I 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:
- 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.
- 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.
- 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.
- 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.
- 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”?