Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
3 Jun

Makes My Blood Boil

bloodboilI had a medical scare two weeks ago that shook me up quite a bit. No, not because there was anything wrong with me, but because if I had been someone else and didn’t know what I know, I might be suffering the side effects of blood pressure meds as I write this today. And that’s a slippery slope I never want to ride. Yet this scenario plays out in most doctors’ offices every day.

I had a slight skin thingy on my always-in-the-sun arm. I thought it might be prudent to get it checked out, and I had an hour before my next meeting, so I took an impromptu opening in my doctor’s schedule to have him take a look. In my naïveté, I thought I could waltz in, have him scan it for 15 seconds and send me home with a clean bill of health and a xylitol lollipop. But this being LA and that being a doctor’s office and needing to follow protocol (so as not to get sued for malpractice AND to be able to bill me full pop), the nurse ushered me into a waiting room and took my weight (still 165), height (still 5’10”) and my blood pressure, which I had no reason to suspect had changed since I qualified for the lowest rates possible on my in-home life insurance physical just a few years ago. It had been 122/82 that day. Cha ching.

Imagine, then, my mortification when the nurse casually announced that my BP was 140/100.

Now, in the not-too-distant olden days, if you were 100 plus your age for systolic (the first number) you were considered to have normal BP. Then the powers that be started to opine that 120 over 80 was more normal and that 140 over 90 was hypertensive. Recently, the medical industry (always looking for a way to get you medicated) has started to suggest that a “normal” 120/80 is in fact “pre-hypertensive.” Hey, the more drugs they can sell to healthy people the faster our economy will turn around, right? So at 140/100 I was a little taken aback. I sat there for ten more minutes waiting and going over all the possibilities in my mind: jet lag? (I had just gotten back from NYC the day before and hadn’t slept well), dehydration? (as you know, I don’t drink much water), white coat syndrome? (being in a doctor’s office automatically jacks up some peoples’ BP as much as 20 points), stress? (yeah, I do have stress, and I don’t handle it like I should). All these things can artificially elevate BP. I was going through all the other impossible reasons why I might test high when the doctor strode in, looked at my arm for five seconds and proclaimed the skin thingy nothing. Then he looked at my chart.

“Your blood pressure is a bit high” he says, with eyebrows raised behind his glasses.

“Yeah,” I respond, “let’s check it again, because I don’t believe it.”

So he checks it himself, and now it’s 140 over 101. He says, “ordinarily, because I am big on prevention, I would start you on medication right away, but you look pretty healthy, so let’s check it again here in three weeks, and if it’s still in this range, I’ll prescribe something. Meanwhile, try to eat better and cut back on salt. And maybe we should schedule you for a complete physical.” Well. OK, then. That’s sound advice. He was in and out in six minutes, too. Good thing he didn’t check the BP one more time, because it would likely have been 170/130 after that comment.

I had never really thought much about my own blood pressure until that moment. I’ve always had impressive stats when it comes to heart rate, BP, blood sugar, cholesterol and all the other markers we/they use. Not that I get tested much, because I try to stay away from doctors. Hey, I’m Primal. Why shouldn’t I? But something was wrong here and I needed to take control.

I decided it was time for another “experiment of one.” I drove down the street to CVS and, after a brief seminar on the benefits of all the available blood pressure monitors, wound up buying one of the coolest little home-testing devices I’ve ever seen. It’s an Omron 711-DLX with a pressure cuff that inflates automatically and outputs a big-ass digital reading every time. They say it’s as accurate (or more so) than a nurse or doctor. Consumer Reports rated it number one.

Over the next six days, I tested my blood pressure during 10 different sessions under various circumstances. At each session, I performed and recorded five tests, with about two minutes rest between tests. So the total number of “data points” I got was 50. Here is a brief summary of my results:

  1. In 50 readings, there were no repeats. Every single reading was unique. Not once was my blood pressure repeatable from one test to another or one day to another. I think that defies even common laws of probability.
  2. I never got up to 140/100 in any of my tests. The closest I got was the very first test I did the following morning (which was closest to when I had left the doc’s office). That was a single first reading of 133/92. But even then, my five-test-average for that session was 128/90 with a low of 127/83.
  3. That same night, after dinner (including two glasses of wine) I recorded a low reading of 102/66 and a five-reading average of 108/66! So in one 28 hour period, I had gone from “mild stage-1, give’em drugs” to “low-normal.”  That’s a huge variation.
  4. Almost invariably, the first reading in any session was the highest of the five tests. So if you throw that first one out, the average drops even more. I didn’t, though.
  5. Over the next several days, I tried to look for patterns. The closest I got was that in the evening I generally settle at around 110/67. I guess dinner is relaxing. Otherwise I’m up at times and down at times.

If you plot my results, they are all over the place. It’s a scattergram that only remotely correlates to time of day and/or circumstance. It turns out that blood pressure in most people (as in me) is a very dynamic metric. One solitary reading is about as useful for diagnosing hypertension as one piano note is for identifying a song. Yet, historically, the medical profession has recommended you test for BP once a year, and as recently as 2004 Dr.  William M. Tierney concluded that “a single elevated blood pressure reading – particularly an elevated systolic reading – is a reliable predictor of future problems and should not be dismissed as a fluke.” Start the drugs, nurse.

It’s only now beginning to change. Here’s a very cool article well worth the read. In it Dr. Norman M. Kaplan admits, “Of all the procedures done in a doctor’s office, measurement of blood pressure is usually the least well performed but has the most important implications for the care of the patient.” It also acknowledges that readings in doctors’ offices are notoriously bad and should not form the basis for a diagnosis, and further suggests multiple readings in the home throughout the day as the only reliable method.

Here’s what I know: The body is constantly seeking homeostasis and must make adjustments to blood pressure, heart rate, breathing, immune function, cholesterol and a hundred other parameters literally minute by minute, day-to-day based on input from you. Every time you take a bite of food, move around, decide to sleep or not, react to stress or perform any number of other normal human functions, hormonal and gene signals are sent to readjust and bring you back into balance. As long as you are eating well (Primally), exercising moderately and controlling stress, there’s a very good chance your blood pressure will be exactly where it needs to be. I was 140/100 for a reason that day. Just like I was 102/66 a day later for a different reason. Not that it had a chance in hell of happening, but what makes me sick is the idea that I might have been prescribed a diuretic and/or an ACE inhibitor to artificially lower my blood pressure had I been someone else and just accepted the good doctor’s advice without truly investigating this. And believe me, this happens every day in doctor’s offices throughout the country. Based on a government medical committee assessment that 120/80 (formerly normal) is now “pre-hypertensive,” some 50 million Americans are in line to be on blood pressure lowering meds. Some might actually benefit. Most would be far better off living Primally and letting the body do what it needs to do naturally to achieve balance.

Of course, all this begs the next question: I’m 8% body fat…does that make me “pre-obese”?

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. I’ve never thought about how unreliable a single blood pressure test would be. I have a home bp machine, and have found that taking multiple readings in a row, tends to give me many different outcomes, but I always contributed that to user error. (I.e., ME)

    jpippenger wrote on June 3rd, 2009
    • A few things:

      –I hope this quy doesn’t really get sick, because he has no faith in the medical community.

      –I am a Nurse Practitioner with Cardiology Background; First, medicine is EVIDENCE-BASED in today’s practice; There are STANDARDS of Care — and these are all based on reliable multi-centered double-blinded research studies and outcomes. It is shown numerous times that getting and maintaing a B/P < 120 systolic and < 90 Diastolic (120/90) significantly decreases your chances of cardiovascular events (like stroke and heart attack).. So I suggest who ever reads this, research the studies for your answer. Don’t take someone not medically trained and stake your life on it. Secondly, The research says you cannot make a diagnosis of hypertension on ONE b/p reading in the office. There is such a thing as “reactive hypertension” formally known as “white coat syndrome”. Therefore, we have the patients do EXACTly what this guy did; take home blood pressure readings on various occasions and document this in a journal— then bring the journal with him at his next office visit. Dr’s aren’t trying to “give you a nother pill”… they are trying to prevent a poor outcome (Called primary and secondary prevention).

      Also, It is a known fact that Sodium intake reduction actually decreases blood pressure (<2000-2500 mg/day; which is equivalent to a teaspoon), as does increased CV exercise <30 min/day) and weight loss. Just look it up– Go to the American Heart Association’s website and check it out for yourself.

      I don’t know what kind of beef this gentleman has with Medicine, but like I said, I hope he gains more confidence in the medical community because one day his life just may depend on it.

      Susan Q wrote on June 5th, 2009
      • Additionally, it is expected to have variance in your blood pressure from minute to minute. No different than heart rate variabilty. If you take your blood pressure 30 min before you eat chinese food (high in sodium, extremely so) then take it 3o min after you eat — you will see a difference in readings.

        Susan Q wrote on June 5th, 2009
      • @SusanQ: “It is a known fact that Sodium intake reduction actually decreases blood pressure … Go to the American Heart Association’s website and check it out for yourself.”

        No, it isn’t. No, it doesn’t. This is an unfortunately persistent piece of misinformation that’s been foisted on us in recent decades. See Gary Taube’s award-winning article on the subject, “The (Political) Science of Salt,” originally published in Science magazine.

        http://www.nasw.org/awards/1999/99Taubesarticle1.htm

        Vesna wrote on January 3rd, 2010
      • I know two people who almost died as a result of low sodium. Reducing it SOMEWHAT is good; trying to reduce it too much is really asking for trouble.

        White Coat Syndrome most assuredly DOES exist. I’m a prime example. It’s gotten so bad that I’m almost in panic mode when someone in a doctor’s office takes my blood pressure. I’m scared to death it will be too high, and then of course it is too high. Furthermore, most of the medical people I’ve encountered don’t even know the proper way to measure blood pressure.

        I was placed on toxic blood pressure meds by a pill-happy MD as a result of this panic-related spiking (that bore no relationship to my normal b.p.) This junk was so full of side effects that they made me sick, tired, and achy, so I threw them out. Anything that can make your life so miserable is NOT helping your body.

        I’ve solved my own problem by avoiding the medical community to the maximum extent possible. Instead I follow a healthy Primal Blueprint-oriented lifestyle, and my primary care “doctor” is an experienced homeopath. I feel better now than I ever have.

        Susan Q. needs to update and broaden her knowledge base. People lack faith in allopathic medicine for good reason.

        Shary wrote on June 5th, 2012
      • As a medical professional for 40 years I spent all day recording B/P every 5 minutes or even more often of patients under anesthesia. The graph was rarely a straight line as the crow flies. More like a highway through the mountains. If there was an exact duplication of numbers in a 4 hour time that was a rare event. No white coat syndrome here, these patients were “out of it”. For 40 years I operated under the belief that pharmaceuticals were the answer to restoring “health” under the “health” care system. After having my own issues for which the “health” care system had no “answers”, I set out to “heal” myself! Understanding Hippocrates phrase of “Let food by your medicine & your medicine be your food” turned the “health”care system into the “medical sick care” system. Acute care- YES, Best in the world. Chronic “disease” care- NO Worst in the world! Turns out Adele Davis phrase “You ARE what you eat” was spot on! I am now cured & healthy without the pharmaceuticals or the medical professionals! I suggest you follow this man’s blogs. There is none so blind as those who will not see! Medicine is very blind not to mention very ARROGANT! “That has not been studied” Well it has! Just not published in your medical journal!

        Enlightened wrote on January 18th, 2013
      • Actually, Susan Q, let me hit YOU with some knowledge. The “Evidence Based Medicine” that you worship at the altar of, has been bastardized. Most of it is paid for by the drug companies, and it is well-known and studied that industry funded studies are much more likely to find benefit for a treatment than non-industry funded studies. I wonder why that would be?? Also, there is a TON of things within conventional western medicine which are NOT evidence based. Including treating Stage I hypertension in primary prevention with antihypertensives. Don’t believe me, then here would be a good place to start:

        http://www.thennt.com/nnt/anti-hypertensives-for-cardiovascular-prevention-in-mild-hypertension/

        As a cardiology NP, you also might want to look into those statins that you are prescribing to otherwise healthy people, especially women, or the elderly. And those LDL goals that you faithfully chased for your high-risk patients, ya those weren’t based on evidence either. In fact, the committee that revised the cholesterol guidelines this year acknowledged as much. No, there wasn’t new evidence to overturn old evidence, it’s just that the evidence was never there in the first place! Low-fat, low-cholesterol diets? I could go on, but basically a good amount of what you are telling people in your cardiology clinic is NOT evidenced based. Yes, it can be supported by bad and incomplete evidence, but it is not evidence based, because it does not reflect a complete and honest assessment of ALL the available evidence. It is a system that looks to reinforce preconceived dogma, instead of to reject it. And that is precisely the opposite of how science should work. You need to be a little more critical I think Susan Q, maybe not be so quick to attack and defend your profession and instead do a little more reflection and digging into the evidence. Of course, usually NP’s aren’t too good at doing that, most are good little soldiers and don’t ask too many questions and try not to ruffle too many feathers. I’m an MD by the way. Regards.

        Tim N. wrote on December 5th, 2013
  2. I tend to trust my resting heart rate over my BP. :)

    dalvarez wrote on June 3rd, 2009
    • Those are two different things. Just curious – why “trust”? Is your heart rate more “true” than your blood pressure reading? Does heart rate indicate the same thing as a blood pressure reading?

      Ray Butlers wrote on January 10th, 2010
  3. Good article Mark….im 28, im at 10% – 11% BF and never get sick, so i never go to the doctor, its been years since I last saw a doctor, other than a dentist for regular cleaning. At what age should i start worrying about HR pressure and that kind of stuff? I feel like im still to young and “healthy” to worry about that…

    MikeGP wrote on June 3rd, 2009
  4. …does that make me “pre-obese”?

    your BMI is 23.7 which is on the high side of normal, so I guess the answer is that you are pre-overweight not yet pre-obese, but keep working out an you will get there. :)

    Don’t you love numbers you can make them be whatever you want them to be.

    rob wrote on June 3rd, 2009
  5. Mark,

    Wow. That is a scary, but sadly, unsurprising story.

    Your doctor is either thoroughly brainwashed, or completely irresponsible.

    My sister is a doctor, and in any medical measurements, there are always healthy outliers (people who don’t fall into statistical norms in some areas–damned lies and statistics–but whose other indicators are normal/healthy).

    I’m really glad you’re posting this. It is very critical for people to know about this. I hope it gets a lot of Internet buzz.

    BTW, on the sleep section of your fabulous book. I’m really enjoying it. I already had a lot of respect for your knowledge and writing because of this blog, but your book has taken that to a whole new level. It’s inspiring, entertaining, informative…all I would have expected and much more.

    And best of all, my ex-athlete, basically healthy (low grade lifestyle health issues), but carb-loading husband is reading and slowly but surely implementing more primal ways. As a former sprinter, martial artist, and being from the Mediterranean, a lot of what you say makes sense to him, so he’s willing to take it up.

    I think the hardest thing for him will be to “break-up” with “good” bread…

    Ruth wrote on June 3rd, 2009
    • Hey Ruth, would you ask your sister a question on how much of a doctors education is in prevention? My guess is it is pretty close to nil.
      I’m sorry to say,but IMO most MD’s and pharmaceutical companies are in cahoots. A lot of money involved, makes for some pretty hasty decisions based on a couple of “higher than normal’ tests :-(

      Cody wrote on June 3rd, 2009
      • Cody,

        I’d be glad to. It probably depends a bit upon where one goes to school, but I’ll ask her.

        My sister is actually a pediatric psychiatrist, and I know she’s perturbed by Ridlin abuse, etc., etc.

        Ruth wrote on June 3rd, 2009
      • That’s a Straw Man question. Doctor’s are not in the prevention business. They’re in the diagnosis business. They do not go out in the streets and look for people to advise. Sick people go to them.

        Further, thousands of doctors do preventive work.

        Ahem.

        Monitoring and lowering blood pressure is a preventative process. The goal is to prevent heart attacks and strokes.

        You really need to get over this paranoia about medicine.

        Ray Butlers wrote on January 10th, 2010
        • They don’t have to go out in the street. We are sent to them. (job physical, school physical) Although, have you noticed all the commercials for drugs? Instructing you to ask your doctor if it’s right for you? The drug companies are sending you in.

          I have to say, I don’t see the point in taking meds that make you miserable. (some of the side effects are worse than what it’s prescribed for.) It’s not like they make you immortal. A doctor works for you. You don’t HAVE to do what he/she says.

          I worked in a retirement area. Customers would come in, and talk about how now they’re on a medication. Next thing you know, they’re on four. Personally, I think the first med causes symptoms/problems that brought on the the rest. I also think these people are retired. They probably will only live another 20 years or so. Why make it physically and financially difficult? Of course, some love to list their meds for the attention. But, I will not be one of them. =) I’m planning to channel Maxine.. LOL

          Teresa wrote on January 2nd, 2012
        • Please do not take this as me being combative or negative. There is a very real issue with doctors and people being paranoid. I completely understand the paranoia as I’ve had to deal with this myself with taking bad meds and not fixing the real problem. The doctors are in cahoots with the pharmacutical industry and the doctors have a little book with all the drugs listed and symptoms they supposedly fix. Doctors get a kickback when they prescribe either certain or all medicines, so their motiviation is mostly financial. The doctors don’t really know what they are doing all the time. Not all doctors are like this, but I would bet that most are. If what the doctor says makes sense, then I check it out, but I never blindly follow doctor’s advise after doing so before. I did this once, and next thing I know I’m hooked up blood pressure meds (purely my fault since I didn’t realize I had a serious condition and didn’t research it)

          Jeremiah Pell wrote on March 21st, 2012
  6. This post really hit home for me and I can absolutely relate to the title. I can not stand it when fat people tell me I need to workout out more and eat better.

    I am 6′ tall, 195 pounds and 7.1% bodyfat (according to a hydrostactic bodyfat test). I have been told several times that I have high blood pressure, with a typical reading of 140/60 with a heart rate of 46, and was even prescribed hydrochlorothiazide (which I never took a single pill of). A good friend of mine is a nurse and told me a probably have white coat syndrom.

    I mentioned that to the doctor the next time I had a high blood pressure reading and he claimed that if I truly had white coat syndrom, then my heart rate would be much higher as well. He also added the fact that my BMI was over 26 which made me over weight. “The combination of an over weight BMI and a high blood pressure reading are very solid and reliable indicators that you are in fact hypertensive,” he added.

    It always seemed very absurd to me that a highly educated professional would rely on something as arbitrary as a simple BMI number and one blood pressure reading (which I now know can be error prone) to make a decision to prescribe drugs. I have refused to believe that I have high blood pressure and now I am glad to finally have some actual evidence (Dr. Kaplan’s article) to stand behind.

    Thank you for the post Mark!!!
    Erich

    Erich wrote on June 3rd, 2009
    • See ya at your funeral!

      Ray Butlers wrote on January 10th, 2010
  7. Just a few random thoughts.

    1. As you have noted, stress can cause elevated blood pressure, and you might not even feel stressed, but you can’t trick your body. When I had a minor knee operation I felt completely at ease at the hospital getting ready to go, but my blood pressure was unusually high nonetheless.

    2. This brings to mind the phrase “white coat syndrome” to describe a transient elevated blood pressure brought on by the stress of being in the presence of a physician.

    3. If you ever get an unusually high reading make sure to check it in both arms, and ensure that the blood pressure cuff is the correct size. If the cuff is too big OR too small you can get erroneous readings.

    4. Most people in the US would demand medicine immediately for their high blood pressure (or any condition) rather than do the hard work of eating sensibly, exercising, losing weight, etc. People tend to want the easy way out. That leads to physicians being quick to offer drugs, since they otherwise are often faced with irate patients. Antibiotics for childhood viral infections are another good example. It’s easier to give parents unnecessary antibiotics than to spend the time to educate them and convince them otherwise.

    Of course the readers of this site are the exception rather than the rule but when you look at it from the perspective of the masses it all makes more sense (not true common sense, but average American sense).

    Rodney wrote on June 3rd, 2009
  8. The inability of most doctors to understand even basic statistics amazes and frightens me. In a situation where 50 observations show (what seem like) wild differences, how can any doctor seriously diagnose a patient after one or two readings?

    JohnG wrote on June 3rd, 2009
  9. This is very scary, and really worries me for all those who aren’t properly informed (sadly, the majority). One of the worst things I ever hear is, “Well, my doctor said…”

    Emily wrote on June 3rd, 2009
    • so…. you’re scared that someone might lower their blood pressure? This is scary because….?

      Ray Butlers wrote on January 10th, 2010
  10. Mark,

    I dig the personal feel to this post, especially “big-ass digital” reading, and the use of “hell”. I agree with you too on BMI, at 5’7”, 150 lbs, and 10% BF, I am borderline overweight. As you noted, “start the drugs nurse”.

    Ryan Denner wrote on June 3rd, 2009
    • Ryan,
      You need to consider that BMI’s are a “dated” measure. They don’t take body-composition type into account. Mesomorphs, for instance, are not considered differently even though they have greater lean muscle mass and proportionally greater bone density than ectomorphs. Just follow a couple standard deviations above the norm, that’s what I hear, maybe even seek a DO, get a entirely contrasting slant to your typical MD. Best

      Jdawg wrote on June 3rd, 2009
  11. Mark,
    Unfortunaately I am one of those statistics trying to get out of this mess. Pre January 2009 I have been pretty overweight and had a so-so diet. I have been on 2 major BP meds for almost 10 years trying to get off of them recently. The sad thing is that with over 12 hours a week of working out (insert plug to Beach Body here) I am now experiencing light headed-ness constantly and my BP is all over the place. Sounds normal. Here is the scary part.

    I was 29 years old when I was prescribed these meds. I was never asked what I eat, how I eat, or how I stay active. I was given these meds “just because.” Now I am almost 40 and would give anything to get off of these but I am afraid that I may have been re programmed and my heart may not know what a primal life is like without meds. Its scary.

    Great article. Sorry you had a high reading in front of a “health care professional.”

    -merk

    Daniel Merk wrote on June 3rd, 2009
    • I did something similar about 18 months ago, started bp meds because my bp was about 140/80 and there were several visits that showed similar readings. I was with a new doctor, an internal medicine guy, and he thought I needed treatment so I went along with it, not questioning.

      Two months ago I stopped taking my bp meds (wanted to see if they were the cause of two new conditions I developed since starting the meds; acid reflux and anxiety attacks). I went through about a month of light-headedness, dizziness, and daily headaches. I think I’m back to normal now, with bp measurements that range from normal to the borderline numbers I put up in the doc’s office.

      Glad to say anxiety attacks haven’t been a problem though acid reflux is still there – hoping my primal diet will fix that.

      Good luck with your transition off the meds. It is scary.

      musajen wrote on June 3rd, 2009
  12. People have a tendency to suffer a sort of stress effect when getting pulse and blood pressure taken in the doctor’s office. Often blood pressure is significantly higher when the nurse takes it before seeing the doctor than if they take it again after.

    Cass wrote on June 3rd, 2009
    • That is why the nurse takes a lot or readings, and asks a lot of questions, and then the doctor does the same. You learn the machine really wasn’t that bad, so you relax next time. You have time to remember details that you should have told the nurse.

      Henry Miller wrote on June 3rd, 2009
      • I wish. I’ve never had a nurse or doctor take more than one test. Good thing I have a home BP monitor.

        Geoff wrote on June 3rd, 2009
  13. So Mark
    Couple of comments, I was a dummy for a PA program when they were testing the students on BP stuff. I learned that the way in which you sit can change your BP a lot, along with a great number of other factors. There is apparently a lot of error in the way that BP is taken at doctors offices etc.

    Secondly as a scientist, when I take my measurements I get pretty suspicious something is wrong if I get identical readings on any measurment I take. You have to assume there is some error etc, don’t know if this would apply to Bp measurements.

    John FitzGibbon wrote on June 3rd, 2009
  14. “It also acknowledges that readings in doctors’ offices are notoriously bad”

    I agree. I mean Sports Illustrated? or Good Huntin’ Times? C’mon! Who reads that stuff! What about a few recent copies of Wise Traditions from the Weston A Price Foundation? Hell, I’ll even take some old copies.

    Sorry for the humor; can’t resist. Seriously though, measurement error is something everyone in the sciences learns about on Day 1. This same problem crops up with many other “one-shot” measurements taken at the doctor’s office, including blood glucose levels. A friend of mine (Seth Roberts) bought a few meters to test. After taking a series of repeated measures from each one in the space of a few minutes, he found wild fluctuations–over 10 units in many cases! And people are screened for diabetes based on a single measure. I guess the medical profession is very disconnected from the scientific profession. And as Mark’s post suggests, the medical profession is anti-intellectual. I think it’s more akin to a priesthood.

    AaronBlaisdell wrote on June 3rd, 2009
  15. I had a very similar experience while pregnant many moons back. I borrowed my grandfather-in-law’s Omron bp reader after a single elevated reading that had the obstetrician lecturing me severely, and found just what you describe – enormous variation over time but nothing ever elevated it as effectively as a trip to the ob man it seems. I just added bp to the list of topics on which I ignored him after that.

    whitecap wrote on June 3rd, 2009
  16. As someone who ‘suffers’ from ‘white-coat hypertension’ I dread having my BP taken at the docs. My main gripe (and probably ties in with your highly fluctuating readings) is that these automatic electronic BP meters are woefully unreliable – no matter what the marketing blurb says – even the one’s in GPs offices (especially those if my experience is anything to go by!). I long for the days when GPs actually used a sphygmomanometer that was pumped up and deflated manually while he listened to your brachial artery pulse through a stethoscope. In fact I bought a set myself and used that to test my own BP alongside one of the electronic ones – the manual method consistently puts me at 120/80 give or take a couple of points while the electronic BP meter can put my BP at 160/95 right down to 105/60 and anywhere in between!

    Alex wrote on June 3rd, 2009
    • At least where I’ve been to the doctor, they only seem to use the manual cuffs. I can’t imagine relying on a piece of technology when a brain should be able to detect these things just as well.

      Katie wrote on June 5th, 2009
  17. That’s an interesting story Mark. It is remarkable how little critical thinking actually occurs during primary care visits these days.

    How long were you seated and relaxed before your BP was taken the first time?

    One thing that makes my blood boil is that most Dr.s are so quick to use the prescription pad. One thing that I use with my patients ( I am a healthcare provider) to help train lower BP can be found here:

    http://www.resperate.com/clinician/clinical/demo.aspx

    It is a great little device that is FDA approved for the treatment of hypertension and has no known side-effects. However, very few people know of it. It is just craziness.

    primalman wrote on June 3rd, 2009
  18. No, it does not make you pre-obese. Your weight is muscle-which weighs more than fat-and you’re certainly not that! Your body fat is low which is not enough fat to make you overweight. High body fat hinders athletic ability to move quickly, run fast, jump high, you definitely don’t have that problem, either!

    Donna wrote on June 3rd, 2009
    • It was obviously a jab at the BMI, which is completely arbitrary and an unrealistic metric for obesity. The fact that it is based solely on weight and height, combined with the fact that muscle is five times as dense as fat, should tell you how wildly imprecise it is.

      Most athletes are overweight according to the BMI (excepting long distance runners and other ultra-skinny athletes), and every well-muscled man you’ve ever met is probably borderline obese according to the BMI.

      Nobody who is serious about body fat uses the BMI, but it is still the only metric most doctors will use. The military uses the caliper method, which is much more accurate and just as quick as weighing someone and taking their height, and there are a number of electronic methods that are much more accurate than the BMI as well. The most accurate of course is a weight + volume measurement, but that generally requires a dunk in a pool to measure.

      BigJeff wrote on September 4th, 2010
  19. So, so, so, so TRUE!! ‘Quick’ health checks are a line item for physicians and a ‘check-the-box’, ‘eat better’…is one step away from yet another visit (cha-ching) and a prescription (cha-ching).

    Sterling wrote on June 3rd, 2009
  20. Outstanding post!

    mark wrote on June 3rd, 2009
  21. The implications of this are alarming – vast numbers of people who have a single high reading and trust the medical profession blindly, therefore ending up on BP reducing drugs. It is truly sad.

    I know many friends/family that are on some form of BP drug – I wonder how many of those folks have actual BP issues.

    As an aside, I had a similar experience a couple of years ago – had a check-up and was told that I had high BP. Like Mark, I bought my own home monitor (also have an Omron 711 – great BP tool) and found that my typical reading was and still is around 120/65 – but it varies depending on when I take the reading and what I’ve been doing. My philosophy is and has always been to avoid any form of medication.

    ReachWest wrote on June 3rd, 2009
  22. This is an eerily timely and relevant post since I had a bit of a blood pressure shocker at the doctor’s office just yesterday.

    A few weeks ago I was at the supermarket, having walked 15 blocks to get there right after my fasted morning workout, to pick up some things for the day. I saw a blood pressure monitor and decided to give it a go. I’d last checked my BP more than a year ago when it was hovering near the golden 120 / 80. This time it read 150 / 93. So I tested it again later the following day, after eating and resting from my workout. Similar results. Then yesterday at the doctor’s, it was 157/103.

    He measured it three times, and for the last time he left me alone in the room, as he himself acknowledged the “white coat syndrome.” The reading went down to 136/78. I went for a complete checkup anyway so we’ll see what he says about all of that when the bloodwork and urine test are in.

    The cool part was that all three times, my pulse was between 46 and 52 BPM.

    Primalchild wrote on June 3rd, 2009
  23. My parents have an at home BP monitor for the wrists and one day I tested my BP and it was 140/100. It really scared me a lot b/c I knew my eating and exercising habits had really gone downhill. I stumbled upon MDA searching for some advice and guidance. This site and all it’s info all sounded very sound and made scientific and logical sense to me.

    In about 1 1/2 months my BP readings have considerably decreased on a steady basis. I began working out and following the Primal way of eating. It is now around 94/60 sometimes as low as 84/56 on a consistent basis. Looking on a few BP charts I read as “child or athlete” range.

    I am a 24 year old female and I used to be a D-1 college track athlete. I was a sprinter and stopped running about two yrs ago. Given those facts, combined with the known inaccuracies of a wrist BP monitor, I am amazed and confused by the sudden drop. I still don’t feel like I’m in great shape, but I’m getting there

    I was wondering Mark if you had any input, or if other MDA readers had consistent BP readings this low and if I should be worried about anything?

    Kaydee wrote on June 3rd, 2009
  24. Same thing happened to me. Way high in the office. Got home, Omron was around 130 / 80. Later, and next day,121/70, pulse rate of 58. Not stellar, but hardly the 150/95 in the doctors office.

    I wonder if the same occurs with intraoptic eye pressure? (I have pigmentary glaucoma).??

    diamond wrote on June 3rd, 2009
  25. The low salt thing brings up a question. Where did grok get his iodine from? Especially those groks who were land locked?

    rob wrote on June 3rd, 2009
    • There is no iodine in sea-salt, so grok wouldn’t have gotten it there anyway. It is naturally found in the soil in most regions of the world, and vegetables generally have the needed iodine.

      Iodine is added to salt primarily because processed foods have little to no iodine in them (creating the modern iodine deficiency), and adding it to salt is easy.

      Small amounts of iodine are necessary for proper thyroid function, and a lack of iodine in the diet increases mental retardation rates. Thus the big push for iodised salt.

      BigJeff wrote on September 4th, 2010
  26. It just sounds like you need to prescribe yourself a new doctor. My doctor is great – he even told me to go low-carb (basically eat primal as he described it) and take a walk at night to stay healthy! They even do BP the old-fashioned way. It takes some shopping around but not all doctors are bad.

    Holly wrote on June 3rd, 2009
  27. I had something very similar to this happen a couple years back. The initial nurse took my BP with an electronic meter twice and readings came back in the 150/80 range. This was a shock to me since my BP has always been in the 110/60 range. Later once the Doctor comes in we have a conversation about my health/habits and he thinks the measurement maybe wrong. We conclude that maybe the device or measuring using the electronic machine is not accurate, so he does it manually and gets a reading of 117/65.

    Joe wrote on June 3rd, 2009
  28. Rob,
    From flesh, mostly. Dairy has it, too.

    Karin wrote on June 3rd, 2009
  29. Aaron,

    Great post. Do you know of any other academic sources criticizing medicine in such a manner? I’d love to read anything that you know of. For example, I’ve glanced through a few papers by John P. A. Ioannidis about the reliability of medical studies.

    Thanks,
    John

    JohnG wrote on June 3rd, 2009
  30. Caffeine elevates my blood pressure for several hours, so maybe you had too much coffee that morning? Also NutraSweet cranks it up faster than anything (I know you don’t use the stuff, but others might). Mine was elevated despite medication and cutting back on the salt. Cutting back on the sugar and grains was much more beneficial. I’m still on medication, but my doctor says I may be able to get off of it in about 20 more pounds and to keep eating the way I’m eating.

    I just had my cholesterol checked and HDL is higher, and LDL & triglycerides are lower. My doctor was pleased. The only thing that is still out of whack is my c-reactive protein is still 16.52. My doctor says to take more fish oil which I am doing. Any other advice?

    Marlys wrote on June 3rd, 2009
  31. My husband has the White Coat Effect. He dislikes doctors offices and it raises his BP. He was given a prescription. I now use my own BP machine at home – like you.

    Here is another thing people should be aware of. Doctors must use the proper cuff size to get an accurate reading. Often if one is overweight, obese or has a nice set of “guns” – doctors/assistants will often use a regular sized cuff and get high readings. When I inform them of their mistake, they just write the high number in my chart. Thankfully, low carb primal eating has got my numbers back to normal.

    Let me not even start with talking during BP evaluation or arm placement – two more things that alter results.

    Danielle wrote on June 3rd, 2009
  32. This is a testament to how doctors have been brainwashed into medicating healthy people. Cholesterol is no different.

    Not only do the parameters of our body change on a day to day and even second to second basis for good reason, “white coat syndrome” is an important consideration, as is the measurement techniques used (the nurse should be supporting your arm at heart height). It’s a great idea to have a unit at home to measure blood pressure yourself.

    Vin | NaturalBias.com wrote on June 3rd, 2009
  33. Another thing that could influence blood pressure is body position, and I’ve seen a lot of nurses that don’t take the time to make sure someone’s in the proper position for having their blood pressure taken. You should be seated with your arm resting on a surface at heart-level with your elbow bent. Holding your arm at heart level, or having it supported above or below heart level or having it straight out can all influence BP readings.

    I’ve not been to the doctor in several years, but I remember many times the nurse would bring me and immediately take my BP, without giving me a chance to get into a good position. My BP would always come out like you describe, around 140/110. And every time the doctor would come in, usually after I had been seated comfortably for 20-30 minutes and take my BP after I had time to get my body into the proper position. Every time I can remember, my BP would come back closer to the 110/80 range.

    My doctor always chalked this up to the white coat syndrome you mentioned, but I think there’s more to it.

    Brian wrote on June 3rd, 2009
  34. Tanks Mark for heightening our BP awareness by sharing your recent dr. office visit!

    Speaking of raising a person’s BP, maybe someone can give me some insight on the following:
    I’m eating Paleo and doing crossfit 5 days a week. trying to cut back on body fat which was at 12% 4 months ago, I’ve noticed more body fat around my stomach the past 2 weeks. What gives?! I’m eating mostly lean meat, good fats, and vegetables and some fruit for carbs. Wish I knew the reason for this. Can someone give me some sage advice how to change the flab course? I do eat about 1/2 cup of cottage cheese every day, in the evening. Does cottage cheese spike insulin?
    Thanks Mark for sharing your experiences!

    David wrote on June 3rd, 2009
  35. People go to doctors —–> Sit and wait anxiously (waiting room, small exam room) for long time —-> First thing they check is BP —–> It’s always going to be high in a DR’s office —–> Dr gives out meds and moves onto the next patient.

    and we wonder why everyone is so sick and unhealthy.

    Mike OD - Life Spotlight wrote on June 3rd, 2009
  36. @ Dave – You workout way too much….need to cut back and stop creating so much stress to your body (aka weight gain to your belly), that only will take you in the other direction. Like Mark says…do your workouts with more intensity and shorter/less often…and all other activity longer and with less intensity. Do workouts 2-3x a week for the muscles and then just get out and enjoy life/go play! I’m sure you’ll see the weight start falling off again.

    Mike OD - Life Spotlight wrote on June 3rd, 2009
    • Sage advice Mike for Dave and I’m 100% in agreement. That’s why i gave up CF, it set’s you up for over training. But even though I’ve moved on from CF, I still have a hard time not over training. Trying to find the right balance. It’s tough for sure, as excercise get’s those endorphins moving, it’s hard to realize less is better!

      Cody wrote on June 3rd, 2009
    • Thanks! I use Crossfit’s 3 days on 1 day off workout cycle. I’ve gained only 1 lb. but have cut back on the intensity due to tendinitis in one elbow and, recently. a pulled quad from walking lunges! Could cutting back on the intensity of the workout due to my injuries cause an increase in body fat?

      David wrote on June 3rd, 2009
  37. Happens to me all the time – but I monitor it at home and its fine. I’m 8% BF as well.

    Robert Gioia wrote on June 3rd, 2009
  38. had to comment on this one. all my overweight life ive been 140/90 range. most of those years that was considered borderline. as in “lets keep a wary eye on this”.

    now 180/120 is borderline.

    since dropping lots of fat/girth with paleo type IFing, i havent checked my b.p. just checking it raises my numbers. educating post!

    rachel allen wrote on June 3rd, 2009
  39. Ditto all the comments on having the correct size cuff. My armspan is 74″, I am 5’6″. My arms are large and muscular (for a woman) but since my arms are so long — they don’t LOOK overly large. But they really are large enough to need to large size cuff. I have to carry around a tape measure in my purse to prove this. My husband’s arms are very muscular — he needs to ask for the thigh cuff. If he doesn’t have it taken with the thigh cuff, they freak out because it seems so high.

    Make sure they don’t keep you talking during the test, and that you are sitting down, and that the arm that is being tested is resting on a firm surface not your thigh or the testers’ arm. If these conditions are not met — the test has been performed incorrectly and the resulting reading is useless.

    Halle wrote on June 3rd, 2009
  40. The next time you go in try having realations with your wife before hand and avoid coffee and such.

    My beef is I have bigger arms and if they use the right size cuff I am much healthier.

    Jim wrote on June 3rd, 2009

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