Treating The Underlying Causes Of High Blood Pressure

there's so many other ways to treat hypertension besides just using pharmaceutical agents [Music] [Applause] welcome to the doctors pharmacy I'm dr. Mark Hyman as pharmacy with an FFA RM Acy a place for conversation in the matter and if you're one of the millions and millions of people who have high blood pressure or you know some of that blood pressure this conversation is gonna matter to you because it's with Mike friend and colleague at the Ultra Wellness Center in Lenox Massachusetts dr. George Papanicolaou he's one of our leading physicians here he's incredible guy who is doing great work here treating patients and they love him I can just tell you they love them and I love them so it's all good now we're gonna talk about in this special episode of house call on the doctors pharmacy we're gonna talk about high blood pressure or hypertension so George tell us how big of a deal is this and and what is the general approach of traditional medicine to dealing with high blood pressure and why should we care well we should care because you know in in the in the worldwide scheme of things there is about 1 billion adults so it's about 25 percent of the adult population in the world that has hypertension 1 billion people have high represent by 2025 they think it's gonna be closer to the 32 to almost 30 percent of the world adult population and it's also considered one of the leading causes of mortality to mankind so it's a big deal and in our country it's about 75 million Americans that have hypertension that's one in three and an additional one in three have what we call pre-hypertensive condition so they're like pre high blood pressure or pre-high blood pressure so that the the way it's staged you you can you know there's a category that's pre hypertension what was interesting Georgia is like we constantly changed the goalposts when I go to school the blood pressure we wanted was anything under 140 over 90 then I was 120 over 80 now we're down like 115 over 75 is being normal right so why are we do why are we changing the below post constantly that's that's interesting that's interesting and I'm quite honestly I'm not sure why we changed why we change the Georgia this reason because we keep doing the research that's finding that even at lower blood pressures people are experiencing the consequences of high blood pressure right so what are the consequences of high blood pressure why should we care yeah blood pressures are because it's a silent killer yeah and that's that's the key it's a sign you don't know how people won't know they have it and and what it causes it's one of the leading causes of heart disease that's considered like heart attacks congestive heart failure arrhythmias which is abnormal the way the abnormal electrical activity in your heart that can lead to critical events these cars of all kinds of heart yes heart disease it causes a end-stage renal disease kidney failure yep kidney failure and Stroke you know stroke and then stroke creates a great deal of mortality morbidity for adult population even blindness yeah right yeah I pretend like micro vascular disease and blindness or dementia because of its effects on the vastest in the brain yeah and also affects things lower down right yeah like sexual function oh yeah right blood vessels get problematic in your sexual organs you're not Michael doing things disease in your in your in your in the penis it can definitely result in erectile dysfunction and that's not a good State nobody likes that it also causes stiffening a heart of your arteries you get vascular problems in your legs and blood flow yeah peripheral artery disease is it is a major issue and particularly if you have diabetes and 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 progress years and a billion people have it in America a lot of people have it yeah right yeah fifty to seventy-five million American absolutely and growing and how many people are actually like treated well it's probably like yeah fourteen million out of those yeah this and as we talk about that treatment is you know is primarily medication it's not always effective 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 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 our medication you can't let it go and it's um you should do as a preventive strategy you can go to the drug store they have blood pressure machines you can stick your arm in or you can buy one for next to nothing in the drugstore or 29 bucks 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 my blood pressure cuz one it fluctuates all day long - just getting one blood pressure reading the doctor's office may not really tell you what's going on you might have white coat hypertension mean you get nervous and stressed it goes up I mean when you exercise your blood pressure on your stress your buddy well what's your average blood pressure so right one of the Diagnostics we do is a 24 hour blood pressure test which I found really effective cuz you can see what it's 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 damn tonight an average and that'll tell you what what your real risks are right so doing 24-hour ambulatory monitoring is something that is really important to do particularly if you're you have any concern that the readings you're getting in your office are inappropriate and you mentioned why could hypertension and that is not uncommon it actually is fairly common and so we will oftentimes recommend an ambulatory blood pressure readings and that gives us the clear clear picture possible yes true and sometimes you can just get a cuff at home and have people monitor blood pressure out today and that that'll help to you know I want to just dig into a little bit before we get talking about the difference with functional medicine and traditional medicine right traditional medicine is you check your blood pressure it's high you get medication you're moderate 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 that's not true we know that's not true so everything has a cause nothing is just random right all right if you have diabetes it's not a random event it's not like oh I I got a virus right something happened any type you know 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 so one of the biggest factors is insulin resistance which is an epidemic in this country we have one in two Americans at pre-diabetes or type 2 diabetes 75% are overweight 42% are obese and they all have some degree of trouble regulating their blood sugar which is 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 in some 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 belly fat is an immune organ and it arrives 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 in some 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 know I call it you know you mentioned the adiposity we have around our waist I called it I call it the toxic waste dump of the body yeah and it did that fat just does have a metabolic effect that is toxic to the body as you said it creates the hardening of the arteries which is you know one important cause of high blood pressure yeah and the other big thing is often misdiagnosed and by the way by the way in some resistance affects so many people ninety percent 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 fallacy because tolerance test they do I do an 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 everyone in two hours after but most doctors just check blood sugar but that's a very late point and you want to check insulin no I'm doing a fasting insulin isn't going to give you an answer in some health yeah but I'm your insulin goes up fasting it's already down the road very far right you know I agree and then and then we have this other issue which is sleep apnea yeah which is so under diagnosed yeah so sleep apnea you're about 25 million Americans at have sleep apnea it is under diagnosed 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 they're a pallid small airway right you have sinus issues and when right 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're they actually can't perform the work they need to do and create the energy they need to have and so they they can't contract and expand the way they should and that can result in high blood pressure yeah and and then it also drives in some resistance so if you have sleep apnea it also causes you to be pre-diabetic yeah and what you're eating weight weight gains insulin resistance that leads to diabetes which complicates everything I mean I this guy couldn't lose 50 pounds he was a he was a lawyer and he told me the stories like he said look I I need to lose 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 does push your life like as well I mean 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 is before standing desks yeah right and and and I'm likewise as well if I sit down I fall asleep and I'm like gee maybe you have sleep apnea so if you're falling asleep at work if you're fall asleep in front of the TV if you feel it's hard during the day if your wife says you're snoring another zaps you can get that actually record your you're on your phone and they record your snoring so you can see because people don't believe it I don't snore and then I love the and then someone called sleep cycle look like it's a porter story and and and it's something that is easy to treat I mean it there's different methods to CPAP and you know but but it is a treatable condition and the weight loss then will happen and you'll feel better so that's really important I'm just talking 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% right how people have low magnesium which is you know magnesium it's not magic but you know when we replace my knees 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 in and certainly plays a big role in lowering blood pressure yeah but I called the relaxation mineral and you know it's funny how in medicine we had 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 and pregnancy and when they come in and their 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 you know to relax their blood vessels and save their life okay so so and in 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 and for example environmental toxins heavy metals in particularly lead and mercury are really common they're under diagnosed and when you're going your high blood pressure visit your doctors 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 key later and then we check their urine and see how much dumps in there and if they levels that's often a big factor is why and I think you're you know you're 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 gonna get your hypertension better by not treating your hypertension we're not going to treat your hypertension we're gonna treat everything else that's causing your hypertension we're gonna find the sleep apnea we're gonna find the nutritional deficiencies we're gonna work on your stress levels we're gonna 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 per pound I think 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 is so key you know it might create a program called the ten day reset which you can find and get pharmacy comm we put a thousand people through it track their blood pressures it was incredible their blood pressure's dropped an average of 20 points ya know in ten days well if you think about that most Americans are at least 25 pounds overweight or you know so let's it's it's better than medication results exactly you if you get them to drop that 25 pounds they're gonna drop your blood pressure by you know near 15 millimeters of mercury yeah so so we have we have insulin resistance sleep apnea low magnesium low mega three fats which about 90 percent of Americans have you have heavy metals environmental toxins and we now are learning that that the gut microbiota the microbiome in the gut if it's altered through our bad process 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 you know that's a 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 high blood pressure and and that speaks to where to get potassium to get it from green leafy vegetables so having a you know having a vegetable based diet you know is is very very important and let 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 on high blood pressure this is something we should worry it's not it's not something everybody needs to worry about there's more partners there's certain populations that are gonna 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 limited 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 um it can be iodized and I did I then can cause problems so it's not the salt that we personally add in our kitchen it's the salt that's out in factories and processed food yeah exactly if we caused huge amounts of intake of salt because how do they make junk ingredients taste edible off that's all yeah and sugar and processed fats right yeah so we know that and but if you get really good salt the seesaw 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 or not checking your insulin resistance they're not checking necessary sleep apnea although some might be thinking about this you know it's interesting they're not checking your your magnesium or and the reality is is that you know and and just because when I was 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 the blood pressure so my 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 you know how to lower their stress with meditation wouldn't that didn't drive it and so you know 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 you know the traditional approach your medicine is you diagnose and then you treat yeah when we diagnose you say you have high blood pressure that's the first step in our thinking yeah then we start to ask why why why and everybody gets treated differently right in some patients that treatment of high blood pressure is getting off the sugar and starch another person who might be treating their sleep apnea another person of a detoxifying from heavy metals another person it might be giving them extra magnesium and then well we have a lot of techniques that we can use to help mitigate this sleep stress management exercise exercise lowers blood pressure so it's it's it's often frustrating to me understanding how the body really works yeah when I see this knee-jerk response in medicine it just 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 you all listen to the patient because the clues are always gonna be there I can't tell you how many of my patients that come here do true Wellness Center I I asked them so they're fatigued we have a lot of patients that come with chronic fatigue or fatigue is part of their their complex of complaints and I asked them if they snore yeah my mom tells me I snore all the time I said so how long has that been going on and they has anybody asked you whether you snore before is anybody asked you if you wake up refreshed does anybody ask you if you have daytime fatigue and no they they 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 map yeah yeah that's beautiful about function medicines we really do a very detailed history so because I how do you diagnose mostly history I mean we do a 32-page questionnaire right which is annoying for patients but it allows us to get a really deep sense of what's going on so mark at me you know how many times have you had a patient come in who has let's say hi blue and maybe they're there 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're they have heartburn or they have yeah I get occasional heartburn I take a pee pee I take I think an h2 blocker these are acid blocking blocking medications and they don't connect it to their high blood pressure right why is PPI are as a blocking medications problem because they didn't hits acid production which you need to absorb magnesium exact right and so you're always in calcium and vitamin D right right um which can be impacted but you know and they have oh yeah I also you know I also have difficulties constipation or I get loose stools you know what there's a connection between the gut and the blood pressure so tell us about this patient you had yeah you treated perfect segue because he had gut issues and that sort of is what really was leading to his high blood pressure so he's the gentleman that came in that issues leads to inflammation it leads the inflammation and it's not just inflammation the blood vessels is inflammation in the gut lining so you can get this nonspecific lymphocytic infiltration it's basically inflammation that means a lot of white blood cells show up in the gut and makes it inflamed exactly so and so it happens though is then you get a malabsorption of minerals and nutrients that's when you don't absorb the vitamin D that's when you don't absorb potassium that's when you don't absorb your calcium that's when you don't observe your magnesium those are the things that can help regulate blood pressure so at this particular patient that came in he was a 52 year old gentleman and he had been diagnosed with blood pressure high blood pressure about unless the year prior to coming and they tried multiple blood pressure medications and he had different side effects which is one of the issues with blood pressure medicine so yeah there's that we forgot to tell you exactly so you know that's a big problem lots of people have side effects they get dizzy they get tired they get erectile dysfunction to get lower libido leaves they've been hair loss associated with their blood pressure medicine so he had been put on different medications that resulted in loss of libido fatigue brain fog one of the medications actually caused dehydration that resulted in him being in the emergency room where they found his potassium to be really really low and had to be replaced so he was like I'm coming here because I want a different approach to my my blood pressure so as we were you know we go through our our new patient packet that's very long some things that started to stick out were that he was you know he did have fatigue and he also had irritable bowel syndrome and I asked him to explain that to me and right when I hear you're irritable bowel I don't hear this like again we talk about like just a syndrome yeah like essential hypertension they we essentially don't know what's causing it it's like we say irritable bowel it's like you know what your diarrhea is irritating me I don't want to talk about it right we don't want to get to the bottom line well it's not even that they don't know it's like yeah in other words when we say people have your Ballack oh the reason you have bloating and gas and diarrhea and constipation is because you have irritable bowel syndrome right no that's just a name we give to people who have those symptoms it doesn't tell you about the cause and that is what's unique about functional medicine is we have a methodology right an operating system to navigate to the root cause and we treat that and we don't have to treat the hypertension which well cause and the disease goes away the side effect right so in this particular case we do we do testing for the gut microbiome and we can also do testing that tells us some things about the gut so we can find out if there is inflammation in that endothelial lining and that's basically if you look down a really big stainless steel tube and it's really shiny imagine that shiny layer is basically a very thin membrane that protects the rest of the tube from anything that's going in the tube so that's the endothelial lining that very shiny stainless feel I got one cell layer between you and the sewer right you got it you're sad immune system and they'll poop inside of you that's a great thing that's a great way to put it so so when that membrane gets inflamed it cannot function to absorb nutrients away should and that can lead to all of the things that you spoke about earlier in regards to low magnesium love item Indy low calcium and and so we know that people who have irritable bowel there's a good percentage of them have non-celiac gluten sensitivity and so I that triggered my thinking and that's why I ordered that test that will look at whether you have leaky gut whether you have gluten sensitivity and whether you have cross over to other foods like gluten that can create gluten light impact on the gut and so with this particular gentleman I also did a whole host of metabolic tests that included you know a glucose tolerance test I also looked at his magnesium levels I look at inflammatory markers that made every fat making three fats that we look at so it did a comprehensive metabolic evaluation I looked at a very expansive profile that looks at macronutrients micronutrients organic acids amino acids that gives us a really good clear picture of what his nutritional status is whether his the the very important energy making systems in his body are actually working the way they should are they getting the nutrients that they need are they being blocked from doing their work by toxins we do this panel that gives us all that information this is a very unusual panel in traditional medicine but we're looking not for disease we're looking for imbalances or dysfunction that we can correct that will help the body do what it's supposed to do exactly so I gather all that information the lab tests but the most interesting thing about this gentleman is that he had one gene positive it's a gene that that would Express for celiac disease but the tests that we do to see if you actually had celiac disease were negative and what we know about people who have at least one or both of the celiac genes that do not have active celiac disease is they're more likely to be sensitive to gluten and indeed he was he had two things going on on that panel that we do to evaluate inflammation and antibody interaction or where the immune system creating antibodies against gluten in the body so he did have leaky gut meaning that that that endothelial lining that one thing saving you from the poop in the center of your intestine from the rest of your body was leaking and so the immune system was creating antibodies so we knew there's inflammation and the second thing was he had enormous numbers that showed that he was sensitive to gluten and so that gluten sensitivity does not seal yeah because it people understand that there's celiac and most traditional medicines like you have the other of celiac or your mind right but now there's an increasing body of research particularly dr. Alessio Fasano from Harvard it shows that a lot of people have non-celiac gluten sensitivity right which son you can tell through anybody testing a little bit but it's it's a milder case but it still causes leaky gut inflammation and many many problems and then there's all another category which you can't measure on lab tests called the innate immune system response or cell meet in response to gluten which means you can't measure it because it's just a generalized irritation of your immune system yeah so that can be a case even though these other things are normal so gluten is often driving leaky gut and it's and it's often overlooked yeah very overlooked and particularly in a case like this so I'm a normal doctor will check your levels and if they're normal quote normal like it's zero to twenty yeah is nineteen the same as one no no is five the same as zero no so I think we have to understand that if there's any level of anybody it means there's some irritation of your immune system that's causing potential symptoms yeah so in this particular case I put him on a gluten-free diet and I also we land and the great thing the great and honestly I didn't put him on gluten free diet identified that the gluten sensitivity and here deal to wellness center we have amazing nutritionists and when I discuss these types of cases then they develop a program for our patient that is going to be customized to what their need are their needs are so in this particular case he was on a Mediterranean diet that was gluten free and that that made all the difference and when he tried to reintroduce gluten back in his diet his blood pressure went back up yeah so it was driving the inflammation that was driving his blood pressure and he was also low in vitamin D which was impacted by his gluten because gluten will keep you from absorbing iron and magnesium and potassium and calcium and it can have impacts on lowering vitamin D and vitamin D regulates inflammation selenium right interacted and there's a hammock biology where everything's connected and that's really what we doing yeah and there's a lot of observational studies that show that vitamin D in people that have low vitamin D and you replace it you can lower their blood pressure particularly in people over 50 so I replaced his vitamin D put him on a gluten-free diet and gave him things that we know that work make it fit he wasn't eating a lot of fish so he gave him a mega threes I also added in some coq10 and magnesium yeah and he did phenomenally well he never went back well I shouldn't say never he's been my patient for about eight months now but his blood pressures have been normal yeah so this is really incredible story which-which no medication no side and here's here's the view in traditional medicine essential hypertension is a one-way street once you got it you got it you got high blood pressure you can't get rid of it you've got to treat it and that is just is not true if you address the root causes which is what we do it's functional medicine and what we do with the ultra Wellness Center we can't often get to the bottom of this now there are some people who have more genetic factors or there's more difficult to treat but for the most part we can have huge impacts on people's lives and health and well-being using this approach of functional medicine and it's it's so refreshing and so it's so invigorating as a provider because we're not just managing these diseases were getting rid of them and we're not treating them we're treating the factors that are causing them and the disease's go away as a side effect yeah and and and that's I can't say it any better than that mark you know we do it and you know we've been doing it here at the ultra Wellness Center for almost 20 years and and we continue to do it and we work as a team to do it and we just have built you know we have worked on the things that you know if you written about four years and we established some really great ways to approach our patients and so this patient has benefited from that I actually had read another case in a functional medicine journals journal that clued me into this so it was in my mind to think about it so he was really excited that by changing his diet not only is improving his blood pressure but he was also going to improve his health span and those are those years of health without disease yeah and health and also health without side effect from medication yeah that's it so so the side effects of this approach are all good ones right excellent I mean getting your omega-3 levels better hair skin and nails and overall well-being and mood you know vitamin D helps your immune system magnesium helps you more relaxed and less anxious and sleep better and have better bowel movement so you basically you get all these nice side effects by fixing these problems it's great so George thank you for sharing this incredible case and talking about high blood pressure which affects a billion people and which is really something we we have really been poorly treating with traditional medicines I'm so excited that we get to have this conversation and be here at the ultra Wellness Center and I encourage everybody who's concerned about high blood pressure who has it or as someone in their family they love or someone they know to share this information with them we at ultra mana center here are now doing all virtual visits we can do patients from anywhere in the world through zoom and great jobs with getting your tests where you are you can certainly come in if you want and we'd love to see you so you just go to Ultra Wellness Center common more about our practice and I would love you to share this podcast if you liked it with your friends and family on social media leave a comment we'd love to hear from you to share your story about how you may have tackled your high blood pressure and subscribe wherever you get your podcasts and we'll see you next time on the doctors pharmacy [Music] [Music]

Channel: Mark Hyman, MD

Views: 116,211

Keywords: high blood presure, hypertension, Dr. George Papanicolaou, dr. mark hyman, the doctor's farmacy, nutrition, health, health podcast

Id: BzSwNh880tc

Length: 32min 57sec (1977 seconds)

Published: Mon Jun 22 2020