Treating The Underlying Causes Of High Blood Pressure with Dr. George Papanicolaou - Transcript

Dr. Mark Hyman (00:04): Welcome to The Doctor's Farmacy. I'm Dr. Mark Hyman. And it's farmacy with an F, F-A-R-M-A-C-Y. A place for conversations that matter. And if you're one of the millions and millions of people who have high blood pressure or you know with someone by blood pressure, this conversation's going to matter to you because it's with my friend and colleague at The UltraWellness Center in Lenox, Massachusetts, Dr. George Papanicolaou. He's one of our leading physicians here. He's an incredible guy who is doing great work here, treating patients. And they love him. I can just tell you, they love him. And I love him. So, it's all good. Dr. Mark Hyman (00:31): Now, we're going to talk about, in this special episode of House Call in The Doctor’s Farmacy, we're going to talk about high blood pressure or hypertension. So, George, tell us, how big of a deal is this? And what is the general approach of traditional medicine to dealing with high blood pressure? And why should we care? Dr. George Papanicolaou (00:50): Well, we should care because in the worldwide scheme of things, there is about 1 billion adults, which is about 25% of the adult population in the world, that has hypertension. Dr. Mark Hyman (01:02): 1 billion people have high blood pressure. Dr. George Papanicolaou (01:04): Yeah, it's 25%. Dr. Mark Hyman (01:04): Holy cow. Dr. George Papanicolaou (01:05): By 2025, they think it's going to be closer to almost 30% of the world adult population. And it's also considered one of the leading causes of mortality to mankind. So, it's a big deal. Dr. George Papanicolaou (01:18): And in our country, it's about 75 million Americans that have hypertension. That's 1 in 3. And an additional 1 in 3 have what we call pre-hypertensive condition. Dr. Mark Hyman (01:30): They have pre-high blood pressure. Dr. George Papanicolaou (01:30): Yeah. Pre-high blood pressure. So, the way it's staged, there's a category that's pre-hypertension. Dr. Mark Hyman (01:38): Well, what's interesting George is we constantly change the goalposts. Dr. George Papanicolaou (01:41): We do. Yeah, yeah, right. Dr. Mark Hyman (01:41): So, when I graduated medical school, the blood pressure we wanted was anything under 140 over 90. Then it was one 120 over 80. Now, we're down to 115 over 75 as being normal. So, why are we changing the goalposts constantly? Dr. George Papanicolaou (01:56): That's interesting, that's interesting. And, quite honestly, I'm not sure why we change the [crosstalk 00:02:01]. Dr. Mark Hyman (02:01): Why we change it, George, is this reason. Because we keep doing the research that's finding that even at lower blood pressures, people are experiencing the consequences of high blood pressure. So, what are the consequences of high blood pressure? Why should we care if our blood pressure's high? Because it's a silent killer, we call it. Dr. George Papanicolaou (02:18): Yeah. And that's the key. It's a silent killer. Dr. Mark Hyman (02:21): You don't know you have it. Dr. George Papanicolaou (02:21): People won't know they have it. And what it causes, it's one of the leading causes of heart disease. That's considered heart attacks, congestive heart failure, arrhythmias, which is the abnormal electrical activity in your heart that can lead to critical events. It leads to heart disease. Dr. Mark Hyman (02:41): So, big cause of all kinds of heart disease. Dr. George Papanicolaou (02:42): Yeah, yeah. Heart disease. It causes end-stage renal disease. Dr. Mark Hyman (02:45): Kidney failure. Dr. George Papanicolaou (02:46): Yep, kidney failure. And stroke. Dr. Mark Hyman (02:48): Stroke. Dr. George Papanicolaou (02:48): And stroke creates a great deal of mortality and morbidity for adult population. Dr. Mark Hyman (02:52): Even blindness, right? Dr. George Papanicolaou (02:53): Yep. Dr. Mark Hyman (02:54): Hypertension. Dr. George Papanicolaou (02:55): Microvascular disease and blindness. Dr. Mark Hyman (02:58): Can lead to dementia because of its effects on the vascular system in the brain. And also affects things lower down, right? Dr. George Papanicolaou (03:04): Yeah. Dr. Mark Hyman (03:05): Like sexual function. Dr. George Papanicolaou (03:06): Oh yeah, oh yeah. Dr. Mark Hyman (03:07): The blood vessels get problematic in your sexual organs, you're not doing things normal. Dr. George Papanicolaou (03:14): Microvascular disease in the penis. It can definitely result in erectile dysfunction. And that's not a good state. Nobody likes that. Dr. Mark Hyman (03:21): It also causes stiffening and hardening of your arteries and you get vascular problems in your legs and blood flow issues.. Dr. George Papanicolaou (03:26): Peripheral artery diseases is a major issue and particularly if you have diabetes, then you have two things that you have to deal with, the diabetic changes that create the peripheral vascular disease and also the hypertension. Dr. Mark Hyman (03:37): And you can get literally blood flow issues. You need amputations. So, this is a serious problem. Dr. George Papanicolaou (03:42): Yeah. Very serious. Dr. Mark Hyman (03:42): And a billion people have it. In America, a lot of people have it, right? Dr. George Papanicolaou (03:46): Yeah. Dr. Mark Hyman (03:47): 50 to 75 million Americans. Dr. George Papanicolaou (03:49): Absolutely. And growing. Dr. Mark Hyman (03:51): And how many people are actually treated well? It's probably like 14 million out of those 50 to 75- Dr. George Papanicolaou (03:57): Yeah. And as we talk about, that treatment is primarily medication. It's not always effective. It has lots of side effects. And there's so many other ways to treat hypertension besides just using pharmaceutical agents. Dr. Mark Hyman (04:10): And we have determined that by treating people's blood pressure with medications, that people do reduce their risk of these complications. So, it's important to understand that if you have high blood pressure, you need to treat it, whether it's with the things we're going to talk about or medication, you can't let it go. Dr. Mark Hyman (04:28): And it's something you should do as a preventive strategy. You can go to the drug store. They have blood pressure machines. You can stick your arm in. Or you can buy one for next to nothing in the drug store. 29 bucks. And you can monitor your blood pressure. Dr. Mark Hyman (04:40): Now, part of the problem with diagnosing blood pressure is that it's often hard to know if you have high blood pressure because one, it fluctuates all day long; two, just getting one blood pressure reading in the doctor's office may not really tell you what's going on. You might have white coat hypertension, meaning you get nervous and stressed. It goes up. I mean, when you exercise, your blood pressure goes up. When you're stressed, your blood... But what's your average blood pressure? Dr. Mark Hyman (05:04): So, one of the diagnostics we do is a 24-hour blood pressure test, which I found really effective because you can see what's happening when they're sleeping, when they're active, when they're inactive. And you get a really good sense of what their pattern is, day, night and average. And that'll tell you what your real risks are. Dr. George Papanicolaou (05:20): Right. So, doing 24-hour ambulatory monitoring is something that is really important to do, particularly if you have any concern that the readings you're getting in your office are inappropriate. And you mentioned white coat hypertension. And that is not uncommon; it actually is fairly common. And so, we will oftentimes recommend ambulatory blood pressure readings. And that gives us the clearest picture possible. Dr. Mark Hyman (05:42): Yeah. It's true. And sometimes you can just get a cuff at home and have people monitor their blood pressure throughout the day and that'll help too. Dr. Mark Hyman (05:47): I want to just dig into a little bit before we get talking about the difference with functional medicine and traditional medicine. Traditional medicine's you check your pressure, it's high, you get medication, you monitor it. We call it essential hypertension. Now, there are other causes of hypertension that we know of, that are kidney diseases and other problems, but, for the most part, people call it essential hypertension, which I joke and I say, "It means essentially we have no idea what's causing it," but functional medicine- Dr. George Papanicolaou (06:16): But we know that's not true. Dr. Mark Hyman (06:17): We know that's not true. So, everything has a cause. Nothing is just random. If you have diabetes, it's not a random event. It's not like, "Oh, I got a virus." Something happened. Dr. George Papanicolaou (06:29): [crosstalk 00:00:06:28]. Yeah, diabetes [crosstalk 00:06:30]. Dr. Mark Hyman (06:31): Now, we know some of the major causes of high blood pressure are never addressed. And the two biggest ones that I see, treating patients, is insulin resistance- Dr. George Papanicolaou (06:40): And sleep apnea. Dr. Mark Hyman (06:42): ... and sleep apnea. So, one of the biggest factors is insulin resistance, which is an epidemic in this country. We have 1 in 2 Americans are prediabetes or type 2 diabetes, 75% are overweight, 42% are obese. And they all have some degree of trouble regulating their blood sugar, which causes them to get belly fat. Dr. Mark Hyman (07:02): And that belly fat is such a big factor in driving all sorts of diseases, everything from high blood pressure to cancer to heart disease, to diabetes to dementia to depression and so on. But the insulin resistance drives inflammation. And it drives inflammation throughout the body because those belly fat cells aren't just sitting there holding up your pants, they're dynamic, hormonal and immune organs. Your belly fat is an immune organ and it drives inflammation throughout your body. And that causes oxidative stress, which is really what causes rusting. So, it's like your arteries and your pipes are rusting and stiffening, called hardening the arteries. And that happens as a result of this inflammation and oxidative stress. Dr. Mark Hyman (07:46): And so, insulin resistance is probably the biggest cause of that today in America. And it's really driven by diet. So, I think people don't understand how powerful that is. Dr. George Papanicolaou (07:55): Diet is very powerful. You mentioned the adiposity we have around our waists. I call it the toxic waste dump of the body. And that fat just does have a metabolic effect that is toxic to the body. And, as you said, it creates the hardening of the arteries, which is one important cause of high blood pressure. Dr. Mark Hyman (08:16): Yeah. And the other big thing that's often misdiagnosed... And by the way, insulin resistance affects so many people. 90% are not diagnosed. So, the way you diagnose it is you do a test for insulin and blood sugar and hemoglobin A1c. Dr. George Papanicolaou (08:29): And fasting glucose tolerance test, that we do, I do on almost every patient. Dr. Mark Hyman (08:33): Yeah. And this is the other test, it's a little more advanced, where you take a sugar drink, basically drink the equivalent of two Cokes, check your blood sugar and insulin fasting and then every one and two hours after. But most doctors just check blood sugar, but that's a very late finding. You want to check insulin early on. Dr. George Papanicolaou (08:46): And even been doing a fasting insulin isn't going to give you an answer in some- Dr. Mark Hyman (08:50): It'll help. Dr. George Papanicolaou (08:50): Yeah. It helps, but- Dr. Mark Hyman (08:51): But by the time your insulin goes up fasting, it's already down the road pretty far, right? Dr. George Papanicolaou (08:55): Yeah, yeah. Dr. Mark Hyman (08:56): So, I agree. And then, we have this other issue, which is sleep apnea, which is so underdiagnosed. Dr. George Papanicolaou (09:03): Yeah. So, sleep apnea, there are about 25 million Americans that have sleep apnea. It is underdiagnosed. It's not just a disease of people that are overweight. Most people think about obstructive sleep apnea being related to just being overweight. But you also can have upper respiratory anatomy and muscular relaxation that, even if you're thin, you can have obstructive sleep apnea. Dr. Mark Hyman (09:26): Yeah. Even narrow palate, the small airway, you have sinus issues. Dr. George Papanicolaou (09:32): Right. And when you have sleep apnea, that means you're just not getting enough oxygen to your body, particularly your brain, also to all your blood vessels. And your cortisol levels rise. And then you get into that whole cycle you talked about before, which is an inflammatory cycle, which is an oxidative stress cycle, which can lead to hardening of the arteries. Dr. George Papanicolaou (09:51): And when you're not getting oxygen to those blood vessels, then they actually can't perform the work they need to do and create the energy they need to have. And so, they can't contract and expand the way they should. And that can result in high blood pressure. Dr. Mark Hyman (10:05): Yeah. And then it also drives insulin resistance. So, if you have sleep apnea, it also causes you to be pre-diabetic- Dr. George Papanicolaou (10:11): Weight gain. Yeah, it causes weight gain. Dr. Mark Hyman (10:12): ... independent of what you're eating. Weight gain. Dr. George Papanicolaou (10:13): It causes weight gain. It leads to insulin resistance. It leads to diabetes, which complicates everything. Dr. Mark Hyman (10:17): I mean, I had this guy who couldn't lose 50 pounds. He was a lawyer. And he told me this story. He said, "Look, I need to lose the weight. I don't know what to do. I'm trying to eat right. It's not working. I'm trying to exercise." I said, "What's your life like?" He says, "Well, I'm a lawyer and I work really hard, but every day I have to stand up at my desk. I can't sit down." And this was before standing desks. And I'm like, "Why?" He says, "Well, if I sit down, I fall asleep." And I'm like, "Gee, maybe you have sleep apnea." Dr. Mark Hyman (10:47): So, if you're falling asleep at work, if you fall asleep in front of the TV, if you feel tired during the day, if your wife says you're snoring, now there's apps you can get that actually record your... On your phone, they record your snoring so you can see because people don't believe it, "Oh, I don't snore." Dr. George Papanicolaou (11:01): I love that app by the way. Dr. Mark Hyman (11:03): And then there's one called Sleep Cycle that I like. It records your snoring. And it's something that is easy to treat. I mean, there's different methods, there's sleep app, but it is a treatable condition. And the weight loss then will happen and you'll feel better. So, that's really important. Dr. Mark Hyman (11:18): I just want to talk about a few other causes that I think are really important and worth noting because those are the two biggest ones, but there's a lot of other ones. People who are nutritionally deficient in certain things can cause high blood pressure, like magnesium. Dr. George Papanicolaou (11:34): Right. Studies show that there's a very large percentage of people in our country have low magnesium. Dr. Mark Hyman (11:40): 45% of people have low magnesium, which is a- Dr. George Papanicolaou (11:44): And you know magnesium, it's not magic, but when we replace magnesium in patients we see amazing things happen. We see blood pressure come down. We see them being able to sleep better. We see muscle twitching and cramping go away. We see mood improve. Magnesium has a very important role in the body and certainly plays a big role in lowering blood pressure. Dr. Mark Hyman (12:05): Yeah. I call it the relaxation mineral. And it's funny how, in medicine, we have these blind spots. But when I was training in obstetrics and gynecology, I was a family doctor, I delivered lots of babies, there's this common condition that women get called preeclampsia, which is high blood pressure in pregnancy. And when they come in and their blood pressure's high, which can cause seizures, the treatment isn't high blood pressure pills- Dr. George Papanicolaou (12:27): No. It's magnesium. Dr. Mark Hyman (12:27): ... because they don't tend to work. We give them intravenous magnesium to relax their blood vessels and save their life. And it's just a strange thing to me. We don't think about it that way. Dr. Mark Hyman (12:40): The other thing that is important is omega-3 fats and fish oil because it helps relax your blood vessels, make them more pliable. But there's other causes that we also see, for example, environmental toxins. Heavy metals, in particular, lead and mercury are really common. They're underdiagnosed. And when you go in your high blood pressure visit, your doctor's not checking your mercury and lead levels, not even in your blood and probably not on the most important test, which we do at the UltraWellness Center, which is a challenge test, where we give people a drug to pull out the metals, a chelator. And then we check their urine and see how much dumps in there. And if they have high levels, that's often a big factor as well. Dr. George Papanicolaou (13:14): Right. And I think you're really hitting on all the things that I think about. And I tell people when they come to me and hypertension is part of what they want me to work with, I said, "We're going to get your hypertension better by not treating your hypertension. We're not going to treat your hypertension; we're going to treat everything else that's causing your hypertension. We're going to find the sleep apnea. We're going to find the nutritional deficiencies. We're going to work on your stress levels. We're going to help you lose weight. When you lose weight, I mean, you actually are going to drop your blood pressure." Dr. George Papanicolaou (13:43): I think the number is per pound, I think... For every two pounds you lose, you drop your blood pressure by a millimeter of mercury. So, if you lose 20 pounds, you can drop your blood pressure by close to 10 [crosstalk 00:13:57] mercury. Dr. Mark Hyman (13:57): Diet is so key. We created a program called the 10-Day Reset, which you can find in We put 1,000 people through it, tracked their blood pressures. It was incredible. Their blood pressures dropped an average of 20 points in 10 days. Dr. George Papanicolaou (14:14): Well, if you think about that most Americans are at least 25 pounds overweight or... So, let's- Dr. Mark Hyman (14:19): It's better than medication results. Dr. George Papanicolaou (14:21): Exactly. If you get them to drop that 25 pounds, they're going to drop their blood pressure by near 15 millimeters of mercury. Dr. Mark Hyman (14:28): Yeah. So, we have insulin resistance, sleep apnea, low magnesium, low omega-3 fats, which about 90% of Americans have. You have heavy metals, environmental toxins. Dr. Mark Hyman (14:40): And we now are learning that the gut microbiota, the microbiome in the gut, if it's altered through our bad processed diet and all the nasty drugs we take, it actually causes inflammation throughout the body that drives high blood pressure. Anything that causes inflammation or oxidative stress will cause high blood pressure. Dr. Mark Hyman (15:00): And the thing that struck me, and this is stuff that's in the traditional medical literature, is that high blood pressure is an inflammatory disease. And we treat it like a plumbing problem. Dr. George Papanicolaou (15:09): We do. And going back to the nutritional piece, low potassium can be another reason why you can have high blood pressure. And that speaks to where do you get potassium. You get it from green, leafy vegetables. So, having a vegetable-based diet is very, very important. Dr. Mark Hyman (15:26): I love my green smoothie in the morning. Dr. George Papanicolaou (15:28): Absolutely, yeah. More kale, more kale. Dr. Mark Hyman (15:31): Yeah. So, this is very important. I think people also think about salt. So, people think, "High blood pressure? Salt." But what's the deal with salt and high blood pressure? Is this something we should worry about? Is it as big a deal as we thought? Dr. George Papanicolaou (15:44): It's not something everybody needs to worry about. There's certain populations that are going to be more salt-sensitive than others. And so, we can actually do genetic tests, and we do them here at the UltraWellness Center, that lets us know if you have those genes that make you more sensitive to salt, more likely to have high blood pressure. So, we do need to be concerned about it in certain populations and limit it. Dr. George Papanicolaou (16:03): It's the salt we add to our food that is the problem because it's processed, all the natural nutrients are taken out of it. It can be iodized. And iodine can cause problems. Dr. Mark Hyman (16:16): So, it's not the salt that we personally add in our kitchen. It's the salt that's added in factories to processed food that allows huge amounts of intake of salt because how do they make junk ingredients taste edible? Dr. George Papanicolaou (16:27): Salt, fat and sugar. Dr. Mark Hyman (16:30): Salt and sugar and processed fats, right? Dr. George Papanicolaou (16:31): Yeah. So, we know that. But if you get really good salt, sea salt, that you've purchased, that actually has nutrients in it that can be valuable to you. Dr. Mark Hyman (16:42): Minerals and so forth, yeah. So, these are some of the common causes we see and they're often things that aren't looked at. And when you go to your doctor with high blood pressure, they're not checking your heavy metals. They're not checking your insulin resistance. They're not checking necessarily sleep apnea, although some might be thinking of that. That's just good medicine. They're not checking your magnesium or anything. Dr. George Papanicolaou (17:01): And the reality is, is that because when I was practicing private medicine before I started functional medicine years ago, I was being graded on, if I had a high blood pressure patient, if I had them on certain medications to lower the blood pressure. So, my reimbursement was based on whether or not I was using medication, not whether or not I was finding the root cause of the problem, not whether or not I was helping somebody lose weight, not whether I was counseling them on how to lower their stress with meditation. That didn't drive it. And so, in contrast to what we do in functional medicine, we focus on making those changes that really get to the root of the problems and the causes we just talked about. Dr. Mark Hyman (17:49): Absolutely true. I think the traditional approach of medicine is you diagnose and then you treat. When we diagnose, you say you have high blood pressure, that's the first step in our thinking. Then we start to ask, "Why? Why? Why?" Dr. Mark Hyman (18:03): And everybody gets treated differently. In some patients, the treatment of high blood pressure is getting off the sugar and starch. Another person, it might be treating their sleep apnea. Another person, it might be- Dr. George Papanicolaou (18:13): Weight loss. Dr. Mark Hyman (18:13): ... detoxifying from heavy metals. Another person, it might be giving them extra magnesium. And then, we have a lot of techniques that we can use to help mitigate this: sleep, stress management, exercise. Exercise lowers blood pressure. Dr. Mark Hyman (18:27): So, it's often frustrating to me, understanding how the body really works, when I see this knee-jerk response in medicine. It just feels like we're missing the boat. And this is not stuff that we're making up in functional medicine; this is all in the science. It's all in the literature. Dr. George Papanicolaou (18:44): You just have the listen to the patient because the clues are always going to be there. I can't tell you how many of my patients that come into the UltraWellness Center, I ask them... So, they're fatigued. We have a lot of patients that come with chronic fatigue or fatigue is part of their complex of complaints. And I ask them if they snore. Dr. Mark Hyman (19:03): They don't know [crosstalk 00:19:03]. Dr. George Papanicolaou (19:05): "Yeah, I snore. Yeah, I snore." They say, "Yeah, my wife tells me that I snore all the time." I said, "So, how long's that been going on?" And I say, "Has anybody asked you whether you snore before? Has anybody asked you if you wake up refreshed? Has anybody asked you if you have daytime fatigue?" And no, they've gone years and nobody's really explored it. So, you have to listen to the patient and ask why and ask it again and keep asking questions, so you make sure you have the whole terrain mapped out. Dr. Mark Hyman (19:32): Yeah, yeah. That's beautiful about functional medicine. We really do a very detailed history. So, people say, "How do you diagnose?" Mostly history. I mean, we do a 32-page questionnaire, which is annoying for patients, but it allows us to get a really deep sense of what's going on. Dr. George Papanicolaou (19:45): So, Mark, how many times have you had a patient come in who has, let's say, high blood pressure? And maybe they're having headaches, they're having migraines. But they have the high blood pressure. They may be a little bit overweight. They have high cholesterol. But they have heartburn or they have, "Yeah, I get occasional heartburn. I take a PPI. I take an H2 blocker." These are- Dr. Mark Hyman (20:07): Acid-blocking medications. Dr. George Papanicolaou (20:08): ... acid-blocking medications. And they don't connect it to their high blood pressure. Dr. Mark Hyman (20:15): Right. Why is PPI or acid-blocking medications a problem? Because it inhibits acid production, which you need to absorb magnesium, right? Dr. George Papanicolaou (20:21): Right. Dr. Mark Hyman (20:21): And so, you go, "Oh, wait a minute- " Dr. George Papanicolaou (20:21): ... and calcium and vitamin D, which can be impacted. And they have, "Oh yeah, I also have difficulties with constipation or I get loose stools." You know what? There's a connection between the gut and the blood pressure. Dr. Mark Hyman (20:38): So, tell us about this patient you had who you treated with [crosstalk 00:20:41]. Dr. George Papanicolaou (20:41): Okay. Well, I'm glad because this is a perfect segue because he had gut issues. And that sort of is what really was leading to his high blood pressure. So, here's the gentleman that came in. Dr. Mark Hyman (20:51): Because gut issues leads to inflammation. Dr. George Papanicolaou (20:52): It leads to inflammation. And it's not just inflammation in the blood vessels; it's inflammation in the gut lining. So, you can get this nonspecific, lymphocytic infiltration. It's basically inflammation that- Dr. Mark Hyman (21:05): That means a lot of white blood cells show up in the gut and makes it inflamed. Dr. George Papanicolaou (21:08): Exactly. And so, what happens though, is then you get a malabsorption of minerals and nutrients. That's when you don't absorb vitamin D. That's when you don't absorb potassium. That's when you don't absorb your calcium. That's when you don't absorb your magnesium. Those are the things that can help regulate blood pressure. Dr. George Papanicolaou (21:27): So, with this particular patient that came in, he was a 52-year-old gentlemen and he had been diagnosed with blood pressure, high blood pressure about almost a year prior to coming. And they'd tried multiple blood pressure medications and he had different side effects, which is one of the issues with blood pressure medicines. Dr. Mark Hyman (21:45): Oh yeah, there's that. We forgot to talk about that. Dr. George Papanicolaou (21:47): Exactly. So, that's a big problem. Lots of people have side effects. They get dizzy. They get tired. They get erectile dysfunction. They get lower libido. They've been hair loss associated with their high blood pressure medicine. So, he had been put on different medications that resulted in loss of libido, fatigue, brain fog. One of the medications actually caused dehydration that resulted in him being in the emergency room, where they found his potassium to be really, really low and it had to be replaced. Dr. George Papanicolaou (22:18): So, he was like, "I'm coming here because I want a different approach to my blood pressure." So, as we go through our new patient packet that's very long, some things that started to stick out were that he did have fatigue and he also had irritable bowel syndrome. And I asked him to explain that to me. And when I hear irritable bowl, I don't hear this... Again, we talk about like- Dr. Mark Hyman (22:46): It's just a syndrome. Dr. George Papanicolaou (22:47): Yeah. Like essential hypertension, we essentially don't know what's causing it. It's like we say, "Irritable bowel," it's like, "You know what? Your diarrhea's irritating me. I don't want to talk about it." We don't want to get to the bottom line of it. Dr. Mark Hyman (22:58): Well, it's not even that. They don't know. In other words, when we say people have irritable bowel, like, "Oh, the reason you have bloating and gas and diarrhea and constipation is because you have irritable bowel syndrome." Dr. George Papanicolaou (23:07): No. Dr. Mark Hyman (23:07): No. That's just the name we give to people who have those symptoms. It doesn't tell you about the cause. And that is what's unique about functional medicine, is we have a methodology, an operating system to navigate to the root cause. And we treat that. And we don't have to treat the hypertension; we treat the cause and the disease goes away as a side effect. Dr. George Papanicolaou (23:24): Right. And so, in this particular case, we did testing for the gut microbiome. And we can also do testing that tells us some things about the gut. So, we can find out if there is inflammation in the endothelial lining. And that's basically, if you look down a really big stainless steel tube and it's really shiny. Imagine that shiny layer is basically a very thin membrane that protects the rest of the tube from anything that's going in the tube. So, that's the endothelial lining, that very shiny stainless steel. Dr. Mark Hyman (23:54): It's basically like I have one cell layer between you and the sewer, right? Dr. George Papanicolaou (23:56): You got it, exactly. Dr. Mark Hyman (23:58): Your immune system and the poop inside of you. Dr. George Papanicolaou (24:01): That's a great way to put it. So, when that membrane gets inflamed, it cannot function to absorb nutrients the way it should. And that can lead to all of the things I just spoke about earlier in regards to low magnesium, low vitamin D, low calcium. Dr. George Papanicolaou (24:20): And so, we know that people who have irritable bowel, there's a good percentage of them have non-celiac gluten sensitivity. And so, that triggered my thinking. And that's why I ordered that test that will look at whether you have leaky gut, whether you have gluten sensitivity, and whether you have crossover to other foods like gluten that can create gluten-like impact on the gut. Dr. George Papanicolaou (24:44): And so, with this particular gentleman, I also did a whole host of metabolic tests and included a glucose tolerance test. I also looked at his magnesium levels. I looked at inflammatory markers that- Dr. Mark Hyman (24:57): Omega-3 fats. Dr. George Papanicolaou (24:58): Omega-3 fats that we look at. So, we did a comprehensive metabolic evaluation. I looked at a very expansive profile that looks at macronutrients, micronutrients, organic acids, amino acids that gives us a really good, clear picture of what his nutritional status is, whether the very important energy making systems in his body are actually working the way they should. Are they getting the nutrients that they need? Are they being blocked from doing their work by toxins? We do this panel that gives us all that information. Dr. Mark Hyman (25:28): And this is a very unusual panel in traditional medicine, but we're looking not for disease; we're looking for imbalances or dysfunction that we can correct, that will help the body do what it's supposed to do. Dr. George Papanicolaou (25:38): Exactly. So, I gathered all that information with a lab test. But the most interesting thing about this gentlemen is that he had one gene positive. It's a gene that would express for celiac disease. But the tests that we do to see if he actually had celiac disease were negative. Dr. George Papanicolaou (25:59): And what we know about who people have at least one or both of the celiac genes that do not have active celiac disease is they're more likely to be sensitive to gluten. And indeed, he was. He had two things going on on that panel that we do to evaluate inflammation and antibody interaction or where the immune system creating antibodies against gluten in the body. Dr. George Papanicolaou (26:22): So, he did have leaky gut, meaning that endothelial lining, that one thing saving you from the poop in the center of your intestine from the rest of your body, was leaking. And so, the immune system was creating antibodies. So, we knew there was inflammation. And the second thing was he had enormous numbers that showed that he was sensitive to gluten. And so, that gluten sensitivity- Dr. Mark Hyman (26:46): It's not celiac because people understand that there's celiac. And most traditional medicine's like, "You either have celiac- " Dr. George Papanicolaou (26:53): Or nothing. Dr. Mark Hyman (26:53): "... or you're fine." But now there's an increasing body of research, particularly by Dr. Alessio Fasano from Harvard, that shows that a lot of people have non-celiac gluten sensitivity, which you can tell through antibody testing a little bit. But it's a milder case, but it still causes leaky gut, inflammation and many, many problems. Dr. Mark Hyman (27:11): And then there's a whole another category, which you can't measure on lab tests, called the innate immune system response or cell-mediated response to gluten, which means you can't measure it because it's just a generalized irritation of your immune system. So, that can be a case, even if these other things are normal. So, gluten is often driving leaky gut. Dr. George Papanicolaou (27:29): And it's often overlooked. Very overlooked. Particularly in a case like this. Dr. Mark Hyman (27:35): And a normal doctor will check your levels. And if they're normal, quote "normal," like it's 0 to 20. Is 19 the same as 1? No. Dr. George Papanicolaou (27:44): No, not at all. Dr. Mark Hyman (27:45): Is 5 the same as 0? No. Dr. George Papanicolaou (27:48): No. Dr. Mark Hyman (27:48): So, I think we have to understand that if there's any level of antibody, it means there's some irritation of your immune system that's causing potential symptoms. Dr. George Papanicolaou (27:55): Yeah. So, in his particular case, I put him on a gluten-free diet. And honestly, I didn't put him on gluten-free diet. I identified the gluten sensitivity. And here at the UltraWellness Center, we have amazing nutritionists. And when I discuss these types of cases, then they develop a program for a patient that is going to be customized to what their needs are. Dr. George Papanicolaou (28:24): So, in this particular case, he was on a Mediterranean diet that was gluten-free. And that made all the difference. And when he tried to re-introduce gluten back into his diet, his blood pressure went back up. So, it was driving the inflammation that was driving his blood pressure. Dr. George Papanicolaou (28:41): And he was also low in vitamin D, which was impacted by his gluten because gluten will keep you from absorbing iron and magnesium and potassium and calcium. And it can have impacts on lowering vitamin D. Dr. Mark Hyman (28:52): And vitamin D regulates inflammation too, so you're in this- Dr. George Papanicolaou (28:53): It regulates inflammation. Dr. Mark Hyman (28:56): ... interactive, dynamic biology where everything's connected. And that's really what we do in functional medicine. Dr. George Papanicolaou (29:00): Yeah. And there's a lot of observational studies that show that in people that have low vitamin D and you replace it, you can lower their blood pressure, particularly in people over 50. Dr. George Papanicolaou (29:11): So, I replaced his vitamin D, put him on a gluten-free diet, and gave him things that we know that work. Omega-3. He wasn't eating a lot of fish, so we gave him omega-3s. I also added in some CoQ10 and magnesium. Dr. George Papanicolaou (29:25): And he did phenomenally well. He never went back. Well, I shouldn't say never. He's been my patient for about eight months now, but his blood pressures have been normal. Dr. Mark Hyman (29:35): Yeah. So, this is really an incredible story, which is- Dr. George Papanicolaou (29:39): No medication, no side effects. Dr. Mark Hyman (29:40): And here's the view in traditional medicine: essential hypertension is a one-way street. Once you got it, you got it. You got high blood pressure? You can't get rid of it. You just got to treat it. And that just is not true. If you address the root causes, which is what we do with functional medicine and what we do at the UltraWellness Center, we can often get to the bottom of this. Dr. Mark Hyman (30:01): Now, there are some people who have more genetic factors or it's more difficult to treat, but for the most part we can have huge impacts on people's lives and health and well-being using this approach of functional medicine. And it's so refreshing and it's so invigorating as a provider because we're not just managing these diseases; we're getting rid of them. And we're not treating them; we're treating the factors that are causing them. And the diseases go away as a side effect. Dr. George Papanicolaou (30:28): Yeah. I can't say it any better than that, Mark. We do it. And you've been doing it here at the UltraWellness Center for almost 20 years. And we continue to do it. And we work as a team to do it. And we have worked on the things that you've written about for years. And we've established some really great ways to approach our patients. Dr. George Papanicolaou (30:55): And so, this patient has benefited from that. I actually had read another case in a functional medicine journal that clued me into this, so it was in my mind to think about it. So, he was really excited that, by changing his diet not only is he improving his blood pressure, but he was also going to improve his health span. And those are those years of health without disease. Dr. Mark Hyman (31:23): Yeah. [crosstalk 00:31:24]. Dr. George Papanicolaou (31:25): And also, health without side effect from medication. Dr. Mark Hyman (31:27): Yeah. Well, that's it. So, the side effects of this approach are all good ones, right? Dr. George Papanicolaou (31:31): Excellent ones. Dr. Mark Hyman (31:32): I mean, getting your omega-3 levels is better hair, skin and nails and overall well-being and mood. Vitamin D helps your immune system. Magnesium helps you more relaxed and less anxious and sleep better and have better bowel movements. So, you basically get all these nice side effects by fixing these problems. It's great. Dr. Mark Hyman (31:48): So, George, thank you for sharing this incredible case and talking about high blood pressure, which affects a billion people- Dr. George Papanicolaou (31:53): Worldwide. Dr. Mark Hyman (31:53): ... and which is really something we have really been poorly treating with traditional medicines. I'm so excited that we get to have this conversation and be here at the UltraWellness Center. Dr. Mark Hyman (32:02): And I encourage everybody who's concerned about high blood pressure, who has it or has someone in their family they love or someone they know, to share this information with them. We, at the UltraWellness Center here are now doing all virtual visits. We can do patients from anywhere in the world through Zoom and do great jobs with getting you tests where you are. You can certainly come in if you want. And we'd love to see you. Dr. Mark Hyman (32:22): So, just go to to learn more about our practice. And I would love you to share this podcast, if you liked it, with your friends and family on social media. Leave a comment. We'd love to hear from you. Share your story about how you may have tackled your high blood pressure. And subscribe wherever you get your podcasts. And we'll see you next time on The Doctor's Farmacy.