Hypertension Through the Lens of Metabolic Cardiology

Welcome back. Once again, I'm super excited to continue talking about metabolic, cardiology, all things arteries, vascular. Ultimately, this is the ultimate form of anti aging, the ultimate form of regenerative medicine, because you're literally going to the vessel that goes to your brain, your heart, everywhere.

Every organ, anywhere. Yeah.

And looking at how old it is and then reversing that, which is really cool. We did some introductory marks before. Before we go forward, I do need to say a little quick thing. This information is for educational purposes only. We cannot diagnose or treat any condition via podcast or YouTube or anything else. So, of course, discuss anything you learned today with your personal healthcare provider. With that, let's talk about hypertension. It's a big elephant in the room. It's one of the first things people start treating when people in their 20s and 30s. So what is hypertension? What is high blood pressure? How is it defined currently? And how should we define it?

Yeah. So, I mean, hypertension or high blood pressure is essentially a rise in the systolic blood pressure over diastolic blood pressure, or two numbers that you measure with a blood pressure cough and a monitor. And. And the cuffs are done differently, the monitors are done differently. None of them are done correctly, but it's a marker of compliance or pliability of your blood vessels. So it's kind of a surrogate for what we would call systemic vascular resistance. And systemic vascular resistance kind of goes along with how much your heart is working, how hard it might be working, how compliant your blood vessels are. Is this microvascular disease? Is this macrovascular disease? So is this peripheral or central? And ultimately how that affects the way that your blood flows. I mean, it's plumbing. Your heart is a pump. Your blood vessels are pipes, essentially, but they're compliant pipes. And instead of being rigid and stiff, which you don't want to, the walls are made out of muscle. And then there's the lining, that endothelium that we discussed previously that we'll talk about more in probably every one of these episodes. And, and essentially there needs to be a degree of compliance. They should expand and contract and expand and contract. Arteries tend to be more, more muscular because they're pumping blood to the distal tissue. You're collecting waste product, you're delivering oxygen. And then as blood mixes with those arterioles and ultimately in the capillary bed, then into the venules, then into the veins, and then back up to the heart, goes to the lung to collect oxygen, rinse and repeat. So as this process is happening, if that heart is working too hard. Cardiac output, which is essentially heart rate times systemic vascular resistance has to be, gets kind of taxed or damaged in some way. And so you don't want to have that muscle work every day, all day. The heart can change over time. You can get hypertrophic cardiomyopathy, you can strain the heart to the point where you can get valvular dysfunction, or you can create problems that lead to things like hemorrhagic strokes. We're going to talk about at some point in time, you obviously increase your risk of heart disease. So globally, hypertension is kind of this increased systemic vascular resistance, this decrease in compliance for whatever reason that leads to those numbers that are measured going up. Normally when you go to the doctor and you get your blood pressure tested, it's in and out, they slap a cuff on you. Maybe they're not even paying attention to the fact that the cuff is big enough or small enough for you. Is it right for that patient's arm size? Is it too tight? Are they doing it in both arms? Usually not. Is that person late to the appointment, running in, sitting down, legs crossed, already stressed out, and now you're getting their blood pressure, or have they had time to calm down and relax? And there's so many variables that can cause these numbers to be askew. The top variable being the systemic or the systolic blood pressure is the one that gets probably the most confounded. The diastolic or lower number is that relaxation phase. If that one's up, it's a little bit more concerning because that's the relaxation phase of the heart. Stress, pain and bad night's sleep, high sodium intake, caffeine, these are all going to drive up that top number. So you want to do it when these variables are not in play. The best key scenario is to check blood pressure morning and night because there is this bimodal variation. You should dip at nighttime, meaning your nocturnal blood pressure should be lower than your morning or daytime blood pressure. If it's higher, that's basically called a paradoxical dipper. If it doesn't dip, you're called a non dipper. Non dipping and paradoxical dipping is actually concerning for future heart disease. White coat hypertension, which gets dismissed. Oh, you just have white coat hypertension. You don't like the doctor is also a independent risk factor for vascular disease. So these are things not to be poo pooed and just dismissed. The best way to measure blood pressure is a 24 hour ambulatory blood pressure cough, which nobody tends to do. But if you do this morning and nighttime, over the course of two weeks, looking at trends, pulling out any confounding variables, you're going to get an estimate of what your blood pressure is or should be. What should those numbers look like as far as you're concerned?

So there depends on who you're talking to. The standard definition for hypertension, stage one hypertension is a systolic blood pressure 140 over 90 to 160 over 100. And then stage two is over that. So that's what we treat. You know, stage one, stage two pre hypertension, which is. And these are just American Heart Association.

Yeah, These are a cat A cardiology academies that have kind of set these numbers.

Yeah, yeah. Pre hypertension would be 30 over 80 to 140 over 90. So what does that mean? So basically, as your blood pressure goes up, your risk for an event, heart attack, stroke, goes up. And so between the 130 over 80 and 140 over 90, if you, if you put it on a graph, you'll see it start to go up. So it goes up a little bit. Risk is a little higher. The inflection point which starts to skyrocket is that 140 over 90 and then the 160 over 100 is when it like just goes to the moon. So those are the numbers we typically look at. Current recommendation stage, Pre hypertension, stage one diet, lifestyle recommendations first, which I 100% agree with that. The issue is though, is what is the blood pressure above which there is any increase risk. Not just the inflection points, but any at all. And that's actually one. You want it 120 over 70.

120 or 70.

Yeah.

And so, and even some emerging data about 110s, like one teens.

Agreed. Yeah. Now where it gets a little tricky was with grandma. Yeah. Because grandma has really hard arteries. Then all of a sudden if you get it too low, she can actually between pumps the blood pressure will drop and she can get a stroke or heart attack. So that's.

Or sink buys and hit her head. She's on blood thinners already. Because we know grandma is.

I know. So the point is that there's lots of nuances to all, but those are the numbers. But in our world, I want my blood pressure to be in the teens over 70ish for optimal health. And one thing you kind of alluded to is blood pressure lives one, it lives in the space. Right. But there are a couple things that control that space. One is the elasticity. You talked about the Way I think about it, it's like a balloon. If you take a balloon and blow it up and it's really flexible, you can put a lot of air into it. You let the pressure out and it's pretty, it's uniform, it's like the same amount to the very end. If that balloon is hard, you push into it to put more air into it. You have to increase the pressure. Yeah, that's what happens as the collagen, you get scarring, et cetera. And then you've got, you've got actually the nervous system. While there are some people who have adrenergic or stress induced, you know, high blood pressure, their nerves around all these, these muscles. And some people, because of a dysfunction in the nervous system will keep a little over a sympathetic fight or flight tone and that can keep your blood pressure high. And those are people that, you know, the white curve, hypertension. So they've got this dysfunction in their sympathetic nervous system. And then you have hormones, renin, angiotensin, aldosterone, it's your renal system. And people forget. And this is also where nitric oxide comes into play as well, which is made by your arteries that cause dilation, relaxation. So high blood pressure is not just the number and not just the nuances of it. Is it a nervous system, a neurovascular issue? Is it a hardness which you mentioned, some of the markers, Is it a.

Hormone or hormone volume?

Volume, yeah. And so all of a sudden again, you can measure, you know, renin androtuce aldosterone ratios just to find out, is this a high renin, low renin, you can actually measure someone's sympathetic, compare sympathetic nervous system to see if there's overdrive there. And you can use inflammatory markers and measure that and you can literally give someone a T tailored program.

Yeah.

For what's going on their arteries or.

Or if medication is indicated, choose the right medicine for that person. Right. Like instead of just saying if diabetic, then this, if female, then this, if African American, then this. Which is kind of how it's done.

Yes, it should be.

What's the person in front of me like? What is that person hypertensive because they have low renin hypertension and also have high cortisol levels and also have a weight issue and metabolic dysfunction and inflammation. Now I'm going to pick what I'm going to do about it, but it should be specific to that individual and not just, let's just do this medication. Their body is going to be more responsive to the medication. If you're choosing a medication that's appropriate for the condition that's leading to their hypertension to begin with. It's, it's that simple, but it's not thought that way. It's if this, then that instead of let's look at the data and see, let's look at you as a whole and see. And then let's make a decision together and then a trial of therapeutic intervention. And if they're responding, you're done. If they're not responding, then you either go up on the dose or you modify the medication to something else. But that's how I think blood pressure should be addressed. There's also a lot of low hanging fruits like nutritional intervention for blood pressure. This is something that again, our Guru, Mark Houston, Dr. Houston taught us is before you even consider putting someone on blood pressure medication, there's four things that I check nutritionally. Is their vitamin D level maximized, is there omega 3 index maximized, is there magnesium? Red blood cell, not serum red blood cell magnesium maximized. And is there CoQ10 level maximized? Get their CoQ10 serum level to 3, close to 3 or higher. Red blood cell magnesium to 5.8 or higher, assuming normal kidney function omega check close to 8, assuming they don't have a bleeding risk or on blood thinners and vitamin D above 60. If you've done that, then maybe you can consider medication amidst other things. But if that hasn't been done yet, start there and you'll be shocked. Five points come off the systolic. Now all of a sudden we're no longer in need of a blood pressure medicine. Now maybe you've decided this person might have sleep apnea. Let me send them to the sleep specialist and they get a study and they do and you treat that. Five more points come off. They never needed a medicine because you just took 140 down to 130 with vitamin D, fish oil and a CPAP machine. It's, that's the lens through which you should be looking at this. But you have to get the proper measurements through blood pressure. And then you have to kind of look at the context of why this person might be hypertensive.

And to your point, like the vitamin D, the Omega 3, the magnesium, the CoQ10, all affect inflammation, immune dysregulation. Yes.

And so it's like your vascular compliance, like all of that.

I think the reason those three interventions are so powerful is because CoQ10 deficiency, vitamin D deficiency, magnesium deficiency, ubiquitous omega 3 deficiency are so common. Yeah. And so it's kind of like you're saying everybody's probably got one of these, throw it the wall. And it's amazing if you do that, then put some weight loss in there.

Dietary changes, you would have strict sodium, increase potassium in the diet, manage their stress, get their sleep right. And man, it's shocking what can happen.

And we haven't even done fancy testing yet. No, we've just done super basic nutritional lifestyle interventions, which, according to the American Heart association, like I mentioned before, treatment for preoperative stage one, the initial treatment is always supposed to be diet, lifestyle modifications before. It's just. What that usually means is here's your piece of paper.

Yeah.

For eating better. You come back next visit, you're five pounds heavier. Okay. Here's your medication.

Yeah. There's, there's, there's just a suggestion of. With some carbon copy handout that's not specific to that individual that they just basically throw in the garbage on their way out and do nothing about.

And hypertension, I think we all know hypertension is bad.

Yeah.

I mean, increases your risk for blindness in old age. Yeah. Dementia, kidney failure, kidney erectile dysfunction if you're a male. Heart attacks, peripheral vascular disease, dysrhythmias, you know, cardiomyopathy.

Cardiomyopathy.

Just bad, right?

It's bad.

So, so, so everybody agrees that we should treat this. And the basic things we talked about, I don't think these are controversial. What could be controversial is looking at things like a uric acid level.

Yeah.

And homocysteine level. So my first question, which I think I know the answer, and then you can expound on it. Have you ever given someone something to help get their homocysteine level down or the uric acid level down? Have you ever seen. Have you ever done that and seen their blood pressure come down?

Yeah.

You have?

Yeah.

Explain that to us, Dr. Allison.

So, in particular, homocysteine, for sure. I mean, homocysteine is a surrogate marker for methylation. And methylation is akin to basically a metabolic light switch. It is the pathway that kind of essentially governs everything important that's happening in the body. To me, it's kind of akin to mitochondrial function. Mitochondria functioning well means the body works well. Not working well. The body's not working well. Methylation is doing its job. Body's working well. You're not methylating well. The body's not working well. So methylation is a switch that allows for you to detoxify. Methylation is a switch that allows for you to make nitric Oxide, so you can vasodilate. Methylation is a switch that allows you to make neurotransmitters. Methylation is doing all these beautiful things that are mitigating cardiovascular metabolic risk, cancer and stroke risk, mood disorder risk, and just allowing the body itself to function as a whole. When you measure a homocysteine level, if it's high, it means that person's not methylating. Well, it's not as simple as just giving them some methylfolate. Even if they have an MTHFR snp, which is kind of a common genetic typo, that means that they don't take folate. Folate and methylate it or activate it. Well, sometimes you got to add other B vitamins, sometimes it's adding fancy methyl donors like TMG or Sammy. Sometimes it's all about magnesium. It's got to be individualized. But the whole goal is to get that homocysteine level down and get it to an optimal range and then see what, what transpires. Is that mood lift, does that blood pressure get better? Does that person have less gut issues? Does that person feel more energized? And you just see it. And, and so you're giving someone B vitamins, you're giving someone methyl donors, you're maybe cleaning up their diet a little bit, and now all of a sudden you've hacked genetics or their methylation, and all of a sudden blood pressure gets better. The uric acid component is because uric acid is quite literally a metabolic marker. It's not a gout marker. Yes, it's a gout marker, but it's not just a gout marker. It is correlated with whether or not you are metabolically flexible or not. In my opinion, it is a harbinger of badness to come if it's high. Whether you have gout or not, you're going to be inflamed, you're going to be oxidative, you probably have fatty liver disease, your diet is most likely not great, and you are probably a ticking time bomb of cardiovascular disease if you don't have it already. If your uric acid is riding high all the time, and quite literally by cleaning out some fructose from the diet, get them off processed food, get them off of sugar, get them on some whole foods, get them on some more plant based, get them losing weight, get them active or using an intervention like colchicine, which is what we use for gout, or allopurinol, which is what we use for gout. And now all of a sudden their blood Pressure gets better. And you're treating uric acid, not hypertension, but their blood pressure gets better. That's not a coincidence. These are things that we see and.

Happen all the time and think about. There's dozens of markers like these two. We mentioned that we look at hscrp, fibrinogen levels. Yeah. There's the thing, I think to stay here. There's over 300 different biomarkers we know of that you can, that can be measured that reflect neurocardiovascular disease.

Yeah.

But yeah, our current system looks at five or six.

Yeah.

And it's really cool when we can look at 20 or 30 or 40, it's impossible to look at all 300. Yeah. You know, one thing, when I did my training early on, I cut my teeth with. My very, very first training thing was with, was with Dr. Mark Houston, vascular Biology. It was a massive dump overload. Yeah. I remember drinking from a fire hose. Yeah, pretty much. Yeah. But I remember when I did my dementia training with Dale Bredinsen, we did the whole thing. I did that several years later. And to me it was really interesting. Like 80% of a Dr. Bredinsen talked about with dementia was crossed right over with Dr. Houston talked about vascular disease. And so when we talk about vascular disease, people need to realize your brain, like there's, there's some nuances with Dr. Way Dr. Dale Brunson does stuff with mold and toxins and traumatic brain injuries and some other things. Yeah. But 80% of it's roughly the same. Yeah. And so when you're doing this, you're also preventing cognitive decline and a whole bunch of other things. And to one of the points you mentioned as well, with methylene factors and mood, this is even recognized by pharmaceutical companies. There's a drug called Deplin, which is a high dosed methylate approved, FDA approved to treat difficult depression. It's like 5, 7 and a half, 14, 15 milligrams of methyl folic acid. Yeah.

Which is a big dose.

This is a big dose. Yeah. So we usually use that dose with our Lyme patients in dapsone or our really difficult depression or bipolar. But the point is like the idea that these things can affect mental health as well as vascular health, it's not unique to this metabolic cardiology world. These little data points have been accepted by other specialties and they, because they make a drug out of them, they'll address that. But there's so many other things can be done that you don't have to wait for a drug to be available. To treat a problem.

Yeah, exactly. I agree with that 100%. And I love, like, some of these other markers that we haven't even mentioned yet, like adma. It's asymmetric dimethyl arginine, and it's basically a marker. For me, the way I explain to patients is it's kind of like the leaky gut marker of the blood vessel. When your ADMA is elevated, your blood vessels are leaky, or your blood vessels are a little bit inflamed, or your ability to make endogenous or in the body, nitric oxide is diminished. So when I see ADMA elevated, I'm looking at the patient's blood pressure, I'm looking at their exercise tolerance, I'm looking at their energy, I'm looking at their vascular risk markers. And I'm saying, you know, this person's a ticking time bomb of future vascular disease, that they don't have it already. Why is this happening? What we can do? What can we do about it? Sometimes it's as simple as adding some fish oil. Sometimes you got to do other things. But there's all these cool little nuances and markers that you can use that go beyond just risk, but give you kind of surrogate markers of what's happening at that vascular level, which is huge, or tmao, which is a gut marker. Basically, it's how the gut heart axis kind of ties together, right? Like when you eat carnitine and you convert it into trimethylamine, and then your gut bugs are off because you have intestinal dysbiosis, and they convert it into an oxidized form called trimethylamine oxidized, or tmao, that is an independent cardiovascular risk marker. So you clean up that person's gut, and now all of a sudden, that normalizes. You just took away one of the risks. Like, to me, that's crazy cool. Like, you heal dysbiosis. I made your heart better. No one's saying stuff like that. Like, really? And. And so I think there's a lot that can be gained from just looking at these things, understanding them, seeing the body as a whole, and then intervening.

And also, you gotta meet the patient where they're at. And so it's. Everything's built in the foundations. So if. Do all these fancy tests, you know, TMAO, ADMA, SDMA, F2, isoprostane, you know.

LPPLA2, all that stuff, you know, LP.

Et cetera, et cetera. What's your diet look like? Yeah, let's clean up. Let's Eat real food.

Yeah.

How physically active are you? Are you doing something at least 150 minutes a week? No. How many hours are you sleeping at night? You know, do you have meaning, value in your life? Do you have a purpose in your life? Like, if you don't have these things, you can tweak these numbers, but it's not going to have the same impact as if you. And we talk about this a lot, perfecting the basics and supplies to everything, not just mold and Lyme and not just all those other things, applies to cardiovascular neurovascular dementia. All these things. You know, one of the tests I like a lot, which I'm sure you do as well, is a microalbumin.

Yeah.

It's literally a test for kidney leaky. Leaky vest vasculature. It's been used in the diabetes world forever as an early marker for kidney disease. So it's literally a urine test that picks up, hey, your kidneys are leaky. They're leaking out small amounts of protein, which mean you have other leaky stuff. Otherware.

Yeah.

And other vessels in the rest of your body. We're just picking up a new urine. And typically in the, in the diabetes world, what you do is you give someone an ACE inhibitor, which we'll talk about that later, is how they affect higher end people with hypertension. And that's it. You control the diabetes and that's it. But for general population screening, people should be getting this because if you have a, if your blood pressure is 130 over 79 and you have mild microalbuminemia, sorry, microaluma, and your urine, and you're a little overweight and you snore a little bit at night, all of a sudden there's little small data points. You have leaky kidneys.

Yeah.

Which means you also have a leaky vasculature in your heart, your brain, and that that slight elevation is having more damage than you possibly think. And then you can do some interventions, lose some weight, change your diet, add in some vitamin C, use some natural ACE inhibitors, add whey protein, which is mother Nature's, you know, ACE inhibitor. And all of a sudden you can fix that without potentially starting some wrong medication.

Yeah.

So.

And you're protecting our kidneys. Right. That's a quick path to nephropathy. Essentially. Early stage kidney disease is reversible, late stage is not. And so the goal is ultimately to get to the point where you are preventing things, not having to dig out of the mud, you know?

Yeah. So hypertension, we've spent a bit talking about. A little later on this session, we'll talk this series, we'll talk about treating blood pressure more specifically. But I think next I want to talk about what I want to talk about next. Maybe talk about heart attacks.

Yeah.

A little later, stud. Today we'll talk about strokes, then afib and other things. But the idea again with this is to help people realize their true rages in their arteries, arterials, capillaries. And you can actually measure this, you can actually address it, you can actually treat it and do true preventive prevention. If you've had a heart attack or stroke, you can actually use this to actually uplevel whatever else the person's doing in a real and meaningful way. That literally is the most cutting edge science out there right now.

Yeah, agreed.

So any departing thoughts about hypertension before we.

No, I think we covered it.

Excellent. Well, thank you so much. Hopefully you're enjoying this. If you have anybody, you know, has any metabolic issues like we've mentioned before, blood pressure, et cetera, encourage them to listen to this. We do make turn these into actually blogs on our website. This will be available on YouTube as well. But the purpose of all this, to educate people. Because if people don't realize what they can do, once you realize what you can do, there's no limit to what can be done.

Yeah.

And so we want people to have all the tools in their toolkit to make sure they can have the ultimate health possible.

And so much of this is actionable, so much of this is accessible, so much of this is within their control and their grasp. That doesn't require you to see a specialist like us or spend a lot of money on testing. Start with the basics. I think what you brought up was really, really important. I, I think as a disclaimer, it should just kind of go without saying that no matter what topic we're talking about, no matter how nuanced and deep we get, we always, always, always start with lifestyle. Every single patient gets a lifestyle plan and then all this other stuff on top of it. Because none of this works without that. Like that's the key. That's the key to everything being better. But that's also how you hold that space once you get there and minimize what you need to stay there. It's, it's about putting forward that best foot so that you only need a little bit of intervention at the point in time when you're finally optimized.

And people with blood pressure or diabetes or any high cholesterol. The natural thing is if you only use a medication for your blood pressure. Then what happens is several years later now you need a second blood pressure medication. Then several years later you need a third blood pressure medication.

No.

By the way, you're beta blocker and you're diuretic. Now you're diabetic because you've induced insulin resistance through direct from the beta blocker or low potassium from the diuretic. So let's now put you on metformin.

Those are all the nutritional deficiencies, like not even the side effects, but the nutritional deficiencies that. Deficiencies that come along. These medications. That's a whole topic on its. On its own. And then ultimately nowadays a lot of these medications are two in ones anyway. You know, it's a combination medicine. It's not just one. You think you're getting monotherapy because you're taking one pill, but there's two different.

Medicines in there, which means twice as many side effects. Yes.

And twice as many nutrients leaching out of your body. Usually things like potassium and magnesium, especially if it's a diuretic, which we just talked about how important they are.

So let's do that with. Let's do this. Let's play this game real quick. Yeah, I like this. This is so during my functional training, I never learned about this in medical school. There's actually a textbook of basically side effects from pharmaceuticals that we kind of talk about. And so basic blood pressure stuff. Diuretics. Yeah, Hydrochlorothiazide. What are the, what are some of the side effects from using hydrochlorothiazide?

That's a great one to start with. It's my least favorite of all the drugs that are out there. And honestly, I think Mark Houston would agree with me because I've heard him lecture to this. It shouldn't exist as a drug. It does nothing. There's no data that shows that it has long term utility in the remodeling of a heart. For anybody that's had heart disease or a heart attack, it has the increased risk of renal insufficiency or renal failure. It has the increased risk of diabetes the longer you use it. So those are just things that clearly you don't want for a drug that you're taking to treat a problem, to prevent those things, which is counterintuitive. And it's leashing magnesium and potassium and zinc out of your body. So your immune system, your thyroid function, your. Your previous arrhythmia, that's kicking back in your blood pressure, that's getting worse. Like all These things because of a drug that you're taking, not to mention the fact that it makes you pee all the time. So you're getting up all the time to go urinate in the middle of the night. So now your sleep's disrupted, which is affecting your blood pressure. It's just kind of a nightmare. I don't like HTTC at all.

And so. And low potassium magnesium.

Yeah.

One thing you can get with low potassium magnesium is cramping and cramping and palpitations. Yeah.

So now you have palpitations or ectopies, you get PVCs.

So what do we do? We treat that with typically beta blockers. Okay. Oh, by the way, the diuretic, low potassium magnesium also increase insulin resistance. Now we have beta blockers. Beta blockers also increase crease in insulin.

And also mask hypoglycemia. So if you're put on a drug to treat your diabetes that's dropping your sugar too low, you're on a beta blocker that's preventing you from feeling the peripheral effects of your low glucose. It's just, it's, it's a self perpetuating loop. It's kind of a nightmare. It's really.

So now you're on it. Now you're on a diuretic. And this is standard, this is standard operating procedure. So diuretic palpitations, beta blocker, beta blocker. Now you're now pre diabetics.

Metformin.

Metformin what? What nutritional deficiencies are metformin, B12.

So now you have neuropathy.

So you're on gabapentin, B12, B12, CoQ10.

Yeah. And so I think melatonin maybe too.

Yeah. It's several B vitamins. It's also has some negative mitochondrial.

Mitochondrial toxic.

Yeah. Some of the good things about metformin, it does increase your akkermansium ecinophyllum. Yeah. Which is one of the very important keystone bacteria in your gut tenfold. So.

Yeah. And AMP kinase, which is technically a pro longevity path, but it hurts your mitochondria.

Yeah. So if you take it, you should take it with CoQ10 and then B.

Complex and B complex.

But the point is something as simple as hypertension and I've seen, I remember hearing this first time I heard this.

When a basic water pill sends you down this slippery slab.

Oh, I remember like how many times have I seen this in primary care where someone starts on a diuretic, then a beta blocker, then a calcium channel blocker or metformin or an ACE inhibitor now the kid, it's like, is this process 100% due to medication side effects?

Yeah, maybe.

Potentially. Potentially. And that's what I think. Something as simple as hypertension, if done the right way, treated increased longevity, anti aging, da da, da, da. Done the wrong way.

Yeah.

And then all of a sudden, by the way, if you do directs uric acid goes up a little bit.

Yeah.

So it gets kind of tricky. This is.

Yeah, this is great.

So just imagine this with every single solitary drug.

Yeah.

And then your cholesterol is high, so you get put on a statin, which also. Or mitochondrial toxicants is also depleted. Yeah, they can also. And if you're female, I remember rebreeding this one study. If you're menopausal, female, taking a statin can increase your risk of developing diabetes up to 48%.

Yeah.

If you're a male in general. General population, it increases your risk for developing diabetes 8%. So the number needed to treat with a statin for Zocor for someone who already had a. Has a coronary risk equivalent, you've already had a heart attack.

So secondary prevention.

Yeah. Was one in 40. So 40 people need to get statins.

For one to get benefit.

Over five years. Yeah, over five years. Yeah. And I remember that number just stuck in my head because I'm like. Yeah, it's not, it's. It's significant. Over millions of people. Yeah. But for you in front of me, I'm gonna treat 40 people like you for five years and they'll help one. Yeah.

And it's. It's worse for primary prevention. It's one out of a hundred.

Yeah.

The number needed to treat is a hundred.

100.

You need a hundred patients who don't have heart disease but have dyslipidemia, high cholesterol, high ldl that get put on a statin. One of them will get benefit.

Was it just. So this is. I want you to educate me real quick. Was that for just hyperlipidemia? Were there any other factors like blood pressure, cholesterol?

Just hyperlipide.

So it wasn't coronary risk equivalent. It was just hyperlipide. Okay.

One out of 100. Primary prevention.

That's not very impressive.

No. And that's why it shouldn't be handed out like candy, you know, And. But like in a situation where it's indicated coronary artery disease, known coronary artery disease, still one out of 40. Right. That's the absolute risk. They talk about relative risk ratios because those numbers are much nicer.

Yes. The place where these things Are gold is post mi, post stroke, where you have vascular instability. Yeah. And they're great anti inflammatories. They can stabilize plaques.

That's 1%.

That's where you got to use them. If you're diabetic and you're not controlling your, your stuff, then you probably should be on statin. If you have high blood pressure, 150, 160, high cholesterol, and you're not doing the right stuff. And this is where it gets tricky, like meeting people where they're at. And if you're like, look, I'm not going to do all the things you said recommend, you probably need statin.

Yeah, but even then, like minimal effective dose. Don't put everybody on 40. If five does the, does the thing or ten or five three times a week. I mean, my, my goal is to make sure that the patient is getting adequately protected for the disease pathology that they have doing the right thing by them, but, but not overdoing it. You know, meeting them where they're at is easy for us to say, but it's complicated. You have to figure out does this person need a statin and by need will they benefit from it? And if benefit, will there be risk involved and do the benefits outweigh the risks? And so what number am I looking for? And I have patients that come in on 20, and they need it because they have coronary artery disease and ongoing dyslipidemia. But then we hit our marks for secondary prevention. We hit the cutoffs. We get the numbers low and sometimes I think they're too low and maybe their cardiologist disagrees with me. So we find a happy medium and I cut them from 20 to 10. And as long as their numbers don't go up, their cardiology doesn't say anything and they stay on 10. And now all of a sudden they feel less tired or they have less muscle aches. That's not a coincidence. So you have to kind of figure out what that sweet spot is. It's not black and white and it's not I'm pro or anti statin. It's, it's got to be individualized.

It can't be treatment by committee. Yeah, which is what it tends to. Committee said this. We follow the standard recommendations. And so every person gets the exact same recommendations that the committee said we're supposed to do, which is what the standard of care is. It's actually individualizing it, which is 100%. With statins, there's water soluble and fat soluble. Yeah, some get in the Brain better, which means you also have more neurological side effects. Yeah. Maybe you don't use those ones and use the less lipophilic statins, which some people don't realize. There's a difference.

Yeah.

Which probably correlates to the difference for people with Crestor versus, you know, Zocor, for example. Yeah. So 100%. So anyway, so that was supposed to be just hypertension, but we did. They're all. And it was, it was.

We were also exiting.

It was like. Anything?

No, I'm good.

And then we just went on like a 15 minute tangent. We're excited about this. You made me start talking about side effects of medication.

I know, man. But I'm telling you, we can. We can literally do 100 these. This is such an important topic and there's so much good information to get out there and I just really hope that people kind of absorb it and do something about it because this is how these chronic diseases that we're seeing on the rise that are killing millions and millions of people start going the other way. Like, we're seeing these. We're seeing these diseases in like younger and younger people. And it's just kind of crazy.

Did you read the white paper that came out in January with. I'm trying to think, I don't want to get political about stuff, but make America healthy again. That white paper came out. One of the five things on there that they recommended us researching was medications as a cause for crack health.

Interesting. Yeah.

Which if 30% of all drugs are mitochondrial toxicants. They also said processed foods, chemicals, which, I mean, that doesn't seem very controversial to me. But the idea that it's taken us this long to recognize that the drugs themselves may be problematic. Yeah, yeah. I mean, and that for us as functional medicine people, that's not questionable.

No, no.

It's like. Yeah, it's like that's part of what we learn is.

Yeah.

You know, the, the. Was it the doses, the. Sometimes the cure, the poisons in the dose. Yeah. And sometimes any doses has a little bit of poison. You just gotta be. You might need a little bit in some situation. But.

Yeah.

Anyway, now we'll officially stop and go to the next topic.

We'll move on.

That's it. Talk to y' all later. See ya.