EP. 03: Hypertension
We’re talking about holistic support for hypertension, today.
My colleague, Corey Schuler FNP-C, CNS, wants you to hear this: Medications by themselves are not the answer. Another way to say this is, medications alone don’t improve health. Medication + No Lifestyle change or an unfavorable Lifestyle does NOT positively change your cardiovascular mortality outcomes. *You can actually reduce your risk by 1/3 when you do medication + lifestyle interventions.
As an example, one of his patients is a pilot and maintaining healthy blood pressure is an important component in his line of work. He’s prescribed medical and lifestyle interventions through Corey's practice and they’ve been managing his hypertension.
Heather dove into how medications like those for high blood pressure can deplete individuals of trace minerals like magnesium and potassium. So, Corey provided examples of how he prescribes supplements like magnesium citrate for his patients. He also includes some herbs like black seed oil as a typical treatment regimen for his patients. Additionally, the foods we eat can help blood pressure; garlic is an example as well as red fruits and vegetables, potatoes, and avocado.
Let’s also debunk the myth that sodium needs to be eliminated from the diet of hypertension patients. If you’re eating a whole foods, you can actually be liberal with your sodium intake.
Lifestyle-wise, Corey is a huge proponent of weight training, isometric exercises (i.e. planks), better sleep, and low stress to combat high blood pressure.
He also shares an interesting fact about mouthwash and high blood pressure… even Heather learned something new!
Show Notes
3
0:00:00
Hi. I like this. This is nice. Yeah, it's relatively new. It's the little things that matter, right?
2
0:00:15
So welcome to Holistic Health with Dr. Heather Heck, and I would like to introduce Dr. Corey Shuler. I'll let Dr. Shuler introduce himself. We have been peers for a very long time in the nutrition world, and he's one of the smartest colleagues that I know. So go ahead and introduce yourself, Corey.
1
0:00:43
Well, thanks. It's a pleasure to be on here. We, I, I guess I'm a nurse practitioner by training as well as a chiropractor, but I practice kind of holistic primary care at Synergy Family Physicians in White Bear Lake, Minnesota. So if I get some Os and a Boats in here, you'll know why. The other, we talked about, or you said we're, you know, nutrition colleagues and yeah, we've been, I've been teaching for a long time in the nutrition field. I'm a certified nutrition specialist and really been focused my whole practice on,
1
0:01:20
um, on holistic interventions rather than medications. Although when medications are needed, we certainly employ those as well.
2
0:01:27
Yeah, I was actually doing a search yesterday on the most commonly prescribed medications because it seems to me, and I don't know if you've noticed this on your end in the medical field, Eliquis is really growing in popularity. There's so many of my patients with blood clots. And so when I looked at the list, that wasn't even in the top 10, but many hypertension medications were in the top 10.
2
0:01:50
Lisinopril. So yeah, if we could talk about how to naturally manage hypertension, I would love that today. Yeah, absolutely.
1
0:01:59
So I mean, when we see, so I have a bit of an obligation, right? So standard care is that somebody has elevated blood pressure multiple visits in a row, we do have to intervene to a degree. And, you know, normal blood pressure is 120 over 80. That's sort of what we're aiming for. That's what we're all shooting for. And a couple of things about this, there's a lot of so I'll do the best I can, is that I usually do start with a medication and then say, let's try to wean this off. They're actually difficult medications to back off of. There's something called rebound hypertension. So these medications are things you can't stop just quickly,
1
0:02:41
kind of like depression medications are like that too. What we're finding is that, so lisinopril is common there's some side effects to lisinopril it's often like dry cough there's something called and the word is funny but it's angioedema and you see it on TV commercials but it's like swelling of the lips and other tissues that can occur from lisinopril and so it's super rare but it's a medical emergency so it's like oh I came in for blood pressure you gave me a blood pressure medication and now I had to go to the ER because of it. Like I don't love that. I will often start people on Lisartan. Lisartan is a little bit different medication. It's sort of the it's a different class of medication
1
0:03:27
but it still has some pretty good benefits. Both are acting on essentially kidney function to make sure that the fluid is in balance and that's the that's the primary intervention in medicine is to just keep fluid balance right. Because blood vessels are just big tubes. They're large, expansive tubes, but just tubes. And if you put too much fluid, well it's not water, but think of it like water through a garden hose. You put too much pressure in it, that's when things can go And so one of the ways is to reduce that fluid volume. The other thing is to increase the size of the garden hose, right?
1
0:04:06
So vasodilation is one way that we approach that. It's super interesting though, and I don't mean to go off on a huge tangent, but I wanted to share that these medications by themselves are definitely not the answer, even though I prescribe them and recommend them. And I'm going to get into a little bit of the research on it, is that when we look at the broad use of these medications,
1
0:04:35
the medications alone actually don't improve health. When we look at the outcomes of hypertension, the things that we look for are all-cause mortality, so death by any reason. We look at cardiovascular mortality, so death by cardiovascular disease. And then interestingly enough, cancer mortality. And when you combine the medication with lifestyle interventions, you actually reduce your risks by about a third. There's something called a hazards ratio, and it's anywhere between.32 and.33, so about a third you reduce your risk by a third when you do the medication and the lifestyle
1
0:05:19
interventions. But get this and this is the punchline. This is what I want everybody to know. medication plus no lifestyle change or an unfavorable lifestyle doesn't change the hazard ratio, it doesn't reduce risk of all cause mortality, cardiovascular mortality or cancer mortality. Like it's a big, big deal to also increase the healthy lifestyle along with those medications.
2
0:05:47
How often do you find if you have a patient that has no change in lifestyle that in a certain amount of time you'll have to change their medication or increase their dose?
1
0:05:57
Yeah, it's a great point. And this is one of the things that we know, and it's funny that, because there's such a correlation between the framework of depression medications and hypertension medications, is that you're spot on. It's a good leading question because it's like you have to,
1
0:06:15
you almost always have to increase the dose. You almost always have to, you get something where the medication just doesn't work anymore. So if we start somebody on Losartan, oftentimes we have to increase their dose, increase their dose, that's not working. We'll have to add a diuretic or something else
1
0:06:30
to if we were just managing it solely medically. So yeah, changing the dose, changing the medication. There's some people that do tolerate a medication and they're just sort of like it's a good unlock and it's great for them, but that's few and far between. I would say that's probably a one or two in 10. So 10 to 20% is like we start them on a medication and they're good. I have a story I have a commercial pilot that I work with and you know, they
1
0:06:58
have FAA regulations on you know, blood pressure because you don't want your pilot having a stroke. So that's good. But it's really important for him to maintain a good blood pressure. He's doing all the lifestyle interventions like very good exerciser, as best he can manage his stress and sleep, that's hard in his line of work. But he's been on a single medication, happens to be lisinopril, relatively low dose, has been on it for the last seven years, and we haven't needed to change the dose, we haven't needed to do anything, and everything has sort of been copacetic.
1
0:07:33
The only time we ran into a problem is when he tried to discontinue the medication on his own and he got some rebound. They actually grounded him for a little bit. And so then he came back and was like, okay, Corey, what do we need to do? We tried some of the other interventions that I like, didn't get the result that we wanted, went back to the medication
1
0:07:53
and everything was just fine again.
3
0:07:55
Very cool.
2
0:07:56
Now, how often, and you have the beautiful dance with the medical knowledge versus the nutritional world. When you suggest a medication, how often do you address any possible drug-induced nutrient depletion? So with like, you know, hydrochlorothiazide, depleting magnesium and the trace minerals,
2
0:08:18
do you help make recommendations to combat those negative side effects?
1
0:08:25
Yeah, and that's also a bit of a dance too because it's the a lot of the data is Qualitative like we know that when you use a diuretic like hydrochlorothiazide, which is the most common one You are spilling potassium magnesium those sorts of things But repleting them can actually be a little bit of a concern So we have to do it carefully and it requires some monitoring So I usually stay in like the daily value level of repletion. There's some cool data that shows magnesium, there's a break and I'm gonna just look at my notes here because this these are this is really important. When you look at the
1
0:09:01
the meta-analyses and and the also the epidemiologic data, magnesium intake of of less than 240 milligrams per day, which is pretty low. 240 milligrams per day of magnesium is well below the daily value, but frankly it's where most Americans sit. The difference between that and 320 milligrams of magnesium is a 34% risk reduction. And so that, even for a male,
1
0:09:32
the male daily value is 420. So you're still not even at the daily value. So the first thing that I do with anybody with elevated blood pressure, whether they're on a medication or I'm starting them on a medication or they don't want a medication, is we make sure their magnesium levels are up. And not necessarily their levels, but more their intake. Magnesium levels on lab analysis aren't always that good. So we just look at dietary intake of that Awesome. Is there a form of magnesium that you recommend the most for hypertension?
1
0:10:04
So there's not something specific to hypertension and I'm gonna answer this two ways because that's the way I do Is that magnesium glycinate is by far the best because it's absorbed in that form and so it has less issues of bowel intolerance, so loose stools. Nobody wants to try to help their blood pressure and get disaster pants, like it's a thing. However, in the beginning when I'm trying to figure out how much magnesium somebody needs, I actually don't use magnesium glycinate, so when I'm trying to titrate and figure out how much magnesium, supplemental magnesium they should take over and
1
0:10:52
above what they're getting in their diet. I'll use something like magnesium citrate because that bowel intolerance actually gives me feedback on how much they can tolerate. And I have a little bit of a protocol on that. I'll share it with your listeners now. I like to be about 75% of bowel tolerance for elemental magnesium. 75% of bowel tolerance. What that means is that I have them take their magnesium at night and so let's say they take 400 milligrams of magnesium at night and they wake up in the morning and they have no loose stools. Very cool. Then they haven't reached bowel tolerance. So the next
1
0:11:33
night I'll say let's let's bump it up to 475, 500 just based on the dose of the supplement that they have and Like they get 500 and now let's say all right. That's that's a problem that did cause loose stools Well, whatever caused loose stools. I want them to take 75% of that so you know They're probably back to 400 milligrams. That's about 80% but doing quick math at home That's a that seems to be works pretty well I just don't want them to to lose anything that they have worked hard to retain. And then we switch them over to magnesium glycinate so then they even have less of a
3
0:12:09
concern.
2
0:12:10
Perfect. Yeah, I like that. Normally when I recommend it, I'll have them do magnesium at night and in the morning and then work up to loose stools and then, yep, do about 75-80%.
1
0:12:22
It's such an old, old thing that, you know, maybe old naturopathic doctors and chiropractors have been doing since the 60s but I continue to share it because it works so
2
0:12:33
well. Yeah and so many as you said so many of us are depleted in magnesium I know I mean we take it I give my little guy magnesium it helps with so many
1
0:12:43
functions. Yeah. Yeah and there's no good lab test for it. No there's the serum magnesium only tells if it's low, man, you're low. Like we really need to do something. If it's normal, you still might be low. There is a red blood cell magnesium that I, it's not used in a lot of the literature, so it's hard to tell what optimal is for that. But I noticed that people who are supplementing with magnesium at these types of dosages are usually on the high end of the reference range for red blood cell magnesium, and that's where I want them to be,
1
0:13:20
just because it is useful in so many different enzymes throughout the body.
5
0:13:24
Now, what do you recommend?
2
0:13:26
I know you're well-experienced with nitric oxide for vasodilation, Hawthorne Berry for hypertension. What do you typically recommend for natural support if somebody necessarily doesn't want to do a blood pressure medication?
1
0:13:45
Yeah, absolutely. So there's a couple things that I really like and have found to be super useful. There's a pomegranate extract that has some benefits. It's actually a little bit better for diastolic, so that bottom number, and we're seeing modest effects typically like a five over five reduction, something like that. But I combine that with an olive leaf extract, which is another maybe five over five. And it seems to be additive. So when I combine them, that's beneficial. I have a list,
1
0:14:15
so I'll go through the whole list so everybody can hear and pick and choose their favorites. One of the herbs that got a lot of interest during COVID was black seed oil, so Nigella sativa, but black seed oil has a active constituent called thymoquinone, and at 15 milligrams of thymoquinone daily, we can see up to a 20 over 10 reduction in blood pressure.
1
0:14:45
So that's really, really big. Now, the study on that was in unmedicated individuals, so it's not over and above. So if they're naive to medication, meaning they haven't started anything, then I think black seed oil is a really good option. So 15 milligrams, thymoquinone. The study was six weeks, I believe, so I give them a full six weeks. That's generally what we do for follow-up, is we look at about four to six weeks, unless they have really, really elevated blood pressure, then I might see them within the week, but I'm using sort of heavier-handed
1
0:15:22
medications on that. Another one that I really like, and this is the active constituent, is called Eugenol. Eugenol is found in holy basil, sweet basil, clove. I like it in holy basil. Holy basil is one of my favorite herbs of all time. I think it's the kind of the coolest thing ever. stress and sleep and those sorts of things which hypertension has a
1
0:15:46
correlate there but there's a lot of really good basic science on eugenol affecting I'll just say the blood blood vessel health and prevention of things like clots and stroke risk those sorts of things. Rosmarinic acid is another one that comes primarily, we think of as rosemary. Actually rosemary is not the highest content of rosmarinic acid. Things like spearmint have generally higher rosmarinic acid content. And then
1
0:16:34
there's other polyphenols. I mentioned pomegranate already, but any kind of, generally think of like the red color of vegetables and even fruits. So we think of like dark, dark grapes and blueberries and those sorts of things have some really significant benefit. Grape seed extract has been studied significantly in hypertension for sure. And then it would be remiss to kind of mentioned Hawthorne. Hawthorne has pretty mixed evidence when you look at all the research on Hawthorne. Sometimes it benefits people, sometimes not. It's really hard to kind of
1
0:17:08
figure it out. It's better for blood pressure if the person already has a chronic heart failure. So that's usually down further in the pike in their disease state. So that's where it really works well. And garlic has some mixed evidence, too, but I still like it. I like it as a food. I don't often supplement with garlic,
1
0:17:30
just because it is such a common food. It's generally like four to eight cloves a day of garlic. So if you're not a heavy garlic user, it's probably, you're not getting what you need.
3
0:17:42
Ah.
2
0:17:42
Yeah, that could be a big jump.
1
0:17:45
Yeah, yeah, absolutely. And then, this isn't a supplement, but I think it's a super important food ingredient, is potassium, right? If we can increase our potassium-rich foods, and everybody hears potassium and thinks bananas, I actually don't think bananas are that great a source but things like potatoes can be really great sources of potassium You know potato baked potato is better than a french fry like the way this is prepared matters a whole lot
1
0:18:13
But that's I think potassium levels are really important. There was some data You know data guy over here the potassium intake over three grams a day versus 2,500 grams per day. So only a 500 milligram difference showed another 25% risk reduction for all-cause mortality. So every little bit
2
0:18:40
of potassium can be helpful. For sure, and just like magnesium, so many are depleted. I actually really like avocado for potassium and coconut water too. Those are my favorites. Both are really great sources for sure.
1
0:18:53
Yeah. And less calorically, you know, less calorically dense. Potatoes, not everybody tolerates them well. Yeah, you're entirely right. Yeah, potatoes, bananas, a little less
2
0:19:05
glycemic spike. Yeah. What other lifestyle recommendations do you suggest for
1
0:19:11
patients? Got to be active. No question, got to be active, got to manage stress and got to sleep. And if those three things are, if those three are sort of out of the picture or not, not great, I have a lot harder time getting blood pressure and cardiovascular risk down. So a lot of people run and that's a good cardiovascular exercise, but you don't, not everybody likes to run and so I give alternatives to running and cycling and those sorts of things. Weight training can be really significant for that, has other metabolic effects. I'm totally biased towards weight training as a foundational thing, but exercise is a preference thing. We have to do what is, what we can do consistently, what we like to do, what gets us the benefit that we're looking for.
1
0:20:04
But I find that weight training is really important. I know that there's this dogma about seven to eight hours of sleep. I find that people who have hypertension generally need more. I actually find the same correlation to men with low normal or low testosterone. They just need, they're on the higher end of things and many people need eight to nine hours of sleep rather than seven to eight. I've made a note in my practice that, because I ask everybody to get really specific about their sleep, I really like diving into the sleep aspect of things, a lot of people are getting
1
0:20:39
six, a lot of people are getting five and a half, and they're wondering why they're not feeling well, but you really don't, if you don't sleep, you don't heal. And so this is the time, the place and the opportunity to do that. So sleep gets a prominent stage on that. And then chronic stress is ubiquitous in our society. If we can't manage it with breathing exercises, meditation, the stresses aren't going away, there's no end in sight to the stressors, then I say maybe we need to supplement with things like adaptogens and do a little bit more. I have, I've been well known to say everybody needs yoga,
1
0:21:29
because it's like a stress reduction in a very short period of time. And then so funny that is and I'm mixing between the stress reduction and the exercise is that the one exercise that now has some really good benefit in hypertension that sort of has been forgotten about maybe made fun of in exercise circles is isometric exercises. So holding the same position for a period of time, like yoga, but if you're more on the fitness side of things, you might think of like wall sits or holding a deep squat or planks. You know, you can kind of talk about them in different terms, whether you're doing yoga poses or asanas or if you're looking at more of the fitness perspective.
2
0:22:23
Yeah, that's a great point. And at least for me personally, I mean, I am a yoga instructor. I find that running to me is easier than yoga and isometrics. Isometrics and yoga are so hard. Yeah. And just like with lifting,
2
0:22:38
I feel like that's more of a cardiovascular benefit
7
0:22:40
than running.
10
0:22:42
Yeah. I really do.
1
0:22:43
Yeah. If I could get more people to lift weights, then I've made some progress in life, but I don't look like I lift weights, but I'm definitely an advocate of it.
2
0:22:52
Well, and you brought up some great points. One of the most common features I see with hypertension in my practice is sleep apnea, right? And then men with low T. Low T, depression, weight that they just can't lose. If you check sleep apnea and testosterone, I mean, those are two big contributors right there. Absolutely, 100%. So what you mentioned when we started the the recommended
2
0:23:21
range is 120 over 80 for blood pressure. At what point do you start to maybe suggest a medication? Like 130 over 90, 140? Yeah, I don't start anything on a
1
0:23:34
single reading. So one reading does not hypertension make is something I will generally tell people. So I have to have them, if we get repeated outcomes that they're elevated, anything over anything over 135, over 90, and I'll let diastolic, I'll let that bottom number come up without any intervention because the data shows that that's not the driver of things like stroke risk, but there is data that suggests the blood pressure in that range of 120 to 129, so just super minor elevations over 80 to 84, increases cardiovascular risk overall by about 46%.
1
0:24:19
And if you just take out the men data on that, because we're kind of leaning on that men thing, it's 80%. It's an 80% change in risk. So even modestly, like, okay, we need to do something about it, but as far as the medications go, if it's 135 over 90, it's probably worthwhile, and it also depends on age.
1
0:24:43
Way different in elderly versus young and healthy people. Young and healthy and hypertensive is a flag for me. I gotta do something about that. I actually like blood pressure being a little bit elevated in my older population because I'd rather they be high than low. Low blood pressure in older people generally results in things like falls
1
0:25:07
and just feeling unwell, that sort of thing.
2
0:25:09
Yeah, absolutely, I would agree with that. And then what about diet? What kind of diet recommendations do you typically suggest for your patients?
1
0:25:19
Yeah, it's hard to ignore the Mediterranean diet or paleo-Mediterranean diet if you're looking to increase more protein, but it's a whole foods diet, either one. Same with, the one that has the most data on blood pressure is the DASH diet, but really that's, it's a low sodium diet, but it's also a super low sugar diet, and it's a high whole food
1
0:25:42
diet. So getting your foods from not packaged places. You know, there's this whole other controversy, we probably won't get to a lot of it, but I'll touch on it, is that one of the first things that people like me in primary care say is, you want to reduce your sodium risk, or your sodium intake. It's actually really, really controversial that that's maybe not the right approach unless your sodium is coming from boxed and packaged
1
0:26:10
and fast food and restaurant food, then yeah, you need to reduce your sodium risk. But if you're eating whole foods, you actually can be fairly liberal with your sodium intake without cause for concern.
5
0:26:23
Yeah, that's a great point.
2
0:26:24
We get most of the sodium from packaged foods.
5
0:26:28
Yeah.
2
0:26:29
That's detrimental for sure. So shopping around the perimeter of the grocery store.
4
0:26:33
Yep.
1
0:26:34
You know, ramen. Probably avoid your ramen. Probably avoid your boxed macaroni and cheese. Like, I'm making all the, anybody who's listening that's recently out of college be like, wait, that's my whole diet. It's really problematic and it's hard to recover from a diet like that.
2
0:26:52
Yep, frozen foods. I've even noticed as I've evolved and as I've gotten older with my diet, not that we eat out often, but when we do eat out at, say, Chipotle, you notice how salty that food is. We can't eat that anymore just because for me it's too salty. I'm too salt-sensitive to that processed food. Um, so I think for a lot of my patients as well, eating out, even just one or once or twice a week can really impact their hypertension.
9
0:27:23
Yeah.
1
0:27:23
It changes your palate entirely. Um, and. When you get used to it, you know, you don't notice it, but if you're doing more eating at home. And a home meal is generally like 500 to 600 calories. And a going out meal, even though you feel like you're eating the same volume of food, is anywhere between 1,000 and 1,200. obesity or overweightedness can contribute to cardiovascular disease, high blood pressure, all the things and you just don't recognize it because it's
1
0:28:07
about the same volume of food. That's a great point. And now for salt
2
0:28:13
recommendations, if you're eating a clean diet, you're eating whole foods, organic, I typically recommend like a pink Himalayan salt to use at home? What kind of salt do you recommend your patients use? Yeah I
1
0:28:28
happen to use, it's a brand name, but it's kind of the same thing as the original Himalayan crystal salt. I have just been using it since 2011 and so that's my my habit. I have amounts for you just because you know I like data. So The between 2,500 and 3,500 milligrams of sodium per day seems to be the sweet spot, which is higher than what is recommended for hypertension, but lower levels or higher levels so no show no increased benefit for sodium intake. So yeah, I like the Himalayan crystal salt. And yeah, any pink salt, anything that's more than just sodium and chloride when it has other minerals in there to offset any negative impacts of the chloride or the sodium is probably a good idea.
2
0:29:21
Absolutely, and then what about water with recommendations for patients with hypertension, especially if they're on a diuretic? Does the type of water
1
0:29:31
matter? How much water should they get? It's hard enough for me to get people to just consume enough water, and so I generally don't get into the nuances of it, but I have thoughts on it. What I generally like is just trying to hit about that 3 liters of water a day, whatever the dogma was about 64 ounces or 8 glasses of 8 ounces of water a day. I don't find that terribly helpful because it doesn't account for being on a diuretic, it doesn't account for your exercise, it doesn't account for other things. People don't want to do a calculus experiment to figure out how much water they need. So I have sort of a way of doing it.
1
0:30:11
I say drink 12 to 20 ounces of water first thing in the morning. Rehydrate from all the breathing and sweating and stuff that you did overnight. And then you're going to have to urinate throughout the day. And every time you urinate, have another 8 to 12 ounces of water until you hit about that, um, about that three liters of water. Now it's, that's sort of the gulping method. It's better to sip water throughout the day, but if you can't get in the habit and you're not reaching anywhere close to that three liters,
1
0:30:40
then I found this little like environmental cue benefit of every time you go to the bathroom, drink water to help people get into understand how much water they should be actually bringing in.
2
0:30:53
That's a good one, and that's easy to follow too.
1
0:30:55
Seems okay. That's what I use. Yeah, yeah, that works.
8
0:30:58
Awesome.
2
0:31:00
Anything else that you can think to share with our listeners? One of the craziest things that I've come across
1
0:31:05
for hypertension that I had no idea about is if you have elevated, even minorly elevated blood pressure, check your mouthwash. Mouthwash consumption reduces microbes that make nitric oxide, that natural vasodilator that won a Nobel Prize in what, 1999, and as an inorganic molecule had something to do with something health-related. But that's the one thing I'd be paying attention to. If you're a frequent mouthwash user and have high blood pressure, it's one of the first things that we cut out and say, sorry, you're going to have to find a different way for oral hygiene.
2
0:31:55
No kidding.
7
0:31:56
What about toothpaste?
1
0:31:57
I've gotten some great results too.
3
0:31:59
So what's that?
6
0:32:00
What about toothpaste?
5
0:32:01
Does toothpaste matter?
1
0:32:02
Toothpaste? Probably not to the same degree. I mean I still think everybody should brush their teeth and oral hygiene is super important even for cardiovascular disease. But I don't think it has it doesn't wipe out I mean it a mouthwash is basically an antibiotic for your mouth and it takes out all of those microbes that are making that nitric oxide and I don't think toothpaste has the same antimicrobial effect. It's a little bit more mechanical and saponification method, or like it kind of makes soap in your mouth, right? That's why it's all bubbly and stuff, and so it mechanically removes the bacteria rather
1
0:32:38
than being an antibacterial effect directly. Interesting, that's a great
2
0:32:43
point. What kind of, looking at that in your practice, what kind of results have you gotten?
1
0:32:56
I've had a few kind of ridiculous things where I had people that, and we'd gone through multiple different medications, multiple doses, tried a lot of different lifestyle things. Actually, two cases are super important that I'll share. Both were dentists. And, and I was like, why is this so familiar? And like, why is this case so frustrating to me? And it happened to be another dentist. And so with the second dentist,
1
0:33:25
I was like, what do you do? Tell me about your oral hygiene routine, because I'm super interested. You're an expert. Tell me what you do. And he was telling me Listerine and all this sort of stuff. And I was like, you know, there's data that says you shouldn't do that, he dropped his mouthwash, improved. I called the other dentist who I hadn't seen for like six months and said, hey are you still having blood pressure problems? And he's like, yeah. And I said, drop the mouthwash. And he's like, really? So yeah, drop the mouthwash. Give it two weeks, see
1
0:33:55
what happens. And so my home monitoring for blood pressure is to take your blood pressure once a day for two weeks at different times of the day. I want to kind of get an understanding of how things are going at different times of the day. So he did that. He had already bought the blood pressure cuff based on my recommendation and the blood pressure cuff that goes on the arm not the one that goes on the wrist. And he had found that that really made a big difference for him. I think he saw a drop, the first guy saw a drop of 30 over 10. So 30 points systolic, he was very hypertensive.
1
0:34:31
The other guy saw, the second guy that I had to call back, he saw a 20 over five reduction in his blood pressure. And I was, so now I'm convinced.
2
0:34:40
That's significant.
1
0:34:43
It was huge.
2
0:34:44
Yeah, that's really, really interesting.
5
0:34:46
Yeah, thanks for sharing that.
2
0:34:47
And then I have to ask this question, just because we're both in the medical field and you're so knowledgeable, with hypertension, how do you think that has been impacted by COVID?
5
0:34:59
It's made it a lot worse.
1
0:35:01
You mentioned at the beginning of the conversation, Eloquus, and right, we use Eloquus for things like atrial fibrillation and just heart rhythm problems. We use it for clotting issues. You know, it's a step up from things like warfarin, which is a pretty nasty medication that interferes with everything. And we still use warfarin in fall risk patients,
1
0:35:24
but we see a lot of clotting cascade issues, especially in long COVID. So we have to do sort of extra help to make sure that that's right. And so I'm focused as a sort of scientist guy on just how to improve the endothelial health, the inner layer of the blood vessels, rather than just messing with the fluid, rather than just messing with anything like that. I want to make sure that the cardiovascular system of the blood vessel, the interior of the blood vessel, can respond to any damage appropriately
1
0:36:00
because that's how blood pressure and I'll say clots and things happen is because there's actually an immune reaction that goes on. The immune system comes to the rescue of a damaged inside of your blood vessel. It creates something called a foam cell, causes thinning or a decrease in the lumen of those blood vessels, and then it gets worse over time and sort of parks itself inside that endothelium. So that's where it gets smaller. I'd like to improve that by just making sure that really never happens or doesn't happen more. Right, yeah, that's a great point.
2
0:36:34
I was doing a little bit of research over the weekend for a lecture on cancer, and you might have heard this, but I ran across a TED Talk by a cardiologist named Dr. Leeper. He came out with a publication showing a link between cardiovascular disease and cancer and how it's that same inflammatory response and that endothelial compromise. And I don't know why it didn't, like, light bulb moment, like, of course they're related, why wouldn't they be?
2
0:36:59
So, yeah, that's a great point. Yeah, no, I'd love to hear that because I kind of feel that,
1
0:37:16
like I feel that that's right, but I haven't been exposed to the data around it. So that'd be cool.
4
0:37:21
Yep.
2
0:37:23
Well, thank you. Thank you for joining us today. You shared so much great knowledge. If our listeners want to learn more about you or hear more from you, how can they get in touch with you?
1
0:37:36
I think the best way is to just look me up on synergyfamilyphysicians.com. Synergyfamilyphysicians.com is our home for the clinical practice. I do lectures and teach a variety of other places, but oftentimes it is directly to health care practitioners. I have a couple lectures here at the end of the month for a state association for PAs, but and I But I probably not relevant to everybody so that's probably a best way to keep in touch with me
1
0:38:07
I also love my LinkedIn if you happen to be in LinkedIn world Just look me up on LinkedIn
2
0:38:13
Sounds great, and I'm sure we'll be seeing you again. I enjoy talking to you today Thanks for having me Heather appreciate it. Thanks Corey. Have a good one. Yeah Well, thank you for joining us today. That was quite a bit of information, all very informative. I'm in the nutritional and medical field and my mind is still thinking about everything we talked about. Please review the show notes. If Dr. Corey and I sparked some interest in other topics such as cancer or COVID,
2
0:38:48
or with his experience as a nurse practitioner, making some holistic recommendations. If there's some other topic that you would be interested in learning about, please let me know. And then we will see you next week. And then we will see you next week. So have a wonderful week, take care.
Transcribed with Cockatoo
