Participants: N. David Emerson
Series Code: WM
Program Code: WM000430
00:01 The following program presents principles designed
00:03 to promote good health and is not intended to take 00:05 the place of personalized professional care. 00:07 The opinions and ideas expressed are those of the speaker. 00:11 Viewers are encouraged to draw their own conclusions 00:14 about the information presented. 00:36 Hello. I am Dr. Emerson, 00:38 Medical Director at Eden Valley Lifestyle Center. 00:40 And I wanna continue discussion on Hypertension today. 00:45 As we learned last time Hypertension 00:47 is part of the Insulin Resistance Syndrome. 00:50 We want to find out what are some of the underlying 00:53 causes of Essential Hypertension. 00:57 Also I mentioned last time, 01:00 in Insulin Resistance there are couple of problems. 01:05 The way it's supposed to work as you take a sugar in, 01:08 blood sugar increases in your blood. 01:11 The pancreases senses that, releases insulin 01:15 that is a little key which opens the doors to your cells, 01:18 allows sugar to leave the blood go into cells 01:20 and get burned and that brings your blood sugars down 01:22 and so is supposed to work. 01:23 Animal products we found increase amount of fats 01:28 in your diet and when those go into the system 01:30 they plug up the little keyholes 01:32 and they cause an increase in Insulin Resistance. 01:35 Now when you take a sugar, the blood sugar raises, 01:39 pancreases releases insulin, can't get in those keyholes. 01:42 The doors they shut, blood sugars rise, 01:44 that's Insulin Resistance leading to diabetes. 01:48 I want to look today how that affects your blood pressure also 01:52 What we find is that insulin's job is to get sugar 01:56 from the intestines into the cells. 02:00 And so part of what it does is, 02:01 opens the insulin doors to allow sugar 02:04 to enter the cells to be burned. 02:08 The other thing it does is it dilates arterioles 02:11 in a dose-dependent way to help blood flow from intestines 02:16 to the peripheral organs to help the delivery of sugar. 02:22 Insulin has been found to increase something 02:27 called nitric oxide in the blood arterioles. 02:31 Nitric oxide is what actually does the vessel dilating. 02:38 What they find is that in arterioles, 02:41 the inside lining of the walls of arterioles 02:44 are called Endothelial Cells, 02:45 and when insulin stimulates endothelial cells 02:49 they release something called Nitric Oxide Synthase 02:53 which changes arginine to nitric oxide 02:56 and that nitric oxide acts like 02:58 nitroglycerin under your tongue. 03:00 It's what dilates those arterioles. 03:03 It relaxes the arterial muscles 03:05 and allows it to become bigger and enlarged. 03:11 They are found that when they infuse insulin into arterioles, 03:15 the arterioles dilate and the nitric oxide levels 03:19 increase in a dose-dependent fashion. 03:22 In other words, the higher the insulin levels 03:23 the higher the nitric oxide levels. 03:26 This was true in both arterioles and also in venules. 03:32 Now this Vasodilatory Effect can be blocked 03:37 by insulin resistance just like fat can block 03:42 the effect of insulin in opening 03:45 the cell doors to allow sugar to enter a cell. 03:48 It also can block the effect of insulin 03:51 on dilating those arterioles. 03:53 This can occur in diabetics but it also can occur 03:57 in people who are obese and who have Hypertension. 04:00 It's been demonstrated that these people 04:02 have a resistance to the Vasodilatory Effect 04:06 of insulin on their arterioles. 04:14 So high sugar levels have also been shown to block 04:18 this Vasodilatory Effect of insulin on the arterioles. 04:22 So when people are having problems 04:27 with circulation in the heart, 04:29 they find that if you give insulin the perfusion 04:32 can actually increase but that this effect is blocked 04:35 if the sugar levels are too high. 04:38 So two things can block insulin's Vasodilatory Effect, 04:41 that's insulin resistance from the animal products 04:45 that we've talked about, 04:47 but also a high sugar levels can also block 04:49 that Vasodilatory Effect. 04:52 Well, the question then is what is this insulin resistance 04:58 on the Vasodilatory Effect of insulin 05:00 have to do with Hypertension. 05:02 In other words if you block insulin's ability 05:04 to dilate the arterioles how does that cause 05:08 or effect Hypertension. 05:10 Well, the first place we would look 05:13 is how does it affect the kidneys? 05:16 Kidneys get about a fifth of your blood supply 05:18 and there the organs that regulate your blood pressure. 05:22 They adjust the blood pressure thermostat 05:24 up and down based on their need. 05:29 Dr. Goldblatt did an experiment to demonstrate 05:33 how kidneys affect and adjust the blood pressure. 05:38 He took a dog and he took the artery 05:42 that would supply the dog's kidney 05:44 and he tied a string around that, 05:48 after removing the other kidney and he narrowed the artery. 05:52 So now the kidney thought it was not getting 05:55 the blood supply when kidney wasn't that it was before. 05:58 The pressure it saw was much lower 06:02 than the pressure to the rest of the body 06:03 because that constriction in the artery. 06:08 The kidney responded. how does the kidney respond? 06:11 Well, the kidney thought, you know, 06:13 I am not getting the blood pressure or the perfusion. 06:17 I was getting before I need to fix that. 06:20 What I need to do is turn up 06:22 the blood pressure thermostat and it did this. 06:26 It did this through a complicated system, 06:28 renin-angiotensin system in the kidney, turned on. 06:33 There was an initial hanging on to salt and water. 06:36 This increased the blood volume, 06:38 cardiac output increased transiently, 06:40 when that happened the other organs 06:43 tried to protect themselves from this increase 06:45 blood pressure by narrowing the arterioles 06:48 that were supplying each of those peripheral organs 06:51 that increase the pressure even more. 06:54 Once the pressure was increased the kidney said, 06:59 okay blood pressure is high. 07:00 Now we can get rid of that excess fluid. 07:03 The renal level came back to normal. 07:05 The excess fluid was released to the kidneys 07:09 and what you were left with was a higher blood pressure 07:13 and you had arterial constriction 07:15 to the peripheral organs. 07:17 Now you don't have to really understand all those steps 07:20 that led to this but the final picture was important. 07:23 It showed increased blood pressure 07:26 and arterial constriction to all the little blood vessels 07:31 supplying the peripheral organs. 07:34 Well, what is the picture that we see in Hypertension? 07:39 Is there any evidence that this is actually 07:41 what's happening in Hypertension the essential Hypertension? 07:47 Well, when they look at the physiologic picture 07:50 of essential Hypertension and this dog 07:54 with the artery that's narrowed, 07:55 we find the same identical picture between the dog 07:59 and people with essential Hypertension. 08:02 What they find is that the resistance flow through 08:05 the kidneys has increased 2-4 times in both the dog 08:08 and people with essential Hypertension. 08:12 Renal perfusion that flow of blood through 08:14 the kidneys is decreased in both the dog 08:17 and the people with essential Hypertension. 08:20 Sometime half normal. 08:23 Blood pressure is increased by 40% to 60%. 08:29 Cardiac output is maintained as the same, 08:32 you know, ability to make urines, 08:33 the same in both pictures. 08:36 Renin levels have come back down to normal. 08:39 Essentially what you have is the same picture 08:41 between essential Hypertension patients 08:44 and the dog with the narrowed arterial 08:47 or narrowed artery going to the kidney. 08:52 Dr. Guyton is a famous physiologist. 08:57 He's written the text book on "Medical Physiology" 09:01 for many years, in fact, he is the standing 09:04 feet of written the whole text book. 09:05 Most people write text book today will write a chapter 09:08 or two and sign the other chapters to other people. 09:12 He was in such caliber that he was able 09:14 to actually write the whole book. 09:16 He did and studies in Cardiac Physiology. 09:22 He gave us the concept of cardiac output, 09:26 peripheral resistance. All these things 09:28 were developed by Dr. Guyton. 09:31 He studied essential Hypertension 09:34 and question is, what did he believe, 09:36 was the cause of essential Hypertension. 09:41 He actually said that, according to him, 09:43 He said, the significant vascular changes in the kidney 09:46 that is the Increased Vascular Resistance through the kidneys, 09:53 suggest the basic kidney abnormality 09:55 is in essential Hypertension is these vascular changes 09:59 or the increased resistance to blood flow through 10:02 the kidney that is found in essential Hypertensions. 10:07 Well, what can cause increased vascular resistance 10:12 through the kidneys? 10:14 Well, as we've seen insulin resistance 10:16 can't do that very thing. 10:20 And so in essential, in insulin resistance 10:25 we would expect to see as part 10:28 of the insulin resistance syndrome, 10:29 essential Hypertension and in fact, 10:32 when we look at the list of things 10:33 that is included in the Insulin Resistance Syndrome 10:36 we have blood sugars above 100 10:40 which we've talked about diabetes. 10:44 We also have abdominal obesity but essential Hypertension 10:48 is part of the Insulin Resistance Syndrome 10:50 and it's through this mechanism 10:51 that the blood pressures are elevated. 10:56 Well, It would then follow that if we can do something 11:00 to decrease insulin resistance we should able 11:02 to increase insulin's ability to dilate those arterioles, 11:09 increase flow through the kidneys 11:11 and then allow the kidneys to say, 11:13 I don't need this high blood pressure anymore. 11:15 I can adjust the blood pressure down. 11:18 A plant-based diet we've found as we've talked 11:22 about earlier can help reverse insulin resistance 11:25 and in fact, bring blood pressures down. 11:27 And this is what we have found in patients 11:29 who chosen to try the plant based diet 11:33 that with essential Hypertension, 11:35 usually in a week or two we see blood pressures 11:37 coming down and we've been able to adjust 11:40 their medications in the downward direction. 11:45 Is there any evidence that vegetarians 11:46 actually have lower blood pressures? 11:49 Yes, there are. We find that male college students 11:51 that were Lacto-ovo vegetarians had lower blood pressures 11:54 than their carnivorous counterparts. 12:01 They found that Lacto-ovo vegetarian 12:03 German monks had lower blood pressures at all ages 12:06 compared to meat eating monks. 12:08 It's also found in Czechoslovakia areas 12:11 that had greater animal consumption 12:13 had higher blood pressures than those 12:15 that had lower animal consumption. 12:18 In Japan, greater consumption of animal products 12:22 which was also associated with higher blood pressures. 12:27 They also found that the differences 12:29 were not attributed to changes in salt intakes, 12:31 but the salt intakes were very similar between the two groups. 12:35 Railway clerks in South India had sixfold greater meat intake 12:39 than the Northern workers 12:42 and also had much higher blood pressures. 12:47 Studies in the Polynesians showed that areas 12:52 that had higher meat consumption 12:53 also had again higher blood pressures. 12:56 They've also found that in New Guinea, 12:59 the natives that had a higher meat rash 13:02 than the others again had higher blood pressures. 13:05 And numerous studies have been showing these. 13:09 Well, the question then is what about salt. 13:12 Haven't I have been told 13:13 that high salt intake causes Hypertension? 13:18 Actually what we want to look at, 13:19 what we were finding is that hanging on 13:22 to salt is the kidney's response to this narrowed arterioles 13:26 and we are going to look at that at this point. 13:29 What they found is that, yes, if we take 13:31 a general population give them a high salt intake. 13:36 Blood pressures can rise about 2.5 mmHg systolic. 13:42 If we take hypertenses 13:44 and give them a high salt intake, 13:47 their blood pressure rises about 4.5 points. 13:50 On the other hand, if we take normal tenses of people. 13:53 People who don't have high blood pressure 13:55 and give them a high salt intake, 13:57 blood pressure only rises 1.9 points. 14:00 So they have a lower response to salt 14:04 if they are not hypertensive to begin with. 14:08 And these figures can occur with Dr. Guyton's findings 14:12 that an average blood pressure drop 4 to 6 mm of Hg 14:17 occurs when you restrict salt. 14:21 Well, they found that vegetarians 14:25 again have a lower blood pressure 14:28 than non-vegetarians and one of the arguments 14:32 or hypothesis for this was that well maybe vegetarians 14:35 have a lower salt intake, 14:37 maybe that's why their blood pressure is lower. 14:39 So they want and they tested this. 14:42 They looked at a group of vegetarians and found that, 14:46 yes, the vegetarians blood pressure was significantly 14:49 lower than the meat eaters, 14:53 but when they measure the salt intake 14:55 between two groups they found that the vegetarians 14:59 were actually eating more salt than the meat eaters 15:02 but their blood pressure was less. 15:04 So he said, well, it can't be the salt 15:07 which is the advantage for the vegetarians 15:09 because they are eating more salt. 15:11 There must be something else going on 15:13 and of course, we understand 15:14 that it is the Insulin Resistance Syndrome 15:16 was not affecting the vegetarians 15:20 as it was the meat eaters. 15:24 The next question is what causes salt sensitivity? 15:27 What they found is that for some people 15:30 you give them a high salt intake 15:32 and the blood pressures go up, other groups of people 15:35 that blood pressures do not go up significantly, 15:38 what is the difference? 15:39 Well, they separated a large group of people 15:43 into those whose blood pressure went up with salt. 15:46 They were the salt sensitives. 15:48 Another group whose blood pressure 15:50 didn't go up significantly they were the salt insensitives. 15:54 And then they tested them for insulin resistance. 15:57 What they found was the people that were sensitive 16:00 to salt had insulin resistance. 16:02 They were resistance to the action of insulin. 16:05 Those that did not have sensitivity to salt, 16:08 the blood pressure stayed fairly normal 16:10 when they gave them large dose of salt, 16:11 were not insulin resistance. So what's going on? 16:15 Why does insulin resistance have anything 16:18 to do with salt sensitivity? 16:21 What happens is when there is insulin resistance 16:24 the arterials again to the kidneys 16:26 are narrowed and the kidney, 16:31 a normal kidney who has no insulin resistance 16:34 let say you know out of blood pressure 120/80, 16:37 I am getting all the perfusion I need. 16:39 I am going to leave the blood pressure 120/80. 16:42 But if they become insulin resistance 16:44 the arterioles narrow. 16:46 The kindney says, I am not getting 16:48 the perfusion I was before. 16:50 I need more perfusion. 16:51 I am going to turn up the thermostat. 16:54 And we found how the kidney does that, 16:56 hangs on the salt water and goes through process 16:59 to eventually come to a higher 17:00 equilibrium point for Hypertension. 17:03 The blood pressure is now says 160/100. 17:07 The kidney says, well, this is better perfusion. 17:11 This is better than it was. It's not ideal. 17:14 I wish I could bring it maybe upto 180, 17:16 but this is better. 17:18 If that person takes salt, a high dose of salt, 17:21 the kidney says, oh, salt. 17:23 This is just what I am looking for. 17:24 It hangs on to the salt. 17:26 Blood pressure goes up even higher. 17:29 And now kidneys say, okay 180/100 17:32 that's getting better perfusion 17:34 and he will leave it at a higher level 17:36 with addition of that salt. 17:39 If this person on the other hand would go on a say 17:42 plant based diet, the kidney's vascular system can now dilate. 17:48 It gets better perfusion and then what we find 17:51 is the kidneys can now get rid of that extra fluid 17:57 and that extra salt and bring the blood pressures 18:00 back down to say 120/80. 18:03 And it says now with these dilated arterioles, 18:06 since we don't have insulin resistance, 18:08 I am getting all the perfusion 18:09 I need with a blood pressure 120/80. 18:11 If this person gets a high dose of salt, 18:14 the kidneys say, thanks for the salt 18:17 but I really don't need it 18:18 and just dumps it out into the urine. 18:21 And so these people without insulin resistance 18:23 are not salt sensitive and are not as sensitive 18:28 to the effects of salt in their diet, 18:29 because the blood pressure can stay normal. 18:33 Now I shared this concept at a Lifestyle Center once 18:37 and I got in trouble for it. 18:39 One of the patients was furious after I shared this concept 18:44 about salt being not the core issue 18:46 but that was insulin resistance. 18:48 And she wrote an awful evaluation 18:51 and stormed out of the room and one of the patients 18:53 who had been listening said, see that lady. 18:55 She was very upset. I said, yes, what happened? 18:57 Why was she so upset? 18:59 And he explained it, well, she had been following 19:02 another patient around who had Hypertension 19:04 and every time he put salt on his food 19:06 she was behind him saying I saw you do that, 19:08 don't you put salt on that food. 19:10 I am going to watch you 19:11 and when I said that salt wasn't the core problem, 19:14 he turned around and looked at her 19:15 and said, nah, nah, nah, nah. 19:18 So she was not happy but nevertheless 19:24 salt wasn't the core issue. 19:26 Now if you have insulin resistance 19:29 it would be prudent towards salt 19:31 until you are not insulin resistant anymore. 19:33 Once you are out of the insulin resistance face 19:36 then you should be able to handle salt 19:39 much more easily then before. 19:42 So question then is, how can I lower my blood pressure? 19:47 Well, it's helpful do things that can avoid 19:53 the short term elevations of blood pressure. 19:57 Things that will cause a transient elevations 20:00 of blood pressure include caffeine, smoking, alcohol 20:05 these can cause transient elevations of blood pressure. 20:09 Nicotine, for instance cigarette can elevate 20:12 your blood pressure for about 30 minutes. 20:15 You might think well, this is in lung. 20:17 How can that really be of significance? 20:21 Well, a pack-a-day smoker will smoke about 20 cigarettes a day 20:24 and that's about 10 hours worth of blood pressure elevation. 20:28 That can be almost your whole waking time during the day. 20:35 Caffeine can also cause 20:37 elevations of blood pressures again transiently. 20:40 They are both vessel constrictors. 20:43 They cause vasoconstriction and actually this is part 20:48 of the problem with withdrawal headaches 20:52 because they cause vasoconstriction 20:54 when you come off of the caffeine 20:56 or the nicotine you actually get a vasodilation. 21:00 Now this is not a problem in the arms 21:02 or the legs where there is plenty of room 21:03 for the arteries to dilate. 21:05 But what happens in the head you can get that vasodilation 21:08 and it causes pounding headache. 21:13 The people that make aspirins realize 21:15 that many of the headaches they are treating 21:17 are caffeine withdrawal headaches 21:19 or nicotine withdrawal headache. 21:22 So what do they add to the aspirin to treat that? 21:26 Many times they will add caffeine. 21:28 This will then cause a vasoconstriction 21:30 and help relieve the vascular dilation in their head 21:34 causing that pounding headache. 21:36 The problem is that this prolongs the nicotine 21:40 and the caffeine addiction. 21:42 So what you need to do is do something 21:45 which can cause vasoconstriction in the brain 21:49 without prolonging the caffeine or nicotine addiction. 21:53 One of the best ways is to use a Hot Foot Bath, 21:56 put your feet in hot water that helps 21:59 give you some vasodilation in the feet, 22:00 helps pull blood away from the heads, 22:03 eyes to the forehead can also cause some vasoconstriction 22:06 and help relive that pounding headache. 22:09 The benefits' of this approach is that if you do it 22:12 for three or four days, by the fifth day 22:14 you are over the nicotine withdrawal syndrome 22:17 or the caffeine withdrawal symptoms. 22:19 And you don't have to worry about having to repeat 22:23 the nicotine or caffeine to cause vasoconstriction. 22:26 If on the other hand, you continue to treat 22:28 with nicotine or caffeine you gonna continue 22:30 the addiction and every time you go into withdrawal, 22:33 you can have the headaches again. 22:35 People who use high levels of caffeine and nicotine 22:41 when they go at night and go to sleep, 22:43 they go through withdrawal and what happens 22:47 is their Arterioles dilate and what do they wake up 22:50 with but many times a pounding splitting headache 22:53 and the first thing they need to do 22:54 to get rid of that is to get a cup of coffee or the nicotine 23:00 again to help relief that. 23:02 If you can, however, break the cycle 23:05 and get over these addictions, you can do much better. 23:09 Things that can be done to help get over these addictions, 23:16 drinking plenty of water can flush the nicotine and caffeine 23:20 out of your system more quickly. 23:22 You can do warm showers. 23:26 It actually flushes it out through your system. 23:31 There are people have gone through 23:36 nicotine and caffeine withdrawal programs, 23:39 where they actually put them in the sauna. 23:41 They come out and give them a massage 23:43 and the towel comes up yellow. 23:45 Because the nicotine is actually coming out their sweat pores. 23:48 So if you take warm showers or saunas, 23:50 you can actually get rid of that nicotine, 23:53 caffeine much more quickly than otherwise. 23:58 You also want to avoid triggers that will cause 23:59 you to want to smoke or use caffeine 24:03 and the biggest trigger for smokers is caffeine. 24:06 It triggers a desire to smoke. 24:08 So it's best if you can stop them both together. 24:12 They have done a study at one lifestyle center 24:14 where people that stopped nicotine and caffeine 24:18 at the same time, they were followed 24:20 after they left the program. 24:22 Those that stayed off of caffeine, 24:25 90 percent of those were able to stay off the cigarettes. 24:29 Those that went back to caffeine, 24:31 90 percent of those went back to smoking. 24:34 So there is high correlation between 24:36 smoking and cigarettes and caffeine. 24:41 You also want to avoid other triggers 24:43 that will cause you to want to smoke 24:44 or and those include alcohol, lack of sleep 24:49 and the smell of smoke. 24:51 You can avoid those. 24:52 You can decrease your risk of going back to those habits. 25:00 Also, encourage patients to pray 25:02 because giving up smoking or tobacco 25:06 can be a spiritual battle. 25:09 A friend of mine, we helped him in Guam. 25:12 He was able to stop his hard drugs 25:15 and he stopped his alcohol 25:18 and then when he stopped cigarettes, 25:20 he was coming out of the store 25:22 and somebody in the parking lot, 25:23 said hey, you wanna cigarette. 25:26 In fact, he handed the whole pack. 25:27 In fact, you can have the whole carton. 25:30 And I asked Mr. John, you are 30 years old. 25:32 Does everyone ever offer you 25:34 a free pack of cigarettes before? 25:35 And He said, no and certainly never a whole carton. 25:38 And I said, do you think it's a coincidence 25:40 that on the day you stop someone 25:41 offers you a whole carton. 25:43 I said God's got His angels, Satan's got his angels, 25:45 and they are fighting over territory. 25:47 You are the territory. 25:49 I shared this with a nurse, friend of mine. 25:50 She was a Christian. She said, oh yes, I know that. 25:54 I told the friend of mine the same thing 25:56 and he didn't believe me but the day after 25:58 he stopped smoking, there was a knock on his door. 26:00 He answered the door. 26:02 It was friend of his and his friend said, dear George 26:03 You remember that cigarette I borrowed 26:06 from you a year ago? 26:08 I never gave it back. Here it is. 26:10 So I consult patients. You gonna stop cigarettes. 26:14 Remember it is a spiritual battle 26:16 and prayer is really needed 26:18 because they are bigger than we are. 26:20 So, it's important to remember that if for any reason 26:25 your blood pressure does not response 26:26 to simple lifestyle changes, you may have a secondary 26:29 cause of Hypertension. Endocrine tumor can do this. 26:36 Renal artery stenosis can do this. 26:38 There are several things that you should be checked for. 26:40 And so for any reason it does not respond, 26:43 check with your doctor. 26:45 You may need a further evaluation, 26:46 further work up. But 95 percent of hypertensive 26:50 is essential Hypertension and does respond 26:53 very well to lifestyle programs. 26:56 So again the things to remember, 26:59 plant based diet, eliminate the animal products, 27:03 eliminate the oils, caffeine, nicotine, the alcohol, 27:08 and try to get on a walking program. 27:11 Do things proactively to avoid stress in your life 27:15 that could be very healthful. 27:17 And you will find that if you actually do these for lifestyle, 27:21 things that many times, 27:23 the stress in your life will go away. 27:26 If you are struggling remember God's grace can give us 27:30 the power to follow through on the choices 27:32 that we know are going to give us the best help, 27:36 encourage you to seek God and prayer. 27:38 He can give you the strength and guide you 27:41 in the choices that will help you to obtain the good health 27:46 that He does want you to have. 27:49 He does encourage us that He does want us 27:51 to have good health, that we might reflect His image 27:56 and be of better service to Him 27:57 and to our brothers and sisters. I enjoyed talking with you. 28:00 Look forward to talking with you again. 28:03 Until next time, God bless. |
Revised 2014-12-17