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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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June 03 2009

Makes My Blood Boil

By Mark Sisson
124 Comments

blood boilI 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”?

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124 thoughts on “Makes My Blood Boil”

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  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)

    1. 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.

      1. 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.

      2. @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

      3. 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.

      4. 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!

      5. 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.

    1. 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?

  2. 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…

  3. …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.

    1. oh, BTW if you want to loose a little of that excess weight, here is some advice emailed to me today:

      Here’s what you can do to lose weight or avoid becoming overweight or obese:

      Eat more fruit, vegetables, nuts, and whole grains.
      Exercise, even moderately, for at least 30 minutes a day.
      Cut down your consumption of fatty and sugary foods.
      Use vegetable-based oils rather than animal-based fats.

      from: http://www.everydayhealth.com/healthy-living/obesity-prevention.aspx?xid=nl_EverydayHealthHeartHealth_20090603

  4. 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…

    1. 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 🙁

      1. 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.

      2. 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.

        1. 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

        2. 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)

  5. 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

  6. 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).

  7. 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?

  8. 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…”

    1. so…. you’re scared that someone might lower their blood pressure? This is scary because….?

  9. 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”.

    1. 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

  10. 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

    1. 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.

  11. 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.

    1. 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.

      1. I wish. I’ve never had a nurse or doctor take more than one test. Good thing I have a home BP monitor.

  12. 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.

  13. “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.

  14. 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.

  15. 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!

    1. 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.

  16. 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.

  17. 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!

    1. 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.

  18. 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).

  19. 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.

  20. 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.

  21. 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?

  22. 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).??

  23. The low salt thing brings up a question. Where did grok get his iodine from? Especially those groks who were land locked?

    1. 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.

  24. 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.

  25. 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.

  26. 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

  27. 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?

  28. 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.

  29. 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.

  30. 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.

  31. 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!

  32. 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.

  33. @ 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.

    1. 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!

    2. 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?

  34. Happens to me all the time – but I monitor it at home and its fine. I’m 8% BF as well.

  35. 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!

  36. 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.

  37. 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.

  38. These things are best taken as averages across a large time period, as you did. Unfortunately, the truth is that most people won’t take the time to monitor thwie health that closely.

  39. Consider magnesium deficiency if you have high blood pressure. With the poor quality of our soils these days many people are deficient. It takes awhile to get your body stores replenished but it can help. Guess what they give you through an iv in a hospital if your blood pressure is critically high. Magnesium! Taking pills is a slower but equally effective way to replenish. Not a cure all for everyone, but worth a consideration. There is no good way to measure it in the blood though, so be wary if someone tries to sell you on a blood test.

  40. Great article! I also bought the Omron machine a few years ago. I had tested my BP at a couple of grocery stores, and was getting numbers anywhere from 152/100 to 110/65. Testing at home, I came up with an average of about 114/70 HR 60 – the same as it has been for the last 20 years. Moral to the story: Don’t trust that one time at the doctor’s office, and don’t use the BP machines at the store!

    1. Ya it is, and it’s not good. Heart failure… get it check out

  41. Mark…I think you should have another doctor check the thingy on your arm.

  42. I have been lurking on this site for a year now & have avidly read everything that Mark has put out. I thank him for his tireless questions & especially for his book which I finished this past weekend. I agree with everything in it and wish that more people would subscribe to even a small percentage of what he recommends. I am writing into this forum because I am one of those “health practitioners” that everyone seems to be demonising in the current posts.

    Mark has taken a very sensible approach to this situation & I applaud his random thoughts on the subject. I think he is fair & balanced. What people need to realise is that the majority of doctors (I am a board certified family practitioner & therefore in the front line of blood pressure control)are faced with multiple dilemmas when seeing people with high blood pressures. Firstly, in answer to those people who were put on meds after one reading that is not the usual recommendation. Most doctors will get at least 2 readings unless the readings is so high that they think there is imminent danger to the patient. Mark would not have been diagnosed with Hypertension, but rather “Elevated blood pressure, without diagnosis of hypertension” & most guidelines would recommend getting at least 3 elevated readings on separate occasions before labelling someone as hypertensive. Secondly, most doctors will tell you to start with diet & exercise (although as most people reading the PB will atest to, those conventional guidelines are based on faulty food pyramids, etc). I almost beg my patients not to “make me” diagnose them with hypertension & especially diabetes as they usually can do far more good with diet & exercise than with medication.

    Unfortunately most people want nothing to do with diet & exercise & most doctors are so jaded from trying to discuss this with patients that they throw in the towel before they have even started trying to get people to change their lifestyle. If at least 10% of my patients followed dietary recommendations or bought the books I recommend (Paleo, Protein Power Plan, & now PB) I would be extremely happy. As it is that number is probably less than 5%. Most doctors don’t try because insurance companies do not pay you to educate patients about these things. That is not an excuse but unfortunately it is one of the greatest failings of our health care system. We simply cannot get enough med school grads to go into family med or IM at the moment. We therefore have far too many specialists who are getting paid for doing procedures (but that is another discussion).

    Lastly, what most people don’t know is that doctors are now being told that they will get paid for “performance”. This is the government’s way (with Medicare) of supposedly “ensuring” that people have their blood sugar, blood pressure & cholesterol at “acceptable levels”. Unfortunately the onus is being placed on the physicians with the carrot being a bonus at the end of the year. The potential stick in the future will be payment withheld for poor control. What is a physician to do if the patient has an elevated BP & does not check their readings, lose weight, fill their prescriptions in a timely manner, etc? The answer is generally add more medication to get the number down. It is a recipe for disaster & most patients are not even aware of it & the government guidelines are not something your family doc can control.

    Please talk to your family doctor about what you can do rather than go on medication. If they are not receptive find another one who will talk with you (preferably someone who is familiar with PB or at least open minded about various diets). Even better still follow the PB & then go back & show him/her how well it works. They might be more receptive to looking into it. Mark gives doctors a fair shake in his book by admitting that we are trained to treat, not prevent diseases(especially the specialists). Unfortunately not enough patients are diligent enough about their own health & especially BP. If it is elevated check it at home & in a variety of circumstances. If it is above 140/90 on a regular basis (more than half the time) you most likely have problems & need to find a solution. And yes, try diet & exercise first before going to meds. Having said that, after smoking, high blood pressure is going to be the number one cause of heart attacks & strokes in the USA (the number 1 & 2 killers) & so if your doctor is worried about yours he is actually showing appropriate concern. How you decide to address that with him/her should be a team decision.

    Thanks again for a great job Mark. I have recommended your book & blog to a lot of patients already.

  43. With all the lousy side effects from those stupid drugs, people would probably be better off living with chronic high blood pressure anyway. And like you say, most people who’ve been diagnosed with it don’t even have it… AND the medical establishment has pushed down the “healthy” levels over time which makes it even more ridiculous and pointless to base such a serious diagnosis on only a small number of tests.

    My paternal grandmother probably had BP through the roof… she was always worrying and fretting about something or other. On the other hand she ate things like codfish heads and greens and carrots and zucchini every day. No junk at all, and she lived to be 96—almost entirely self-sufficient up until the last few months of her life.

    1. I’ve known people like your grandmother, who should have been dead at 50 and then prove everybody wrong by making to 90. The medical profession needs to understand that people are more than just numbers.

  44. I agreee with everyone here, BUT… maybe Mark does have a bp problem inspite of his great diet? My bp is nearly always 90/60 ish… even when I had to wait for ever in a waiting room with all my children. Once, when very pregnant and under much stress, it went up to 120/80. Not saying meds are the answer… just that there may be a problem.
    Conversely, we have naturally high cholesterol in my family, despite being normal weight and active. I have recently stopped taking my statin and will monitor my status (via diet improvement)…but my mom had two heart attacks at 50 and 52… and I don’t want to be in the same boat.

  45. Mark I think the massive amount of comments is a testament of how much we value your life.

    I have the highest respect for the medical profession. But I am also aware of it’s limitations.

    In some cases, expecting a Doctor to question standard procedures is equal to asking a car mechanic about thermodynamics.

    Medicine is, for the most part, empirical.

  46. It is a dirty little secret of the medical community that very few drs. or nurses take accurate BP. That is why many offices and hospitals have moved to the automated machines -which suck too btw! The other thing to be very wary of is the size of the cuff that they use. Use the standard cuff on someone with large-ish biceps and you get a much higher #. I almost bought myself BP meds that way as I am a short woman with thick arms! Grok would have thought I was hot!

  47. Duh Mark, you always hold your breath when getting a blood pressure check.

    I use Zen breathing every time I get checked and they always tell me the same thing…

    “Your blood pressure and heart rate are too low”.

    I happen to believe you thought your way into a higher number Mark on this one.

  48. I bet the Doctors wish we were all on statins. Don’t worry though, someday the medical community will come around and see things our way… 🙂

    “All great truths begin as blasphemies.”
    – George Bernard Shaw

  49. Mark, sounds like almost an identical experience I had a few years ago – right down to buying the home Omron BP toy. Same readings, and same variation in BP. Never quite made the link until recently that some doctors default solution is medication. I’m trusting them less and less these days.

  50. Hey guys, I’m another long time reader/first time poster….That’s quite the experience and commentary on the health care system in general. It really makes me think and second guess the opinions of people in positions of power who are supposed to know what is best…more than usual.

    It’s interesting that this was posted today seing as I had a blood pressure problem today. I’m a 20 year old male and I eat as Paleo as possible considering my living arrangements, which isn’t too far off. I’m also active (one of those Crossfit guys) and keep moving as much as possible.

    To my story…today I went to donate blood as I usually do, and I generally have a slightly higher than ‘normal’ systolic pressure and lower diastolic at around 135/60. When the nurse took my blood pressure today it was an astounding 118/40, which by their standards is too low of a diastolic to donate blood….this caught me off guard as to how I could possibly be so low. I looked a bit into hypotension and based on my age and diet the only thing I could really conclude is it being a side effect from the “cardiovascular shock” of my workout in the morning. I finished my workout at around 9 AM and had my blood pressure taken at 3 PM.

    I am still quite thrown off by the entire situation of having to LOW of a blood pressure. Is it possible that my body was still compensating for the stress on it’s system 6 hours later? Has anyone else heard of similar things?

    Thanks.
    Matt

  51. It seems so obvious now that you’ve written it, but I also have never thought to do repeated follow-up BP tests at home.

    My BP is always around 110/70 but I commonly speak with clients prescribed medicated for high BP and – although I intrinsically don’t trust the churn’n’burn approach of doctors – don’t feel confident enough in that area to try and give advice. Aside from real nutrition of course!

    Great tip, I’m going to be recommending that to everyone I talk to.

    Mark I’d love to see you write something on how to face-off against a doctor with a ‘high’ cholesterol black mark against you!

  52. Well, most doctors should take your lifestyle into consideration when prescribing drugs, moreso in BP cases. In most mediterranean countries (I live in Spain) a doctor will tell you that with a 140/80 BP reading you are perfectly fine. A “primal” dude is not the average Joe all these readings are based upon.

  53. very informative, mark!
    I knew that one’s bp could vary throughout the day, but I didn’t know it could go up and down so much.
    in our house, everyone’s bp measuring master except for me..lol…

  54. You know sometimes blood pressure meds aren’t the worst thing…

    I’m 24, considered extremely fit, eating/living primal, limiting carb intake and am currently on a minimal dose ACE Inhibitor.

    I struggled for over 2 years trying to avoid BP meds and eventually gave in.
    I gave in because each day living with elevated blood pressure was doing myself great harm. I have a heart condition where the right-side of my heart is enlarged and merely having an elevated resting blood pressure contributes to muscular hypertrophy (further enlargement that’s supposed to be permanent).

    I have tried nearly everything to get it under control the natural way. The only thing that reliably kept my blood pressure in the “normal” range was severe calorie restriction and with this, quality of life diminished significantly.

    Whilst primal/paleo living has helped me gain a greater control of my health and taught me some amazing things about the human body, I find a combination of primal plus low dose BP meds the best for me.

    If you’re like me and do have to resort to BP meds, ACE inhibitors have a very good side effect profile and don’t cause your pulse rate to plunge (very important for an athelete). They also have have other benefits to the circulatory system and kidneys.

  55. I have to have my arm – resting on the arm of the chair and totally relaxed to have an accurate reading. Having my arm just hanging down at my side – or my trying to hold it ‘out’ raises my readings significantly.

  56. I’ve just taken my BP with my electronic BP monitor in a sitting and lying (‘fundamental BP’) position. I get readings of 139/68 (HR 91 BPM) & 96/62 (HR 62 BPM) respectively!

  57. 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.

  58. 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!

  59. 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!

  60. 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.

  61. 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

  62. 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.

  63. 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.

  64. 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.

  65. 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.

  66. 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.

  67. 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.

  68. 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?

  69. 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.

  70. 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.

  71. 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

  72. 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?

  73. 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.

  74. 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

  75. 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.

  76. 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.

  77. 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!

  78. 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.

  79. i have the same thing when the doct. told me i have 170/ 94 , i was shock he sent me out to all kind of test and give me some sample med to, it ‘d was so nice of him??? time go by all the test found nothing, i test it in many drugs store a litle high but not that high, test at home too but the number was every where until it broke , then i found a new job that require a test that include bp test , no surprise to me it was 150/ 95
    then i decided to buy a new machine it’s was the ***HOMEDICS***
    Manual Inflate Blood Pressure Monitor
    this solve everything , it’s is acurate and the number does not jump all over the place
    one thing you have to make sure is the tube have to be level of your heart , my blood pressure right now is very normal please try that bp monior

  80. Butters needs to take his pom-poms and cheerlead somewhere else, maybe at his favorite hospital. lol This group doesn’t need conventional coaching.

  81. I know this is an old thread, but I thought I would put in a good word for my doctor. My blood pressure was measuring a little high, (I don’t remember the exact numbers). My doctor was not particularly worried about it, but my father had high blood pressure troubles, and he had a heart attack in his mid-fifties, so my doctor sent me home with a blood pressure monitor to wear for 24 hours that took my blood pressure every fifteen minutes or so. Based on the chart, which showed my blood pressure followed a good cycle, (dropping down to 98 over something in the middle of the night), my doctor told me not to worry too much.

    BTW, after my mother’s death, I was going through some old paper’s, and I saw that my father’s blood pressure was astronomically high. I don’t remember the exact numbers, but it was 200 something over 100 something. I didn’t even know that was possible. My seems to average about 134 over 83.

  82. This happened to me today. I had scheduled an appointment for something entirely different and when all was said and done the doctor had spoken to me more about my blood pressure than about the reason I originally booked the appointment. I walked out with a prescription for some very yucky blood pressure medication that I WONT be taking. Given that I was in pain, stressed and had drank the night before (which I never do) I was not shocked that my BP was slightly above normal. Did the doctor ask me if I had drank? Acknowledge that my pain could be elevating my blood pressure? Inquire about my diet? NOPE. Here’s a pill. Take it or you’re going to die! Unbelievable!

  83. I have three blood pressure monitors at home and the readings are normal. A week ago I went to the dentist and my BP was 138/94. As soon as I got home I measured and it was 113/74. I went back to the dentist the very same day and my BP was 140/93. I have been measuring at home even when I feel stress and the reading are still normal. Once I go to a medical setting and see the monitor, my body associates it with death and dying and I have a reaction. I am not being stubborn. I simply refuse to take medication because I don’t need it.

  84. I haven’t been to a doc in four years. No complaints, for one reason — although I would like to get a blood test and see how my electrolytes, etc. are doing. I’ll have to scrounge up a PC in order to do this though, darn it. They never let us sit quietly for several minutes before taking our BP, and this I resent. Mine is always high in a medical office. The last time I went they wanted to put me on Lipinosil, and after three days I threw the pills away. OMG, those things are killers! Turns out they are, too….just check the AskAPatient website and read what they say about Lipinosil.

  85. Exactly the article I needed today, as i faced the exact same situation in the doc’s office. Thanks mark.

  86. Cool story bro. Filled with a bunch of excuses.

    Your doctor was RIGHT. YOU KNEW IT since you were “mortified”.

    You were dehydrated. That doesn’t mean the “reason” isn’t valid. It means your heart WAS having to work harder.

    Yeah it changes all the time, duh. Yeah you can’t just rely on one reading, duh, That doesn’t mean you shouldn’t take measures to CORRECT your blood pressure when you see all those diastolic numbers floating up there near 130 as you see in #2. . IE drinking 8 oz water when you get up in the morning before taking it. Seeing if things like Beets, celery, hibiscus tea improve it. ETC.

    If your diet was so stellar, you wouldn’t have even been dehydrated. You’d be hydrated from eating a HEALTHY amount of dark leafy greens and raw vegetables. And it doesn’t matter WHAT your diet is today

    And NO, the solution is not to shop around for the “lowest time of day” you can find. LOL

    Gonna take a wild guess your lipid panel is crappy?

    And FYI, being dehydrated messes up your bloodwork if you even man-up to get a full work up so I’d be fixing THAT right away. Instead of defending sodium as the hill to die on. Literally.

    1. *edit “Doesn’t matter what your diet is today; if you don’t repair your arteries from all the years of the BAD diet’s damage. ESPECIALLY CELL DAMAGING OILS

  87. Mark – What about essential hypertension? Could this be genetic or lifestyle related? My partner suffer from this and is on meds. Despite being on meds, last night his blood pressure shot up, he got the sweats and said he felt as if his heart was going to explode. Could this be stressed induced? Or just….essential hypertension?! He is only 42. Works out A LOT everyday. Moderately healthy. Not primal however. High stress job. Been skimping on sleep all his life…any advice?