Participants: N. David Emerson
Series Code: WM
Program Code: WM000429
00:01 The following program presents principles designed to
00:03 promote good health and is not intended to take 00:05 the place of personalized professional care. 00:08 The opinions and ideas expressed are those of the 00:11 speaker. Viewers are encouraged to draw their 00:13 own conclusions about the information presented. 00:35 Hello, I'm Dr. Emerson. I'm Medical Director 00:38 at Eden Valley Lifestyle Center. And I wanted to 00:40 talk to you today about hypertension. 00:43 This is actually part of the insulin resistance syndrome. 00:45 It's part of a package that we've been exploring 00:48 in the series. Like to talk to you about a patient 00:53 we had Guam. He was the president of the 00:59 University of Guam and I was called to the emergency room 01:03 to see him. He was a VIP and so I was little bit apprehensive 01:08 about going up. But on the way up I reviewed his case 01:11 as I was driving up to the hospital. We've seen him 01:14 a couple of weeks earlier in the urgent care in a clinic 01:17 and at that his blood pressure was 220 over 120. 01:23 I said to him you know, really with this blood pressure 01:27 this high we usually like to admit you to hospital and try 01:29 to get it down with medications. 01:31 And he said oh no, no don't do that. 01:33 Anything, can't you do anything to keep it down here 01:35 in the clinic. Oh, we gave him a couple of medications. 01:37 His blood pressure did come down. He did respond. 01:40 We gave him prescriptions and some medications and 01:43 told him to follow up with us, because we would need 01:46 to adjust his medications. Well, he then asked, 01:51 do I have to take this the rest of my life? 01:54 I said well that depends. Now if you don't make any 01:57 changes probably so that would be advised. 02:02 On the other hand, if you make some changes you maybe able 02:07 to get off your medications. Well, one of his situations 02:11 at that time he was overweight, 02:13 had a stressful job, he had a high flesh food intake, 02:17 he smoked, he drank caffeine, he drank alcohol 02:21 and he got no exercise. And I said if you would want 02:26 to get off your medicines, if you make some changes, 02:28 you've a very good chance of getting off the medications. 02:33 First thing to do would be to stop the flesh foods 02:37 and get rid of the animal products. 02:39 Go to a plant based product. This will lower you 02:41 insulin resistance and start dropping your blood pressure. 02:49 I told him to start walking. Walking program will be 02:52 very helpful. Avoid the caffeine. Stop the alcohol. 02:58 And if you do these things, you'll find that your mind 03:04 will start clear and you might have a better experience 03:07 at work which would decrease your stress level at work. 03:13 Well when I got up to the hospital, I got to hear the rest 03:19 of the story. He had again done something 03:23 little bit unusual. He had actually done everything 03:26 I asked him to do. He is very type-A personality, 03:29 very motivated. So he actually took a week off the work 03:32 to make all of these changes. He'd gone on complete 03:36 vegan diet. He had stopped smoking. He stopped 03:38 the alcohol. He stopped the caffeine. He started walking. 03:44 And something he noticed was that when he returned to 03:49 work about a week later, his mind was clear and 03:53 he was actually on top of his job, instead of trying 03:57 to catch up. Putting out fires, now he was actually 04:01 planning how to avoid fires in the future. 04:04 His stress level was markedly decreased and he is 04:07 feeling a lot better. Well we had told him to call us 04:13 if he made any of these changes and he started feeling 04:16 lightheaded. Well he told his wife at one point, 04:20 he says you know, I was getting out a chair 04:23 I felt lightheaded. She says well I'll your doctor. 04:25 You know, I said to call me if he started feeling 04:28 lightheaded. And he said well I'm going to seem him 04:30 a couple days all. I'll give him a call then. 04:32 Next day he was getting out of car, 04:35 opening the trunk and he has told his wife, 04:37 he said yeah you know I feel a little lightheaded 04:39 again today. She says well, give your doctor a call. 04:42 I said give me a call if you feel lightheaded. 04:45 And he said well. I'm going to see him tomorrow. 04:47 I'll talk to him about it tomorrow. Well that evening, 04:51 a very special occasion at the University of Guam, 04:55 because he was a president there. 04:57 It was graduation night and all the faculty was there 05:01 and all the students were there and all the press 05:03 were there. And he was handing out diplomas and 05:07 he passed out. Well, when I examined him there 05:13 I told him you know. I've some good news and some 05:16 bad news. So the good news is, as that you've made 05:19 all these changes your blood pressure has come down 05:22 to normal and you don't need your blood pressure 05:25 medications anymore. The bad news is, 05:29 is that you're still taking your blood pressure medications 05:32 when your blood pressure was now being controlled 05:35 with your lifestyle and your blood pressure dropped 05:38 too low and you passed out. 05:40 And I'm sorry you had to pass out in front of all 05:42 those people, and that's the bad news. 05:44 But the good news was as long he stayed on that 05:48 program his blood pressure stayed normal and 05:51 he didn't need medications. If he strayed from programs 05:54 right to getting back on American lifestyle 05:56 which Guam had adopted since World War II, 05:59 blood pressure started increasing and 06:02 we needed to get him back on his medications. 06:07 So, how big a problem is hypertension in America? 06:17 Well, it's actually one of the second leading cause 06:25 for office visits in United States, 06:27 accounting for about nine percent of all office visits. 06:32 And it's also one of the most common class of drugs 06:38 that are prescribed for hypertension medications. 06:42 We find that in America blood pressure as people get 06:47 older increases and the prevalence and incidence 06:52 increases as we get older. Especially with men actually 06:56 over age 65 blood pressure is over160 over 85 06:59 or common in fact more than half of men over age 65 07:03 have blood pressures in that range. 07:07 Women also have blood pressures increasing as time 07:11 goes on as they get older. American blacks tend to get 07:17 high blood pressure sooner and more frequently 07:21 than the whites or even Hispanics. 07:24 Is this because they are more sick? 07:26 Actually as we're gonna find out later on 07:30 high blood pressure is a response to a disease 07:34 circulatory system. A system that is being blocked, 07:39 blocked up and clogged up and narrowed. 07:41 And hypertension is a response to this. 07:44 Blocks being generally more muscular, more strong, 07:49 react more violently to this diseases vascular problem 07:54 with a higher blood pressure. Unfortunately it causes 07:59 complications, which we're gonna talk about as well. 08:06 Now we used to think high blood pressure was a part 08:11 of aging. We used to have a formula of what a normal 08:14 blood pressure was and it included your age in that 08:18 formula. It determined what a normal or expected 08:20 blood pressure was or would be for you. 08:23 However in later years we found that in countries that 08:29 are on vegan type diet or plant based diet, 08:32 the Third World countries blood pressure does not 08:34 increase with age. So, what we find in American 08:38 is that blood pressure doesn't necessarily increase with age, 08:41 it increases with the length of time you're on the 08:43 American diet. That's the problem with blood pressure. 08:49 We find that in China. There are three aboriginal groups 08:52 in China that basically subsist on cereals and vegetables 08:57 blood pressure stays the same throughout the lifetime. 09:01 In Kenya nomads consisting mainly of milk, 09:04 the blood pressure stays the same throughout their 09:07 lifetime as well. In urban Africa, we find 09:13 that blood pressures are high and rise again significantly 09:17 with age. But in the tribal African areas, 09:22 blood pressure stays the same, no matter how old 09:26 they get. It stays constant. In fact urban Africa weight 09:33 is also a problem, but in the tribal communities its not. 09:37 Now we had a problem at one point, a lady came to us 09:43 in Guam and she was complaining that her 09:47 blood pressure was high and that she should be getting 09:50 workmen's compensation for it. Because it was her job 09:53 that was stressing her out and causing her 09:55 blood pressure to be too high. I was kind of thinking 09:59 that if I give her workmen's compensation then half of Guam 10:03 would be needing workmen's compensation. 10:06 What we found in the literature actually was that 10:10 with people with Hypertension, stress does 10:13 cause the blood pressure to go higher, 10:16 but it's related to their vascular problem which 10:19 we gonna look at little bit later. 10:21 And that a normal person under stress blood pressure 10:23 will go up, but if they don't have Hypertension 10:26 blood pressure doesn't go up as high. 10:29 So I shared with her that your stress can cause 10:32 blood pressure to go up but if we get to the underline 10:34 problem of why you have Hypertension to begin with, 10:37 stress will not cause it to go as high. 10:40 I said you know in tribal Africa, they're under stress. 10:44 When they've tribal wars, they're afraid to go the 10:47 bathroom behind a tree because they're afraid 10:49 their enemy is gonna come up and kill them. 10:51 I said now that's stress and they don't have Hypertension. 10:55 And anyway I didn't give her workmen's compensation. 11:01 Now among vegetarians here in United States, 11:05 we find that blood pressure also does not rise with age, 11:09 stays very constant. However on the American diet, 11:13 blood pressure does rise. In Third World communities 11:18 where stroke and heart disease is fairly rare 11:22 and they eat plant based diets, 11:24 again their blood pressure stays fairly constant, 11:28 strokes, heart attacks are virtually unknown. 11:30 But in America blood pressure 11:32 rises from the teens to the 70's. 11:40 So, another question we would like to ask is, is 11:44 Hypertension genetic? Is this one of the problems 11:50 that we really can't address because we don't know 11:52 how to change genetics? Again we look at the African 11:56 cultures and the tribal Africans blood pressures today 12:01 are still in the normal healthy range but their ancestors 12:05 who came over to America centuries ago, 12:08 their blood pressures are very high. 12:10 Some are genetics different environment. 12:14 And we find today that when blacks move from their 12:16 tribal communities to urban areas in the cities, 12:21 blood pressures go up, obesity becomes a problem, 12:24 atherosclerosis becomes a problem and they develop 12:27 our problems that we've in the western culture. 12:33 Well, some may say you know, I feel okay, 12:37 why should I try to bring my blood pressure down? 12:42 Well Hypertension does increase your risk of morbidity 12:47 and mortality, Morbidity meaning sickness, 12:49 Mortality of course meaning death. 12:52 What they found is that if you have Hypertension 12:55 your chance of dying of anything is usually twice as great. 13:00 You've two times of chance of closure in left artery, 13:03 artery narrowing in climbing off. 13:06 You've three times of chance of dying of a heart attack. 13:09 Four times of chance of dying of heart failure, 13:12 where the heart can no longer pump effectively to do the 13:15 job that it needs to do. Seven times a risk of a stroke. 13:22 And these are all risks with Hypertension and are usually 13:26 a result of years of the effects of Hypertension on the body. 13:33 It's usually not considered an acute problem, 13:39 because friends since weightlifters 13:42 when they're pressing their weights their blood pressures 13:45 can get up to 300 to 400 systolic and they don't have 13:49 strokes or heart attacks because they got 13:51 healthy arteries. But you combine the Hypertension 13:54 with unhealthy arteries then you have problems. 14:01 Are there other risk factors for heart diseases, 14:04 heart attacks and strokes? Yes. Hypertension is just 14:08 one risk factor. And now risk factor is something that 14:11 increases your risk of a certain disease. 14:15 Other risk factors include being a male, male sex, 14:23 older age, race, smoking, high cholesterol levels, 14:30 and diabetes is a very strong risk factor, obesity, 14:34 stress, physical inactivity. These are all risk factors. 14:39 Some of them are major risk factors. 14:42 Last ones I mentioned are more minor risk factors, 14:44 like physical inactivity and stress. 14:49 How do these risk factors combine? 14:52 Well, if you just have for instance high blood pressure, 14:56 five, the ten year risk of heart attack, 15:00 be lessen about five percent. However if you had 15:04 other risk factors to Hypertension such as high 15:07 cholesterol or a low HDL, which is a good cholesterol 15:12 or diabetes, cigarette smoking, and then large heart, 15:18 as you add each risk factor to the previous ones your risk, 15:24 your ten year risk of heart attack increases dramatically, 15:27 so that if you have all of those risk factors, 15:29 your risk of heart attack or stroke in ten years 15:32 about 60 percent. So generally physicians will 15:38 work with you to try to decrease those risk factors, 15:42 decrease your chance of getting those complications. 15:48 Well blood pressure what is it, and how low is safe? 15:54 Well, blood pressure is the pressure in your arterial 15:59 walls that occurs after the heart contracts. 16:02 When the heart contracts it shoots blood out of left 16:06 ventricle into the aorta. The aorta, if its healthy will 16:09 actually stretch and expand and when the heart then 16:13 relaxes the aorta starts contracting and the aortic valve 16:19 prevents blood from going back into the heart and 16:21 helps keep the blood pressure up so it can profuse 16:24 to rest of the body. The aorta will continue to contract 16:28 until the heart relaxes and then expands and then gives 16:32 another squeeze and pushes out another ejection of blood. 16:36 The peek is called your systolic blood pressure. 16:39 The drop of the blood pressure between beats, 16:42 the low part is called the Diastolic Blood Pressure. 16:46 What's normal? Well high normal is considered 140 over 90, 16:51 but if you check the literature that is not optimal. 16:57 Optimal is less than 120 over 90. 17:01 And how do you get optimal blood pressures? 17:07 Well, there are lifestyle approaches which we're 17:13 going to talk about shortly, ways of getting your 17:17 blood pressure down. Typically medications are given 17:22 but again many cases these can be avoided or eliminated 17:26 if we approach it from a lifestyle point of view. 17:34 What's a difference between optimal and normal or 17:37 again high normal 140 over 90, optimal 120 over 80 17:43 or less? If a person has a diastolic of 90, 17:51 they have what would be called an average risk of 17:53 a stroke or heart attack. If they get that blood pressure 17:58 from 90 down to 80 with lifestyle approach, 18:02 their risk of heart attack and stroke is cut in half. 18:05 So going from normal to optimal can cut your risk of 18:09 heart attack or stroke in half. And there are countries 18:14 where this is normal, 120 over 90, 18:18 or even less is normal. As I was doing a medical, 18:27 some medical training in one of our little Adventist 18:32 clinics down in Mexico, took two weeks and went 18:35 down there, I was helping the little country a physician 18:38 down there and he had just delivered baby and I think 18:42 he is trying to find something from me. 18:43 He says why don't you go and check her blood pressure. 18:45 And I went and I checked her blood pressure. 18:47 I came out and I was shocked. 18:49 I said her blood pressure is 90 over 60. 18:51 She must be hemorrhaging. And he looked over me 18:54 and he smiles and says they are all 90 over 60 18:57 down here because they are all on plant based diet. 19:00 They couldn't afford meat products and that's why their 19:02 blood pressure ran. They've actually shown that the 19:05 lower you get your blood pressure if it's with lifestyle, 19:08 the less your risk of heart attacks and strokes. 19:13 High blood pressure can also cause problems such 19:16 as kidney failure. The higher your blood pressures overtime, 19:22 the higher your risk of kidney failure. 19:25 And this is a very real problem. We had a black 19:29 woman coming to the emergency room. 19:32 Young girl in her 20s blood pressure is very high. 19:36 We started her on a couple medications and we're trying 19:39 to get her, we got her blood down in the hospital. 19:42 And I share with her. I said you've got very high 19:43 blood pressure. We need you do workouts and 19:46 we need to get you started on some medications 19:47 and continue to follow you and make sure blood pressure 19:49 is controlled. Well I think we saw her one time in the 19:52 office afterwards and she stopped coming. 19:57 We then saw her about a year and half later. 20:00 She is in emergency room and now she had again 20:03 very high blood pressure but her kidneys were in failure. 20:07 We got her blood pressure down but we were unable 20:10 to get her kidney function, to be restored and she 20:14 went on dialysis, young girl. It's tragic, now on dialysis. 20:21 So blood pressure is something to take seriously 20:23 and to get it addressed if it is elevated. 20:30 In Guam, we had some wonderful toping nurses 20:37 there but I was always kind a worried about how 20:41 technical proficient they were coming from America 20:44 of course as I had them. And one of the problems 20:46 was they would get their blood pressure and whenever 20:49 I would take the blood pressure in the room, 20:51 blood pressure is always 10 points higher and I thought 20:54 can't these nurses take the blood pressures. 20:57 And then I read about the white Coat Syndrome. 21:01 White Coat Syndrome is very well documented that 21:03 when nurse takes a blood pressure for the first 21:06 four visits, blood pressure generally 10 to 13 21:09 points higher. When the physician takes it, 21:12 it runs anywhere as high as 22 points higher. 21:15 Now this effect will attenuate after about four minutes 21:18 of the visit. We've also found that the effect of the 21:25 White Coat Syndrome that will also usually go away 21:29 after the fifth visit once the patient gets familiar 21:32 with the physician and the nurse and 21:33 then no longer seems to be a problem. 21:39 Well the question then comes up what essentially 21:42 causes Hypertension or Essential Hypertension? 21:46 Essential Hypertension is a term used for the 21:49 blood pressure elevation we see in 95 percent 21:53 of patients. There is a five percent of the people 22:01 that have Hypertension that's caused by something else. 22:03 Either Hyperthyroidism or Renal Artery Stenosis or 22:09 an Endocrine Tumor or something of this nature can 22:11 cause Hypertension as well. But 95 percent of patients 22:15 is what they call Essential Hypertension and that is 22:18 what responds most readily to a vegan type diet. 22:25 So what causes Hypertension anyway? 22:27 Well we go back to the Insulin Resistance Syndrome 22:31 and we'll be talking a little bit more about this in our 22:34 next talk on Hypertension. But in general, 22:37 briefly the insulin, its job in is to get sugar from the 22:46 intestines into the cells to get burned. 22:49 So part of what insulin does is a key and it opens a 22:53 little door to the cell and opens a cell, 22:55 allows sugar to leave the blood go into the cell and 22:57 get burned and that brings your blood sugar down. 23:00 The other thing that insulin does is it dilates arterioles 23:04 to help the blood flow, get from the intestines to the 23:07 kidney or wherever else it needs to get to. 23:13 This is, has been demonstrated in many tests 23:19 and they've actually found the mechanism by which 23:21 insulin dilates arterioles. It's a same mechanism 23:25 by which nitroglycerin under the tongue dilates 23:28 arterioles. Insulin goes into the arterioles and there 23:33 are little endothelial cells lining arterial walls insulin 23:36 stimulate search those endothelial cells to release 23:40 Nitric Oxide Synthase which changes Arginine into 23:44 Nitric Oxide and that's similar to the Nitroglycerin 23:48 that you put under your tongue, 23:49 and that nitric oxide dilates the arterioles and gives 23:53 you laser dilation. They have done tests where 23:58 they have measured nitric oxide levels after infusions 24:02 of insulin and found the nitric oxide levels increase 24:05 in a dose-dependent way. This was true in both 24:11 venous vessels and also arterial vessels. 24:17 It was also shown to be true. 24:22 In patients with type 2 diabetes this relationship is 24:26 disturbed. And even in non diabetics patients said 24:30 are obese, have Hypertension this insulin resistance 24:34 prevents the insulin from dilating those arterioles. 24:42 So, insulin stimulates nitric oxide release and causes 24:48 laser dilation and this in turn helps blood flow. 24:56 What can block this effect? Insulin resistance can 25:00 block this effect. So that insulin no longer has that 25:03 laser dilatory effect that it had before. 25:07 And this can cause Hypertension. 25:11 We're going to look into this in more detail in our next talk 25:15 on Hypertension. But in brief the kidneys get blood 25:21 flow from the heart and in fact these little organs get 25:26 about 25 percent of your total blood flow out of 25:30 the heart. When there is no insulin system shows 25:34 arterioles are nice and open and there is a good blood 25:36 flow through the kidneys. When there is insulin 25:39 resistance on the other hand, the kidneys say you know 25:42 at a blood pressure 120 over 80, I'm not getting the 25:44 blood flow I need I'm going to turn the blood pressure 25:47 thermostat up. So hangs on the salt water, 25:50 blood pressures rise, the perfusion through the 25:55 kidney improves to some extent. 25:58 And the kidney says well this is a better. 26:00 I'm gonna leave this new blood pressure thermostat 26:02 let's say 160 over a 100. And it maintains this 26:07 as long as there is that, there is our construction 26:12 from the insulin resistance. We find that patients who go 26:18 on a plant based diet usually take a week or two the 26:22 arterioles open up and you get better perfusion and 26:26 the kidney says oh no the blood pressure of 26:28 160 over 100 I'm getting too much flow I can go 26:33 ahead and turn down the blood pressure thermostat. 26:37 Gets rid of the extra salt and water, many times 26:40 people with edema on the legs usually takes about a week 26:43 and their edema can go away. That's something 26:45 we see commonly in people that make these 26:47 lifestyle changes. And then the blood pressure drops 26:52 and many times we can get them off the medications. 26:57 This is something that can be done at home but again 27:01 its good to be working with your physician so that he 27:03 can adjust your medications if indeed your 27:07 blood pressure starts to respond to this and help 27:10 prevent you from passing out like our university 27:15 president did at the beginning of our talk. 27:18 Plant based foods tend to take anywhere from three, 27:23 seven, fourteen days before we see this response 27:27 but its good to get blood pressure cuff of your own. 27:30 Monitor your blood pressures and as you see changes 27:33 stay in touch with your physician and monitor 27:36 that blood pressure and make the adjustments as needed. 27:40 Next time we're going to be talking more about the 27:42 mechanisms by which a plant based diet helps alleviate 27:46 hypertension, and some of the studies done by a 27:50 famous physiologist Arthur Guyton to 27:53 demonstrate this. We're hoping you can 27:57 join us with, join us at that time and pray that you can, 28:03 if you have Hypertension you might 28:05 experience Gods healing. Thank you. |
Revised 2014-12-17