← The Dr. Hyman Show
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- [00:00]
Dr. Mark Hyman
Coming up on this episode of the Dr. 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.
- [00:12]
Cindy Guyer
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- [01:18]
Dr. Mark Hyman
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- [01:19]
Cindy Guyer
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- [02:04]
Dr. Mark Hyman
Before we jump into today's episode, I.
- [02:06]
Cindy Guyer
Want to 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've 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 Hyman Hive for live Q&As, 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@doctor hyman.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.
- [02:44]
Dr. Mark Hyman
Hey everybody, it's Dr. 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. And we've gone in 1960, when I was born, from about 24% of the population having high blood pressure to now 47%, 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, Dr. Cindy Guyer, who we worked together since the 90s at Canyon Ranch and then at the Ultra Window Center. She's been doing this for, I don't know, it's close to 30 years with me. And it's kind of scary to say that actually, but I'M so happy to have you, Cindy, to be able to actually dive into the 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 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.
- [04:40]
Cindy Guyer
Thank you, Mark. I'm thrilled to be here. It's really exciting.
- [04:43]
Dr. Mark Hyman
Let's sort of dive in. Because, you know, I sort of mentioned the increase doubling over the last 60 years since I was born, the fact that it affects one in two Americans, and so many people are on high blood pressure drugs. And the question. And there was actually a great book from a friend of ours, a cardiologist, called what your Doctor May Not Tell youl About Hypertension, that talks a lot about a functional medicine approach. And so from your perspective as a functional medicine practitioner at the Ultra Wellness center, 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 what we kind of need to look for.
- [05:17]
Cindy Guyer
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 want to 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 going to 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 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.
- [06:25]
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, you know, I was sort of really shocked to learn, you know, when I sort of 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 function of our blood vessels, and they're all treatable. So you kind of treating patients, and, you know, I want you to sort of present this case here of your patient who had high blood pressure and what you kind of thought of what you did diagnostically, and to kind of unpack some of 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'll go into why, like, what's going on underneath the hood. How do we find things and search for things and hunt for things that may be treatable and modifiable factors that are driving you touched on a bunch of them. You know, whether it's pre diabetes and insulin resistance, whether it's sleep apnea, whether it's nutritional deficiencies like magnesium or omega 3s, or whether it's environmental toxins to some of which we can measure, some which 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 I'd love you to sort of share her story.
- [07:59]
Cindy Guyer
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.
- [08:18]
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 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 ultrawellnesscenter.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?
- [08:52]
Cindy Guyer
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 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 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 120s, 130s, maybe as high as 140. 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 think about the case of, oh, your blood sugar is borderline, come back and we'll check it in a year. Well, no, we want to 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 want to go upstream. We want to see what the variables are that played a role with this particular patient, why she's showing up with this reactive blood pressure and 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.
- [10:23]
Dr. Mark Hyman
It's important to get into the story because, you know, like I think of my parents, my mom and dad just obviously didn't listen to me and they ate crappy and they both run high blood pressure pills. And I'm 65 and my blood pressure is like 170, 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 1 in 2 people in America have diabetes or pre diabetes, and also one in two people have high blood pressure because they're very related.
- [11:03]
Cindy Guyer
Going back to her story, I mean, she had a pretty uneventful early life. She. 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.
- [11:32]
Dr. Mark Hyman
Why is that?
- [11:34]
Cindy Guyer
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.
- [11:46]
Dr. Mark Hyman
Yeah, I mean, the birth control pill is interesting because, you know, estrogen does make you retain a little more fluid, and that may be part of it. The progesterone can also make you gain. Gain weight sometimes that may be part of it. So there are things that, you know, medications that may also, like the birth control, may actually drive increased risk of hypertension.
- [12:05]
Cindy Guyer
That's true, especially through the Ren and 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 40s 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.
- [13:35]
Dr. Mark Hyman
Just to double down on that, a lot of people who have high blood pressure have undiagnosed sleep apnea.
- [13:41]
Cindy Guyer
Yes.
- [13:41]
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, these are clues. And it's important that people get this diagnosed because, you know, 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 pre diabetes and insulin resistance and sleep apnea as both causes of.
- [14:09]
Cindy Guyer
Absolutely, Mark, And 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 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 snorts really loudly. It gets missed in lean women in particular.
- [14:56]
Dr. Mark Hyman
And then what else did you find on her?
- [14:58]
Cindy Guyer
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 OB GYN 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 going to keep her heart and her brain healthy. She's always been physically active. Another piece of her story that I think is going to 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 stay physically active. And she periodically would be plagued by multiple soft tissue injuries. She'd had plantar fasciitis, she'd had posterior tibialis tendinitis, 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 want to 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 risks 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 glymphatic system that removes waste from the brain. Any vascular insults are potentially going to contribute to that leaky blood brain barrier. So optimizing your Blood pressure. Looking at those upstream factors is going to be really, really important for her to meet her goals.
- [17:49]
Dr. Mark Hyman
One of the things 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 with Ultra 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 do something about that are probably affecting your health in an immediate way and 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 SC science of genomics and our understanding of the biology of what happens when you have certain variations to modify your risk factor. 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 a real issue there with like, who. How many people are salt sensitive? And it's probably maybe you know, 40% 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 inter salt study, for example, 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 in your system. So what are your thoughts about that?
- [19:23]
Cindy Guyer
You know, it's a great question mark, and I think it's not simple. Right? So we know that that subset genetically of people who are sensitive to salt, it's less than 50%. 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 produce these free radicals that directly impact vascular Health.
- [19:54]
Dr. Mark Hyman
So also, like, nobody talks about the fact that historically we had 10 times as much potassium as sodium in our diet. As hunter gatherers, now we have 10 times as much sodium. So 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 have really high levels of potassium.
- [20:17]
Cindy Guyer
And magnesium.
- [20:18]
Dr. Mark Hyman
And magnesium, yeah. Magnesium is the other nutrient where probably 45% 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 functional medicine? The traditional doctors won't look for that 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 the combination of all the other factors that are being ignored?
- [21:00]
Cindy Guyer
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.
- [21:11]
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.
- [21:35]
Cindy Guyer
So coming back to the genetics, I love this test because 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 30s or 40s or 50s, 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 just regular potential dysregulation of that 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 endothelials, endothelial cells to make their own nitric oxide. We know that extra virgin olive oil and omega 3s. There's a lot of great things we can do.
- [23:11]
Dr. Mark Hyman
Yeah. So why is that important? Because nitric oxide dentate does something really important to the blood vessels. Right. What does it do?
- [23:17]
Cindy Guyer
It dilates them, makes them more elastic.
- [23:19]
Dr. Mark Hyman
So basically it helps your healthy blood vessels function better and it increases your blood vessel dilation, lowers blood pressure. So it's really, really important.
- [23:27]
Cindy Guyer
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.
- [23:58]
Dr. Mark Hyman
And ray nose is a. Ray nose is kind of an autoimmune disease. Right. So it's an inflammatory problem.
- [24:02]
Cindy Guyer
It can be.
- [24:03]
Dr. Mark Hyman
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. It's just an inflammatory problem in the.
- [24:11]
Cindy Guyer
Blood vessels, 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. 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.
- [25:09]
Dr. Mark Hyman
And she also had a gene that helped, then made her have trouble kind of metabolizing some of those stress hormones. Right?
- [25:15]
Cindy Guyer
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.
- [25:29]
Dr. Mark Hyman
What you're saying is individuals have different response to stress based on their genetics. 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 stress will increase, you know, the blood pressure tone. That's what you're supposed to do when you're running from a tiger. You want your blood pressure to go up. You know, when you're, you want your, your all your blood heart 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, you know, kidney failure and like all kinds of problems with your vascular system, lower extremity, 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.
- [26:21]
Cindy Guyer
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- [26:40]
Dr. Mark Hyman
Why?
- [26:40]
Cindy Guyer
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- [27:09]
Dr. Mark Hyman
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- [27:11]
Cindy Guyer
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- [28:07]
Dr. Mark Hyman
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- [28:09]
Cindy Guyer
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- [28:22]
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 into Those clues that you need to shift gears and then engage in whatever breath based practice you can so you can mitigate the negative impact on your vascular health. And you know, 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.
- [29:38]
Dr. Mark Hyman
Yeah, 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 like the cheaty way I put on headphones and there's different mind spa. Use an app or Newcom and it basically takes you through a guided visualization meditation. I'm like woo. I feel like I go into Never Neverland and it's really interesting. It activates your sympathy parasympathetic system. It can use different technology like binaural beats. But I mean there's even like devices like a shiftwave chair which you can use. It's like, 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 you know, for someone who's got high blood pressure, it's especially important.
- [30:14]
Cindy Guyer
It's especially important.
- [30:15]
Dr. Mark Hyman
You also found this woman had had some other issues, right? She had like her blood sugar A1C was high and normal. And let's talk about that connection between like blood sugar, insulin, prediabetes and high blood pressure. Because it's such an important thing.
- [30:29]
Cindy Guyer
It's a really important one. 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 big waist size.
- [30:46]
Dr. Mark Hyman
Big waist size?
- [30:48]
Cindy Guyer
Yeah. Waist hip ratio was low risk. Her weight was normal, she had a healthy BMI, but yet she had an A1C 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, a little more digging to see what was driving that and what she could control.
- [31:24]
Dr. Mark Hyman
We kind of don't really look carefully at this problem. 90% of people with prediabetes are not diagnosed by their doctor.
- [31:31]
Cindy Guyer
Right.
- [31:31]
Dr. Mark Hyman
And they don't measure insulin. They probably don't measure a 1C 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 to go up in this whole spectrum of this condition. Like, insulin goes up after a meal, then it goes up fasting, and then you're blood shows up after a meal, then it goes up fasting. So it's like the fourth step down the chain of disease, and you're kind of picking up late. So a 1C 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 when you have high insulin levels, what does it do that causes high blood pressure?
- [32:12]
Cindy Guyer
Insulin itself causes dysreg. It's. It 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.
- [32:31]
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 kind of touched on before, when people are 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, you know, it's maybe 7% of Americans are technically metabolically healthy. You know, 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 exercise regularly. I eat a low sugar starch diet. When you, when you have high insulin, you get like, not just the salt retention, but you get activation of your stress Response adrenaline. You get activation of, of, of like you know, various things like 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 basic dilation. So all this can be a factor 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're on in 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.
- [33:52]
Cindy Guyer
At that's important because here she is at 56. Nobody had ever measured an A1C 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 the 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.
- [34:12]
Dr. Mark Hyman
Wait, that's a bomb you just dropped, Cindy. Say that again.
- [34:15]
Cindy Guyer
I believe the statistic is 2/3 of people with a so called normal weight are not metabolically healthy.
- [34:22]
Dr. Mark Hyman
Doesn't mean skinny. 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 pre diabetes or to even have all the dangers from insulin resistance.
- [34:34]
Cindy Guyer
And that's only going to 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 A1C, just like everything else it is, 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 5.0, every tenth of a point you go up, there's a linear incremental increased association with dysregulated insulatory insulin and glucose metabolism and vascular health.
- [35:06]
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 with an arbitrary cutoff. It used to be 6.0 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.
- [35:26]
Cindy Guyer
And the great part of tracking over time is you can pick things up before somebody gets to that point. Like, if somebody's 5.2 one year, the next year they're 5.4, the next year they're five point five. What's that telling us? They're on a trajectory that's going the wrong direction.
- [35:40]
Dr. Mark Hyman
And what's really interesting with high blood pressure is that insulin resistance is a big thing you can actually track and measure. As we just talked about. You know, one of the ways and 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, 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 look 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.
- [36:20]
Cindy Guyer
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 colon. 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 butyrate production, and increased intestinal permeability is one of the drivers of insulin resistance. Chronic endotoxemia, chronic systemic inflammation.
- [37:12]
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. They come from eating a 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 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.
- [37:46]
Cindy Guyer
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 particular keystone species that you've talked a lot about, Mark. Akkermansia, which seems to play a role with, 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 Akkermansia probiotic.
- [38:36]
Dr. Mark Hyman
So in functional medicine at the Ultra Wellness center, this is what we do. We look at the poop, we look at all your stuff, toxins, we look at your nutritional status, we see what's going on with you. And it's different for different people. Like you said at the beginning, and not everybody has the same issue. And so we 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 essentially we don't know what it is, but we actually do. So what are the nutritional factors that are common and that are linked to high blood pressure?
- [39:03]
Cindy Guyer
I think you hit on two of the biggest, most important one, it's the potassium and the magnesium. Most of us by far don't get our magnesium needs. Metabolic 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 3 fatty acids are another one. That's overlooked. Most of us are not getting our needs met. So Omega 3s, you can get shorter Omega 3s from nuts and seeds. The longer Omega 3s can come from algae, seaweed and fish.
- [40:08]
Dr. Mark Hyman
And some people also talk about CoQ10 and potassium as supplements to help. Can you talk a little bit about that?
- [40:14]
Cindy Guyer
Yeah. So COQ10 is a, is a critical nutrient, I think the highest food sources. Correct me if I'm wrong, Mark, but it's actually in meat and animal foods. CoQ10 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 CoQ10 levels, although I will tell you they, in my experience, they don't really necessarily mirror again cellular deficiencies. So supplementing CoQ10 can not only lower blood pressure potentially, but also lower cholesterol. In some studies, like you said, the.
- [40:56]
Dr. Mark Hyman
Sources 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 Coq 10. The next they may be per kilo. Beef heart has about 115 milligrams, but some people need more than that, like 2, 3, 400 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 so we can actually help our mitochondria by giving supplements.
- [41:35]
Cindy Guyer
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 cool new tests now that we can do to actually look at the pathways of energy conversion in the mitochondria and help people understand, all right, 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?
- [42:07]
Dr. Mark Hyman
There's some other supplements that can help, like arginine, which you can take, or garlic has been used.
- [42:13]
Cindy Guyer
Garlic Beetroot 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. And 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.
- [42:32]
Dr. Mark Hyman
Yeah, because it increases arginine, which is what increases nitric oxide, which is what Viagra or those drugs do. They increase nitric oxide, which is great. And they're actually what's interesting about these drugs. I don't know 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 their health and not just erectile function, but also just mortality goes down.
- [43:01]
Cindy Guyer
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. One of the first things that changes that leads to a leaky blood brain barrier.
- [43:17]
Dr. Mark Hyman
Tell us more about having. With this. With this patient of yours. And then I want to sort of summarize and go through, you know, how we think about this differently in functional medicine.
- [43:24]
Cindy Guyer
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 there. 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 going to 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 going to 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. The vascular system as well. So that's an emergency story. We're going to hear more about. So a couple other things we did for her. She's now post menopause. 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 non apneic respiratory events. So center 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 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.
- [45:56]
Dr. Mark Hyman
And you mentioned a challenge test. We do. 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 to bind 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 that may be another avenue for treatment for people who are resistant to the normal lifestyle changes because it may not be their fault. It may be some environmental factor that's driving some pathology that's leading to inflammation and oxidative stress that then causes high blood pressure.
- [46:29]
Cindy Guyer
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 have kidney dysfunction that kidney function improves. So it's really important not to miss that.
- [46:41]
Dr. Mark Hyman
And this is such an important topic. Think about, 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. So I think doctors really need to think about how we, how we get 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 found many of these problems in this particular woman who had high blood pressure, she had a little bit of prediabetes, she had high stress, she had some vascular issues genetically, she had some genetic predispositions to high blood pressure. She had some chronic, probably some toxic load, a little bit. Maybe she's going through menopause and lead. So we kind of start to, to see patterns and things we can actually treat. So I think it's. It's kind of, 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 practice. Like, you're, you're quoting all kinds of scientific papers. So am I. And. And yet 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, 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.
- [48:21]
Cindy Guyer
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 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.
- [48:54]
Dr. Mark Hyman
Amazing, Cindy. So this is such 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. Causing problems like, you know, environmental toxins or certain foods that might be triggering inflammation in the body. So it's sort of like the 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. 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 3s or whether it's heavy metals or whether it's, you know, increasing insulin resistance and prediabetes that makes you retain salt, all those things need to be looked at. And unfortunately, they're just not. And that's really why, kind 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. You know, my, my daughter Cindy, I don't know if she's in medical school. She just graduated. I mean, and 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, like, you've got a broken bone, you gotta see the broken bone doctor. Right.
- [50:16]
Cindy Guyer
But you know what's funny, Mark? Think about what we were touching on. All these things that affect vascular health. They also nourish joints. So people who develop hypertension and insulin resistance, they're more likely to develop osteoarthritis and need joint replacements. And they're. It still is going to be connected, even in her field.
- [50:34]
Dr. Mark Hyman
Sydney, thanks for joining us. This is an incredible story. I 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 Sydney, thank you for joining us today on how we deal with common chronic disease problems using functional medicine at the Elger Wellness Center.
- [51:05]
Cindy Guyer
Thank you Mark don't forget there's a way to listen completely ad free with Hyman plus on Apple Podcasts. You can enjoy every episode without any breaks. Just open Apple Podcasts and tap try free to start your seven day free trial.
- [51:18]
Dr. Mark Hyman
If you love this podcast, please share it with someone else you think would also enjoy it.
- [51:23]
Cindy Guyer
You can find me on all social.
- [51:24]
Dr. Mark Hyman
Media channels at rmark Hyman. Please reach out.
- [51:26]
I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman show wherever you get your podcasts.
- [51:33]
Cindy Guyer
And don't forget to check out my.
- [51:34]
Dr. Mark Hyman
YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness center, my work at Cleveland Clinic, and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guests opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness center at ultrawellnesscenter.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public, so I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.