Bonus Episode: Treating High Blood Pressure at the UltraWellness Center - Transcript

Dr. Mark Hyman
Coming up on this episode of The Doctor Hyman show. We call it essential hypertension, meaning essentially, we don't know what causes it. But the truth is the science has evolved and we do know a lot. Before we jump into today's episode, I wanna share a few ways you can go deeper on your health journey.

While I wish I could work with everyone one on one, there just isn't enough time in the day. So I built several tools to help you take control of your health. If you're looking for guidance, education, and community, check out my private membership, the HymanHive, for live q and a's exclusive content and direct connection. For real time lab testing and personalized insights into your biology, visit Function Health. You can also explore my curated doctor trusted supplements and health products at doctorhymen.com.

And if you prefer to listen without any breaks, don't forget you can enjoy every episode of this podcast ad free with Hyman Plus. Just open Apple Podcasts and tap try free to start your seven day free trial. Hey, everybody. It's doctor Mark Hyman. I'm so excited to have you be part of our new series that focuses on common chronic diseases that traditional medicine just sucks at dealing with and how a functional medicine approach can help you understand the root cause, can help you recover or heal or get rid of your medications.

We do a lot of deep prescribing. And, you know, I want to talk today about an incredible problem we have in our society, which is this dramatic increase in high blood pressure. We've gone in 1960 when I was born from about twenty four percent of the population having high blood pressure to now forty seven percent, almost one in two Americans has high blood pressure. That's crazy. And the question is why?

Why do we have such an increase? And what do we do about it? And why are we needing to prescribe high blood pressure medications? Is this a design flaw in human beings? Did God make us wrong to have high blood pressure?

I don't think so. And so what traditional medicine generally does is give you a drug. And here's your drug for high blood pressure and see you later and just take this for the rest of your life. Rather than asking why, we call it essential hypertension meaning essentially we don't know what causes it. But the truth is the science has evolved and we do know a lot and we can do a lot of things without actually having to give you a drug.

Now sometimes people may need medication and that's okay if they need it. But a lot of times you don't if you understand the root causes. And I'm really excited today to have my friend and my colleague Cindy Guyer, Doctor. Cindy Guyer who we worked together since the nineties at Canyon Ranch and then at the Ultra One o Center. She's been doing this for, I don't know, it's close to thirty years with me.

And, it's kinda scary to say that actually. But I'm so happy to have you, Cindy, to be able to actually dive into this topic because it's such a common problem. There's often simple fixes, and there's deep dives that people need to do on their biology that they're often not doing. And and this is what we do at the Ultra Wellness Center in Lenox, Massachusetts. We take deep dives with people on chronic illness, help them understand what's going on, and give them their life back, essentially.

So, Cindy, welcome.

Dr. Cindy Geyer
Thank you, Mark. I'm thrilled to be here. It's really exciting.

Dr. Mark Hyman
Let's sort of dive in because, you know, I I sort of mentioned the the increase, doubling over the last sixty years since I was born. The fact that it affects one in two Americans, and so many people on high blood pressure drugs. And the quest and and there was actually a great book from a friend of ours, a cardiologist called, What Your Doctor May Not Tell You About Hypertension that talks a lot about a functional medicine approach. And so so from your perspective as a functional medicine practitioner at Delta Wellness Center, what what's really going on with this at a high level? And then let's, like, dive into a case that helps us sort of unpack this in a very personal way and what you did and and what we kinda need to look for.

Dr. Cindy Geyer
Yeah. That's a great question. I mean, we do know that genetics play a role. So somebody who has strong family history of high blood pressure, we might wanna be paying more attention. But as you've said so many times, our genes aren't our destiny.

Those genes that we come into the world with are gonna be influenced by so many other factors, many of which can unmask that potential and manifest as high blood pressure. So some of the root causes of high blood pressure, we know that weight gain and insulin resistance is a huge one. We know that diet plays a big role because of its effects on oxidative stress and endothelial dysfunction. Insufficient sleep, whether that's sleep quality, quantity, or timing can play a role with high blood pressure. Loss of artery elasticity.

So our our endothelium is a target for a lot of the negative effects of lifestyle. We know that artery elasticity can be adversely affected by stress, by certain foods, and there's even emerging evidence that food sensitivities, disruptions in the gut microbiome, and toxic exposures can all have negative impacts on our arteries leading to or contributing to high blood pressure.

Dr. Mark Hyman
So basically, you're talking about modifiable factors that are treatable and fixable that cause the stiffening of our arteries and that lead to high blood pressure. When you say endothelium, you mean the lining of the blood vessels and that becomes dysfunctional because of inflammation and oxidative stress which has many causes, right? So Mhmm. You know, I was sort of really shocked to learn, you know, when I sort got into functional medicine that high blood pressure wasn't just like a plumbing problem, that it was an inflammation problem. And that the inflammation has many many causes and you outlined some of them, genetic predispositions, environmental toxins, change in the microbiome, or crappy high sugar processed diet, nutritional deficiencies, all these things impact the the the function of our blood vessels and and they're all treatable.

So you kind of treating patients and you you you know, I want you to sort of present this case here of of your patient who had who had high blood pressure and what you've kind of thought of, what you did diagnostically, and to kind of unpack some the things we do at the Ultra Wellness Center which is doing a deeper dive on your biology, not just taking at face value, oh your blood pressure is high, here's a pill, but we go into why. Like what's going on underneath the hood, How do we find things in our sun search for things and hunt for things that may be treatable and modifiable factors that are driving you you touched on a bunch of them, you know, whether it's

Dr. Cindy Geyer
Mhmm.

Dr. Mark Hyman
Pre diabetes and insulin resistance, whether it's sleep apnea, whether it's nutritional deficiencies like magnesium or omega threes, or whether it's environmental toxins, some of which we can measure, of we can't, but heavy metals have been linked to high blood pressure. So we kind of have to look for all these things and and that's what you did with your with your patient that that I'd love you to sort of share her story.

Dr. Cindy Geyer
Actually, Mark, I think I love this idea of personalizing the story and the recommendations because you can have 20 different people with high blood pressure, and there may be different combinations of those variables that are playing a role for any individual patient. So we have to go back and understand who the person is sitting across across the table from us.

Dr. Mark Hyman
If you see one person with hypertension, you've seen one person with hypertension or any condition, whether it's autism or depression. And that's the sort of one of the fundamental principles of functional medicine. You know, one disease can have many causes and one cause can create many diseases. We call N of one medicine. What what is that person in front of me doing?

What are their risk factors? What is their lifestyle? What are the other factors that may not even know about? And how do we dig into those? And that's that's what we've been doing for decades at the Ultra Wellness Center.

By the way, if anybody wants to learn more about what we're doing, go to ultra wellness center dot com. You can learn more about how to become a patient. But now let's sort of dive into that in that case. And how did you think about this case?

Dr. Cindy Geyer
Sure. So this was a 56 year old woman, and she had a long history of so called white coat hypertension. We'll unpack that in in a few minutes. She also had a strong family history of high blood pressure and late onset memory concerns. Her mother had recently been diagnosed with, cognitive impairment at the age of 80 who also had a long history of white coat hypertension and then sustained hypertension.

And she was starting to get concerned about, you know, what is this white coat variable telling her about her vascular system? How can she do everything she can to try to optimize vascular health and prevent disease down the road? For years, she'd been told with her blood pressure, don't worry about it. She'd go into the doctor. It would run one twenties, one thirties, maybe as high as one forty, and she was told not to worry about it.

So what do we do in conventional medicine? Either tell them not to worry about it or, you know, you think about you think about the case of, oh, your blood sugar's borderline. Come back, and we'll check it in a year. Well, no. We wanna do better than that, or decide, okay.

Now we need to put you on a blood pressure medication. So what's different in functional medicine as you already talked about, Mark? We really wanna go upstream. We wanna see what the variables are that played a role with this particular patient, why she's showing up with this reactive blood pressure, What are the things we can do to modify those risk factors and hopefully delay or prevent her from ever needing medication and at the same time keeping her heart and her brain healthy? And it starts by gathering a story.

Dr. Mark Hyman
It's important to get into the story because, know, like, I I think of my my my parents, my mom and dad just obviously didn't listen to me. They ate crappy and they both run high blood pressure pills. And I'm 65 and my blood pressure is like one That's why I'm down over 70, which is really highly unusual for someone my age. But it's not an anomaly, it's just because I understand what to do to regulate my biology and stay healthy as I get older. And most people don't do that, and our default in our society is basically leading us all to have these problems.

That's why one in two Americans have high blood pressure and prediabetes. And by the way, I don't think it's an accident that one in two people in America have diabetes or prediabetes, and also one in, two people have high blood pressure because they're very related.

Dr. Cindy Geyer
Going back to her story, I mean, she had a pretty uneventful early life. She had she was born vaginally. She was breastfed back at a time when it wasn't the common thing to do. She didn't have a lot of infections, not a lot of situational stress. All of those early life exposures that we know can prime the vascular system to be more potentially more reactive.

She did have a history of allergies, but kind of unremarkable other than that. Started birth control pills at 19 and interestingly enough developed hypertension on the birth control pills.

Dr. Mark Hyman
Why is that?

Dr. Cindy Geyer
Well, the blood pressures that can be that can be genetically determined. It may be that it unmasks a potential for oxidative stress. I don't actually have the answer to that one, but I think there's some clues later.

Dr. Mark Hyman
Yeah. I mean, the the birth control pill is interesting because it you know, estrogen does make you retain a little more fluid Mhmm. And and that may be part of it. The progesterone can also make you, you know, gain gain weight sometimes. That may be part of it.

So there there are things that, you know, medications that may also like, the birth control may actually drive increased risk of hypertension.

Dr. Cindy Geyer
That's true. Especially through the renin aldosterone system that we know plays a big role, and they're much higher doses in the birth control pills than what a woman would have made with her own natural cycling hormones. Other than that, pretty healthy until she had her first pregnancy at 35. It was a twin pregnancy, and it was complicated by low amniotic fluid, preterm labor, and pregnancy induced hypertension. She went on to carry her babies to term.

She had a vaginal delivery. She nursed them for a year and a half, and that was when she started having the white coat periodic elevations in her blood pressure. Again, she was told, don't worry about it. It was attributed to the stress of being a young mom with two kids and maybe some sleep deprivation and working as an emergency room nurse. Fast forward, she in her early forties because she was snoring probably related to her allergies, and she had some daytime fatigue.

She was set for a sleep study that did not show sleep apnea. It showed a pattern that's called upper airway resistance syndrome, more common in women. That is a pattern we'll talk about in a few minutes, but, it's where the airway becomes a little bit more collapsible or there's a restriction in the ability to get air into your body maybe because you've got nasal allergies or you've got a small jaw, but you're not actually stopping breathing and you're not really dropping your oxygen level. So back then, there was no treatment recommended other than to work on her allergy symptoms.

Dr. Mark Hyman
Just to to double down on that, a lot of people who have high blood pressure have undiagnosed sleep apnea.

Dr. Cindy Geyer
Yes.

Dr. Mark Hyman
You know, if you're snoring or your partner says you're snoring or you gasp for breath or you have other symptoms of sleep apnea, meaning you fall asleep easily watching TV or when you're driving, you feel tired. I mean, are these are clues and it's important that people get this diagnosed because it's treatable, often with weight loss and other things, but sometimes you need to take a breathing machine at night, and that can often resolve high blood pressure. So when I sleep someone, the first two things I think of are prediabetes and insulin resistance and sleep apnea as both causes of

Dr. Cindy Geyer
Absolutely, Mark. And I'm I'm so glad you said that because I think what's emerged is upper airway resistance syndrome isn't just benign. I mean, that's another area where it's like, don't worry about it. It's not sleep apnea. There's really nothing to do except treat your allergies.

But what do we know about even that pattern? If you're having these subtle disruptions in the continuity of this of your sleep, even if you're not stopping breathing, you wake up tired, you have trouble with daytime fatigue, and it's associated with high blood pressure. This is also a more common pattern for women, and it gets overlooked all the time because we have a stereotype about who's the more likely person to present with sleep apnea, and it's usually an overweight man with a big neck circumference who snores really loudly. It gets missed in lean women in particular.

Dr. Mark Hyman
And then what else did you find on her?

Dr. Cindy Geyer
So well, the next piece was she had gone she went through a pretty significant menopause, lots of heavy periods. Last period was finally around 49, tons of hot flashes and night sweats. Why is that important? Well, guess what? There's now been a recognized association between women who have more of those vasomotor symptoms also being associated with more vascular reactivity and higher risk of cardiovascular disease.

But at the time, again, we weren't think nobody was thinking along those lines. She had a conversation with her OBGYN and decided to go on an estradiol patch and progesterone. She had good relief in her symptoms. Another really important thing, though, about the menopause transition is the changes in estrogen that happen can also unmask more effects of stress on the vascular system. We also know that insulin resistance tends to get worse in the menopause transition.

So it's a potential window of opportunity to think beyond just should you take hormones or not because, again, fitting into her story, looking way upstream and trying to put things into place that are gonna keep her heart and her brain healthy. She's always been physically active. Another piece of her story that I think is gonna be relevant down the road, she's always been physically active. In fact, one of the main things that she sort of hung her hat on in terms of trying to keep her heart and brain healthy was to to stay physically active, and she periodically would be plagued by multiple soft tissue injuries. She'd had plantar fasciitis.

She'd had posterior tibialis tendonitis. She'd had epicondylitis. So she'd had a lot of these soft tissue injuries, which would periodically take her out of commission from her exercise. So that's sort of her backdrop, and it leads us to some interesting clues of some other things we might wanna think about related to her blood pressure beyond just medications or not. And think back to her original goal.

She's really concerned about future risk for cognitive decline. What's the connection between blood pressure and cognitive decline? We know that the blood brain barrier, that critical interface between the body and the brain, it is really vulnerable to the effects of any kind of vascular risk factor, whether that's prediabetes, insulin resistance, high blood pressure, oxidative stress, inflammation. That blood brain barrier can become more permeable or leaky, and it plays such an important role at selectively letting in the nutrients to the brain that we want getting in, keeping out toxins and microbes that we don't want getting in, and then also supporting the brain's waste removal system, the lymphatic system that removes waste from the brain. Any vascular insults are potentially gonna contribute to that leaky blood brain barrier.

So optimizing her blood pressure, looking at those upstream factors is gonna be really, really important for her to meet her goals.

Dr. Mark Hyman
One of things that's interesting with your with your diagnostics is that you looked at genetics related to high blood pressure, which we can now do. So these are tests that we do at Telstra Wellness Center. It's a cheek swab. You can look at your full sort of panel of risk genes. And we don't look at your entire genome because it's like too many things, 20,000 genes.

We look at the ones that are common, that we can just think about that are probably affecting your your health in in an immediate way and they we can actually modify. And so you found a number of things there and I think there are a lot of variations and we can use the science of genomics and our understanding of the biology of what happens when you have certain variations to modify your risk factors. So the genes like you said, you know, load the gun, the environment pulls the trigger. And there are certain people have salt sensitivity which we can pick up through genetic testing. But not everybody with high blood pressure has a salt issue, you know.

I think there's there's a real issue there with like who how many people are salt sensitive. And it's probably maybe you know forty percent of people who have high blood pressure are are salt sensitive. But a lot of people aren't and there's, you know, real controversy about salt whether it's the issue or not the issue. And and there's been large population studies that kind of show that there's maybe a slight risk. There's an Intra Salt study for example in 1988.

It was just a tiny tiny little risk and the question is, you know, is it the salt or is it and this is just a question I have. Is it the salt or is it the salt in connection with certain genetics or the salt in connection with prediabetes or insulin resistance, which makes you retain more water, hence, you'll get high blood pressure because you have bigger, fluid fluid in your system. So what what are your thoughts about that?

Dr. Cindy Geyer
You know, it's a great question, Mark, and I think it's not simple. Right? So we know that that that subset genetically of people who are sensitive to salt, it's not it's less than fifty percent. But there was an older mouse study that found that high sodium intake actually increased oxidative stress. So there may be another mechanism that it's not just about the sodium's effects on the renin aldosterone angiotensin system and fluid retention, but it also creates more opportunity to to produce these free radicals that directly impact vascular health.

Dr. Mark Hyman
So, also, like, nobody talks about the fact that, historically we had 10 times as much sodium, potassium as sodium in our diet as hunter gatherers. Now we have 10 times as much sodium. So it's it's it's not just the excess sodium, it's the lack of potassium. And where does potassium come from? It comes from all our vegetables and fruits and stuff.

So we're not eating enough plant foods, and those those have, really high high levels of potassium.

Dr. Cindy Geyer
And magnesium.

Dr. Mark Hyman
And magnesium. Yeah. Magnesium is the other nutrient where probably forty five percent of us are deficient in. So is it the salt or is it the balance of all these other electrolytes like magnesium and potassium and calcium that we tend to ignore, but that we do look at in in functional medicine. The traditional doctors won't look for that

Dr. Cindy Geyer
Right.

Dr. Mark Hyman
And they won't modify that, but it can be really a huge factor and you can give people potassium supplements, you can increase their potassium in their diet, you can do the same with magnesium, in terms of dietary magnesium, as well as, supplements, and same thing with calcium. So we had to be really aware. It's not just such a simple reductionist view that, oh, salt cause high blood pressure, and so you should eat less salt. It's like, what is a combination of all the other factors that are being ignored?

Dr. Cindy Geyer
It's the company it keeps. Like, where do most Americans get their salt from? It's not the little bit of salt they use to season their food. It's coming from packaged and processed foods and eating out at fast food restaurants.

Dr. Mark Hyman
It's not the salt that you add to your food at your dinner table or in your cooking at home. It's the salt that's added by corporations that are providing fast food or junk food or ultra processed food that are extremely high in salt. And the only way they make food that's basically these these kind of industrial science projects taste good is by adding a lot of sugar and by the way, a lot of salt.

Dr. Cindy Geyer
So coming back to the genetics, I love this test because it's it's it number one helps us be more informed about what people came into the world with that could have played a role with what's showing up when they come in in their thirties or forties or fifties in part because it's been modulated by their diet, their lifestyle, their experiences, and their exposures. But there's something that's really fascinating about seeing the data in front of you of this helps explain the why that people take it in in a whole different way. You can't argue with some of the things that show up. So I think it can be incredibly helpful at personalizing the recommendations for people. And for her, that was really, really true.

So what were some of the things that showed up? She did have some she did have some gene variants in that she had an ACE gene that, is not associated with salt sensitivity, but this dysregulation of the angiotensin system. She also had a gene variant called ENOS, endothelial nitric oxide synthase. So she had a predisposition to potentially have difficulty with making nitric oxide in her blood vessels. We know a lot from a lifestyle standpoint that can really support that, particularly foods, some of the ones you've mentioned, Mark, the magnesium rich foods, the polyphenolic rich foods, these deeply pigmented dark leafy greens and blueberries and black raspberries.

We know that nuts and seeds provide arginine, a precursor for endothelial of the endothelial cells to make their own nitric oxide. We know that extra virgin olive oil and omega threes, there's a lot of great things we can do.

Dr. Mark Hyman
Yeah. So why why is it why is that important? Because nitric oxide finthate does something really important to the blood vessels. Right? What does it do?

Dr. Cindy Geyer
It dilates them, makes them more elastic.

Dr. Mark Hyman
So, basically, it helps your your healthy blood vessels function better. And it increases your blood vessel dilation, lowers blood pressure. So it's really, really important.

Dr. Cindy Geyer
It's really important. And it is probably the very first thing that changes when there's anything in the lifestyle or diet or stressors that is starting to impact the vascular system. It's loss of that elasticity in the arteries, the endothelial dysfunction. Just a little side note about that too. There are other clinical clues.

Her Raynaud's was a big clue that she was predisposed to that or potentially had some endothelial dysfunction. For men, it could be erectile dysfunction. That's a huge red flag to think about endothelial dysfunction.

Dr. Mark Hyman
And Raynaud's is a Raynaud's is kind of an autoimmune disease. Right? It's it's an inflammatory problem.

Dr. Cindy Geyer
It can be.

Dr. Mark Hyman
And that's when you get, like, your hands turn white when you go out in the cold weather and stuff like that, you lose all the circulation. And it's often an it's just an inflammatory problem in the blood vessels.

Dr. Cindy Geyer
Often in response to cold, but it can occur in response to stress as well, and it can coexist with autoimmune diseases. So that's another important piece to make sure you're not missing a secondary autoimmune condition, which, again, then leads us back to some of the root causes when somebody does show signs of an autoimmune condition. We go back upstream and think, how healthy is your microbiome? What's going on with the health of the gut lining? Do they have food sensitivities that are driving inflammation?

Always going upstream to figure out what's going on. Yeah. Another thing that was eye opener for her is she saw on paper that she was a relatively slow metabolizer of stress hormones. So for years, she'd been saying, oh, okay. I just need to do better with my stress.

I need to do better with my stress, and she kept having the reactive blood pressure. This hit home. It's like, yeah. I really do. And there's something different about seeing it on paper and then testing her salivary cortisol throughout the day, seeing that she was high a good portion of the time that made it much more real and tangible for her.

Dr. Mark Hyman
And she also had a gene that helped that made her have trouble kinda metabolizing some of those stress hormones. Right? So

Dr. Cindy Geyer
they Exactly. So the genes and the high cortisol allowed her to really shift and take it more seriously to do the breath based practices that she needed to do to try to reduce the impact of stress on her artery elasticity and vasculature.

Dr. Mark Hyman
But you're saying is individuals have different response to stress based on their genetics. So so when you have this particular gene that she had, it makes it harder for you to respond to stress. You have to be more proactive about modifying your stress response, not just sort of live in this stew of stress that we all do. And that that stress will increase, you know, the blood pressure tone. That's what you're supposed to do when you're a runner from a tiger, you want your blood pressure to go up, you know, and you're you want your your your all your blood pumping as fast as you can.

But that's a good short term adaptation, but long term it leads to these problems of hypertension and all the consequences which is stroke and dementia and heart attacks and kidney failure and like all kinds of problems with your vascular system, lower extremity, a lack of blood flow which leads to ulcers, amputation. So basically you can you can have all sorts of issues from high blood pressure that are really caused by some of these other factors that we can modify.

Dr. Cindy Geyer
That gene that you mentioned, it's called COMT. We actually talked about this recently in a webinar that we did about hormone metabolism because it's the main enzyme that inactivates reactive estrogen, but it also inactivates the fight or flight hormones. And people can have two genes that code for a fast copy, two genes that slow for a slow copy, or have one of each. And double slow metabolizers, it might take them 10 times longer to clear those fight or flight hormones out of their system whenever they have a stress response. You can't change those genes, but I think it can help you, number one, have compassion for yourself if you start to feel your body tensing up.

Tune in to those clues that you need to shift gears and then engage in whatever break breath based practice you can so you can mitigate the negative impact on your vascular health. And, you know, I I I like to think of it this way. Breath based practices, meditation, yoga, they are great fundamental practices for all of us, but it is doubly important for people who are slow metabolizers. And not just your baseline practice that you might start your day with, but finding little mini moments during the day to figuratively empty your stress bucket, whether that's one or two quick breaths or giving somebody a hug or walking outside or doing whatever you need to shift gears.

Dr. Mark Hyman
Yeah. It's so important, and I most people don't know how to do that. We don't learn how to actively relax. It takes work to relax. Although I I like the cheaty way.

I I put on headphones, and there's, like, different like, MindSpa use an app or NuComm, and it basically takes you through like a guided visualization meditation. I'm like, oh, I feel like I go into Never Never Land, and it it's really interesting. It activates your sympath parasympathetic system. It can use different technologies like binaural beats, but I mean, there's even like devices like a Shiftwave chair which you can use. It's like a it's a little expensive but you can use it to kind of put yourself in this altered state.

There's a lot of ways to do it, but it you know, for someone who's got high blood pressure, it's especially important.

Dr. Cindy Geyer
It's especially important.

Dr. Mark Hyman
You also found this woman had had had some other issues, right? She had like, her blood sugar a one c was high in a normal. And let's talk about that connection between, like, blood sugar, insulin, prediabetes, and and high blood pressure because it's such an important thing.

Dr. Cindy Geyer
It's a really important one. So so interestingly enough, high blood pressure is one of the criteria for metabolic syndrome. Metabolic syndrome is that combination of a higher than optimal fasting blood sugar, high triglycerides, low HDL, high blood pressure, and truncal

Dr. Mark Hyman
weight distribution. Waist size. Big waist size. Yeah.

Dr. Cindy Geyer
Waist hip ratio was low risk. Her weight was normal. She had a healthy BMI, but yet she had an a one c of 5.7. So that's in the prediabetes range. What does that tell us?

That she's either eating foods that are playing a role with post meal spikes and or her stress is also contributing to high blood sugar or her sleep disruption is playing a role with her blood sugar. So it's another clue that her vascular health and her cardiometabolic health is not optimal. So she had some room to move the needle, and we needed to do a little more digging to see what was driving that and what she could control.

Dr. Mark Hyman
We we kind of don't really look carefully at this problem. Ninety percent of people with prediabetes are not diagnosed by their doctor.

Dr. Cindy Geyer
Right.

Dr. Mark Hyman
And they don't measure insulin. They probably don't measure a one c on their regular blood tests. They look at blood sugar, but if that's normal, they go, you're normal. But blood sugar is the last thing they go up in this whole

Dr. Cindy Geyer
spectrum of

Dr. Mark Hyman
this condition. Like insulin goes up after a meal, then it goes up fasting, and then your blood sugar goes up after after a meal, then it goes up fasting. So it's like the fourth step down the chain of disease, and then you're kind of picking it up late. So a one c is a is a good way to check things. Your fasting insulin is a good way and these are not things that are typically done when you go to your traditional doctor, but we do this almost routinely at the Ultra Wellness Center because we know this is a problem affecting so many people.

And what happens when you have high insulin and and when you have high insulin levels? What does it do that causes high pressure?

Dr. Cindy Geyer
Insulin itself causes disreg it's it's drives oxidative stress, and it drives inflammation. Insulin is also a player in terms of contributing to more weight gain around the middle, dysregulated metabolism in terms of more difficulty getting glucose into the cells to get processed for energy, but it's multifactorial.

Dr. Mark Hyman
Yeah. And the other reason is that is that when you have high insulin, the secondary effect is you retain sodium. So you retain salt. So we tried to touch on before, people eating ultra processed food, it's got a lot of sugar and a lot of salt, or a lot of starch and a lot of salt, which is essentially the same as sugar. And so that's what's causing you to hold onto the salt.

But if you're metabolically healthy, which by the way is not that many people anymore in America, know, it's maybe seven percent of Americans are technically metabolically healthy, you know, you you you can have salt without causing high blood pressure. I eat a lot of salt and I don't have high blood pressure. And it's because my metabolic health is really good. I I exercise regularly, I eat a low sugar starch diet. When you have high insulin you get like not just a salt retention but you get activation of your stress response, adrenaline, you get activation of various things called the growth factor properties that activate smooth muscle to be, growing more where that leads to high blood pressure.

You get endothelial dysfunction which you talked about like with nitric oxide issues, you get no base of dilation. So all this can be a factor of of why high sugar diets cause high blood pressure. You know, most people need to know what their metabolic health is and their status is and where they are on that spectrum. Because it's it's you know, you get risk all the way, not from just 5.7, but even lower, you get risk. So it's it's something to really look at.

Dr. Cindy Geyer
That's important because here she is at 56, nobody had ever measured an a one c on her because she wasn't overweight. And I think that's really important to understand that you don't have to be overweight to be on spectrum of insulin resistance, number one. When you talk about that metabolically healthy, two thirds of people with a healthy weight are actually metabolically unhealthy.

Dr. Mark Hyman
Wait. That's a bomb you just dropped, Cindy. Say that again.

Dr. Cindy Geyer
I believe the statistic is two thirds of people with a so called normal weight are not metabolically healthy.

Dr. Mark Hyman
Doesn't mean you're skinny fat. You're skinny fat. Like, you look thin on the outside, but you're fat on the inside, and you're metabolically unhealthy. So you don't have to be overweight to have prediabetes or to even have all the dangers from insulin resistance.

Dr. Cindy Geyer
And that's only gonna get worse, unfortunately, unless something changes with our food system and how we eat. So she'd never had that done. And and also the point that a one c, just like everything else, it is a it's a linear spectrum. So 5.7 is the cutoff to say you're in the increased risk for diabetes category. But if you start at five point o, every tenth of a point you go up, there's a linear incremental increased association with dysregulated insulin insulin and glucose metabolism and vascular health.

Dr. Mark Hyman
If you're five, you're probably good. But every point you go up from that, even within the quote normal range, you're still increasing your risk gradually. And then, you know, we we come up as arbitrary cutoff. It used to be six point o or 6.5, and now it's 5.7. Like, what should it be?

It should probably be, like, you know, 5.2 or something like that.

Dr. Cindy Geyer
And the great part of tracking over time is you can pick things up before somebody gets to that point. Like, if somebody's 5.21 year, the next year they're 5.4, the next year they're 5.5. What's that telling us? They're on a trajectory that's going the wrong direction.

Dr. Mark Hyman
And what's really interesting with with high blood pressure is that this resistance is a big thing you can actually track and measure as we just talked about. You know, one of the ways in the mechanisms by which it causes high blood pressure is inflammation, And there are many causes of inflammation besides that. So let's talk about some of those other factors like nutrient deficiencies or things like gut inflammation that comes from, you know, poor diet or lack of healthy gut microbiome. Let's kind of dive into some of those or even toxins and environmental factors that cause it. So I think people don't really look for those things.

When you go to your doctor and cardiologist, they don't look at a poop test, they don't for heavy metals, they're not looking at your nutritional status, like they're just kind of like, oh, you have high blood pressure, here, take the pill.

Dr. Cindy Geyer
So what are the patterns in the gut microbiome that are associated with insulin resistance and vascular dysregulation? Loss of overall microbial diversity, changes in the composition of the different microbes that exist, so overgrowth of less beneficial species like yeast or some other microbes, changes in the metabolic health of the colis. So when we think about what your gut microbes do, they ferment dietary fiber. They create these signaling molecules like butyrate that play a key role in maintaining a healthy gut lining. And, again, it is both chicken and the egg with diet, but loss of microbial diversity, loss of the butyrate species, lower b butyrate production, and increased intestinal permeability is one of the drivers of insulin resistance, chronic endotoxemia, chronic systemic inflammation.

Dr. Mark Hyman
So basically in English, what you're saying you're saying in English is that you got a lot of bad bugs in your gut that come from eating crappy diet and then you get damaged through gut lining that causes you your body be exposed to all the crap literally in your gut and also foods that you shouldn't be interacting with in unless when they're already digested and broken down. And so you create this inflammatory response in the body that you can change by healing your gut. So maybe a part of, you know, dealing with high blood pressure, it's not only dealing with the sugar and starch in your diet and pre diabetes, not only dealing with things like sleep apnea, actually repairing your gut and optimizing your gut microbiome.

Dr. Cindy Geyer
We can do that through foods like good prebiotic foods, things like Jerusalem artichoke or greenish bananas and garlic and onions in the leek family, provide food to allow the rebloom of those beneficial gut microbes. Those polyphenols, again, those same foods that help with artery elasticity, They support growth of a a particular keystone species that you've talked a lot about, Mark, acromancy, which seems to play a role with a healthy tends to mirror a healthy mucus layer in the gut. So we know that nutrition can go a long way. Sometimes we'll use supplemental support, especially if somebody's really got a lot of intestinal permeability, supplements that contain things like glutamine and zinc carnosine, just to help provide extra support for healing that gut lining or adding butyrate or taking an acromancy, a probiotic.

Dr. Mark Hyman
So in functional medicine in the Ultramomona Center, this is what we do. We look at the poop, we look at all your toxins, we look at your nutritional status, we see what's going on with you, it's different for different people like you said at the beginning, and not everybody has the same issue. And so we opt to optimize gut function. What about common nutritional deficiencies that can lead to high blood pressure? Because those are usually not looked at.

We go we call it essential hypertension, means an essential we don't know what it is, we actually do. So what what are the nutritional factors that that are common and that are linked to high blood pressure?

Dr. Cindy Geyer
I think you hit hit on two of the biggest, most important one. It's the potassium and the magnesium. Most of us by by far don't get our magnesium needs met, and foods today don't have the same levels of those micronutrients that they did. Magnesium one of the things to understand about magnesium is the blood level of magnesium doesn't tell you anything about your body levels of magnesium because the body is always trying to maintain a blood level at a very critical level, but you can be cellularly deficient in magnesium. And what are the side effects besides high blood pressure?

What symptoms of low magnesium? Irritability, muscle twitches, constipation, premenstrual tension, migraines. Magnesium has a calming effect on nerves and muscles. So if we're not meeting our needs, all of those things can show up. And I think omega three fatty acids are another one that's overlooked.

That's that's most of us are not getting our needs met. So omega threes can get shorter omega threes from nuts and seeds. The longer omega threes can come from algae, seaweed, and fish.

Dr. Mark Hyman
And and some people also talk about co q ten, and potassium as supplements to help. Can you talk a little bit about that?

Dr. Cindy Geyer
Yeah. So co q ten is a is a critical nutrient that I think the highest food sources correct me if I'm wrong, Mark, but it's actually in meat and animal foods. Co q ten is a critical nutrient for the mitochondria, and any organ that is metabolically active relies on mitochondria to convert calories to energy. So mitochondrial dysfunction, which we didn't really touch on before, also plays a role with vascular health and insulin signaling. You can measure co q ten levels, although I will tell you they in in my experience, they don't really necessarily mirror, again, cellular deficiencies.

So supplementing co q ten can not only lower blood pressure potentially, but also lower cholesterol in some studies.

Dr. Mark Hyman
Like you said, the sources are are often organ meats. Those are the richest source, and people don't really like to eat kidneys or liver or beef heart, but they're quite high in them, co q ten. The next, they may be per kilo, beef heart has about a hundred and fifteen milligrams. But some people need more than that, like two, three, four hundred milligrams. So you can't unless you're eating like, you know, four pounds of beef heart a day, you're not getting enough.

Right? Especially when you have higher needs. I mean, you have mitochondrial issues. And our mitochondria are constantly stressed by our modern lifestyle, by our diet, by toxins, by our gut microbiome being off. And and so we can actually help our mitochondria by giving supplements.

Dr. Cindy Geyer
And I'm glad you said that because mitochondria are both negatively impacted by oxidative stress, these overproduction of free radicals. But when the mitochondria don't work well, they create more of those free radicals. So you actually can become a vicious cycle. And we've got some whole new tests now that we can do to actually look at the pathways of energy conversion in the mitochondria and help people understand, alright, what patterns of dysfunction do they have if they have them and how can we best supplement or target them while we're also looking upstream to see what's driving the mitochondrial dysfunction.

Dr. Mark Hyman
Those are other supplements that can help, like arginine, which you can take, or garlic has been used to

Dr. Cindy Geyer
help with blood pressure. Beet root powder. I mean, there's there's lots of different things. Some there's some pretty good combination products out there that we'll often use in people who have endothelial dysfunction. I've seen really good benefits both in blood pressure and interestingly in men who've had erectile dysfunction.

They've done really, really well with some of the supplemental support.

Dr. Mark Hyman
Yeah. Because it increases arginine, which is what increases nitric oxide, is what Viagra or those drugs do, they increase nitric oxide, which is great. And then actually, what's interesting about these drugs, I don't if you've been keeping up with the literature, but that we're seeing immortality benefits from people who take these drugs regularly, from guys who are using daily Cialis or whatever or Viagra every day. They're actually seeing increases in in their health and not just erectile function, but also just mortality goes down.

Dr. Cindy Geyer
Well, you know, it makes perfect sense, Mark. Go back to what we were talking about with the blood brain barrier and how that also depends on nitric oxide to have healthy blood vessels and how endothelial dysfunction is a big upstream, upstream, one of the first things that changes that leads to a leaky blood brain barrier.

Dr. Mark Hyman
Tell us more about what happened with this with this, patient of yours, and then I wanna sort of summarize and go through, you know, how we think about this differently in functional medicine.

Dr. Cindy Geyer
You know, one more piece about her genetics that I think was interesting is she had some genes that could affect collagen recovery and collagen repair, and I think this is also an emerging story. So certainly played a role with her repetitive motion injuries, helped her learn that she needed to exercise smarter, not harder, that, you know, if you're prone to oxidative stress and inflammation, very intense exercise without adequate recovery can actually become counterproductive. And if you keep getting injured because you don't realize that you've got these connective tissue issues, it's not gonna ultimately help you meet your goals. So it actually helped her shift the way she was exercising, pay attention to her recovery needs. And I think another emerging story we're gonna start seeing a lot more about is this connection between fascia, healthy fascia, the connective tissue that joins everything in our bodies, muscle and joint stiffness, and artery stiffness, because they're all made up of connective tissue.

So using things like foam rolling or, something called melt or stretching, they may actually have benefits on the vascular system as well. So that's an emerging story we're gonna hear more about. So a couple other things we did for her. She's now postmenopause. She's still snoring, so we redid her sleep study.

And guess what? Now she met criteria for mild sleep apnea. Also had a lot of those other nonapnic respiratory events. So sent her for a mandibular advancement device. So she got an oral appliance, and we followed up to make sure that that was controlling her sleep apnea.

It was. And after a few months of this, one of the best things that she noticed is she was no longer tired during the day. Quality of life got better even before the vascular changes got better. That's important. We did we also did, we did test her for heavy metals.

She's not had a provoked urine for for burden of heavy metals, but we did blood levels to see if she had a lot of mercury or lead. She did not. But one of the things to keep in mind, especially for postmenopausal women, is you can actually have increases in blood lead levels, not because of a new exposure, but all of us who grew up exposed to lead paint, lead gasoline, the big reservoir of that lead was our bones. So after menopause, as women start to mobilize and turn over bone at a more rapid rate, you can actually release lead that's been there for years. And as those lead levels go up in the blood, impacts oxidative stress, inflammation, and vascular reactivity.

So we have to be mindful of that potential risk as well.

Dr. Mark Hyman
And you mentioned the challenge test we do. We we we don't we look at blood levels, but often if there's a risk factors or we have a reason to suspect there's an issue, and I always do this with high blood pressure patients, we do a challenge test where we give a chelating agent, combine the metals, pull it out, collect it in the urine and see what your body stores are rather than just what happens to be in your blood. And so, you know, that may be another avenue for treatment

Dr. Cindy Geyer
Right.

Dr. Mark Hyman
For people who are resistant to the normal lifestyle changes. Because it may not be their fault, maybe some environmental factor that's driving some pathology that's leading to inflammation or oxidative stress that then causes high blood pressure.

Dr. Cindy Geyer
And and there's been some research showing that when you remove those metals, blood pressure gets better and has a protective effect on kidneys as well. They've seen in people who have kidney dysfunction that kidney function improves, it's really important not to miss that.

Dr. Mark Hyman
And this is such an important topic. When you think about it like all the kidney failure, all the dialysis that people have, all the heart failure that people have. A lot of this is driven by kind of poorly managed high blood pressure and it's such a common issue.

Dr. Cindy Geyer
You got it.

Dr. Mark Hyman
I think doctors really need to think about how we how we get a a more focused approach on root causes and better diagnostics that we do at the Ultra Wellness Center that should be everywhere but are not unfortunately. And you know, you found many of these problems in this particular woman who had high blood pressure. She had a little bit of pre diabetes, she had high stress, she had some vascular issues genetically, she had some genetic predisposition to high blood pressure, she had some probably some toxic load a little bit, maybe she's going through menopause and lead. So we kind of started to see patterns and things we can actually treat. So I think it's it's kind of a you know, it's sort of a shame that we haven't taken this approach with traditional medicine because the science is there.

It just takes decades to get into Like you're you're quoting all kinds of scientific papers, so am I and and but somehow for some reason it doesn't get into the actual doctor's office with the individual patient who's being treated for x y or z disease. And that's really what we try to do with functional medicine. We keep our ear to the ground, we we pay attention to emerging science, we try to look at what makes sense, you know, what's not going to harm someone but it's going to help someone. And you know, doing the things of like optimizing nutrition, taking certain nutritional supplements, increasing potassium in your diet, having your gut health sort of optimized a little bit, dealing with food sensitivities, dealing with things like sleep apnea, dealing with heavy metals. All these things are modifiable risk factors for high blood pressure that are just generally not treated.

Dr. Cindy Geyer
One other thing for her is she turned out to have a dairy sensitivity. Interestingly, not gluten sensitivity, she had a dairy sensitivity. And there was a study last year showing that food sensitivities are also contributors to high blood pressure, probably mediated through inflammatory changes in the gut microbiome. So it all comes back full circle. And interesting thing, when she cut out her dairy, what did she notice?

Her arthritis symptoms were better. She had less stiffness in her hands. I think it was you know, it's it's nice when you actually have a tangible, palpable result to some of the changes that you make. That's a big motivator to stay the course and keep doing it.

Dr. Mark Hyman
Amazing, Sydney. So this is such a a great example of how we think differently about how to treat common problems by looking at root causes, by optimizing different systems in the body, by removing things that are causing problems like, you know, environmental toxins or certain foods that might be triggering inflammation in the body. So it's sort of like thing with high blood pressure, it's it's the result of a whole series of insults that are different in different people that you have to find what those insults are for that particular patient in front of you. Right. And that inflammation and free radical oxidative stress is what drives the pathology of high blood pressure and there's a million reasons why you can have that.

It's the final common pathway and so whether it's the gut or there's nutritional deficiencies like omega threes or whether it's heavy metals or whether it's you know increasing insulin resistance and pre diabetes that makes you retain salt. All those things need to be looked at. Unfortunately they're just not. And that's really what why I of I love our practice at the Ultra Wellness Center because we we do this every day. We've been doing it for decades and it's such a gratifying way to practice medicine.

Know, my my daughter, Cindy, I don't know if she's in medical school, she just graduated. I mean, she's now, in orthopedic residency starting soon. And I mean, I think she didn't go into traditional medicine from a medical specialty because she saw what a shit show is, but she feels like she can actually help people doing orthopedic surgery, which is great because it's like you've got a broken bone, you gotta see the broken bone doctor. Right?

Dr. Cindy Geyer
But you know what's funny, Mark? Think about what we were touching on, all these things that affect vascular health, they also nourish Mhmm. Joints. So people who develop hypertension and insulin resistance, they're more likely to develop osteoarthritis and need joint replacements, and they're it it still is gonna be connected even in her field.

Dr. Mark Hyman
Sydney, thanks for joining us. This is an incredible story. Think for people listening, if you want to learn more about what we're doing at the Ultra Wellness Center, go to ultrawellnesscenter.com. Realize that whatever problem you have, whatever diagnosis you have, there's another way of looking at it and getting under the hood and helping deal with root causes and optimizing the body systems. And that's what we do every day at the Ultra Wellness Center.

It's a dedicated team. We've been working together for decades and, hope you come visit us. And, and, Cindy, thank you for joining us today on how we deal with common chronic disease problems using functional medicine at the Ultra Wellness Center.

Dr. Cindy Geyer
Thank you, Mark.

Dr. Mark Hyman
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