Alcohol, caffeine and tobacco are best avoided.

Alcohol raises BP via a few mechanisms including increasing the hormones aldosterone, cortisol and renin. During withdrawal excess adrenaline is released. Beer contains hops which have estrogen like compounds. Long term exposure to estrogens may cause excess breast development and raised BP. Not a pretty combination.

Caffeine is not a fun compound for the arteries. It reduces pulse wave velocity, increases the activity of plasma renin, causes arteries to constrict and enhances the effect of norepinephrine a stress hormone.

Tobacco is is dreadful for high BP. Is causes constriction of the arteries and increases the fight or flight reaction. It causes the platelets to clump and the blood to become more prone to clotting. There is increased oxidative stress and inflammation.

Pharmaceuticals that increase blood pressure.

This is a fun list. Are you taking any of these popular items?

Amphetamines. This includes some medication for ADD, ADHD etc.

Anabolic steroids and prednisone.

Antidepressants such as MAO inhibitors.

Antihistamines

Bromocriptine

Combines oral contraceptives

Cyclosporin

Digitalis

Disulfuram

Ergot alkaloids – St Anthony’s Fire from moldy rye.

Erythropoietin compounds

Licorice

Lithium

Metoclopramide

NSAIDs

Tacrolimus

So often in medicine we chase our tales treating the side effects of medication with yet another. We understand how certain pairs of drugs interact but if a patient is on three drugs or more they are beyond medical science in terms of the interactions.

In Functional Medicine we take a detailed history including pharmaceutical use. Sometimes medication produces symptoms as a result of side effects. By looking for the root cause of disease we are often able to deprescribe or cut back on the use of medication.

High blood pressure (BP) or hypertension (HTN) can be the result of a combination of deficiencies and poor diet. Although we may get enough calories on a Standard American Diet (SAD) there is poor nutritional density. As a result we miss out on a lot of vital nutrients. When we eat largely processed foods we crowd out vitamins, minerals and essential fats with sugar, high fructose corn syrup, flour, corn and soy. These are very cheap ingredients that are sold to us in a myriad of permutations devised by food scientists to be addictive and highly profitable.

In Functional Medicine we use foods and supplements to correct the adverse biochemistry that expresses itself through symptoms.

Vitamin D

The recommendation in Canada is for the adult population to take 2,000 IUs/Day. This may be too little for some patients who may need to take 5,000. Please ensure you have your levels measured and adjust the dose according to your response. At the Paleo Medical Clinic we have accurate testing available. Know your level and adjust your dose.

Vitamins E, B2, C and B6.

Vitamin E at 100 IUs/day ideally from mixed tocopherols.

Vit B2 (riboflavin) 25 mg/day. The richest natural sources are eggs, organ meats such as heart, meat and milk.

Vit C 500 mgs twice daily (avoid taking at night time as it is slightly stimulating) is recommended for HTN by the Institute for Functional Medicine.

Vit B6 5mg/kg/day (pyridoxal 5-phosphate). This is one of the most common vitamin deficiencies in North America. It reduces the fight or flight side of the nervous system that typically puts up our BP.

Folate and vitamin B12.

Beware if your homocysteine is above 7 mcmol/L. Normal is defined as being less than 15 by most conventional labs. This value is based on a population that is not healthy. It might mean that levels of folate and vitamin B12 are not ideal. We can also measure the activity of vit B12 by testing for methyl malonate. This is routinely done when we run a test called the DUTCH PLUS which includes organic acid testing. Both folate and vitamin B12 can bring down the level of homocysteine but we would recommend that they be in a methylated form.

Minerals.

Potassium is a useful mineral but we do not recommend supplementation as taking too much can cause the heart to stop. Yes this can be fatal. It is best sourced from foods such as cooked spinach, broccoli, mushrooms, cucumbers and tomatoes if tolerated.

Magnesium is often lacking and we would recommend 500-1,000mgs at night time. The types can be varied say citrate for a couple months then glycinate. There are also products that contain up to seven types of magnesium in a single tablet. Build up the dose until you get loose stools then cut back. The dose varies between individuals and the forms have differing laxative effects.

Calcium supplementation in women is associated in an increase in heart disease. We recommend this is from foods. Small wild fish with their bones are ideal rather than from milk.

Zinc 25-50 mgs /day. In the longer term this needs to be balanced with copper rich foods such as liver, organ meats and oysters.

When we expose our skin to sunlight the UVA creates nitric oxide. This dilates the blood vessels and drops our blood pressure (BP). A key ingredient to this process is L-arginine an amino acid. If we are not digesting protein well we may not have enough L-arginine. So we miss out on some of the benefits of sunlight. There is a link between our gut health, our response to sunshine and high BP.

Top sources of arginine are nuts, seeds, dairy and meat.

High BP damages the internal lining of the blood vessels. This is called the endothelium. It is a single cell layer thick and covers an area equivalent to six tennis courts. Damage can occur due to many factors. Low B vitamin status can raise homocysteine which is a risk for heart disease. Oxidised low density lipoprotein (LDL) is also harmful. Sugar can damage this particle. Low folate from a poor diet can also contribute.

Some compounds in the diet may protect the endothelium such as polyphenols and anthocyanins. These may be found in spices and berries.

Gut and mouth.

Dysbiosis in the gut or the oral cavity releases toxins that again affect the blood vessels and the heart. Gut permeability allows lipopolysaccharides (LPS) to go into the blood. This causes the immune system to panic as the LPS are parts of bacteria. The signal to the body is that there may be impeding sepsis. Inflammation occurs damaging the endothelium.

Autoimmunity.

Co-existing autoimmune conditions such as rheumatoid arthritis can be as bad as smoking for arterial disease. Hypothyroidism can lead to disturbances in our blood fats.

Toxins and deficiencies.

Insulin resistance can also damage this vulnerable layer. Lead and mercury can do this too and are common toxic metals. Cadmium in smokers is also a problem as are some insecticides.

Certain treatments for high blood pressure such as beta blocker reduce CoQ10. ACE inhibitors lower zinc which leaves us more vulnerable to viral infections. Magnesium is a very common mineral deficiency due to levels being depleted in the soil. Deficiency may be contributing to high BP.

In Functional Medicine we look at the root causes of high BP. We then may be able to do away with medication for what is a symptom of a poor lifestyle.

It’s been assumed for years that patients with high blood pressure (BP) should cut back on salt. When we eat carbohydrates (sugars and starches) our pancreas releases insulin into the blood. This pushes glucose into the cells. Insulin has hormonal effects far wider than just controlling blood sugar. It causes the release of anti-diuretic hormone (ADH). The kidneys then retain water and salt. Blood volume is increased and BP rises.

Insulin resistance.

If we eat more carbohydrates than the body can cope with our cells start to resist the action of insulin. The pancreas initially responds by producing more of the hormone to over come this. The tissues reply by becoming further resistant.

The wise Dr Unwin.

Dr David Unwin has created a series of infographics at https://phcuk.org/sugar/. These illustrate how many common foods convert to equivalent teaspoons of sugar. He also has a lecture on you-tube about how we have blamed salt for what sugar does. Dr Unwin is a Family Physician from the North of England.

High blood pressure and carbohydrates.

If someone with high BP cuts back on the total grams of carbohydrates to say 25 a day their blood sugar spikes will flatten and their insulin level will drop. Less ADH is produced and a natriuresis occurs. That is salt and fluid are shed by the kidneys. The patient experiences weight loss and a drop in their BP. For this reason if a patient is taking medication BP the change in diet needs to be medically supervised. Medication may need to be de-prescribed to avoid low BP or hypotension.

In Functional Medicine we look for the root cause of medical conditions. This is instead of palliating symptoms with a pharmaceuticals. High blood sugar from our artificial, species inappropriate diet may unwittingly be contributing to a common and preventable medical problem.

Hypertension (HTN) or high blood pressure is very common. About a 1/3 of people are affected half of whom are poorly controlled. The consequences of HTN are stroke, heart disease, erectile dysfunction and heart failure. These conditions are sadly on the horizon for many patients.

Getting an accurate measure.

Getting the measurement of blood pressure accurate is essential. Firstly you need the correct size of cuff. Prior to the obesity epidemic we used a standard cuff but nowadays we have to use a broader one as people have bigger arms. A narrow cuff on a broad arm will give a false high reading.

The patient needs to be relaxed sitting in a chair for 5 minutes with both feet on the ground. Avoiding tea and coffee for at least an hour prior to the reading is important. Heavy exercise just before a reading can also produce a high reading.

Some patients have a high reading in the doctor’s office but not at home. This is so called white coat HTN. I often get patients to measure their blood pressure at home to get a more accurate assessment. If I am uncertain about the diagnosis I will order a 24 hrs ambulatory blood pressure. The patient has the cuff on their arm for a day and is attached to a small monitor that records the readings. The beauty of the 24 hr reading is I can see what happens to blood pressure at night. There should be a 15% drop compared to the day time.

Risk begins early.

The risk for HTN can begin very early on in life even in the womb. If the mother has gestational diabetes the baby has an increased risk for HTN later on in life. Also either being too large or too small at birth can also confer greater susceptibility. In Functional Medicine we would see these as antecedents that eventually contribute to the expression of disease.

Vitamin D is essential for life without it we perish. It is required for thousands of metabolic reactions and acts as a spell checker on our DNA. Just about every modern Western disease is associated with it’s deficiency. Most people are aware that we need it for bone health but it is essential for so much more.

We need it for the functioning of a competent immune system. Without it we are more likely to succumb to viral infections. In one Spanish study of patients admitted to hospital (with our current viral menace) significantly avoided going to the ICU if vit D was given. Although the study has been dismissed for being small it was statically significant.

Ideally we need to make it from the sun. Many other compounds are produced by the sun in the skin than science has yet to document. For instance nitric oxide is produced as a result of exposure to UVA and drops our blood pressure. Being in the sun makes us feel great and gives us a shot of endorphins. Were nature discouraging us from being in the sun I doubt she would give us such a reward.

However, excess sun exposure can be a hazard to our health. There is a sweet spot. I use an app called Dminder which takes into account skin type, UV, latitude and altitude. It then calculates the safe duration of exposure. It’s free and well tested. Give it a go!

When I was at college I had the most amazing biology teacher. One day she brought in a beautiful loaf from Cranks-an up market whole foods restaurant in England. It was artisan, wholegrain, organic and made from sour dough. At that time there were test papers that on contact with glucose turned violet. She gave us one each and cut the loaf into 32 pieces for her pupils.

Then she instructed us to chew the piece of bread for 20 seconds. We put the paper on our tongues. It turned violet. This showed us that even in the mouth there are amylases, that is enzymes, that actively break down starch into it’s basic building blocks-glucose. This continues in the gut after we swallow.

Starches can raise our blood sugar very quickly. Rice cakes, which many consider to be a health food, do it more quickly than sucrose ie. table sugar. Foods are graded in terms of their glycemic index or the speed and extent they raise blood sugar. Portion size also has an effect.

We have 7 pints of blood on average. I often ask my patients how much glucose they think is circulating in their blood stream. Invariably they say things like 1-2 pints or 500 grams. The real figure is near to 5 grams. That is just a teaspoon of glucose in 7 pints of blood. When we eat something like a ripe banana we are taking on 6 teaspoons of sugar. A 150 gram serving of potatoes is the equivalent of 9 teaspoons of sugar.

It is not just the obviously sweet foods that are a problem. Starches that do not taste sweet are very readily digested into simple sugars.

Common foods can wreak havoc metabolically without our knowing. One way to find out how foods are affecting our blood sugar is to use a continuous glucose monitor. The monitor is attached to the upper arm for two weeks and the patient can, without using a lancet, measure their blood sugar with an app on their phone. They can then discover which foods are causing blood sugar excursions. This gives them valuable information. They are then able to make informed dietary changes that prevent future disease.

Long before we express the symptoms of type 2 diabetes (DM2) there are often years of poor metabolic health. This can be asymptomatic and we may unwittingly consider ourselves to be healthy. Only 12% of the US population is normal from a metabolic perspective. Most people are sick. Sugar and carbohydrates that make up a lot of the processed foods we eat cause our blood sugar to oscillate. The peaks stimulate a panic as the body wants to keep blood sugar in a narrow healthy range. Insulin is produced by the pancreas, this encourages the sugar into the cells and out of the blood stream.

Once the cells are swamped with sugar they are increasingly reluctant to take on any more. They start to resist the action of insulin. As a result the body responds by producing even more insulin to over come the resistance. This becomes a vicious cycle of increasing insulin resistance on the part of the tissues and excessive insulin from the pancreas.

The body can also overshoot with insulin leading to low blood sugar (hypoglycemia). This makes us feel ‘hangry’ as stress hormones such as cortisol and adrenaline are released in a desperate bid for the blood sugar to be raised. These hormones can make us feel panicky and anxious which is why I remove foods that destabilise blood sugar from my anxious patients.

Over time if we continue to eat more sugar than the body can cope with insulin becomes ineffective and blood sugar starts to rise. Once our HbA1c is >6.4% our doctor diagnoses DM2. (HbA1c is a protein that picks up how much sugar has been in the blood over the last three months). The solution to the problem; lifelong medication.

Once we become insulin resistant we can no longer respond well to carbohydrates across the board. Now even starches are a problem. Glucose is a monosaccharide that can form long strings of itself. These are commonly referred to as starch. So be it rice, grains, potatoes or pasta you are basically eating sugar. A 150 gram bowl of rice is equivalent to eating over 10 teaspoons of sugar. Fancy a chunky sandwich? That’ll be 12 teaspoons of sugar. It is not just the foods that taste sweet that are a problem but the foods that become sugar when broken down by our digestion.

There are other contributors to insulin resistance apart from sugar and starch such as vit D deficiency. I will explore these other factors in future posts.

Our ability to refine sugar on a mass scale is from an evolutionary perspective very recent. Sugar was first produced in India some 2,5000 years ago and was a rare spice originally only affordable by the aristocracy. The technology that enabled industrial production was not established until the 19th century. In 1700 the average person consumed just under 2 kgs per year, by 1800 this was 10.2 kgs, by 1900 40.8kgs and in 2009 81.6kgs (USA).

Fructose is the sweetest of the sugars and is the one we would have sought out in nature. It is a five sided sugar and has, in excess, an effect on the liver similar to that of alcohol (but without the fun). It is problematic in that most of the cells of the body cannot use it for energy. It combines with our tissues turning them to toffee. This process is called glycation. Only the liver can begin it’s metabolism. Glucose, by comparison, is taken up by most of the cells and can be used directly for the generation of energy. Too much fructose or other sugar can cause the liver to become fatty. Left unchecked this can develop into cirrhosis and eventual liver failure.

Humming birds take advantage of this fatty liver mechanism. They drink fruit nectar during the day and the liver becomes creamy white with fat. At night due to their extreme metabolic needs this is reversed. Sadly in a lot of modern humans we eat so much high fructose corn syrup (HFCS) that the liver has no rest. We never fast long enough to let the liver release the fat and are continually assaulting it with simple carbohydrates. Sugar is added to over 70% of the food in the supermarket.

This is a historically bizarre situation. If sugar was introduced as a new substance now it would not pass safety standards and would be banned alongside heroin, morphine and cocaine. When we ingest it our brains are activated by endogenous opiates and dopamine. This gives us a sensation of pleasure. In the past, prior to agriculture, this hit would have usefully spurred us to eat fruit. No foodstuff in nature is at once sweet and immediately poisonous. That sweet taste is a reassurance of safety. In nature however fruits are not present all year round. The original fruit cultivars are so far removed from the modern ones it is like comparing a wolf frankly with a chihuahua.

So why is this addictive poison still in the food supply? Could it be that there are vested interests? After all there is far more money to be made from the sick than from the healthy. HFCS is cheap, an excellent preservative and is super sweet. On the one hand we have a poisonous, addictive food supply that makes us sick. Then the pharmaceutical industry sells us expensive drugs so we can carry on eating this rubbish. Kerching!

Want to know more? Enjoy this classic lecture from Dr Lustig UCSF.

This pandemic has been cruel to our mental health raising anxiety in even the mellowest of souls. As a result we are getting more panic attacks some of us for the first time. We can feel totally overwhelmed. What can we do at that moment to ease the fear? Get a wet T-towel and wrap around enough ice to cover your face. Bash the ice with a hammer or rolling pin so it will mould to the contours of the face. Take a small breath and lean your head forward into the ice bag. Hold for 30 seconds then remove from your face. You can repeat this after a minute or two for several rounds. 

The parts of the face to cover with the ice that are crucial are the eyelids, nose, inside of the nostrils and the upper lip.

This triggers a very old survival mechanism called the dive reflex. In aquatic mammals such as seals and dolphins this reflex is highly developed so they can survive long periods under water. The sensation of cold and wet travels along the 5th cranial or trigeminal nerve. In turn the sensation is relayed to the 10th cranial nerve or vagus nerve causing the heart rate to slow and the parasympathetic nervous system (rest and digest) to be activated. This is opposite to the sympathetic (fight or flight) that is triggered in the panic attack. 

Running up and down the stairs hard for a few minutes is also effective. Breathing in for 3 counts and out for 6 also stimulates the parasympathetic nervous system. If your hands start to tingle during the attack you have blown off too much carbon dioxide. Get a paper bag, the kind you get from the liquor store or off-licence and breath in and out of it until it settles. This will raise the CO2 again and reverse the symptoms. 

‘Don’t believe every worried thought you have. Worried thoughts are notoriously inaccurate’
-Renee Jain

Gluten is a protein found in grains such as wheat, barley and rye. It has a detrimental effect on the gut lining causing it to become permeable. Our intestines have a lining that is only one cell deep. This is damaged when exposed to gluten and becomes permeable. As a result the content of the gut gets into the bloodstream where it is not supposed to be. This causes the immune system to be stimulated unnecessarily.

Part  of the molecule looks similar to some of our tissues. The molecular mimicry stimulates the immune system to produce antibodies against the self. As a result we can develop an autoimmune disease. One of the most common is Hashimoto’s thyroiditis. This can result in an under active thyroid causing fatigue, dry skin, weight gain and hair loss.

Apart from the fact that wheat can raise our blood sugar quickly it also has a drug like effect on the brain. It is broken down into gluteomorphins. These have a heroin like effect on the brain which may explain why we crave bread and pastries. Although our daily bread may seem to have been around forever this is far from the truth from an evolutionary perspective.

It was introduced into the diets of the people of the Middle East about 12,000 years ago. Modern humans are a 195,000 year old species so we have spent most of the time on the planet in prehistory or the paleolithic notably without agriculture. Could it be that we are ill adapted to wheat yet it has hijacked our brains? From that perspective it is a very smart plant!

Vit A is needed for the integrity and defence of our skin and the mucous membranes that line our mouth, nose, gut and lungs. Without this we are vulnerable to attack by viruses and other microorganisms.

There are tiny hair like projection in the windpipe called cilia that waft any particles we have breathed in up and out of the lungs. They too depend on vitamin A. Some viruses enter the body through the surface of the eye. Vit A helps to lubricate it and defend it from infection.

It is essential in the formation of mucus, again a protective layer, against attack by germs. It also plays a role inside the body supporting our immune system. It is needed for our immediate response to invaders. White cell such as neutrophils and macrophages are our front line troops that instantly go after what is recognized as foreign.

Real vitamin A is called retinol. This is only available from animal foods. The richest sources are liver, eggs, cod liver oil and high fat dairy. It is a fat soluble vitamin and is best absorbed with fat.

Many people think that carrots are a good source of vit A and that they help with night vision. Indeed there are about 600 compounds called carotenoids, named after carrots, that can undergo conversion by the body to vit A. These compounds are termed pro-vitamin A. In some individuals this conversion is poor. In about 25% of the population have a marked reduction in the ability to convert the carotenoids to real vit A. Is it worth the risk? Carotenoids are not an essential food as a result.

How much do I need?

4 oz of ideally liver from pastured or grass fed animals per week. Pate is a great food made from liver and butter – both good sources of vit A.

3 eggs a day from pastured chickens.

3 servings of full fat dairy from grass fed animals. Butter from grass fed cows is great.

1 teaspoon of cod liver oil.