Ask Dr. Cheryl

Topics discussed in this episode:

• What Dr. Cheryl learned in her residency (1:30)
• Understanding our blood vessels and arteries (3:00)
• Understanding blood pressure (4:10)
• Blood pressure ranges (8:00)
• Caring for our arteries and vessels (14:35)
• Lowering blood pressure (16:00)

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Transcript:

Welcome to The Wellness Table. I'm Dr. Cheryl Bothwell. And on this show, we're going to talk about nutrition, longevity and lots of fun things. Today on the show, we are going to talk about the leading cause of death that we don't talk enough about 

So as a dietitian and when I did my undergraduate work at Loma Linda University, we learned so much about nutrition and about food and how do we use food as medicine. And that's really so much about like the therapeutic side of that as well. If someone's in the hospital and we eat, we learn what's the diet, what's the best diet for this and for this and for this. So ultimately we're on the treatment side. And so in my doctoral work at Rutgers, we had to do a residency. And in that residency it had to be with a physician and it had to be in your specialty. And my specialty area that I focused on in my doctoral work was cardio-metabolic disease. So diabetes, cardiovascular disease. I was trying to just look at the big number one chronic diseases.

And so when I did that work during my time in my residency, I had the privilege of working with a cardiologist and I spent six months with the cardiologist. And the thing that was so interesting to me is day one, I'm already I've done everything like, what's the special diets for this? I think I'm going to be seeing his patients and talking about nutrition and heart disease all day long. And the first day, day one, and this was Dr. O and Saint Alina at the Saint  Allina Hospital. And he just says, Put all your notes away. You know about nutrition. You've been studying it for 15 years and I want to talk. I just want you to learn everything about the heart and everything about real people. It really changed everything for me because I spent six months of time in the cath lab where I would see a patient on the stretcher and he'd say, You can't look at the medical record. You can't look at anything about this person. You don't know any vital statistics. I mean, we're sitting there, what's the blood pressure? How much does a patient weigh? What's their medical history? And he would just want me to look at them and then assess, what do you think we'll find when we look at the coronary arteries? And it was like this projection of what I would find. And so it was a pretty exciting because as I experienced really true cardiovascular disease, he would just joke and say, you know, I'm really a plumber. And that really, if we think about all the vessels in our body and all of our arteries, it's like a hose and it's like water flowing through the hose. And we need that hose to be supple and elastic.

And so what we would find is that when we'd go in and they'd enter the catheter into to start this coronary, we're doing that. We're in the cath lab, we put in that catheter. And what I found is that for some people that that needle would go in smooth and this would go into the femoral artery in the leg, and then sometimes they'll do it on the brachial artery. But most of the time, he was doing it in the femoral artery. So this is in your leg. And sometimes that needle would go in and it would be like hitting a block of wood. It was like hard. And I began to see like he would look at me and say, hardening of the arteries, The old term is like a real thing. Like the artery actually can get hard. So that means as we're drinking and our fluid, it's our changing and adjusting. Our arteries are not relaxed and supple to be able to handle fluid shifting. If you think about washing your car and you're holding the end of the hose and you want the pressure to go up, you can constrict that hose and you get this stronger pressure. So he ultimately explained to me that blood pressure was a really, really big deal and a great thing to track and understand as we were assessing patients. And so I really wanted to talk about that today in this podcast because I feel like if we are to think about what are the risk factors, are what should I eat?

Well, we can talk about what to eat to lower blood pressure, but I want you to just understand just a little bit that high systolic blood pressure, which is your heart at its highest pressure, is really, really a big risk factor for stroke and heart disease. But this is an early on science, so we can do something earlier. So I like to look at things that are on the prevention side or what's my first sign that I might not have a pain point? It doesn't hurt to have high blood pressure. We don't feel it. So it's it's completely silent. So as I looked at blood pressure, I started to think, wow, that's something. When people are in the tracking part of, you know, we're tracking how many steps we take. We people track their weight so well. And I'm thinking we should be tracking blood pressure sometimes people ask, what's the diastolic? What's the systolic and what's my number mean? So just in general, so we're on the same page. This systolic blood pressure is the top number on your blood pressure. And so that's usually the highest number. And when we look at a normal blood pressure, we're talking about 120 is the top number, and that's your systolic blood pressure. And the diastolic would be the 120 over 80. The 80 the bottom number is the diastolic, the lower number typically.

So the systolic blood pressure being the top number is one way to really think of systolic blood pressure is we use a blood pressure cuff and it's sort of like we tourniquet the arm and we sort of look at how much pressure does it take to have the tourniquet out, When is kind of how I look at it, where we have finally stopped the pressure from going down to the rest of the arm. Let's say we're doing this on your arm, then we would have stopped that brachial artery. And how much pressure does it take to literally it's measured in millimeters of mercury. And how much pressure does it take for the heart at its workload when it's in its full workload to sort of shut that off? So that's the pressure.

How much pressure? So we actually if we think about a hose, we want a nice flowing system. If we think about Doctor Oh, teaching me that it's it's plumbing, it's like water. So I just got the hose in my mind from that residency. Like the simple way to explain it to people is I need this to be elastic and supple. And then that's going to help the fluid flow very well through my entire body. And why is this important? It's like this is the blood is what's circulating all of the nutrients to all of our body and to all of our cells and to all of our organs. and again, you don't feel it if you're having if you have high blood pressure, there isn't a feeling to it you might not even know until you're testing it. So it is something that I like to see people test. The diastolic now is the heart at rest. So that's my heart. When I am at the the lowest pressure that my heart will be. So often we see like the diastolic pressures, the hardest number to change because that's hard at rest. The high number of systolic is like there's white coat syndrome.

Like I go to the doctor's office and they're checking my blood pressure and I get this stress. And in this little bit of a stress moment, my systolic pressure is the one that will go up my heart when I'm just feeling a little bit of stress. So that number does change. And so this did the diastolic heart at rest sometimes is a really good marker to know what's our heart at rest and where is it sort of sitting. So one of the things that we also see is that we want to be sitting when we take our blood pressure and we want to be neat. Some some people will say have them sit for two or 3 minutes and you'll see that kind of blood pressure, the systolic, and you kind of get a resting blood pressure. So that's a measure that I think is really important for all of us to know.

So if we look at what is a normal blood pressure, it's 120 over 80. And as we look at those are the numbers that we want to shoot for. What I find is that there's a lot of people that have a much lower numbers. And if we think about a child's blood pressure, what we kind of see is that they're often much lower than that. And then as we get older, we sort of accept these higher numbers. You know, when I did my bachelor's degree and I'm a dietitian and I'm just measuring numbers, I'm looking at cut points. So when 20 over 80 did they have 120 over 80, then they have normal blood pressure when they move up to, let's say, 130 or 85, that diastolic creeped from 80 to 85. That's something to look at. And that means my heart at rest. It just started slowly shifting. And so then we start to see 130 over 90, and that's where we start to look at pre hypertension. And so we're slowly moving our blood pressure up a bit. That's the diastolic and the systolic. So when we start to see that, that's when I was learning as I was seeing these these patients in the cath lab and we're checking their coronary arteries, I found it really interesting that somebody might come in there with a hypertension, 160 over 90 blood pressure. Let's say they're on a blood pressure medication maybe, too. But now they need a stent. And we're now going in we're going into the coronary arteries. And I'm watching Dr. O do all of this work for six months, like in there not doing any nutrition counseling and I'm just watching these procedures happen. Person after person. And I found it amazing to see what the coronary arteries look like, like this is what gives circulation and takes care of our heart muscle. So it's like a really important thing. There are coronary arteries and you would go as he would go in there and we're watching everything on the screen. I could see the difference between everybody's coronary arteries and I could start to look at their coronary arteries and realize this person, The people with diabetes had smaller, narrower, thinner, just the millimeters of the width of their coronary arteries. So the normal coronary arteries were around seven millimeters, eight millimeters. But someone they had diabetes, they're like four millimeter coronary arteries. And someone that was smoking their coronary arteries are like even down to two millimeters, which means that the walls of the arteries are there are like an organ system. We don't think about it. And they need to be cared for and they need to have circulation. So there's blood supply going in the walls of our arteries. It's kind of an interesting as we look at the difference between artery and vein. So arteries can handle a lot of pressure and they're designed to really push that fluid through our entire body. So I'm looking at these coronary arteries and I'm seeing like, wow, someone that has real obesity, say, 100 pounds of weight and above, you're looking at 9, 10 millimeter coronary arteries that are all kind of floppy walled, not firm walled.

So our arteries are sort of a pattern of what our health is and it's affecting blood pressure. And now we also ask the walls of the artery and then we have occlusion. So with occlusion, we might have an insult to a certain area. Like if we look at inflammation in the body and we look at that measured by high sensitive CRP, C-reactive protein, we can ask for those numbers down when we get our bloodwork But when you get bloodwork done, we can check as long as we don't have any kind of an acute infection like we have a cold or flu. But if we're just in our normal health without an acute infection, we can track chronic inflammation through measuring high sensitivity CRP. And I like to see that number under two we can get into that a little bit more. But ultimately, as that inflammation raises, it's typically this hidden somewhere in our body. There's inflammation and it's most commonly our arteries. And we we guess at that because we sort of like, okay, these are the hidden, we're just measuring the outside of you and we're trying to figure out what's going on inside of you so we can measure inflammation through the sense high sensitivity CRP.

But the blood pressure is the easiest way to measure how are my what's the health of my arteries and are they elastic and is my blood pressure coming up? Is that systolic rising? Is my diastolic is my heart at rest. So they're important numbers to look at and in occlusion. I just want to add this one little note about occlusion. Then if we get an injury to an area that can happen where it's just like a wound and that creates a little bit of a healing area that needs to happen or a little bit of inflammation and the immune system creates inflammation there. And so this is where cholesterol can come and be kind of caught in the area or a calcification of calcium.So when you're looking at occlusion and we see, okay, there's 80% of that coronary artery or any artery is occluded, we began to now say this is a time for a stent. And a stent kind of cool. Like doctor gave me a stent and it looks like the spring in a pen. And that spring in a pen is they balloon open the artery where the occlusion is. And they put this little spring and it's sort of it's all set so that it will in bed with it about three weeks into that artery and literally open up that artery. So as soon as that artery would be ballooned open and that stent placed, as I'm looking at the monitors, I'm watching blood pressure immediately drop, just like taking your hand off the end of a hose when you're washing your car and watching the change of the flow of water. That's what happens when we put in a stent.

So blood pressure is really important for us to be measuring and monitoring. And one of the things that we see with high blood pressure is depending upon how your genetics are and your how your body's made. For some people, can see occlusion in arteries happening in the coronary arteries, or it could also be happening in the brain. And so we can have a vascular occlusion or a vascular level of occlusion, which can also cause vascular dementia.

We can also get strokes from having a blockage of a blood vessel in the brain if the blockage is in the heart, then it's a heart attack. But these are all really vessel focused diseases. So managing our blood vessels and how we care for our blood vessels is all related to so much of food and lifestyle. And that's what I'm excited to talk about, is how can we protect ourself from having a stroke? Vascular dementia, when we talk about brain health? Well, number one is we're still back to the vessels. So I always come back to my doctor time in my residency. Really understanding blood vessels are like a lot of our disease conditions. So diabetes is ultimately a microvascular disease because with diabetes they're not getting the oxygen. The sugars are so high when blood sugar is high, we're starting to see the vessels begin to shrink. And as those vessels, the walls shrink, that's one problem.And then we have occlusion from high cholesterol diet, from a lifestyle of not drinking enough water and injuries and inflammation that all can cause occlusion. So if we have occlusion, then we end up with a heart attack or the need for a stent or a bypass surgery where we have to bypass that occlusion or in the brain, we can end up with an occlusion in the brain causing a stroke.

So these are the things that can debilitate us or cause early on death. So I like to talk about blood pressure. If you were to ask me, like, what's the most important thing for me to track in the risk factor world, I'm going to put blood pressure right up there at the top because it tells us everything. And then if we start to say, Well, how do I lower my blood pressure? Do I need to take a medication? Am I you know, what are all of the things? So let's talk about that because that's really exciting, because we can see blood pressure lower within an hour of eating certain foods. So one thing I'll say is like, if you do your blood pressure before a meal and one hour after a meal and you can buy these little risk blood pressure, you can buy really great self blood pressure measuring things, you can actually see your blood pressure go out in the sunshine and measure it before go out in the sunshine and get 20 minutes of sun, early morning sun on your skin. Take a ten minute walk and 30 minutes later, measure your blood pressure and you're going to see blood pressure come down. What do you when we talk about relaxation and meditation, deep breathing, we're lowering blood pressure. These are all the things that we're doing to treat high blood pressure. So they're really wonderful things in our lifestyle that we can do. Getting good sleep. But drinking water is really, really key for high blood pressure. And another thing I keep talking to my doctor with this because I'm just thinking of him today with it. But he would often say to me, the person on this gurney in this cath lab is the safest person in the hospital because I can fix all of this stuff. But the person that's waiting for them in the waiting room, the spouse, the child, the parent, whoever that person is in the waiting room, he would walk in before he started the procedure. And I'll never forget this. And he would bring two bottles of water and say, I need you to drink these two bottles of water while I'm doing the procedure, and then I will come back and I want these bottles. I want you to be drinking water. And it was really neat how he was taking care of the person that often isn't cared for and what was his care? Water. So he was always thinking about prevention and treatment all together. And I just loved my experience with that. And I learned so much and I want to bring that to everybody that I talked to that it's so important for us to think about the caregiver, that person that isn't eating anything.

They're sitting there waiting for their loved one and they're not drinking their water and they didn't have breakfast because they're waiting for the surgery results. But in general, in life, are we drinking enough water? Because that's really, really important for blood pressure, health. the other thing, when we talk about blueberries and brain health, well, the blueberries, how are they doing that? They're relaxing on the arterial wall. So now I get better circulation to my brain. I have more energy. And that's that's really how they're working is relaxing that wall. And they do that within an hour to 6 hours. So then I look at like, wow, I should be eating blueberries every 4 hours. Like if I had a an antibiotic and I take it three times a day to fight this bacteria. If I had blueberries, I could have a half a cup of blueberries at breakfast, a half a cup at lunch, or any berries and a half a cup for dinner. And I'd be medicating my arteries beautifully, drinking enough water, sunshine. So when we look at the ten foods that are the best foods for healing, that are part of the score, and we look at the ten health habits, everything that I built into that was, number one, are they helping us heal our blood vessels, relax the arterial wall and really lower blood pressure? And when we look at nitric oxide, that's really a part of, you know, how are we boosting nitric oxide plant protein? So if we look at almonds, we look at nuts, they're loaded with a higher arginine two lysine ratio. And so what that's doing is it's boosting nitric oxide and nitric oxide is literally helping us lower and relax blood, blood vessels like a medication within an hour of eating them.

So I like to see everything I can do in a day. So you'll see on the score a quarter cup of nuts is your plant protein and at least once a day have a quarter cup of nuts. There are studies that show people that ate a handful of nuts. This is in the evidence health study three times a week. Just a handful. I just described it. And it ends up being a quarter of a cup. Depends on the hand size, but ultimately it was about a quarter of a cup three times a week had a 47% less risk of a heart attack. So these are phenomenal things. So now when we come back and talk about what's the ideal diet, I like to have these conversations because the ideal diet to me should include those nuts, because that's a 47% less risk of having a heart attack. But that just means three times in a week you boosted nitric oxide. So we were lowering our risk on those three days. So what if we did it every day is what I'm saying. What if every single meal we have three meals a day that we have the opportunity to heal our blood vessels, prevent damage, heal the damage?

And then I just want to pop on one thing with Dr. William Lee's latest book on Eating to Beat Disease and Eating to Beat Diet. And he talks about how the regeneration of blood vessels and how that can be done through food. So that's another exciting conversation that I want to have. But there's another level of can we actually reverse the damage after it's happened? Dr. Ornish, his work has supported reversal with even an even 12 weeks with changing how we eat and Dr. William Lee's latest research, again, supporting how we can actually heal blood vessels. So there's a lot of hope if your blood pressure is high to treat it today by one meal, lowering blood pressure, but also after 12 weeks, a longer effects or after a year of actually even reversing and repairing those blood vessels.

So this is super exciting and this is what I call food as a medicine at its very best.

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