Hypertension is another name for high blood pressure. It affects around 45% of the American population. What do you think of that?
It’s too many!
How many people that come to see you have high blood pressure?
It’s so common these days. I’m an internal medicine specialist by training, and internal medicine doctors are the ones who are typically in charge of treating high blood pressure, complicated high blood pressure. Family medicine GPs do it as well, but an internal medicine doctor is going to be trained in using lots of different types of medicines. It’s so common now that I can almost assume that someone’s on one medicine for high blood pressure. If they’ve been seeking medical attention throughout the years, eventually they’re going to be put on blood pressure medicine. Of course, it’s a select group that comes to me, but blood pressure issues are very common, along with now an increasing number of people with diabetes and obesity.
High blood pressure is a big deal. The reason you don’t want it is that, in the immediate or acute situation, very high blood pressure can cause a stroke or a heart attack. But that’s uncommon. Usually you have a headache, you don’t feel well, and you end up going to the emergency room. The long term or chronic complications of high blood pressure is heart disease, atherosclerosis, which is a hardening of the arteries. Hardening of the arteries affects the heart and this may affect the brain and lead to a stroke or atherosclerosis with the brain. (Thickening or narrowing of the arteries to the neck.) In the belly, kidney failure can happen due to long-term high blood pressure that’s not treated. So, a very common thing that we do in internal or obesity medicine is measuring, diagnosing, and treating high blood pressure.
I have heard that there are four different stages of hypertension. What is the meaning of these stages?
Like any progressing illness, you can categorize it into different stages based on whether it has affected any of the other organs. Once you get involvement of the kidneys, mild kidney failure, you’re going to be moving into these other categories. The basic thing is that you don’t want to go down that pathway. You want to find it when it’s early and reverse it. What’s very amazing is that we’re finding with keto medicine or a lifestyle change, you don’t always have to choose a medication to treat it. So, while most doctors are trained to use medications, that’s not the only way to treat high blood pressure.
Something that may be a bit of an urban myth is that a diet high in salt is what causes hypertension. Can you tell us what really causes hypertension?
Hypertension, high blood pressure, is multifactorial, meaning there are many things that cause it. Only ascribing it to salt would be like saying that if you have a headache, there’s only one cause, when we know that there are a lot of different kinds of headaches – stress headaches, migraines, that sort of thing. High blood pressure can be caused by many different things. I think in some individuals, salt is a cause of high blood pressure, but not for everyone. That’s where it gets confusing. You get a public health message that salt causes high blood pressure, so everyone should stop eating salt. Well, there’ll be people who can eat salt who will be told to not eat salt as a collateral damage where the public health people don’t care if you don’t eat salt, because they want to help the people who can’t eat salt. That’s where the messaging for general recommendations can be confusing.
In most people, salt as an issue for long-term blood pressure is not the major factor. (Although for some people it is.) That’s been put in people’s minds so strongly that when I instruct someone to eat a diet that doesn’t limit salt, they’ll think they have to anyway, when a lifestyle change that actually addresses high blood pressure in a different way can have more salt. So, salt in some people can cause high blood pressure. Carbohydrates in some people can cause high blood pressure, so I add in the dietary factors, that it’s carbohydrates – the sugars and starches – that can lead to the increase in blood volume and can cause high blood pressure.
The thing that I really can’t fix is the “tube,” or the artery itself. If the artery is hardened through atherosclerosis, this can be a cause for high blood pressure. You may have heard the term ‘stiff pipes’. If the pipe is stiff, you might get high blood pressure and it’s difficult to fix. A useful way to think about high blood pressure is just think of a garden hose hooked to a faucet on the side of your house or at a sink and every time you turn on the water faucet that’s a heartbeat going through this tube. The hose is your artery. If you leave your hose out in the winter time, it gets hard. Then, every time you increase the water or blood flow, it’s going to increase the pressure. Fortunately, our arteries are not like a stiffened hose; they’re a living thing that can expand, but the older you are, the more possible it is that your arteries have stiffened and that you might not be able to fix the high blood pressure by changing the lifestyle and cutting out carbs and salt. You can see why it’s confusing, because it’s multifactorial, meaning there are multiple factors that contribute to it.
Can a keto diet fix hypertension? It’s often been said that hypertension is incurable, is this true?
Remember, something’s “incurable” if the medical establishment hasn’t figured out how to do it. We talk about diabetes being incurable, but actually, we can fix that! We don’t use medications; we use lifestyle. The same thing goes for high blood pressure.
What’s very interesting is that the change in the metabolism and the reduction in the amount of blood and fluid that’s going around (via a keto or low-carb diet) have improved blood pressure. And the reason I know that is I have to take medications away from people (de-prescribe) who are taking medicines for high blood pressure or their blood pressure will drop too low! I haven’t seen this turned around and I would love to do a study or help people to turn it – turning around meaning, changing your diet, losing weight, and then you won’t need to go on a medicine for high blood pressure. It’s in the guidelines that are taught, but most doctors overlook the lifestyle change because they think none of their patients will do that or there’s a loss of confidence that their patients will actually make a lifestyle change. So, doctors often will go to a medication first.
It’s kind of like the branch point for any drug treatment, whether it’s a drug treatment for high blood pressure or diabetes or heartburn – you can change it by lifestyle. A keto lifestyle fixes just about all of these things, so why not take the time to learn a different way to go about it rather than just automatically accepting the medication that doctors want to give you? That’s a big theme of lifestyle medicine or keto medicine – that we can actually use a different method of treatment – changing the food instead of choosing a medication.
If someone comes to your clinic with prehypertension, how long can it take them to turn that around?
If someone already has high blood pressure and they’re on medication, it usually takes days to weeks, maybe even weeks to months, to lower the blood pressure and get them off the medication. It’s not as fast or as urgent as taking someone off diabetes medicines, but it’s fast enough that I highly recommend home monitoring of blood pressure. There are lots of cuffs that you can get now for use at home. I’m a big fan of measuring blood sugar at home if you have diabetes; same with blood pressure. You don’t live at the medical office where the blood pressure is typically checked, so you want to be measuring your blood pressure at home and watch the levels. Then you’ll know between visits if you can adjust the medicine down or stay off the need for medication. I love home monitoring for these conditions because it will many times mean that you don’t need to take medicines that doctors want to give you.
What are the warning signs of high blood pressure?
This is the problem – it’s usually silent. High blood pressure is something you can really only detect in its early phase by having a blood pressure cuff monitoring it. (A wrist monitor is sufficient.) One of the terms that was used in the past for hypertension was “the silent killer,” because you won’t know. Just about everyone will be asymptomatic, meaning having no headache, no chest pains, which are only associated symptoms if you have a really high blood pressure level. You have to get it checked by a tool, like a blood pressure cuff at the office.
We call these the “vital signs” in a medical office, because they’re vital. The first thing you do in a medical office, in internal medicine or family medicine, is to check your blood pressure, your height, your weight… The blood pressure and the pulse go together, because they’re so vital. It’s pretty amazing that someone figured this out. How did the measurement of blood pressure become important? It’s one of the breakthroughs in internal medicine, figuring out that it was this long-term elevation in blood pressure causing these different problems. So, self-monitoring or self-measurement is important, because there really aren’t any symptoms for most people with high blood pressure.
How often should somebody test their blood pressure?
That’s going to be dependent on how much it changes. I still believe in an annual or every other year check-in with a family doctor or an internal medicine doctor. I haven’t given up on the idea of seeing a doctor. You don’t want to always take the medicine your doctor gives, but you want to check in. Early on it would just be at the doctor’s office. You get a check every year, then every six months and if you see it inching up and borderline then you’re going to follow it more frequently. Every year is fine, unless you’re in that yellow warning zone. Then you want to check it more often or take action on it and not go down the path of having to have medication treatment for high blood pressure.
Check out the full video here.