Makes My Blood Boil
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”?
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Posted By: Mark Sisson
Mark – a very timely article. Someone I know is currently jumping through all kinds of hoops on the basis of such a reading by a doctor – I think I shall direct her at your story. It might provide some perspective.
When my father-in-law was diagnosed with diabetes they put him on BP meds even though his BP was fine. Their rational was that diabetes can lead to BP problems, so they wanted him to be on BP meds “just in case”.
After a few weeks he started having dizziness and fainting spells. They did all kinds of tests to figure out what the problem was, they even talked about putting in a stent thinking there was some type of blockage that was restricting blood flow.
EVENTUALLY they figured out it might be the BP meds. He stopped taking them and guess what? No more dizziness or fainting spells!
Mark,
What a story – WOW!
I guess you are part of the lucky few who is a little more aware than most ordinary people.
This is an extremely detailed account of your whole “blod pressure” store and it’s great that you’re are willing to share it with us!
Mark:
I’m a regular at Track Your Plaque, Dr. William Davis’ site. What you describe is something you should be concerned about. I think glmid (the family doc who responded a few posts above) has the right approach for most of his patients, but I want to share with you some things you should be concerned about:
1. That you were unable to obtain the same results with multiple readings is NOT surprising and it is completely and utterly normal. BP varies throughout the day and often minute to minute.
2. If you do not adopt a proper posture for the test, you will obtain inaccurate results. What’s a proper posture? You can either be sitting, lying down, standing, it doesn’t matter (whether you’re testing ambulatory BP or resting BP, you’ll obviously get different values, but the principles are the same). What is important is that you 1) always test in the same arm (usually the left will read a few mm of mercury higher than the right), and 2) always insure that your arm is level with your heart. If your arm is down by your side, or over your head you will get wildly different readings, no matter whether you’re using a manual sphygmomanometer or a digital device. If your arm is dropped below your heart, the pressures (both systolic and diastolic) will be higher; if your arm is raised higher than your heart, the pressures will be lower. Try it and see for yourself.
3. If you are consistently getting readings at your docs office which are in the range of 140/100, that’s a pretty strong indication of hypertension, and it’s significant enough that you should pay carefule attention to it. Even in very fit athletes, hypertension can develop…in fact especially in endurance athletes.
4. There is a phenomenon known as “athletes heart”, which is a slight thickening of the atrial or ventricular wall muscle, and a generalized enlargement of the atria and/or ventricles. If the condition persists untreated it can develop into a condition known as hypertrophic cardiomyopathy. This frequently happens with endurance athletes (e.g., long distance cyclists, swimmers, marathoners or ultra-distance runners), but also occurs with athletes who engage in “quick busrt” sports, where shorter, but more intense efforts and more “fast twitch” muscles are involved (e.g., basketball, sprinting, tennis, etc.). Because the muscle walls thicken, this leads the heart to have to pump harder, increasing BP. This can have some long-term serious consequences and shouldn’t be ignored. Often there are no symptoms, but over time, it is a leading cause of atherosclerosis, heart disease, plaque formation and deposition in arterial walls, MI, stroke and in some cases heart failure. In particular, people with cardiac hypertrophy (enlargement of the heart) are at particular risk for developing heart failure. What’s heart failure? Again, let’s talk about the heart muscle thickening and becoming enlarged– the heart has to pump harder to move the same amount of blood, even at rest (hence the increased pressure). Eventually the heart muscle weakens from the increased workload, and as it weakens, it has to work harder and harder to move the same amount of blood. Eventually the muscles become unable to properly contract sufficiently, and you wind up with a big, floppy heart that is no longer able to efficiently pump blood, leading to a very unpleasant result, i.e., lack of oxygen and ultimately death.
I am by no means suggesting that Mark’s situation will lead to any of this parade of horribles, but having read all of the postings which precede mine, with the exception of a few people who are knowledgeable about the risks and dangers of high BP, even transitory BP, it is just shocking the level of ignorance that people have about high blood pressure and what values are really “healthy” levels for systolic and diastolic pressures. I don’t mean any of you all are “ignorant” but the level of misunderstanding about BP is dismaying, as equally dismaying as what BP meds are, what they do, and how they work to reduce the risk of coronary disease, atheroclerosis, blindness, glaucoma, kidney failure and a whole host of horribles that are directly caused by untreated high blood pressures.
Mark is right to be concerned. He’s also right to have his BP checked again by his doctor.
The family practitioner above is also right that anyone who demonstrates the sorts of readings that Mark did at the doctor’s office, should be first advised to try to control BP through diet, exercise and TLC (therapuetic lifestyle changes) before resorting to meds. But if meds are in the cards, there are certainly worse fates than taking one or two meds each day before breakfast. Going blind, having kidney failure (high BP can very badly damage the sensitive microvasculature of the eyes, kidneys, and other organs), etc., are all worse than taking a couple of pills every day.
Weight loss, diet, exercise, all can help, but sometimes they can be counter-productive too, particularly if when one is exercising their BP rises to levels which are dangerously high (something you would typically not know unless you underwent exercise stress testing at a lab or at a doctor’s office).
I point this out not to shock or scare anyone, including Mark. But that said, 140/100 is, for someone as fit as he is, an indication of something going on…perhaps an infection or some chronic inflammation, stress, or something….but it’s certainly enough to get one’s attention, and paying attention to it and working with your doctor is really the way to go. Anyone who advises you to ignore a doctor’s advice about repeatedly high BP readings is simply wrong.
I appreciate your philosophy is to let the body primally take care of itself and achieve balance. But sometimes our bodies just refuse to do that, despite our best intentions….even our ancestors developed illnesses and conditions which overwhelmed the natural systems and caused the body to break down and deteriorate and ultimately all of our ancestors became…well, ancestors. We will too. We can’t stop time’s ultimate effects…maybe we can slow things down and lead a healthy, productive life…but ultimately all of us will need to resort to a supplement, a drug, or some form of therapy to deal with something we didn’t anticipate. Taking an ACE or and ARB or a diuretic isn’t the end of life, and depending on where one’s condition is and how serious the condition is, it’s better than the alternatives of untreated high BP.
Anyway, keep up the good work Mark, but don’t underestimate the importance of good BP control, and by that I mean BP well below 120/80, optimally between 100 to 110 systolic and 60-70 diastolic.
Mark…I always have had high blood pressure in a doctors office since I was 19 it was 160/100..the doctors always put it down to white coat syndrome…anyway when I was 30 he said he should do some detailed tests to make sure…so I had a choice go for 24 hour monitoring or buy a bp monitor like you did…. I bought it and always gor resukts like 105/80…so The doctor wanted to check it against his…I go to the office and he uses his equipment bam I have a high reading….I use use my machine wam…normal reading…the doctor says my BP monitor is probably not working….thenhe says let him use it…guess what…I get a high reading…everytime I used my BP device for myself I get a normal reading.. reading was normal…whenever he used my machine I get a high reading…when I turned 40 apparently my white coat syndrome has disappered as I get normal readings now
Why not show the graph of the data?
Hey Mark my BP was always alittle elevated but got as high as 140/110.
I need a change the DR immediately tried putting me on meds. I chose diet and exercise. Lost 30 pounds feel great and my bp is always changing but avg 120′s over the 80′s Great in my book .
Love the article Mark keep up the good work. I wanted to apply for your food blogger position but my cooking is great food for me.
Mark, here’s some data showing how BP varies over time. I’ve recorded my BP at breakfast every day for the past 3 years. Here are the averages and the standard deviations for that data set.
SBP
count: 1061
mean: 114
std dev: 9.1
max: 141
min: 89
These were all taken at the time of day when blood pressure tends to be lowest, and there isn’t much of a trend over that time, but there is considerable scatter.
I also have tracked BP during the day on about 20 days during the same time period. Generally BP increases as the day goes on. Here’s the summary of that data.
SBP
count: 225
mean: 122
std dev: 11.3
max: 162
min: 96
This shows even more scatter. I typically show 10-20 points higher in the doctor’s office than at home, frequently above 140. I have been able to avoid medication by showing him my long-term charts and by showing him that my Omron cuff compares closely to his sphygmomanometer readings.
I think to really get a handle on your blood pressure you need to get your own meter and use it frequently.
One other thing, Mark. You should have a dermatologist look at your arm. My GP didn’t think a sore spot on my skin that hadn’t healed in several weeks was a problem, but my Dermatologist took one look and identified it as a basal cell carcinoma, which was verified on biopsy after he removed it.
I like how the nurse mentioned how wrong you were because medicing shows that MAINTAINING a blood pressure that high is unhealthy… when you weren’t maintaining it.
I had a similar problem, by BP always seems to be high at the doc’s but normal at home. My conclusion: it’s always so frickin cold at the doctor’s office, so I assume its because my body is trying to warm up.
I also had a wacky BP reading at the doctor’s office by the nurse. Read 150/95 ouch!! When measuring at home I am usually in the range of 110/75. The doctor came in and looked at the recorded reading, looked at me (okay I’m not the smallest sprout in the garden), got a larger cuff and presto I’m in the healthy range again.
I was pretty irritated once at a doctor’s office… BEFORE she even took my blood pressure, the nurse was handing me pamphlets about avoiding the dangers of high blood pressure and cholesterol. Why? Because she looked at me and could see I was overweight. Yet, my blood pressure was as normal as normal gets… and my cholesterol is just fine as well.
My mother consulted a doctor and gave her medicines for a high blood pressure and he also added that she may chew garlic if she will have an increase in blood pressure. Why is it?
When getting my BP taken I like to meditate while they’re doing it. Low results every time. If you don’t know how to mediate you should be learning anyway.
Some doctors are obviously more clueful than others (see above).
My BP started showing episodically high years ago but nothing was done other than monitoring until it went up and stayed up AND was tested sitting, standing, lying down and after ten minutes relaxation. Then and only then I was prescribed an ARB.
I use an Omron wrist meter which like you shows considerable variation but mostly around a useful level nowadays. After a high reading from the nurse I was lent a 24 hour monitor (I suspect they disbelived my own readings) and this showed exactly the same thing, quite a range of variation around an average of 120/85 or so.
My BP turns out NOT to be sodium sensitive (not uncommon) and slightly potassium sensitive (potassium reduces it). But that doctor wasn’t entirely clueful, he put me on the standard high carb low fat diet and my BP is VERY carb sensitive (familial diabetes/metabolic syndrome) in no time it was heading north of 150/95.
Low carbing dropped it to the extent that my new GP discussed stopping the meds, but since ACE and ARBs have kidney protective and other benefits we decided to keep on with them. Five years later and it’s starting to increase again. But then I’m five years older. The average is creeping up but the variation appears to be in a smaller range.
Mother is tiny and now 93 so not as fit and active as she used to was, she’s had hypertension for about 50 years now and her BP has fallen to the extent she has had her meds reduced several times: another example of familial factors and things not going the way tradition expects, maybe she’s getting better at not expressing the genes while I’m getting worse.
Great article Mark, the only reason I guessed your body fat a 8.1% is because I took my a few weeks ago and it read 21.4 and that was after I lost 30lbs and have been eating good (primal) for 3 months. I am 6’2 medium to large build and 210. It told me I had 174.6 lbs of muscle and 40 or more lbs of fat. I was worried I looked good and thought “Boy I really need to lose alot of fat” Anyways, liked the article. Merry Christmas from Hamilton, Mi. Dan
It’s bad when medicine strays from science.
This sounds like a rationalization to talk you out of the fact that high protein diets tend to raise blood pressure. As long as this idiot says it’s OK and you’re all afraid of doctors, well, carry on! I’ll come to your funerals in a red dress.
To the nurse practitioner, I don’t think he was bad mouthing the medical profession as much as he was demonstrating that when a patient takes an interest in his care, he can take the information given by his physician and make his OWN decisions. It is easy for a physician to say your have high BP and we need to treat it, even if there was a reading to justify it at the time. When people realize that you are paying your physician for their medical opinion, we will all be better off. It is very difficult to find a physician that is willing to spend any time with you as a patient, and hence where the quickie diagnosis lies. NP usually have more time with the patient, but I am sorry to say that if I am paying the bill, I want to see an internal medicine physician and not a nurse practioner. Do you ever wonder why YOU end up treating all of the indigent/welfare cases?
The last time I had a physical to qualify for my life insurance, they had me lay down for about half an hour before they actually took the reading — it seems they were well aware of the variations. The last time I was at the doctor, they rushed me in and took it immediately and of course it was a bit on the high side. No matter who’s checking it, they know the tricks to get a number that will benefit them.
This situation just happened to me. GGGRRRR
I had high bp readings alot then had one nurse use a bigger cuff and got normal readings….since losing 130lbs I am now able to use regular size bp cuff. Funny how that is….I am on HCTZ because in 3 days I can gain 12lbs in water weight and have all sorts of issues breathing and chest pains. MY bp now averages 108/60 at night and 120/86 during the day
I’m at a loss.
After 1.5 years of eating primally, and for the last 2 weeks ditching all dairy I seem to be at a high risk of developing heart disease and whatnot…because get this…my Fat chart results just came out at 26.5% !!!!
I am 5’10″ female, weighing in at 136 american lbs.
My BMI is less than 20, it said 19 something.
I’m skinny as a rail with long legs and a long neck, I don’t see any fat on me other than ~ 5 lbs of vanity chub on my belly.
Where am I schlepping around 35 lbs of FAT???
Do I have to lose weight? I’m gonna be sick.
Oh and my Blood Pressure is 107/70.
I had a physician prescribe me 10mg of Lisinopril once a day based on two readings. Do you think I should take it? I feel like I would like more readings before I start on medication but my physician scared me into thinking I really need it. Not sure what to do…
I am 34 with no previous high BP readings. My BMI is too high but I have lot 12 pounds over the last year and am trying to make lifestyles changes.
hey guys, I would appreciate any advice. My grandma is in her eighties and has been taking high blood pressure medication for years. Today I sat down with her and taught her the benefits of eating primal and she has come around! I gave her a food plan and all the rest, etc. I am doing research for her in regards to ways to reduce high blood pressure naturally, and I have found many. I want to tell her with confidence to ditch the high BP medication all in one go, but I am worried if she stops them straight away she might have problems? I thought maybe go down to every second day for the first week week, next week every third day, etc. Any thoughts or knowledge in this specific scenario? Eternally appreciated!! Thank you very much!
I’ve a doctor’s appointment in just a couple of days and the dread of having her lecture me again has sent my already high–according to them–BP through the roof. And yes, I’m old. So I do remember the 100+ your age which, according to that, mine is a perfect 160. By today’s standards, well, I died yesterday. Yes, I think the medical community is indeed armed with great intentions. In my life’s experience, however, they are simply doing what they’ve been told and acting on the education they’ve received. And if nothing else can be said about Americans, most have indeed been educated well beyond their intelligence. So, no, I won’t take their drugs. She can write the prescription and I’ll either throw it away or have it filled and throw away the pills.