Dr. Tom Refai explains how to control high blood pressure through diet and lifestyle. Cut sodium and eat more potassium-rich foods like legumes and vegetables. Even lean, active people can have hypertension, often from hidden sodium in processed foods, deli meats, and restaurant soups.
Questions this video answers
About 4,000 milligrams per day (speaker's estimate).
Around 2,000 milligrams per day (World Health Organization target; speaker's recommendation).
Below 1,500 milligrams per day (speaker notes possible slight additional benefit, but diminishing returns/practicality).
"20,000 plus hours of clinical experience" in metabolic medicine and intensive lifestyle intervention (as stated by the speaker).
About 10% body-weight reduction (and a roughly 10% reduction in abdominal circumference measured ~1 inch above the belly button).
Chapters
High blood pressure, hypertension, it can happen to just about anyone. Everybody, this is Dr. Tom Refai. I'm going to help you find where reality meets science. And the story behind this is I just ran into a wonderful colleague, an orthopedic surgeon, a phenomenal foot surgeon who has elevated blood pressure despite being lean, being physically active, exercising regularly, I mean looks great, but he's got hypertension. Of course you wouldn't know that. Most people over focus on the scale and they bias people who have excess weight when the issue regarding lifestyle can manifest in many different windows when it comes to blood pressure. The original silent killer, you wouldn't know. So it is important for everyone to understand how much control you have when it comes to controlling your blood pressure without medication or with as little medication as possible. Now, disclaimer. Yes, I am a very highly trained metabolic physician with 20,000 plus hours of clinical experience and intensive lifestyle intervention. I understand pharmaceuticals when it comes to blood pressure, insulin resistance, lipids, etc. But I am not your doctor. I am here to educate you though with that background so you can take this conversation to your doctor and have something more than just a pill thrown at you, which happened to my friend when he saw his primary care doctor. So a surgeon, a physician goes to see a doctor, blood pressure's high, throws him on a pill, doesn't even discuss, mention anything lifestyle change wise, just assembly line, take a pill, move on. Okay, so first I want to focus on this case study because there was nothing to be said in terms of excess weight, excess abdominal weight or lack of physical activity. We might argue that he doesn't get his 10,000 steps neat freak per day physical activity because he's in the office. But let's just set that aside as a relatively minor issue compared to what is really happening. And that is what I would call the sodium potassium axis. We eat too much sodium salt and too little potassium rich foods. Those potassium rich foods also happen to be great for magnesium and fiber. But I want to keep this simple. Where are we getting this excess sodium? Water retaining salt, artery stiffening mineral, more, way more than we need from. We're getting it from top number one, processed grains. They can even be whole grains, breads, rolls, cereals, tortilla wraps that are based on usually wheat corn tortillas by the way, tend to have virtually no sod added, usually no sodium added. That being said, we are talking about trying to get sodium down from what is probably close to 4,000 milligrams per day on average. You might read 3,300, that's more like the added sodium. We have natural sodium, that's fine. We don't worry about that. About 500, 600 milligrams, 700 a day. So we're talking about 4,000 milligrams. I would say that getting close to 2,000 is realistic. That's where the World Health Organization is. It's where I tend to recommend. Though I would be remiss if I didn't tell you that there is evidence that pushing it down even below 1500mg might be even slightly better. But at that point there's diminishing returns. And the reason I don't push that, although I want you to know about it, is I'm the doctor that helps you find where reality meets science. And we're swimming in so much salt that to tell large group of people, maybe some individuals, I could to try to keep sodium regularly below 1500 milligrams would be to try to hide the sun with my finger, maybe even my middle finger. It's just not really practical for most people getting under 2000 on most days. Yes. But the thing is, once you've identified those sodium sources, number one being processed grains. Look at the box. You now have a number. 2000 milligrams or less per day. If you can get under 1500, good for you. Look at the serving size. Look up foods online. You need to know some other high sodium traps. Stealth sodium from deli meats. Processed meats, they're lean. Yes. You see that Turkey breast, it's 99% lean, but it's from the deli and it's got a whole ton of sodium. Even In a little 2 ounce serving, you might be talking about 5, 6, 700 milligrams. And most people eat more than 2 ounces of deli meat in a sandwich. Now imagine that sandwich also has the bread and you can get into a sodium bomb kind of issue when there's very little high potassium food. Tomatoes, lettuce that might be slightly adorning your sandwich, but nowhere near the kind of ratios that you might see in the Dagwood pictures. You've seen from me where I will switch out the turkey deli meat for the much lower sodium and antibiotic free chicken and panera and then have them pile on kale and radicchio and spinach and onions and tomatoes. So it's just thick plant predominant potassium rich soups. Oh boy. Well, obviously if you make your own, you're great. You're dealing with typical canned soups or Restaurant soups. Watch out. You want to go to a restaurant and try to mitigate the risk. You know the trick. We've got a hack for you. You order a cup, not a bowl. That's portion control 101. Number two, make sure it is a broth based vegetable or preferably even bean based soup. I like my whole lentil soup, typically has some carrots and spinach in it as well. And eat it with a fork. That way you can drain out easily a lot of the sodium rich, low potassium broth relative to the vegetables and beans that will just leak right through cheese. Oh cheese boy. Especially processed, highly processed like American cheese you'll find on a typical hamburger at a fast food restaurant. Super high in sodium Swiss cheese is typically your lowest cheese. If it's a lowest sodium cheese, if it's a quality Swiss. This is not about fats, but I would say go for a reduced fat Swiss cheese if you must have cheese on a regular basis. I do some fat free feta cheese but and that's from a brand called President which is the least high. It's not low sodium present in fat free feta, but I use it in moderate amounts and I'm monitoring my sodium intake so that the rest of my day I make up for it. For instance, if I have toast with my egg white feta, spinach omelet, spinach being high in potassium, I'm going to have a low sodium Ezekiel with no salt added and toasted. But why would I need salt in my bread if I'm already going to get the salt flavor from the feta? So it's not as if you can't have anything with high sodium when you're controlling your sodium. You just have to know the amounts and then figure it into your budget and make sure that the rest of what you're eating isn't jacked up in sodium as well. And preferably a whole lot of fruits, vegetables, beans, lentils and peas. Those are where you can get some of the best potassium. And yes, in skim dairy products like yogurt and milk, you do have a high potassium to sodium ratio. Though there are other reasons to keep the animal products to a moderate. A moderate amount. To be honest, as a plant predominant flexitarian who believes in healthy eating, anywhere from plant predominant to plant pure, you don't need dairy to have a healthy high potassium intake at all. But if you do at least know that the low and no fat yogurts and skim and maybe half and possibly some 1% at most milk would have you know, reasonable doses of potassium used in moderation for other reasons. Mostly the potassium should be coming from our legumes, vegetables and whole fruits. Okay. Which we're not doing much or well enough in. Now that is for our doctor friend because he really didn't have a weight or physical activity issue. That being said, don't forget that aerobic and strength exercise on a regular basis really can accentuate blood pressure control. So can decreasing body weight. If it's excessive, shoot for a goal of about 10% weight reduction. And even better if you can measure your abdominal circumference about an inch above your belly button and reduce that by 10%. That would be huge. Obviously, the other factors are not smoking. And if you do drink, keep it moderate. Some people are quite sensitive to alcohol as far as its blood pressure raising properties. Okay, you add all of those lifestyle medicines up together and you can easily get the same effect as multiple pills. But you'll get an even better risk reduction because medications while effective and you should not switch or stop anything without discussing with your licensed healthcare provider first. Those medications are definitely band aids for equal blood pressure control. It is very likely you will get better heart attack, stroke, kidney dementia, risk reduction through lifestyle changes point per point that your blood pressure drops with lifestyle medicine versus pill medicine. Okay, so that is where reality meets Science with Dr. Tom Refai on blood pressure control. Based on a really interesting story today of someone you would look at and say, oh, you're a picture of health. But hypertension, the number one metabolic health issue as far as I'm concerned, while they're all correlated, I would put it higher risk than weight diabetes, the number one robber of life, the number one metabolic health risk and the number one nutrient of excess concern, of concern for excess in the US is sodium. So I hope that was helpful. Take care you spread this video around. Let people know that when you come to any place where Dr. Tom is or our reality meets science information products, you're going to get something that is meaningful, actionable, practical, and based on evidence, as well as mixed with lots of love and compassion. Take care.
