Monthly Archives: March 2019

Treat High Blood Pressure Naturally – Drink More Water

References: Amer Jr Epidemiology, Am J Medicine,

There are lots of advice columns that say you should drink more water. Then there are plenty of skeptical medical columns that say your thirst is all you need to go by and “there is no evidence” that your kidneys or water controlling system are benefited by drinking more or less, that your natural thirst will figure it out. All that is wrong! Dead wrong. Let me explain. 

Now, how does your water system work? It’s easy. You have a hormone called ADH (anti-diuretic hormone) that stays, “Stop peeing” and hang onto water. When you get dehydrated and dry, your ADH goes up and you don’t pee. And vice versa. You protect the concentration of blood (called osmolality) very jealously with minute-to-minute secretion of ADH to keep your osmolality at 285. Your kidneys work on pushing various items across gradients to get rid of bad stuff and hang onto good stuff. That takes energy to do. The more concentrated your urine, the less water you have to put your garbage into, the harder your kidneys have to work. Kidneys thereby love, love, love dilute urine because it’s easier for them to excrete all your toxins and poisons and extra electrolytes you don’t need.

Now, a small seque into CIRS (chronic inflammatory response syndrome) from mold. I’m finding that about 70% of my clients with CIRS have mismatches of ADH and their osmolality. They come into my office caring a bottle of water and ask to leave for a potty break 15 minutes into our interview. Their brain/hypothalamus can’t read osmolality properly and they put out too much urine and get too concentrated. They drink frantically just to keep up. No matter how much they drink, their osmolality is still way over 285. And they innocently report urinating 15-20 times a day. 

CIRS folks aside, what about the rest of us? 75% of the population isn’t vulnerable to CIRS and we concentrate our urine properly. We drink more, we pee more. Simple. We eat more salt, we get more concentrated in our blood. Our osmolality goes up and we get thirsty. We put on 5 pounds of weight that we pee out over the next few days. We eat lots of sugar and white flour and put out insulin, which also makes us hang onto salt water and retain fluid. All that is understood. And our kidneys have to work harder to excrete extra “milli-osmoles” of toxins if we eat tons of salt and then force our kidneys to put that into a small volume of urine. It should make perfect sense to you (and it does to the medical profession) that your blood pressure is a function of how much fluid you are squeezing into your own vascular tree which acts like a big water balloon. If you inflate a balloon to its limits, the pressure goes up. If your blood is more concentrated with various kinds of stuff, it’s more viscous, more sticky, makes for more blood pressure and more heart disease

Ah! That’s it. If you deflate a balloon, it becomes softer and squishier. If you reduce the milli-osmoles, the extra poisons your kidneys have to pee out every day – the concentration gradient – by drinking more water, you have deflated your vascular tree, your balloon. 

Can you prove this? Yes! Emphatically. It’s not even subtle. That’s what Dr. Chan published in the American Jr of Epidemiology in 2002. From the Adventist Study out of Loma Linda, she found that folks who drank 5 glasses of water a day versus those who drank 2 glasses of water had about HALF the cardiac mortality. ( RR of. 0.46 for men, 0.59 for women). That’s huge. Guess what happens if you substitute milk, or juice, or tea? No improvement. Has to be water. Pure, clean, water. Why? Simple. Water has no milli-osmoles in it. (aka other ingredients you then have to excrete against a gradient.). Come on! “Make it easier for me!” say your kidneys. Liquids that are composed of ingredients turn into more ingredients that have to be excreted. Water. Delicious, pure, clean water. No ingredients. That’s what works. 

Can I put a tiny squirt of raspberry flavor in there? Would that work? You tell me. What’s your blood pressure?

WWW: What will work for me? I’ve tried extra glasses of water. Sure enough, I have to urinate more. My blood pressure is tiptoeing along the edge of normal so I would like a little better. I tried doing what the Israeli army insists for its soldiers – when in combat in the hot desert, drink ahead of time to stay ahead of dehydration. I was in the yard this weekend and I kept ahead of thirst by setting extra water out on the deck I could get to. For now, each day at breakfast I’m drinking one full extra, tall glass of water. Just that. The literature says three more so I’m thinking about replacing one of my big mugs of tea with just pure water.

Pop Quiz

1 Drinking how many glasses of water a day extra does it take to
reduce heart disease 50%?            Answer: 50%
2 Can I drink 5 glasses of milk or tea? Answer: No, if you get all your
liquids from anything but water, no benefit.
3 What hormone does your body put out when you are dehydrated?
Answer: ADH or anti-diuretic hormone
4 25% of the population is vulnerable to getting CIRS if they are
triggered. In their case, 70% of them get dysregulation of their ADH. What happens to them? Answer: they are peeing all day long.
Anything over 10 times a day means they likely have CIRS. (Then, if
they ache, are sore, tired and have brain fog, they definitely do.)
5 Folks with high blood pressure have more sticky blood, filled with
more ingredients than folks without high blood pressure. T or F.
Answer: True.

Take a NAP and lower your Blood Pressure

References: Science DailyAmerican College of Cardiology MeetingsAlzheimer’s Assoc 2018,

We don’t nap much. But blood pressure is important. I mean, really important. It’s one place where standard internal medicine agrees with functional medicine. It’s only the methods that differ. Instead of pushing a pill, which is quick and easy and seemingly the cure, I’m interested in focusing on lowering blood pressure with natural methods. My interest in high blood pressure stems all the way back to my medical school days at Yale, where I got a graduation prize for my thesis on the detection of hypertension in the office. 

Nowadays, I’m focused on high blood pressure because it is also one of the bedrock known risks for cognitive decline. Last July (2017) a report of the SPRINT MIND trial was purported to show a 15% reduction in dementia when folks with high blood pressurewere treatedfor a systolic pressure of 140 down to 120. The problem with the study was that upon reducing the rate of dementia from 18 to 14 per 1,000 patient years (looks huge to me) the study was terminated early, and then the statisticians said it wasn’t statistically significant and can’t be sited. Grrr. 
But back to napping and high blood pressure. This is something that works and you can do yourself. I’m not asking for a 2-hour nap, but the study did show a linear relationship between time napping and effect. The longer you nap, the better off you do. But for starters, just fall asleep so that you wake up and feel like you got a brief snooze. Like the Greeks, where this study was conducted. That study, reported last week (March 2019) at the ACC Meetings showed a 5.3 mm Hg reduction in blood pressure (from 132 to 127) in those who napped. This is not a small deal. Just a 2 mm reduction will reduce your risk of stroke 10%. A 5 mm reduction is as much as a pill. And that gets to be dramatic when you extrapolate the effect out to a population.

Why is this important? It turns out that treating high blood pressure is best done with lifestyle modification. In effect, having high blood pressure says that your metabolism and lifestyle is out of whack. It represents “endothelial dysfunction”. Your blood vessel tree is unhappy with you and your lifestyle. Each little lowering you do results in synergistic benefit. One plus one is three. One plus one plus one is five. If you can do multiple lifestyle modifications, you can control your blood pressure naturally, and lose the pills.

Let’s do it. Here goes a series on high blood pressure. Starting with naps. What caught my eye about napping was Winston Churchill’s habit of taking all his clothes off in the middle of the day and taking a full, two-hour nap. He claimed that allowed him to get two 8 hour work days out of every day. He lived into his 90s, despite his weight issues. Granted, he had a stroke, but never developed dementia.

WWW: What will work for me. I grew up in a household of napping parents. It was routine for my father to head for the bedroom to take a nap when he could. And on driving long distances, he would stop and snooze for a few minutes. His brain made it to 87 without any dementia. Now, we talk about taking a “full Winston” when we take an afternoon nap. The means, “take off your clothes and get between the sheets.”

POP QUIZ

  1. Napping helps lower blood pressure? T or F. Answer: True
  2. How much? Answer: up to 5 points
  3. Which reduces your risk of a stroke by how much? Answer: 10% for every 2 points
  4. Lifestyle changes are more effective than pills because…? Answer: They are synergistic which is better than additive. They multiply each other.
  5. What’s a full Winston? Answer: Copying Winston Churchill by taking off your clothes and getting between the sheets. (Breaks the rules for getting 8 hours of sleep at night, but Winston lived into his creative 90s. One person does not a rule make, but Churchill was such a force of nature, perhaps he does.)

Lack of Sleep is Tied to Cognitive Decline

References: SleepSleep ReviewAlzheimer’s DementiaSleep MedicineNational Sleep FoundationOxid Med Cell LongScience NewsIOS Press,

This is distressing. All of us have some issues with sleep. It might be the most common thing folks complain about to me in my practice. We rattle off the usual list of good sleep practices, (aka: Sleep Hygiene) like don’t nap too long in the day, get exercise, turn the lights down earlier in the evening, don’t eat a lot before bed, go to bed hungry, turn off lights in your bedroom, keep a schedule. All that, especially this weekend when we lose an hour of sleep. 
But what is sleep’s function? Let’s get to the heart of this issue. Sleep isn’t consolidating memory and making dreams that predict your future, like history has suggested it does. Sleep is all about rinsing and flushing your brain. Your glymphatic system in your brain goes into action when you sleep, with a doubling or tripling of flow, thinking your brain by as much as 15%. You are flushing out gunk. All those neurotransmitter breakdown products get flushed. But I believe it’s more fundamental than that.

We now know that copper and iron play a role in our brains. They are unique toxins and have to be removed by a protein called APP, amyloid precursor protein. Each time a molecule of copper, or iron, is excreted out of our brains, a tiny piece of the APP protein breaks off and is also excreted into the interstitial space (between cells). It’s amyloid accumulating in our brains that makes for Alzheimer’s. As we sleep, it’s amyloid that we need to wash out. The longer we sleep, and the better quality of our sleep, the more we flush. Get it? Would it make sense to you that men, who never give any iron away, and who havehigher body iron burdens get Alzheimer’s soonerthan women? 
With that background, we come to these studies that link lousy sleep to cognitive decline. Do I need to argue the point at all? It makes perfect sense. If you can’t sleep, you can’t flush out iron. Men have much more iron than women because they never had babies or periods. And then, it should be no surprise that men get Alzheimer’s 10 years before women.

It starts early. Lousy sleep in your mid life predicts cognitive decline later.

Now here is where I’m fascinated. MicroRNAs. Tiny bits of messenger RNA that is floating around in your body. They function as hormones by themselves, or as the basis for making small peptides. We now have studies that show you can examine the mRNA in your blood and demonstrate your sleep, dementia risk ratio. There are patterns of mRNA that are associated with lower cognition, and with lower sleep. The door that opens is that of peptides. Can we find peptides that we can manufacture and give to you to help your sleep? And would that help your cognition. I’m going to get to that in a couple of months. Hang in there. This is a very interesting journey. Meanwhile, go take a small nap to make up for daylight savings.

WWW: What Will Work for me. I got all my clocks changed this weekend. And I spent the weekend reading about peptides and sleep. I’m trying to focus on all the standard sleep “hygiene” strategies to get to sleep and stay there. If I get 10k of walking in, I sleep much better. If I can resist too big a supper I sleep better. So, there is some truth for me to all those strategies. I’m already older so cognitive decline is worrisome. I have given away blood 4 times now to get my ferritin down.

Pop Quiz

  1. What is the purpose of sleep? Answer: It’s your brain on flush. Getting rid of gunk.
  2. What is the principle “gunk” of Alzheimer’s? Answer: a small protein fragment called beta-amyloid. It accumulates in plaques.
  3. Where does beta-amyloid come from? Answer: exporting toxic minerals out of your brain.
  4. A good night’s sleep flushes out amyloid, and reduces your risk of cognitive decline. T or F. Answer: Bingo. True.
  5. Cognitive decline can be predicted by your risk of lousy sleep way early in life. T or F. Answer: Also true. Conclusion – you’ve got time. Make a habit of getting a good night’s sleep.

Pushups and Risk of Death

References: JAMA Feb 2019JAMA 1999NEJM

Did this ever make the news! “How many pushups you can do predicts your risk of future heart disease.” I promptly read every word and sat there worrying. Goodness, I haven’t done a pushup in a long time. I can walk 5 miles. I can shovel mulch. I can carry my 25 pound French Bulldog a mile home when the ice hurts her feet. Can I do pushups? I plopped down on the floor and managed 4. Hmmm.

So I read the article in a bit more detail. Who was the population? There were 1562 firefighters examined at one clinic for their physical fitness. Their mean age was 39. Their mean BMI was 28 (so they weren’t exactly trim). But they were firefighters. All male. All expected to be fit in order to do the things firefighters need to do. 
What was their risk? Well, of those 1562 men, there were 47 heart attacks over the next 10 years. Doing all the statistical magic one does for age and other risk factors, the authors found that the men who could do 21-30 pushups had a statistically valid reduction in heart disease risk, regardless of age. 

So, here we have a functional medical test that only takes 2 minutes to perform, costs nothing and gives us statistically significant results for a population of firefighters. What does it say about older men? Women? Non-firefighters? All unknown. 
Let’s peak at the Honolulu Retired Men’s Study and Isometric Hand Grip strength as it relates to longevity. Again, men aged 45-64 were followed for 25 years with measurement of their hand grip strength. The findings were pretty interesting. Men with the lowest strength, for their age, by tertile, were dramatically more likely to have the inability to get up without help, walk faster than 0.4 meters per second, or care effectively for themselves. Their conclusion: poor handgrip (arm strength) predicts disability 25 years later.

The Honolulu study had another remarkable finding. Men who walk two miles a day have HALF the mortality of couch potatoes. Get that? Half! Just walking works for older men. Women generally live longer. What does walking do for them? 
Pushups, walking, hand grip are all modifiable. It’s all about daily habits and using muscles as part of that.

WWW: What Will Work for Me. Well, well. Did that ever rattle my cage. I’ve being doing pushups for 10 days now. I was sore for the first three but then, each day, one more. I’m up to 10. I’m old. You can do this too. Women? We don’t have data but upper body strength must be on the same range, just different. Want to buy a an isometric hand gripper and do 50 a day. Start.

Pop Quiz

  1. The number of pushups you can do predicts YOUR risk of death from heart attack? T or F Answer; Whoa Nellie. This is true for firefighters, in America who are male. It may be true for women, on a different scale. It may be true for older folks, on a different scale. Yet to be determined.
  2. What may be a good predictor of future ability/disability? Answer: Hand grip strength. Honolulu Retired men’s study
  3. These are two measures of what? Answer: overall fitness.
  4. IF you are older than an average firefighter, what might you do to keep fit? Answer: walk 2 miles every day. (Get a dog)
  5. Does it help to do more exercise? Answer: You bet. And it doesn’t have to be all at once. Take stairs. Stand. Pick up sticks in your yard . Walk to get the mail from the mail person so they don’t have to carry the package up to your house. Park in the far end of the parking lot from the grocery store. Get up every hour at your desk and do enough squats to get breathing faster. Move.