One of the medications that needs to be monitored by your doctor is blood pressure medication. Why is this so important?
Blood pressure medication has become so common. I’m in an obesity medicine or internal medicine clinic – a keto medicine clinic, specifically, and just about everyone in their 40s, 50s, 60s and certainly in their 70s and 80s is on blood pressure medicine. It’s almost assumed that an American will eventually become hypertensive (having high blood pressure); it’s seen as part of getting older. I’m not convinced.
The reason we treat blood pressure is because the increased pressure inside the arteries – that’s what’s being measured – can cause damage within the arteries, called “atherosclerosis” or “hardening of the arteries.” If blood pressure is extremely high, it can cause very small blood vessels to break, which can cause a heart attack or a stroke. Those can be devastating for someone’s health, so blood pressure is really important to measure.
The thing is, you don’t have to use medication to treat blood pressure. There are other ways to do it. The lifestyle management of blood pressure is, I think, underutilized and underprescribed by physicians today, because we have so many very cheap medications. It’s easier for a doctor to say, “Your blood pressure’s high, here, take this pill.” That’s where I want you to pause. Before you’re on a pill, ask the doctor if there’s another way to go about treating high blood pressure and hopefully they’ll say that you can, through an effective lifestyle. The doctor might not know about effective lifestyle treatment, so you might have to do a little homework about that. The reason I’m so confident about this is I see people come to me on multiple blood pressure medicines and I can help them monitor the blood pressure at home and get them off the medications as they’re improving their health with the weight loss and the metabolic changes that happen on a keto lifestyle. I see that routinely in my office – that we can actually get people off medication and they no longer have high blood pressure, just by lifestyle.
Are there side effects of blood pressure medication?
I wouldn’t be criticizing the medication approach of blood pressure if it was a perfect one. It’s not. Medicines can have side effects. A lot of the blood pressure medicines are side-effect free, which makes it even easier for a doctor to just give these pills. The most commonly used blood pressure medicines actually can have side effects like fatigue and loss of sexual function (those are the beta blockers – metoprolol, atenolol). Hydrochlorothiazides are diuretics, meaning they lower your blood pressure by having you urinate out some of the blood volume. These thiazides, however, can actually raise the blood sugar and can cause diabetes. Tragically, people I see are told they have high blood pressure, so they’re put on these medicines that control the blood pressure legitimately, but then they’re told they have diabetes. Then, they get put on a diabetes pill without evaluating whether the medicine that they were initially on is the cause of the elevated blood sugar and the diabetes! Most doctors in the U.S. are trained to use medication for the treatment. We haven’t been good at training doctors. We’re trying, but we haven’t been able to get into the medical education that effective lifestyle approaches are even better, because then you don’t need the medication at all.
Another common thing that doctors dismiss but which I see in my clinic a lot is the ankle swelling that can occur with calcium channel blockers. If someone comes in and they complain of leg swelling, the doctor may tell them it’s from obesity. But there are some medicines that can cause physical changes like leg swelling; if you stop the medicine, that goes away.
I’m an obesity medicine specialist. I’m an internist who got special training and now keto medicine is my brand of obesity medicine. We help people feel better, because they no longer have the side-effects of the medicines. As we reduce and eliminate the medicines, their body improves. It’s an interesting dynamic and it helps me, because I feel better when my patients feel better. I want them to actually reverse their conditions. Some of us medical experts in the keto world wonder if most of the high blood pressure that we see in the western world is from sugar and starch from carbohydrates, so that even simple dietary changes like reducing carbs can actually prevent high blood pressure. It’s an unappreciated area, because it’s just expected that you’ll experience blood pressure elevation as you get older. That’s not the case. You don’t have to go down that path.
When you see someone who is on type 2 diabetes medications, you’re able to reduce the medication immediately. That’s different for high blood pressure. Could you expand on that?
When we’re helping someone get off medication, I’m a big fan of home monitoring – home monitoring of blood sugar or blood glucose. It’s simple to do. Many stores now have blood pressure measurement devices. I like the daily measurement as we’re taking people off medicine. The blood pressure changes don’t happen on the first day. I don’t reduce or eliminate blood pressure medicines early on. I do with some of the diabetes ones, because the blood sugar plummets. Blood pressure medicines generally take weeks to months. I want to get people in the habit of measuring their blood pressure daily. If you get weak and dizzy when you stand up, these are warning signs (that the medication is becoming too strong). I ask people to then contact me and we’ll adjust the medications. More and more doctors in my area are able and willing and understand how to de-prescribe blood pressure medicine, because it’s a slower process. Most people in my area see their regular doctors maybe once every three or six months and the blood pressure coming down is a relatively slow process.
With diabetes medicine, you need to control it and be careful a lot faster; most doctors don’t understand how to do that and maybe don’t even want to be available off-hours for that. I ask people to contact me the moment they don’t know what to do with insulin, because it’s risky and you want to be safe and sure of what you’re doing. Blood pressure thankfully will come down over time in just about everyone.
If you’re in your 60s, your 70s, you may be on blood pressure medicine even when you’re doing a keto lifestyle and you’re at your goal weight. I think that’s because the arteries themselves can get a little hard or stiff, which is what elevates the blood pressure even when you’re doing a keto lifestyle. I can’t guarantee that people will get off the medicine, but I’m optimistic about it. A lot of times people haven’t been told that. They’ve been told they are just going to be on this forever, but that’s because the doctor doesn’t really know about effective lifestyle tools like the keto diet. If you’re on a medication or your doctor says you need a blood pressure medicine, ask if there are alternative treatments. All the guidelines say lifestyle is the first thing you should try, but most doctors have a belief that none of their patients will try a lifestyle change because it’s too difficult. That’s sad and kind of arrogant of the doctor to think you’re not going to do it, that you can’t do it, or that all lifestyle changes are difficult. They don’t have to be difficult. They can be easy and tasty. We’ve talked about that in other videos. I wish a doctor would at least understand that there are effective lifestyles and maybe even introduce them into their own practice. The guidelines at least give some attention to it, but in practice, most doctors will just go to the pills for high blood pressure without giving an option for the lifestyle change.
What would happen if someone had to go on a strict keto or low-carb diet and they didn’t lower their blood pressure medication or they didn’t tell their doctor?
The medicines for high blood pressure can become too strong, meaning the blood pressure can drop too low. The symptoms of that are feeling weak and dizzy when you stand or go from lying down to sitting or standing. Feeling lightheaded is because the blood pressure is too low for proper brain functioning. If you can feel the blood rushing out of your head, you can pass out and faint. Medicines for blood pressure can become too strong, so you want to be monitoring the blood pressure as you do an effective lifestyle change like the keto program. That’s why we call keto ‘prescription strength’, because it’s as strong as these other medicines or even stronger, because we can eliminate many different types of medicines, including those for blood pressure.
What does someone do if their doctor doesn’t know about the lifestyle option but they want to start the program? How do they get help so that they can be monitored?
In any case where the doctor is going to initiate medication for any disease, you can ask if there are any alternatives. If they don’t understand or don’t have an alternative, say, “Thank you, can I wait and do some of my own research?” If it’s an urgent condition and you need the medicine, then go ahead, take the medicine. I’m not against all medicines for urgent conditions, but if it’s something that could wait a month or two, you have that time to think about it. Do some research, look for keto medicine doctors or keto-friendly doctors. There’s a new organization that we created called The Society of Metabolic Health Practitioners. Do a little homework on your own to see if there are other lifestyles that overlap with your way of thinking about what to eat and your preferences. Thank your doctor for the advice and say that you would like to do a little more research. You can even tell them to send the drug to your pharmacy. You don’t have to go get on it immediately if it’s not an urgent problem. A lot of people will come to me, personally, because they did the search and looked for doctors who use lifestyle instead of medication to treat high blood pressure, diabetes, and a host of other conditions.
Check out the full video here.
