Transcript - Stop Blaming Salt: Fixing High Blood Pressure by Treating the Root Cause

Dr. Mark Hyman
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. Before we jump into today's episode, I 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 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 and a's, exclusive content, and direct connection. For real time lab testing and personalized insights into your biology, visit Function Health. You can also explore my curated doctor trusted supplements and health products at doctorhyman.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. Ninety three percent of Americans have either high blood pressure, high cholesterol, high blood sugar, have had a heart attack or stroke or are overweight. That means that about six point eight percent of Americans are actually healthy and don't have any of these problems. That's scary, that's adult Americans over 18.

So why is this going on? It's because our diet is so bad. We have a very inflammatory diet, creates a lot of oxidative stress and high blood pressure is a problem of inflammation and oxidative stress. And what's triggering that often is the insulin resistance which is triggered by the mountains of sugar and flour we have every day. I mean, the average American has about 152 pounds of sugar and 133 pounds of flour a year, that's almost a pound a day.

And that is driving lots of metabolic issues, insulin resistance, organ fat, and that creates a whole cascade that drives up blood pressure and causes weight gain. And it's really, really important to address those causes. So there are other factors. Heavy metals can be a big factor. Often undiagnosed heavy metals, lead, mercury can drive a lot of issues.

Sleep apnea, another big factor. If you have sleep apnea, you snore at night, it may be driving high blood pressure. Lots of nutritional deficiencies can be a factor. Omega-three, magnesium deficiency, very common, magnesium deficiency about half the population. Omega-three is over ninety percent of the population.

So these are really treatable causes. And obviously stress, lack of exercise, certain environmental toxins all can drive these problems of high blood pressure. And a quarter of the population who are adults worldwide have high blood pressure or hypertension. And a lot of people have pre hypertension, which is sort of early hypertension. We know the levels we say of like one hundred forty over ninety, even when you're down one hundred twenty over 80, you're still have risk.

Below one hundred ten over 70, you're doing good. So most of us don't have blood pressure like that because of our lifestyles, because of our diet, because of the stresses of our environment, of lack of exercise, because of all the inflammatory things. And then high blood pressure is a real killer. It's the silent killer. You often don't know you have it, but it's a huge driver of kidney failure, strokes, heart attacks, dementia.

Dr. Mark Hyman
It's a big deal.

Dr. Mark Hyman
Now normally it's treated with medications and often combinations of medications, which can help reduce the risk of these complications, but it doesn't address the root cause. So we've got to figure out the root cause. These medications are not risk free. Often they have side effects. In functional medicine, really focus on dealing with the root cause, whatever it is.

What's the cause of high blood pressure? So what's really wrong with our current approach? We are just using whack a mole medicine. We treat the symptoms to suppress them with medication without ever really digging into why. So what about salt?

Cause that's a big question, right? Is salt the cause of high blood pressure? Well, no, we need salt. But the problem is since we were hunter gatherers, our ratio of salt and potassium is completely flipped. We used to be 10 times as much potassium as sodium, or potassium as salt, but now we have 10 times as much sodium as potassium.

And potassium helps you lower your blood pressure. Potassium actually is a very important mineral that we are not getting enough of, but it comes primarily from plant foods. So when you're eating a lot of plant foods, you're getting a lot of potassium. If you're eating a lot of processed foods, you're getting a lot of salt. How do they make basically refined oils, flour and sugar taste edible?

They often will add a lot of salt to the product. So it's really a problem with added salt in this country and lack of the right amounts of fruits and vegetables that can help to provide the right amount of potassium. So we need salt, it's not bad. And there are certain patients that are salt sensitive genetically, often African Americans that have to really restrict salt or watch their salt intake. But most of us don't really have to worry so much about salt if we're not eating processed food.

It's not the salt that you add to your diet, it's the salt that's added by corporations and processed food. So if you wanna add a little salt on your food, don't worry about it. If you are using salt, it's actually tricks you can actually put on after you cook and just put it on top of the food and you'll get the same kind of salt flavor without having even as much sodium. But the key is to actually increase dramatically your plant foods to include enough potassium. And that's really the issue.

So a lot of unprocessed plant foods that have a lot of potassium are spinach, broccoli, squash, avocados, papayas, bananas. Also you can make broth if you make a lot of root vegetable broth, greens, mushrooms, boil them up. You don't have to eat the mushy vegetables, but strain it and drink the broth full of potassium. I call it the ultra broth, and there's an ultra broth recipe on our website. We'll link it in the show notes.

Now, if you have high blood pressure, you know, you'll be told to cut your salt, but that may not be a great idea. And there's some studies that kind of say that maybe we shouldn't be so aggressive about lowering salt for everybody if we're having them eat a whole unprocessed diet. So in fact, in one study on heart failure patients, those who were salt restricted were eighty five percent more likely to die or be hospitalized than those who did not limit their salt intake. Now, again, there are people who are salt sensitive, so be careful. So where get are you your salt?

Well, it from foods which is naturally occurring in there. Basically it's high in things like meat and carrots and beets and beans, but you can add a little bit of salt like Himalayan pink sea salt is great. Redmond salt is great from Utah. I like those. You want to make sure though you're kind of adding the salt towards the end of cooking because it'll actually help bring out the flavor without having to eat as much.

So you're definitely going to eat too much salt for sure. So it's not really unlimited but be careful when you have high blood pressure and watch what happens. Check your blood pressure, check your diet. Also iodized salt's really common. They add iodine into the salt because of deficiencies that we had in a population And you do need iodine and it can cause problems if you don't have it.

But often you can get it from fish and from seaweed and other sources. So I think it depends on your diet, but we might need a little extra iodine. Now, what can you do to actually fix high blood pressure? Well, the first is to reduce inflammation, to get rid of oxidative stress in your diet. And how do you do that?

Well, you've got to get off of the junk, right? So eat, get rid of all the processed foods, eat a whole foods plant rich diet that's high in potassium rich foods. And I've created something called the ten day detox diet, which is a very simple ten day approach to cutting all the inflammatory processed foods. And we found people's blood pressure drops up to 20 points when they do that in a week or seven days or ten days. So it's very impressive when you see the results.

You wanna eat a lot of potassium rich foods. Like I said, the broths are great, fruits, vegetables, nuts, seeds, high fiber, good fats, calcium, magnesium. Magnesium is a relaxation mineral, it's really important for regulating blood pressure. In fact, when women come in with preeclampsia, which is a pregnancy induced high blood pressure condition that can cause seizures and high blood pressure, What's the treatment? We give them intravenous magnesium.

Now, I don't know why we start with all the drugs with blood pressure. Why don't we start with magnesium? And you can get a lot of magnesium from your diet, greens, beans, nuts, seeds, little chocolate too. Carbohydrates are a big factor, starch and sugar. So make sure you're cutting those down or cutting those out and eating good carbohydrates, which are all the fruits and vegetables.

Sugar is really the big problem. It's driving insulin resistance, it drives the high blood pressure. Eat the right fats. So omega-three fats are really important, help reduce inflammation but also can help lower blood pressure. Those can come from wild fatty fish.

I like the smash fish which are small, low in toxins, sardines, mackerel, herring, anchovies, salmon. Those are all really good, good quality fats. So you can get also grass fed meats often have omega-3s like bison, grass fed lamb, chickens, depending on what they're eating, all great. Get real food, just eat real food, get rid of all the processed food. Like I said, make sure you try to avoid inflammatory foods that may be triggers for you like gluten and dairy.

Those can be driving problems with blood pressure as well. That's why the ten day detox is a great way to start, reset. Also liquid sugar, really bad, sodas, juices, all that affects you. Hydrogen fat, actually we shouldn't be eating any of that anymore, but that also can be very inflammatory. Get protein and fat for breakfast, not starch or sugar.

Most of our breakfast in America is cereal, bagels, muffins, croissants, blah, blah, blah, all that stuff, pancakes, French toast, that's all dangerous to eat for breakfast. You want fat and protein, I usually have a protein shake. You can have eggs, avocados, those are great. Flax seeds are great also, lots of fiber can help improve insulin resistance. And alcohol, alcohol can be a big factor.

So I would really minimize or eliminate alcohol for a little while. Stay hydrated, really important, keeping your blood pressure normal and don't eat before bed, worsens insulin resistance, weight gain. So you do all these dietary things, you still maybe need a little help. What do you do? Well, there's some supplements that can really be helpful.

I like magnesium and you can take magnesium citrate or glycinate. If you're a little constipated, use magnesium citrate. If you're not, you can use magnesium glycinate. CoQ10 has been shown to help with blood pressure. You can take potassium, omega-three fats, B vitamins, extra fiber, a good multi, all those are great strategies.

What about exercise? Exercise actually can increase your blood pressure when you're exercising, but overall it helps your cardiovascular system and lowers your blood pressure. It'll help you lose weight. I mean, even if you lose five to 10 pounds, we've seen that really have a big impact on blood pressure. Exercise is not a luxury.

I mean, one cartoon I often use in my lecture says, Would you rather exercise an hour a day or be dead twenty four hours a day? So it's definitely not a luxury. It's an essential part of living just like eating and breathing and brushing your teeth. So what about stress? Well, stress is a big factor and we know that stress drives blood pressure up.

We know that it increases adrenaline which increases blood pressure, cortisol. So practices like yoga, Tai Chi, meditation, guided imagery, breath work, all engage your parasympathetic nervous system and help lower your blood pressure and inflammation and help your metabolism and just basically healthy overall. Sleep also super important. A lot of us don't get enough sleep. And, know, in fact, sleep can Deprivation can be a factor in high blood pressure as well.

So I encourage people to get good sleep. And there's a lot of tricks for that. I mean, try to go to bed and wake up at the same time every day. Use your bedroom for sex and sleep only instead of working or you know, doing a lot of stuff that we do in bed, I'm watching TV. Make sure it's dark and quiet and cold in your room.

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, you get nervous and stressed, it goes up. Mean when you exercise your blood pressure goes up. When you're stressed, blood But what's your average blood pressure?

So one of the diagnostics we do is a twenty four 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, And night and that will tell you what your real risks are.

Dr. George Papanicolaou
Right. So doing twenty four 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
Yeah, it's true. As long as you can just get a cuff at home and have people monitor their blood pressure out the day and that will help too. You know I want to just dig into a little bit before we get talking about the difference with functional medicine and traditional medicine. Traditional medicine is you check your blood pressure, it's high, you get medication, you moderate. We call it essential hypertension.

Right. 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 essential, we have no idea what's causing it.

Dr. George Papanicolaou
We know that's not true.

Dr. Mark Hyman
We know that's not true. So everything has a cause. Nothing is just random. Right. If you have diabetes, it's not a random event.

It's not like

Dr. Mark Hyman
oh I got a virus.

Dr. Mark Hyman
It's just a something happened. Diabetes. Now we we know some of the major causes of high blood pressure are never addressed. Right. And the two biggest ones that I see treating patients is insulin resistance.

Dr. George Papanicolaou
And sleep apnea.

Dr. Mark Hyman
And sleep apnea. So one of the biggest factors is insulin resistance, which is an epidemic in this country. We have one in two Americans who have pre diabetes or type two diabetes, seventy five percent are overweight, forty two percent are obese, and they all have some degree of trouble regulating their blood sugar which just causes them to get belly fat. 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.

Yeah. 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 that causes oxidative stress, which is really what causes rusting. So it's like your arteries and your pipes are rusting and stiffening Right.

Called hardening the arteries. And that happens as a result of this inflammation and oxidative stress. And so insulin resistance is probably the biggest cause of that today in America, and it's it's really driven by diet. So I think people don't understand how powerful that is.

Dr. George Papanicolaou
Diet is is very powerful and you know I call it you you mentioned the the adiposity we have around our waist. I call it I call it the toxic waste dump of the body. Yeah. And that fat just does have a metabolic effect that is toxic to the body. As you said it creates the hardening of the arteries which is one important cause of high blood pressure.

Dr. Mark Hyman
Yeah. And the other big thing is often misdiagnosed, and by the way, by the way, insulin resistance affects so many people, ninety percent are not diagnosed. Absolutely. So the way you diagnose it is you do a test for insulin and blood sugar And it's a

Dr. George Papanicolaou
fasting don't want to even glucose tolerance test that we do, I do on almost every patient.

Dr. Mark Hyman
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 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 wanna check insulin early on.

Dr. George Papanicolaou
Even doing a fasting insulin isn't gonna give you an answer.

Dr. Mark Hyman
It'll help. But by the

Dr. Mark Hyman
time your insulin goes up, fasting, it's already down the road pretty far. Right? So I agree. And then we have this other issue which is sleep apnea. Yeah.

Which is so underdiagnosed.

Dr. George Papanicolaou
Yeah. So sleep apnea, there are about twenty five 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 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
Yeah, have a narrow

Dr. Mark Hyman
palate, a small airway, you have sinus issues.

Dr. George Papanicolaou
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. 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
Yeah and then it also drives insulin resistance. So if you have sleep apnea it also causes you to be pre diabetic. Yeah

Dr. Mark Hyman
it causes weight causes weight gain,

Dr. George Papanicolaou
leads to insulin resistance, leads to diabetes, which complicates everything.

Dr. Mark Hyman
I mean I had this guy who couldn't lose 50 pounds, he was a lawyer and he told me this story, was like he said look, I need to lose a 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 your life like? Because well I'm a lawyer and I work really hard and you know, but every day I have to stand up at my desk, I can't sit down. And this was before standing desk. Right.

Right. And I'm like why? He says well if I sit down I fall asleep. Right. And I'm like gee, maybe you have sleep apnea.

So if you're falling asleep at work, if you're falling 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 that record your snoring so you can see because people don't believe it, oh I don't snore.

Dr. George Papanicolaou
Then I love that app by the way.

Dr. Mark Hyman
And then there's one called sleep cycle that I like. It's recording your snoring. And and and it it it's something that is easy to treat. I mean there's different methods of CPAP and but it is a treatable condition and the weight loss then will happen and you'll feel better. So that's really important.

I just wanna 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 Right. In certain things can cause high blood pressure.

Dr. George Papanicolaou
Yeah.

Dr. Mark Hyman
Like magnesium.

Dr. George Papanicolaou
Right. So and magnesium, know, studies show that you know, there's a very large percentage of people in our country have low magnesium.

Dr. Mark Hyman
Forty five percent of people have low magnesium, which

Dr. George Papanicolaou
is and you know magnesium, it's not magic but you know 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
Yeah, but I call it the relaxation middle. And you know, 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 their blood pressure is high, which can cause seizures, the treatment isn't high blood pressure pills because they don't tend to We give them intravenous magnesium Yep.

To relax their blood vessels and save their life. Okay? Absolutely. So we we just and it's it's just a strange thing to me. We don't think about it that way.

The other thing that is important is omega three fats and fish oil because it helps relax your blood vessels, make them more pliable. But there's other causes that we see. For example, environmental toxins. Heavy metals in particular, lead and mercury are really common, they're under diagnosed. And when you go in your high blood pressure visit, your doctor's not checking your mercury and lead levels, not even your blood, and probably not on the most important test, which we do at the Ultra Wellness Center, which is a challenge test where we give people a drug to pull out the metals, the 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
And I think you're really hitting 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 gonna get your hypertension better by not treating your hypertension. We're not gonna treat your hypertension. Hypertension. We're going to treat everything else that's causing your hypertension.

We're going find the sleep apnea, we're going find the nutritional deficiencies, we're going to work on your stress levels, we're going to help you lose weight. You know, when you lose weight, I mean you actually are going to drop your blood pressure.

Dr. Cindy Geyer
I mean we do know that genetics play a role. So somebody who has a strong family history of high blood pressure, we might wanna be paying more attention. But as you've said so many times, our genes aren't our destiny. Those genes that we come into the world with are gonna be influenced by so many other factors, many of which can unmask that potential and manifest as high blood pressure. So some of the root causes of high blood pressure, we know that weight gain and insulin resistance is a huge one.

We know that diet plays a big role because of its effects on oxidative stress and endothelial dysfunction. Insufficient sleep, whether that's sleep quality, quantity or timing can play a role with high blood pressure. Loss of artery elasticity. So our endothelium is a target for a lot of the negative effects of lifestyle. We know that artery elasticity can be adversely affected by stress, by certain foods, and there's even emerging evidence that food sensitivities, disruptions in the gut microbiome and toxic exposures can all have negative impacts on our arteries leading to or contributing to high blood pressure.

Dr. Mark Hyman
So basically you're talking about modifiable factors that are treatable and fixable that cause the stiffening of our arteries and that lead to high blood pressure. When you say endothelium, you mean the lining of the blood vessels, and that becomes dysfunctional because of inflammation and oxidative stress, which has many causes, right? So, you know, I was sort of really shocked to learn 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're kind of treating patients and I want you to sort of present this case here of your patient who had, who had high blood pressure and what you've kind of thought of, what you did diagnostically, and to kind of unpack some of things we do at the Ultra Wellness Center, which is doing a deeper dive on your biology, not just taking at face value, Oh, your blood pressure is high, here's a pill, but we go into why. Like what's going on underneath the hood? How do we find things 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 prediabetes and insulin resistance, whether it's sleep apnea, whether it's nutritional deficiencies like magnesium or omega-3s, or whether it's environmental toxins, some of which we can measure, of 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 that's what you did your patient that I'd love you to sort of share her story.

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

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

What are the 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 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 case. And how did you think about this case?

Dr. Cindy Geyer
Sure. So this was a 56 year old woman and she had a long history of so called white coat hypertension. We'll unpack that in 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's borderline, come back and we'll check it in a year. Well, no, we wanted 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 wanna go upstream. We wanna see what the variables are that played a role with this particular patient. Why is she showing up with this reactive blood pressure?

What are the things that 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

Dr. Mark Hyman
a It's important to get into the story because, know, like I think of my parents, my mom and dad just obviously didn't listen to me. They ate crappy and they both run high blood pressure pills. And I'm 65 and my blood pressure is like 100 over 70, which is really highly unusual for someone my age, but it's not an anomaly. It's just because I understand what to do to regulate my biology and stay healthy as I get older. And most people don't do that.

And our default in our society is basically leading us all to have these problems. That's why one in two Americans have high blood pressure and prediabetes. And by the way, I don't think it's an accident that one or two people in America have diabetes or prediabetes, and also one in, two people have high blood pressure because they're very related.

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

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

Dr. Mark Hyman
Why is that?

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

Dr. Mark Hyman
Yeah. Mean, the birth control pill is interesting because estrogen does make you retain a little more fluid and that may be part of it. And the progesterone can also make you gain weight sometimes. That may be part of it. So there are things that, medications that may also, like the birth control may actually drive increased risk of hypertension.

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

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

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

Dr. Mark Hyman
Just to double down on that, a lot of people who have high blood pressure have undiagnosed sleep apnea. Yes. 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 it's treatable, often with weight loss and other things. But sometimes you need to take a breathing machine at night and that can often resolve high blood pressure.

So when I sleep someone, the first two things I think of are prediabetes and insulin resistance and sleep apnea as both causes of

Dr. Cindy Geyer
Absolutely, Mark. And I'm 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? You're having these subtle disruptions in the continuity 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. 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.

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

Dr. Cindy Geyer
So, well, the next piece was she had gone, she went through a pretty, significant menopause, lots of heavy periods. Last period was finally around 40 nine, 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, nobody was thinking along those lines. She had a conversation with her OBGYN and decided to go on an estradiol patch of progesterone. She had good relief in her symptoms. Another really important thing though about the menopause transition is the changes in estrogen that happen can also unmask more effects of stress on the vascular system. We also know that insulin resistance tends to get worse in the menopause transition.

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

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

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 risk factor, whether that's prediabetes, insulin resistance, high blood pressure, oxidative stress, inflammation, that blood brain barrier can become more permeable or leaky. And it plays such an important role at selectively letting in the nutrients to the brain that we want getting in, keeping out toxins and microbes that we don't want getting in, and then also supporting the brain's waste removal system, the lymphatic system that removes waste from the brain.

Any vascular insults are potentially gonna contribute to that leaky blood brain barrier. So optimizing her blood pressure, looking at those upstream factors is gonna be really, really important for her to meet her goals.

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

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

You know, think there's a real issue there with like how many people are salt sensitive? And it's probably maybe, you know, forty percent of people who have high blood pressure 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 there's been large population studies that kind of show that there's maybe a slight risk. There's an Intra Salt study, for example, in 1988.

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

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

Dr. Mark Hyman
So also like nobody talks about the fact that historically we had 10 times as much potassium and 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.

Dr. Cindy Geyer
And magnesium.

Dr. Mark Hyman
And magnesium. Yeah, magnesium is the other nutrient where probably forty five percent of us are deficient in. So is it the salt or is it the balance of all these other electrolytes like magnesium and potassium and calcium that we tend to ignore, but that we do look at in 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 causes high blood pressure, and so you should eat less salt.

Dr. Mark Hyman
I find that most people have never connected the dots between how they feel and what they eat. They walk around with what I call FLC syndrome. That's when you feel like crap, and that is a big problem for people. What do I mean by that? Well, you might be tired, sluggish.

You might have brain fog. Maybe I have digestive issues, reflux, heartburn, irritable bowel. Maybe I have nasal congestion, sinus issues, muscle aches, joint pains, headaches, insomnia. Should I go on rashes, acne? I mean, it goes on and on and on.

And and many of these things are caused by food. And the only way to know is to do a total body reset. Like hitting the reset button on your commuter when all the systems are jammed. It's a complete reboot. So how do you do a reboot?

It's very powerful, and most people have near experience this. And this is why I love to do it with people. And I actually run programs all around the world where people can come and actually experience this. We we do programs where we have people do this just in five days, not even ten days. People have a seventy percent reduction in all symptoms from all diseases.

Now I'm gonna put in the show notes the medical symptom questionnaire that I use in my practice, which essentially gives you a score based on the degree and frequency and severity of symptoms. So if you have a headache, is it zero, meaning never, or is it four, I get it all the time, it's really bad, or some version in between. And then you get a score at the end, and, you know, people have a score of sixty, seventy, a 100. It should be less than 10, maybe even zero ideally. I I wish I have a symptom.

That's not normal. Raymond B used to suffer this much. And that's really why I created this this book and the program, the ten day detox side, because I was doing this with my patients and seeing such incredible results. So I do this personally regularly. I do it at least two or three times a year, four times a year to really reset my system to kinda get my body back on track, to get rid of all the bad stuff, put in all the good stuff.

Now I'm walk you through how to do this. I'm gonna teach you how to hit the reset button, reboot your system, and to optimize your biology to help your gut, to help your detox system, to help your immune system, to help reset your nervous system, and it's powerful. So, if you wanna really see how your body can feel and get rid of what we call FLC syndrome, I would do this. Most people are like, the frog that's in cold water where you turn the heat up slowly and it starts to boil to death. We just kinda get used to it and think it's normal.

These symptoms are not normal. I remember I wanna do this with a junior high school once, and, the teachers are like, well, I we might have to get permission from the parents to see if it's safe. You know, maybe they don't want their children doing this. I'm like, what? Is it safe to eat fruits and vegetables and nuts and seeds and protein and cut out sugar and starch and processed food?

I mean, they should get a note that it's permission to eat the junk food that they have to dispose. It's the opposite. So, anyway, yes, it's very safe. Anybody could do this. And, some people, by the way, you know, need more of certain things or other things.

But but, basically, this is a very universal approach to resetting your system. The second pillar, aside from what you're eating, the the food is really important. And and by the way, need be approaching the morning. You need to make sure you get rid

Dr. Mark Hyman
of sugar and starch in

Dr. Mark Hyman
the morning. Super important. We'll make people start their diet their day with carbs, which is the worst thing you can do with sugar sweetened coffees, teas, cereals, muffins, bagels, breads. Diamonds. Second pillar are your daily habits.

Essentially, mom's a pattern of eating and living that puts your body back in rhythm. It helps you reset your nervous system. And and there's two really important habits as part of the tending detox. One is when you eat and also when you sleep. So let's talk about when you eat.

Now when you eat might be as important as what you eat. So many of us don't eat in the right pattern. We tend to, you know, eat all day long. We tend to snack. We tend to eat before bed.

We snack late at night. It's kinda bad. So, basically, when you eat is very important. Research shows that doing that can really be bad for your health, if you eat at night. So the first is make sure you give yourself at least twelve to fourteen hours between dinner and breakfast.

So dinner at six, breakfast at eight, that's a fourteen hour fact. Okay? If you eat at six and then you keep snacking all night, that doesn't count. Right? And it's the most simple form of what we call time restricted eating, and it's basically giving your body a rest and getting the body to reset.

And I wrote a lot about this in my book, the young forever. But but, basically, there's a whole process at night that happens called autophagy and clean up and repair. You wanna give your body the ability to do that. The next is food. Now you can do a breakfast if you're eating, you know, for example, dinner at six and breakfast at eight or so.

That's a fourteen hour fast. Really important to have protein in the morning, not carbs and sugar. Also, not eating three hours before bed is really important. So most people eat and snack after dinner. Don't do that.

Have at least three hours of the time you eat and you go to sleep. That way you will lose weight. Your body can repair and heal instead of trying to digest and store the food. What about sleep? Sleep is one of the most underrated pillars of health.

It's probably even before exercise, meditation, maybe even before nutrition. Because when you don't sleep well, you're gonna eat tons of sugar and carbs. You're gonna crave more. So you wanna focus on sleep and restorative rest. We know that, getting in a routine of waking and sleeping can help with a deeper, more restful sleep.

So try to take the same bedtime every night. Try to get off your screens for an hour or two before bed. Keep your room or use blue blocker glasses. Keep your room dark and cold. Probably sixty five and sixty eight.

Really important because your body does much better with sleep at night. Try to relax at night with meditation. Do a guided imagery. Do breath work, stretching, journaling, gratitude practice, whatever you like, but do something. Very important.

So your evening routine should be, like, set a bedtime at six during ten days. Turn your phone off and get it out of your bedroom. Turn the TV off for at least an hour or two before you go to bed, and then use the time at night to read, to journal, to meditate, to connect with people you love, and just kinda wind out.

Dr. Mark Hyman
I want the third pillar

Dr. Mark Hyman
is extra support we need on the journey. Right? Now we all need nutrients. They they're called vitamins because they were vital amines, vital to life. Right?

And and so we've seen a dramatic reduction in the nutrient density of our food. Our organic matter's gone out of our soil. Nutrients can't be extracted. Foods travel long distances. We have commodity crops which are bred to actually breed out the nutrients and in the starch and and, and and, you know, yield.

And so foods aren't as nutritious as they once were. And probably ninety percent of Americans, according to the government own surveys, are deficient in one or more nutrients at the minimum level to prevent deficiencies. So how much vitamin d or do you need to not get rickets? Not very much, like thirty units. How much you need for optimal health?

Probably three to five thousand. So we need to really probably focus on nutrients. And even with a perfect diet,

Dr. Mark Hyman
you know, because none of

Dr. Mark Hyman
us are hunter gatherers anymore. We eat all kinds of food that we never ate and, I mean, nutrient depleted. We need we need the basic supplements. So we need a basic set of supplements. A multivitamin mineral foundational.

Magnesium, a lot of us are deficient. Probably forty five percent are low or deficient in magnesium. It's involved in over 300 different enzymatic reactions. Super important. It helps relax your nervous system at night, help you calm down.

Also, people get constipated. Sometimes they change their diet, so taking magnesium citrate can help. And lastly, vitamin D. But you should also take fish oil, but vitamin D is really important. Vitamin D over eighty percent is lower and deficient in vitamin D.

That's it's involved in so many different things in the body. So really important. And it helps your mood, helps your muscle function, helps your brain, helps your energy, helps inflammation, autoimmunity. It's just super important, and most of us show out. Fish oil is also important, and I I often recommend fish oil to people are omega three fats.

So what are the programmed steps in the ten day detox? What should be the tips? And then we're gonna go through this. The first step is to eat from the ten day detox approved list for ten days. So eat one of the value you eat.

Right? Whole foods, you know, whole food based shake in the morning. You could add, you know, protein powder, grass fed protein if you want. I have a grass fed protein called super simple protein, but you really need to make sure you have a good breakfast. Second is, commit to daily habits.

Right? Take your designated eating window. Right? You want a twelve to fourteen hour night fast, which means eating within a ten or twelve hour window. Don't snack before bed.

Try to have the same bedtime. Get off your technology an hour or two before. Practice some active relaxation. Huge impact on your health. Step three is add in the supplements.

Now you don't have to do this, but I really encourage you to have a multivitamin, magnesium, vitamin d, and potentially fish oil. And we're gonna list which products you should take in the show notes so you have it all listed there. Also, what you should eat and what you should avoid during your ten eighty cal. Let's go through that. So here's a full food list.

You can you know,

Dr. Mark Hyman
we're gonna have it in

Dr. Mark Hyman
the show notes. You can take it with you in store. It's in the book, the ten day detox. It's in the ten day detox cookbook. But, essentially, here's what you should eat and what you should actually get rid of.

What you should eat is protein. You need the right protein. Right? So grass fed or a generally raised, meats is great. You can have a pasture raised lamb, beef, bison, venison, elk, grass fed beef, pasture raised chicken, turkey, duck.

All that's fine. What you should avoid is conventionally raised chicken and poultry and and eggs and so forth. And by the you can also have eggs if they're pasture raised eggs. Meat, get rid of all processed meats, deli meats, all conventionally raised, feedlot meats, get rid of all that stuff. What about fish and seafood?

Lots of small fish are good. Big fish are bad. Right? Big fish like swordfish, tuna, sea bass, halibut. Most farm raised fish are pretty bad for you.

What you should be consuming are things like the, I call it, smashed fish, small wild salmon, sardines, anchovies, herring, mackerel. You can have black cod, shrimp, scallop, trout. All those are fine. Eggs, as I said, pasture's eggs are fine. Nonorganic regular eggs are not fine.

What about nuts and seeds? Very important. Almonds, brazil nuts, cashew nuts, halos, macadamia, pecans, pine nuts, pistachios, walnuts. All that's great. You know, we kept cacao nibs, chocolate mac.

Chocolate milk is where chocolate comes from. Seeds are great. Chia seeds, flax seeds, hemp seeds, pumpkin seeds, sesame seeds, sunflower seeds, pumpkin seeds, all great. Nut butter is also great. So unsweetened nut butter, so almond, cashew, pecan, macadamia.

I love macadamia. Walnut, oh, that's great. You can also eat beans if they're if you're a vegan and you wanna do this, you can use GMO free or non GMO tofu or tempeh as your protein. What you should avoid are nuts that are with sugar. They're cooked in oils, that are basically candied stuff.

A lot of nut butters have sugar, hydrogenated fats. Peanut butter, peanuts can be okay, but I wouldn't say mostly avoid peanuts because, they have aflatoxin, often are rancid, and so you wanna be careful with that. About oils and fats? Well, the ones you wanna use are organic avocado oil. You can use organic coconut oil for cooking, grass fed ghee.

If you wanna use tallow, lard, duck fat, chicken fat, that's okay as long as they're they're, pasture raised or regenerative raised. For salads, you can use certain kinds of oils like almond oil, flax oil, hemp oil, macadamia oil, and convert it olive oil. And you can cook with olive oil, but only, like, tomato sauces and things like that. Things that are not high heat. Sesame oil, tahini is great as well.

Great fat. Sesame seed kind of paste, walnut oil. All the flavorful oils are not main oils, but you wanna avoid the traditional oils. All the seed oils, canola oil, partially hydrogenated oils, margarine, peanut oil, soybean oil, sunflower oil, safflower oil, trans fats, vegetable oil, vegetable shortening, all that stuff's bad. What about veggies?

What should you eat? Well, you wanna stick with lots of nonstarchy veggies or or anchokes, organic if you can. I use the dirty dozen guide from the environmental working group, ewg.org, tell you which are the clean 15, meaning you can eat them when they're not organic or the dirty dozen, which you definitely not eat if they're not organic. But I love asparagus, artichokes, avocado, bean sprouts, broccoli, brussels sprouts, cabbage, cauliflower, celery, cucumber, eggplant, garlic, ginger, hearts of palm, kohlrabi, leafy greens, mushrooms of all kinds, onions, peppers, radicchio radish, rutabagas, all that kind of stuff. Seaweed is great.

Lots of minerals, shallots, summer squash, tomatoes, turnips, zucchini. List goes on. We have all in there. You can have some, things like sweet potatoes. I like the Japanese purple sweet potatoes, winter squash, carrots, pumpkin.

All that's fine. I mean, carrots are fine because unless you're doing carrot juice or that it's a problem. But, basically, try to limit to, like, one, serving, which is, like, half a cup a day. What you should be avoiding is corn and white potatoes mostly. Little you know, some of the little, fingerling potatoes or the Peruvian potatoes, purple potatoes can be fine.

What about dairy? You can eat pasture raised butter or ghee, but I encourage you to get all dairy, including sheep and goat, which are mostly fine for people, but I encourage you to just get all other dairy. And if you're having

Dr. Mark Hyman
I encourage you to have make sure

Dr. Mark Hyman
it's grass breastfed or regionally raised. And what about beans? Well, you can have green beans. You can have green peas. You can have a non Jumbo or organic soy, such as tofu or tempeh.

You can have sap beans. You can have snow peas. But otherwise, definitely no no beans. What about grains? No grains at all.

So, even healthy grains, quinoa, buckwheat, things like that. I agree really off off all of that. Why? Because it just shuts down the insulin response, helps you lose weight, reduce inflammation. Not that these are just all bad, but eventually, you can add them back, but basically get rid of all all the other all grains.

Wheat, barley, rye, rice, amaranthella, oh, it's everything. Get rid of it. Fruit. Fruit can be okay, but, small amounts of nonhydrolycemic fruits. So organic blackberries, blueberries, cranberries, kiwi, lemons, limes, raspberries, all that's fine.

Not too much. Right? You know what I mean? Like, you know, two pounds of blueberries, but you can have a top half cup of day. Wanna get rid of all the other fruit, all the high glycemic fruit, like bananas, pineapple, melons, cherries, grapes is the worst.

Even foods that fruits that you think, you know, maybe good for you are actually good for you. Right? Whether it's, you know, peaches, pears, ectorines, cherry, for example. But you don't wanna eat them while you're on the TEND detox. You wanna really shut down the blood sugar and some risk points.

What about sugar sweeteners? Sorry. The yeah.

Dr. Mark Hyman
You can sometimes add a little funk fruit

Dr. Mark Hyman
or stevia you have in the shake. We have but, generally, you tend to avoid all that stuff. Also, just get rid all

Dr. Mark Hyman
the other

Dr. Mark Hyman
artificial sweeteners, sugar, all that stuff. If you have to ask, the answer is no, basically. Right? Then what should you be drinking? Well, lots of water, herbal tea, green tea, all this caffeine, that's okay.

Love green tea is fine. It'll help you get off coffee. Sparkling water, mineral water, all this moisture void, alcohol, coffee, bottled water, some plastics, soda, obviously, sugary beverages. Basically, that's the program. So if you eat that way for ten days, if you eat those simple habits, your body is gonna totally transform, and you're gonna see just how food is impacting your health, which is something most people don't have a clue about.

And that's why I love this so much. Now after the program, it's really important that you do it for ten days or twenty one days or ten weeks or ten months, you have to be smart about getting off it where you can get into big trouble. Because when you go off of foods that are inflammatory, foods that you're allergic to, and then you reintroduce them, you can get a lot worse symptoms. So let's say you had migraines before and they're gone. Wow.

You're gonna get a dusy of a migraine. Or let's say you had gut issues before, you're a real problem. Or let's say had sinus congestion from eating dairy and then eat it. Again, you might get a sinus infection. So you really have to be smart.

So if you're feeling great and you wanna continue and you unless you have a lot of weight to lose, let's say you have an autoimmune disease, let's say you just wanna you're feeling great, wanna continue, no problem. You continue it, continue to do it. You can do it for another ten days. You You can do it for another ten months. It's fine.

Totally safe to eat. And it's pretty much how I eat most of the time with the occasional grains and meats. Also prioritize sleep and obviously your fasting window, not eating before bed. And then eventually people can transition slowly to the vegan diet, which incorporates a lot of the principles of the ten day detox diet, but gets you more flexibility in your diet.

Dr. Mark Hyman
If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Doctor Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to the doctor Hyman show wherever you get your podcasts.

And don't forget to check out my YouTube channel at Doctor 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 Doctor 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 health care 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.