that's not true. So everything has a cause. Nothing is just random. Right.

Right. If you have diabetes, it's not a random event. It's not like, oh, I got a virus. I know. Something happened. Diabetes just happened. We know some of the major causes of high blood pressure are never addressed. Right.

And the two biggest ones that I see treating patients is insulin resistance. And sleep apnea. And sleep apnea. So one of the biggest factors is insulin resistance, which is an epidemic in this country. We have one in two Americans who have prediabetes or type 2 diabetes. 75% are overweight. 42% are obese.

And they all have some degree of trouble regulating their blood sugar, which just causes them to get belly fat. And that belly fat is such a big factor in driving all sorts of diseases, everything from high blood pressure to cancer to heart disease to diabetes to dementia to depression and so on but the insulin resistance drives inflammation yeah and it drives inflammation throughout the body because those belly fat cells aren't just sitting there holding up your pants they're dynamic hormonal and immune organs your belly fat is an immune organ and it drives inflammation throughout your body that causes oxidative stress which is really what causes

rusting so it's like your arteries and your pipes are rusting and stiffening called hardening the arteries and that happens as a result of this inflammation and oxidative stress and so insulin resistance is probably the biggest cause of that today in america and it's it's really driven by diet so i think people don't understand how powerful that is diet is is very powerful. And you mentioned the adiposity we have around our waist. I call that the toxic waist dump of the body. And that fat just does have a metabolic effect that is toxic to the body. And as you said, it creates the hardening of the arteries, which is one important cause of high blood pressure. Yeah yeah and the other big thing is often misdiagnosed and by the way by the way insulin resistance affects so many people 90 are not

diagnosed absolutely so the way you diagnose it is you do a test for insulin right and blood sugar and it's a fasting glucose tolerance test that we do i do on almost every patient yeah and this is the other test it's a little more advanced where you take a sugar drink, basically drink the equivalent of two Cokes, check your blood sugar and insulin fasting, and then every one in two hours after. But most doctors just check blood sugar. But that's a very late finding. You want to check insulin early on.

Yeah, and even doing a fasting insulin isn't going to give you an answer. It'll help. Yeah, it helps. But by the time your insulin goes up, fasting, it's already down the road pretty far, right? Yeah. So I agree. Right. And then we have this other issue which is sleep apnea yeah which is so underdiagnosed yeah so sleep apnea

there are about 25 million americans that have sleep apnea it is underdiagnosed it's not just a disease of people that are overweight that's you know most people think about obstructive sleep apnea being related just being overweight but you also can have upper respiratory anatomy and muscular relaxation that even if you're thin, you can have obstructive sleep apnea. Yeah, you have a narrow palate, a small airway, you have sinus issues. And when you have sleep apnea, that means you're just not getting enough oxygen to your body particularly your brain also to your you know to all your blood vessels and your cortisol levels rise and then you get into that whole cycle you talked about before which is an inflammatory cycle which is an oxidative stress cycle which can lead the hardening of the arteries and when you're not getting oxygen to those blood vessels, then they actually can't perform the work they need to do

and create the energy they need to have. And so they can't contract and expand the way they should, and that can result in high blood pressure. Yeah, and then it also drives insulin resistance. So if you have sleep apnea, it also causes you to be pre-diabetic. Yeah, it causes weight gain. Independent of what you're eating. It causes weight gain.

It leads to insulin resistance. It leads to diabetes, which complicates everything. I mean, i had this guy who couldn't lose 50 pounds he was a he was a lawyer and he told me the story was like he said look i i need to lose the weight i don't know what to do i'm trying to eat right it's not working i'm trying to exercise i said what is what your life like as well i'm a lawyer and i work really hard and you know but every day i have to stand up at my desk I can't sit down and this was before standing desk right and and and I'm like why he says well if I sit down I fall asleep right and I'm like gee maybe you have sleep apnea so if you're falling asleep

at work if you're falling asleep in front of the tv if you feel tired during the day if your wife says you're snoring now there's apps you can can get that actually record you're on your phone, that record your snoring, so you can see, because people don't believe it. Oh, I don't snore. I love that app, by the way. It's one called Sleep Cycle that I like. It's record your snoring. It's something that is easy to treat.

I mean, there's different methods, CPAP, but it is a treatable condition, and the weight loss then will happen, and you'll feel better. So so that's really important I just want to talk about a few other causes that I think are really important and worth noting because those are the two biggest ones but there's a lot of other ones people who are nutritionally deficient right in certain things can cause high blood pressure yeah like magnesium right so and magnesium you know studies show that you know there's a very large percentage of people in our country have low magnesium. 45% of people have low magnesium. And you know, magnesium, it's not magic, but when we replace magnesium in patients, we see amazing things happen.

We see blood pressure come down. We see them being able to sleep better. We see muscle twitching and cramping go away. We see mood improve. Magnesium has a very important role in the body and certainly plays a big role in lowering blood pressure. Yeah, but I call it the relaxation mineral. And you know, it's funny how in medicine we have these blind spots. But when I was training in obstetrics and gynecology, I was a family doctor.

I deliver lots of babies. There's this common condition that women get called preeclampsia, which is high blood pressure in pregnancy. And when they come in and their blood pressure's high, which can cause seizures, the treatment isn't high blood pressure pills because they don't tend to work. We give them intravenous magnesium to relax their blood vessels and save their life. So we sort of, and it's just a strange thing to me. We don't think about it that way. The other thing that is important is omega-3 fats and fish oil because it helps relax your blood vessels, make them more pliable.

But there's other causes that we also see. For example, environmental toxins, heavy metals in particular, lead and mercury are really common. They're underdiagnosed. And when you go on your high blood pressure visit, your doctor's not checking your mercury and lead levels, not even your blood, and probably not on the most important test, which we do with the Ultra Wellness Center, which is a challenge test,

where we give people a drug to pull out the metals, the chelator, and then we check their urine and see how much dumps in there. And if they have high levels, that's often a big factor as well. And I think you're really hitting on all the things that I think about. And I tell people when they come to me and hypertension is part of what they want me to work with, I said, we're going to get your hypertension better by not treating your hypertension. We're not going to treat your hypertension. We're going to treat everything else that's causing your hypertension.

We're going to find the sleep apnea. We're going to find the nutritional deficiencies. We're going to work on your stress levels. We're going to find the sleep apnea we're going to find the nutritional deficiencies we're going to work on your stress levels we're going to help you lose weight you know when you lose weight i mean you actually are going to drop your blood pressure i think i think the number is um per pound i think uh for every two pounds you lose you drop your blood pressure by a millimeter mercury so if you lose 20 pounds you can drop your blood pressure by close to 10. So it's so key. You know, we create a program called the 10 day reset, which you can find and get pharmacy.com.

We put a thousand people through it, track their blood pressures. It was incredible. Their blood pressures dropped an average of 20 points in 10 days. Well, if you think about it, you think about that most Americans are at least 25 pounds overweight or, you know, so let's say it's better than medication results. Exactly. If you get them to drop that 25 pounds, they're going to drop their blood pressure by, you know, near 15 millimeters of mercury. Yeah. Hey everyone, it's Dr. Mark. People are always asking me how to boost their immune systems. I like to try to help them reframe immune health to understand that it's not always about giving it a boost, but instead about helping to modulate the immune system so that it can do its job the right way. That means giving

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So we have insulin resistance, sleep apnea, low magnesium, low omega-3 fats, which about 90% of Americans have. You have heavy metals, environmental toxins, and we now are learning that the gut microbiota, the microbiome in the gut, if it's altered through our bad processed diet and all the nasty drugs we take, it actually causes inflammation throughout the body that drives high blood pressure. Anything that causes inflammation or oxidative stress will cause high blood pressure. And the thing that struck me as I, and this is stuff that's in the traditional medical literature, is that high blood pressure is an inflammatory disease and we treat it like

a plumbing problem we do and and you know going back to the nutritional piece a little potassium can be another reason why you can have um high blood pressure and and that speaks to where do you get potassium you get it from green leafy vegetables so having a you know having a vegetable based diet you know is is is very very important and my green smoothie in the morning absolutely yeah you know more kale more kale yeah so this is very important i think people also think about salt so people think high blood pressure salt but what's the deal with salt and high blood pressure is it something we should worry about as big a deal as we thought it's not it's not something everybody needs to worry about there's more there's certain populations that are going to

have be more salt sensitive than others. And so we can actually do genetic tests, and we do them here at the Ultra Wellness Center, that lets us know if you have those genes that make you more sensitive to salt, more likely to have high blood pressure. So we do need to be concerned about it in certain populations and limit it. Salt, actually, it's the salt we add to our food that is the problem because it's processed, all the natural nutrients are taken out of it. Salt actually, it's the salt we add to our food that is the problem because it's processed, all the natural nutrients are taken out of it. It can be iodized and iodine can cause problems.

So it's not the salt that we personally add in our kitchen, it's the salt that's added in factories to process food that allows huge amounts of intake of salt. Because how do they make junk ingredients taste edible? Salt, fat, sugar. Salt, yeah, and sugar and processed fats, right? of intake of salt because how do they make junk ingredients taste edible salt fat salt yeah and sugar and processed fats right yeah so we know that and but if you get really good salt um you know sea salt um that you've purchased that's you know that actually has nutrients in it that can be valuable to you minerals and so forth yeah exactly so these are some of the common causes we see and they're often things that aren't looked at. When you go to your doctor with high blood pressure,

they're not checking your heavy metals, they're not checking your insulin resistance, they're not checking necessarily sleep apnea, although some might be thinking of that. It's interesting. They're not checking your magnesium or anything. The reality is that, because when I was practicing private medicine

before I started functional medicine years ago, I was being graded on if I had a high blood pressure patient, if I had them on certain medications to lower their blood pressure. So my reimbursement was based on whether or not I was using medication, not whether or not I was finding the root cause of the problem. Not whether or not I was helping somebody lose weight. Not whether I was counseling them on how to lower their stress with meditation. That didn't drive it. And so in contrast to what we do in functional medicine, you know, we focus on making those changes that really get to the root of the problems and the causes we just talked about. It's absolutely true.

I think the traditional approach in medicine is you diagnose and then you treat. When we diagnose, you say you have high blood pressure, that's the first step in our thinking. Then we start to ask why, why, why, and everybody gets treated differently. In some patients, the treatment for high blood pressure is getting off the sugar and starch. Another person might be treating their sleep apnea. Another person might be detoxifying from heavy metals. Another person might be giving them extra magnesium.

And then we have a lot of techniques that we can use to help mitigate this. Sleep, stress management, exercise. Exercise lowers blood pressure. It's often frustrating to me understanding how the body really works when I see this knee-jerk response in medicine. It just feels like we're missing the boat. And this is not stuff that we're making up. This is all in the science.

It's all in the literature. You just have to listen to the patient because the clues are always going to be there. I can't tell you how many of my patients that come here to the Ultra Wellness Center, I ask them, so they're fatigued. We have a lot of patients that come with chronic fatigue where fatigue is part of their complex of complaints. And I ask them if they snore.

Well, they don't know. Yeah, my wife tells me that I snore all the time. I said, so how long has that been going on? And I said, has anybody asked you whether you snore. Yeah, my wife tells me that I snore all the time. I said, so how long has that been going on? And I said, has anybody asked you whether you snore before? Has anybody asked you if you wake up refreshed? Has anybody asked you if you have daytime fatigue? And no, they've gone years and nobody has really explored it. So you have to listen to the patient and ask why and ask it again

and keep asking questions so you make sure you have the whole terrain mapped out. Yeah. That's beautiful about functional medicines. We really do a very detailed history. So people say, how do you diagnose? Mostly history. I mean, we do a 32-page questionnaire, which is annoying for patients, but it allows us to get a really deep sense of what's going on. So Mark, how many times have you had a patient come in who has, let's say, high blood pressure, and maybe they're having headaches, they're having migraines, but they have the high blood pressure, they may be a little bit overweight, they have high cholesterol, but they have heartburn, or they have, I get occasional heartburn, I take a PPI, I take an H2 blocker, these are acid blocking medications. And they don't connect it to their high blood

pressure. Right. Why is PPI or acid blocking medications a problem? Because it inhibits acid production, which you need to absorb magnesium. Exactly. Right. And so you're all, wait a minute. And calcium and vitamin D. Right. Right. Which can be impacted. But, you know, and they have, oh yeah, I also have difficulties with constipation or I get loose stools. You know what? There's a connection between the gut and the blood pressure. So let's talk about this whole idea of metabolic health

because, you know, we were chatting a little earlier and it's staggering to me as a physician just how poor our metabolic health is uh so so how how healthy are americans metabolically yeah not very so so a recent study was looking at the nahain's data from 2009 to 2016 as a government survey government survey our blood tests and health records and everything right and trying to say well how many people are what we would call metabolically healthy? And if you're not familiar with it, for people who may not be familiar with that term, it's sort of meeting the optimal numbers for a blood pressure less than 120 over 80, HDL

levels being in the high range, a good range, greater than 40 for men and 50 for women, having triglycerides that are low, having a glucose that's less than 100. And they found that 12.12% of Americans- 12.2%. 12.2%. Thank you. 12.2% of Americans were metabolically healthy. Which kind of means that almost 88% of Americans are metabolically unhealthy. And since 75% of people are overweight, there's another 13% there. Yes. It's like, what's going on with the skinny people? Well, and that's the interesting piece.

Fewer than one third of so-called normal weight people were metabolically healthy. So that's another really important message. Oh, wait, wait, wait, wait, wait. Did you just say that two thirds of skinny people are metabolically unhealthy and have prediabetes-like syndrome? Yes. Two-thirds. That's mind-boggling to me.

Okay, so that means that, what, like 95% of Americans are metabolic? No, no, no, it's still the 88%. But we're looking at how strongly it correlated with weight. That's so terrible. So just having a body mass index that's less than 25 is not a guarantee that you're metabolically healthy.

So if you're a skinny sugar and bagel eater, don't think it's fine because you're skinny. Exactly. It's basically the bottom line. Exactly. Because foods have other impacts besides just what they do with cholesterol anyway. Foods directly impact the elasticity of the arteries, for example, which is another key player. You mean food is more than calories, Cindy? Food is information, Mark. You said that for years. It talks to our genes. It talks to our systems. Yeah. Wow. So you're talking about how the food impacts our metabolic health. And we're not really good at diagnosing metabolic dysfunction. I mean, 90%...

I mean, okay, one out of two Americans has prediabetes or type 2 diabetes. And if you look at this new study, I would argue that nine out of 10 Americans have some degree of prediabetes or type 2 diabetes, like 90% of Americans. So when you look at that data and you also look at the parallel data that 90% of Americans with prediabetes are not diagnosed by their doctor, that's terrifying. Especially because this is a 100% reversible, preventable, treatable condition. And it gets worse and worse over time and people just don't even know they have it and doctors miss it because there's no pill to take.

Oh, tecmetformin. Well, that's not going to help, right? It's like, and so what are the kinds of ways that we look at these patients differently? What are the tests that we do? What are the things that we really focus on when someone comes in with a risk of heart disease and they're concerned about heart disease? You know, what's our approach? It's not just looking at the typical cholesterol and even CRP.

Yeah. So we would look at those, of course. We would also want to know what is somebody's insulin. Most doctors measure glucose, but not insulin. I personally like to look at somebody's glucose trends over time. Because if you think about something that's preventable, you don't want to wait till they cross that threshold to prediabetes or diabetes. So even in the range of so-called normal glucose mark,

you know this. Somebody who's fasting glucose runs less than 85 is in a very different metabolic place than somebody who's fasting glucose is 95 to 99, even though they're both technically normal, that it's a spectrum of risk. And the farther along you march that spectrum, the higher the risk of heart disease and diabetes. So if somebody's glucose used to be 85 and then it was 91 and now it's 98, we're going to talk to that person right off the bat about all the things they need to put into place to prevent it from progressing because they're already on that spectrum. We also want to know insulin levels, not just a fasting insulin, but sometimes the insulin

response to food. Because the other thing that's emerged is insulin is a player. And way before somebody's blood glucose goes up, they might be pumping out tons of insulin to try to keep it in a good place. And insulin by itself contributes to inflammation and more weight gain around the middle, that visceral adipose tissue. So we want to know their insulin, both fasting and in response to a challenge. So wait, wait, wait. Are you saying that's sugar,

not fat that's causing heart disease? And sugar, the thing that's driving the insulin? Because fat doesn't cause insulin spikes. Well, there is some... I mean, fat is a player. Fat by itself. If you eat fat with other food, it will. Yeah. Yeah. And I would say that quality of fat does matter. And we can talk some more about that, but I think fat plays a role with artery elasticity, which is another component of vascular risk. Yeah.

So fried foods, trans fats, refined oils, those are nasty. Absolutely. They can't help. Absolutely. But fat itself, if it's made from whole food sources and nuts and seeds and avocados and olive oil. Might actually be beneficial. Actually beneficial, yeah.

So what you're talking about is a set of diagnostic tests that are so important but mostly ignored. So the particle size and number, which nobody's doing. And the second is not just measuring your blood sugar a1c which may be perfect and you may be in really bad trouble but measuring also insulin in response to drinking like a couple of cokes right i i have a patient cindy that i remember who was a super high risk for heart disease and she had uh i mean she looked like the tasmanian devil and she was just like a round apple ball like this. And her belly was like this big thing. And I'm like, this woman is in big trouble.

And she's inflamed. She has a high-risk heart disease, high blood pressure, diabetes. And I'm like, let's check her glucose tolerance test with insulin. And this was like 20-plus years ago. And no one was looking at this. Even today, no one's looking at this. It's like so hard. I mean, it took 50 years from the time the guy said, hey, we should wash our hands before

surgery for us to wash our hands. You know, McKinley died, President McKinley, because he got shot in the belly and the doctor, McBurney, stuck his finger in the wound to check it out without washing his hands. You know, that's like crazy. It took 50 years from the time the guy said, let's do a stethoscope so we don't get lice jumping into the doctor's hair to start using the stethoscope. Because the doctor used to put their head on the patient. So it takes forever. And we've been doing this.

Anyway, this woman, I did this test. I gave her this drink. And it was the most shocking thing I'd ever seen. And it taught me so much about what we miss in medicine. Her blood sugar was perfect, like 80. And she took the sugar drink and it was like perfect. Like it never went over 110

after taking like the equivalent of two Coca-Colas. Oh, she's fine. Her A1C was perfect. Her insulin, normally she'd be under five fasting and under like 25 or 30 after a drink. Her insulin was like 50 fasting and like 250 after a drink, her insulin was like 50 fasting, and like 250 after a drink.

So her body was just pumping out insulin, which was making her hungry, slowing her tablets, putting fat in her belly cells, which were basically inflammation factories, and leading to this perpetual cycle. And she was able to lose 50 pounds like that when we cut out starch and sugar. And I just feel like, you know, that showed me so much

because you can even do a normal glucose tolerance test. If you're not measuring insulin. And that looks perfect. And if you were super hyperinsulinemic, you're going to miss that patient's real problem. And, you know, it's interesting, Mark, because that scenario is also associated with that

cholesterol profile we talked about with the small, dense LDL and low HDL and the sequelae that we usually link to diabetes, fatty liver, peripheral neuropathy, all these other organs that are affected. And it can happen with the high insulins alone before the sugars go up. Yeah. It's a metabolic imbalance. Yeah. So that's really the take home here

is that heart disease is really a hormonal issue around insulin and insulin resistance and an inflammation issue. Unless you address those two things, not with aspirin and statins, which will work to some degree, or metformin, which will work to some degree, but, and by the way, high blood pressure,

which just goes along with all this stuff they're all seen as separate high blood pressure cholesterol diabetes they're seen as separate they're the same condition they're manifestations of the same underlying biology of insulin resistance and unless you really know how to look at the metabolic pathways in the right way like we talked about insulin testing or the cholesterol or the inflammation or the cause of inflammation because it may you know like you said insulin and resistance is probably the biggest cause. So probably the biggest cause of inflammation is diabetes, prediabetes, and the starch and sugar that we eat about a pound of each every day in America. That's the problem. But there are other factors that also contribute

that people don't think so much about, especially cardiologists. So those are the big ones. And of course, you know, exercise, sleep, stress, all those. We've covered those on other podcasts. Relationships, connection, community, really important. But there's some other factors that are a little unusual that we look at in functional medicine that I'd love to dive into that have a big impact. So can you just share some of the other factors that could drive inflammation? Well, yet another example where the gut microbiome seems to play a role. So now that we can do more sophisticated gut testing and look at these microbial patterns, there's a so-called microbial signature that strongly predicts insulin resistance, diabetes, and cardiovascular disease.

And a couple of general scenarios you see is there's a loss of overall microbial diversity in the gut. There's a loss of a couple of signature species. One's called one of the phyla that produced this signaling molecule called butyrate. Butyrate plays a role as fuel for colon cells to help them replenish and be healthy. And it's also an anti-inflammatory molecule. And another species called Acromantia mucinophila. And you can kind of tell from the Latin mucin base that it's a mucus loving bacteria. So that pattern of low diversity, loss of butyrate and

loss of acromantia correlates with loss of integrity of the gut lining, more absorption of unwanted things into the bloodstream, more calories, and more inflammation that in turn exacerbates insulin resistance. So the question is, is it chicken or the egg? Because we know that pattern also shows up in response to diet, of course. The standard American diet creates that pattern, right? I was going to ask you that. Why do you don't have the good guys and why do you have too many bad guys? It's because of what we're eating. It's because of what we're eating. That microbiome is influenced by the foods that we feed it.

But what's really fascinating is even our thinking about how medications work. You mentioned metformin earlier, right? And we used to think that metformin helped our cells respond to insulin better, but it also has a microbiome effect. Interestingly enough, there was a study that found that people who took metformin, you saw a rebound of microbial diversity, a rebound of acromantia, and a rebound of those butyrate species.

With metformin. With metformin, which I think is fascinating, right? The way we think drugs are working may actually be completely different. We call those side effects. We call those side effects, right? But we also know in functional and integrative medicine that we can achieve the same thing when we encourage people to eat a diverse array of plant-based, colorful plant-based foods and foods that are really good for rebound of acromantia, like polyphenolic foods, berries,

deeply pigmented berries and greens and garlic and onions and cranberries, right? So of course, people want a pill, but there are other things that can potentially achieve the same thing. So what about salt? Because that's a big question, right? Is salt the cause of high blood pressure? Well, no, we need salt. But the problem is since we were hunter-gatherers, our ratio of salt and potassium is completely flipped. We used to be 10 times as much sodium. Potassium is sodium, or potassium is salt. But now we have 10 times as much sodium as potassium. And potassium helps you lower your blood pressure. Potassium actually is a very important mineral that we are not getting enough of, but it comes primarily from plant foods. So when you're eating a lot of plant foods, you're getting a lot of potassium. If you're eating a lot of processed foods, you're getting a lot of salt. How do they make

basically refined oils, flour, and sugar taste edible? They often will add a lot of salt to the product. So it's really a problem with added salt in this country and lack of the right amounts of fruits and vegetables that can help to provide the right amount of potassium. So we need salt, it's not bad. And there are certain patients that are salt sensitive genetically, often African-Americans that have to really restrict salt

or watch their salt intake. But most of us don't really have to worry so much about salt if we're not eating processed food. It's not the salt that you add to your diet. It's the salt that's added by corporations in processed food. So if you want to add a little salt on your food, don't worry about it. If you are using salt, it's actually tricks

you can actually put on after you cook and just put it on top of the food and you'll get the same kind of salt flavor without having even as much sodium. But the key is to actually increase dramatically your plant foods to include enough potassium. And that's really the issue. So a lot of unprocessed plant foods that have a lot of potassium are spinach, broccoli, squash, avocados, papayas, bananas. Also, you can make broth if you make a lot of root vegetable broth, greens, squash, avocados, papayas, bananas. Also, you can make broth if you make a lot of root vegetable broth, greens, mushrooms, boil them up. You know, you don't

have to eat the mushy vegetables, but strain it and drink the broth full of potassium. I call it the ultra broth and there's an ultra broth recipe on our website. We'll link it in the show notes. Now, if you have high blood pressure, you know, you'll be told to cut your salt, but that may not be great idea. And there's some studies that kind of say that maybe we shouldn't be so aggressive about lowering salt for everybody if we're having them eat a whole unprocessed diet. So in fact, in one study on heart failure patients, those who were salt restricted were 85% more likely to die or be hospitalized than those who did not limit their salt intake. Now, again, there are people who are salt sensitive,

so be careful. So where are you going to get your salt? Well, get it from foods which is naturally occurring in there. Basically, it's high in things like meat and carrots and beans and beans, but you can add a little bit of salt, like Himalayan pink sea salt is great. Redmond salt is great from Utah. I like those. You want to make sure, though, you're kind of adding the salt towards the end of cooking because it'll actually help bring out the flavor without having to eat as much. So you definitely can eat too much salt for sure. So it's not really unlimited, but be careful when you have high blood pressure and watch what happens. Check your blood pressure, check your diet. Also iodized salt's really common. They add iodine into the salt because of deficiencies that were had in a population.

And you do need iodine and it can cause problems if you don't have it. But often you can get it from fish and from seaweed and other sources. So I think, you know, it depends on your diet, but we might need a little extra iodine. Now, what can you do to actually fix high blood pressure? Well, the first is to reduce inflammation, to get rid of oxidative stress in your diet.

And how do you do that? Well, you've got to get off of the junk, right? So eat, get rid of all the processed foods, eat a whole foods, plant-rich diet that's high in potassium-rich foods. And I've created something called the 10-Day Detox Diet, which is a very simple 10-day approach to cutting all the inflammatory processed foods. And we found people's blood pressure drops up to 20 points when they do that in a week or seven days or 10 days. So it's very impressive when you see the results. You want to eat a lot of potassium-rich foods. Like I said, the broths are great.

Fruits, vegetables, nuts, seeds, high fiber, good fats, calcium, magnesium. Magnesium is a relaxation mineral. It's really important for regulating blood pressure. In fact, when women come in with preeclampsia, which is a pregnancy-induced high blood pressure condition that can cause seizures and high blood pressure, what's the treatment? We give them intravenous magnesium. Now, I don't know why we start with all the drugs with blood pressure. Why don't we start with magnesium? And you can get a lot of magnesium from your diet, greens, beans, nuts, seeds, a little chocolate too. Carbohydrates are a big factor, starch and sugar.

So make sure you're cutting those down or cutting those out and eating good carbohydrates, which are all the fruits and vegetables. Sugar is really the big problem. It's driving insulin resistance that drives the high blood pressure. Eat the right fats. So omega-3 fats are really important, help reduce inflammation, but also can help high blood pressure. Eat the right fats. So omega-3 fats are really important,

help reduce inflammation, but also can help lower blood pressure. Those can come from wild fatty fish. I like the smash fish, which are small, low in toxins, sardines, mackerel, herring, anchovies, salmon. Those are all really good, good quality fats. So you can get also grass-fed meats. I often have omega-3s like bison, grass-fed lamb,

chickens, depending on what they're eating, all great. Get real food. Just eat real food. Get rid of all the processed food. Like I said, make sure you try to avoid inflammatory foods that may be triggers for you like gluten and dairy. Those can be driving problems with blood pressure as well. That's why the 10-day detox is a great way to start, reset.

Also, liquid sugar, really bad. Sodas, juices, all that affects you. Hydrogen and fat, actually, we shouldn't be eating any of that anymore, but that also can be very inflammatory. Get protein and fat for breakfast, not starch and sugar. Most of our breakfast in America is cereal, bagels, muffins, croissants, blah, blah, blah, all that stuff. Pancakes, French toast, that's all dangerous to eat for breakfast. You want fat and protein. I usually have a protein shake. You can have eggs, avocados. Those are great. Flax seeds are great also. Lots of fiber

can help improve insulin resistance. And alcohol. Alcohol can be a big factor. So I would really minimize or eliminate alcohol for a little while. Stay hydrated. Really important. Keeping your blood pressure normal. And don't eat before bed. That worsens insulin resistance, weight gain.

So you do all these dietary things. You still maybe need a little help. What do you do? Well, there's some supplements that can really be helpful. I like magnesium and you can take magnesium citrate or glycinate. If you're a little constipated, use magnesium citrate. If you're not, you can use magnesium glycinate. CoQ10 has been shown to help with blood pressure.

You can take potassium, omega-3 fats, B vitamins, extra fiber, a good multi. All those are great strategies um what about exercise exercise actually can increase your blood pressure when you're exercising but overall it helps your cardiovascular system and lowers your blood pressure it'll help you lose weight i mean even if you lose five to ten pounds we've seen that really have a big impact on blood pressure exercise is not a luxury i mean uh one one one cartoon i often use my lecture says would you rather exercise an hour a day or be dead 24 hours a day so it's definitely not a luxury it's it's an essential part of living just like eating and breathing and brushing your teeth so um what

about stress well stress is a big factor and we know that stress drives blood pressure up. We know that it increases adrenaline, which increases blood pressure, cortisol. So practices like yoga, tai chi, meditation, guided imagery, breath work, all engage your parasympathetic nervous system and help lower your blood pressure and inflammation and help your metabolism and just basically healthy overall. Sleep also super important. A lot of us don't get enough sleep. And, you know, in fact, sleep deprivation can be a factor in high blood pressure as well. So I encourage people to get good sleep. And there's a lot of tricks for that.

I mean, try to go to bed and wake up at the same time every day. You're in bedroom for sex and sleep only instead of working or, you know, doing a lot of stuff that we do in bed. I'm watching TV. Make sure it's dark and quiet and cold in your room. Really important to really reduce all the stimulation. Caffeine, alcohol can be big sleep disruptors. Get morning sunlight. Very important. 20 minutes in the morning can help activate your melatonin cycle and help with mood. Don't eat before bed. Don't exercise after dinner,

except maybe a walk. If you're ruminating, write your worries down. Take a hot bath. I love that at night. Get a massage if you can. Stretch a little bit. Hot water bottle can be great. Actually, I used to love that when I was a kid. And watch for medications that affect sleep, such as antihistamines, stimulants, cold medications, steroids, headache medications that have caffeine. And if you follow all this, if you eliminate all the processed food, if you eat potassium-rich foods, if you get enough magnesium, get omega-3 fats, if you deal with insulin resistance, if you exercise a little and deal with stress, blood pressure is really a very treatable condition. And yes, some people have more significant issues like heavy metal toxicity or more advanced vascular disease. And so they'll need help with blood pressure medication. But getting through cause and fixing high blood pressure is something that many of us can do. Again, it's not a natural condition of being human. It's a product of our modern, really unhealthy lifestyles and diet, and also

some of the other factors like environmental chemicals, which help drive inflammation and oxidative stress, which increases blood pressure. So just remember, if you're diagnosed with high blood pressure, even the guidelines from the American Heart Association, other groups are basically lifestyle first. So try that and try these ideas and I bet you won't need medication. And if you do, make sure you work with your doctor to find the right one for you. I hope you enjoyed today's episode.

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