Transcription
Today, our topic is, uh, we're talking about hypertension. So, we get lots and lots of questions from not only from our coaching clients but from just all the people that follow us on social media about hypertension and insulin resistance. And, and so Ben has taken some time this last week to kind of pull together some of the resources that he follows and some of his research. And so, we'll turn the time over to Dr. Bickman to talk about hypertension.
[Music]
And this is, of course, just when your blood pressure is too high. The main reason people are interested in blood pressure at all is because of its implicated being implicated as one of the primary causes of heart disease, namely the formation of plaques in the blood vessels. And then as the plaques grow, then blood vessels stop moving the blood, and then you would have a heart attack, for example. So, that's the main reason to be interested, or even dare I say, worried about about blood pressure. You don't want it too high all the time.
Classically, the view on hypertension has been that it is almost totally a consequence of the amount of salt a person's eating. This idea is based on on the very real phenomenon that in the body where you have more salt, you will hold on to body water. And so, some of the common drugs that someone will take will be to control their blood pressure will be a drug that will push the salt into the urine. Then more water is going from the blood into the urine, and then as blood volume is coming down, well, then pressure will come down too. But that hasn't really, the evidence on sodium or salt consumption hasn't really played out like many would expect.
But nevertheless, all of this is my way of introducing what's called the DASH diet. The DASH diet is an acronym, D-A-S-H, for Dietary Advances to Stop Hypertension. And the DASH diet is, is really at the heart of our obsession with salt. But they go further than that. So, the DASH diet is generally considered a low-fat diet, and and a diet that is also low salt and low in refined carbohydrates. And that last point is a key there. So, basically, what they tell people to do, it's to eat more real food, less processed foods. And you can see the problem with that.
So, unfortunately, people who, in the DASH diet does lower blood pressure, I need to disclose that right up front. It is, it will lower blood pressure based if someone comes at it from a conventional standard diet. Unfortunately, people have looked at that diet and said, well, it's because of the low sodium, it's the low salt consumption. But you can see the confounding variables there too. They are having them eat fewer refined carbohydrates, less sugar. I would say that's a confounding variable. And then they would say, someone else may say, well, also it's the low fat, and it's the low fat that is helping them have better blood pressure. But you can see all these moving parts, and it's hard to point a finger at which one is it.
So, what this study that I wanted to highlight did, it pointed the finger at fat. And it asked the question, is the fat reduction that comes with a standard DASH diet responsible for the improvements in blood lipids and in the improvements in cholesterol that you see with the conventional low-fat DASH diet? Now, so again, so the name of the study that I'm pulling from all this from is is called the Comparison of the DASH Diet and a Higher Fat DASH Diet on Blood Pressure and Lipids and Lipoproteins: A Randomized Controlled Trial. So, a randomized trial is, of course, what we always want because it actually allows us to establish some causality rather than just coincidence or correlation.
So, the difference between what they did, they took a people on a control diet, so eating standard foods. Then they put some group on the DASH diet, like the actual kind of low-fat, low-sugar or DASH diet. And then they put another group on a high-fat version of that DASH diet. So, basically, um, the, what all the difference was between these two forms of the DASH diet was that the high-fat DASH diet ate less carbohydrate content and more fat. And all of the attributes across these three, the people who were separated into three diets was the same. It was kind of balanced for for sex, it was balanced for body fatness, blood lipids, waist circumference, hypertension. So, they made sure that they had sort of equal representation. So, there were no fundamental differences between the study subjects.
Now, if we look at the diet itself, that's kind of outlined. Well, let me make a comment in the methods. It says that the higher fat and lower carbohydrate content of the high-fat DASH diet was achieved by replacing non-fat and low-fat dairy with full-fat dairy products, mostly in the form of whole milk, cheese, and yogurt. And they were also, of course, allowed to eat more meat. But that was really the only difference. They tried to have every, all the other minerals like magnesium, calcium, sodium, potassium equal across the groups. And then they say in the methods that the diets differed only in the amount of total fat, saturated fat, cholesterol, and carbohydrates.
And in table two, that's where they kind of outline, um, how it all broke down. The DASH diet was eating 55% of calories from carbohydrates, whereas the high-fat DASH diet was still eating about 40%. You know, which is, you know, that's, that's higher than you'd typically see on a low or a low-carb diet. But even still, it was, it was, you know, 15% lower than what we were seeing in the typical DASH diet, which was higher carb, lower fat. The protein was about the same across the groups. The saturated fat or the total amount of fat was 40% in the high-fat DASH group, and it went down to about 25% in the DASH diet. So, it was lower fat than normal. And then importantly, the amount of saturated fat was almost twice as high in the high-fat DASH diet group compared with the DASH diet group. And that matters because it's saturated fat that we've been told to avoid in the context of heart health and blood pressure and lipids and everything else. Sodium was about the same. Cholesterol was significantly higher in the high-fat DASH diet than the typical DASH diet. And they were eating more beef, more eggs, and all that kind of stuff, just what you'd expect.
Now, the consequences. What were the actual clinical outcomes? Where the the the origin for the DASH diet or the reason for the DASH diet is to control blood pressure. So, what happened when you compared these two versions of the DASH diet, the high-fat DASH diet and the low-fat DASH diet? They both had a significant reduction in systolic blood pressure. That's the first number, the pressure that you see in your bloods when your heart pumps. It went down significantly compared to the control group. And the same thing with the diastolic pressure. They both went down significantly compared with the control group. So, this right there, as far down as we've come, which isn't even that far, we immediately see the fat content of the DASH diet is in no way necessary. You know, cutting the fat in the conventional DASH diet, that was not the critical variable in lowering someone's blood pressure because this group was eating significantly more fat and double the amount of saturated fat, and their blood pressure went down to the exact same degree that it did in the low-fat DASH diet.
And then when you look at triglycerides, in fact, now we start to see differences. So, triglycerides are one of the best predictors of heart disease, and you want your triglycerides to be low. And who had the lowest of all triglycerides? It was the high-fat DASH diet group. In fact, it was significantly lower than the DASH diet group. The people eating less fat had higher triglycerides. So, a higher form of this fat in the blood. And triglycerides matter. They are a strong predictor of heart disease. Total cholesterol didn't change. It went down, well, in both of the DASH groups. So, both the high-fat DASH group and the normal low-fat DASH group, both had a significant reduction in total cholesterol. So, even though these people were eating twice as much saturated fat, their total cholesterol went down to the same degree that the low-fat diet eaters did. LDL cholesterol also changed, um, in, in both of the DASH diet groups. And HDL cholesterol, um, was roughly the same across, across all of them. And, but in fact, the DASH group, the low-fat DASH group, had the biggest drop in HDL cholesterol. And remember, they also had the highest increase in triglycerides. And as much as people focus on LDL, which I just mentioned didn't change by number, but it did change by size, which I'll come back to in a moment. LDL cholesterol is actually a pretty terrible predictor of who's going to have a heart attack. What is a stronger predictor is the triglyceride to HDL ratio. You want that number to be low. You want relatively more HDL cholesterol than you have triglycerides. And that triglyceride HDL ratio got best, it got, it was the best response in the high-fat diet DASH diet group, and it was the worst response in the low-fat DASH diet group. So, kind of challenging some of these seminal conclusions of what we think when it comes to fat.
Now, with regards to LDL, I mentioned a moment ago that LDL is a pretty terrible predictor of a heart disease. And that's because it fails to encompass the nuance of LDL. If LDL is really relevant to heart disease, it might be relevant when it's smaller and more dense. So, LDL itself, as a molecule, as a lipoprotein, can encompass a kind of wide spectrum of diameter. And the tighter and smaller the LDL molecule is, the more atherogenic it appears to be. In other words, the more causal it is to heart disease. And if, and the bigger it is, the less problematic it is. Well, wouldn't you know it, and this is, um, based on figure 3C, the high-fat DASH diet group had the biggest, it has, it had an expanding effect. And so, whatever the number of LDL molecules overall didn't change, I mentioned that statistic earlier, but the LDL molecules in the high-fat DASH group got bigger than any of the others, suggesting that those LDL numbers got less, or that LDL, the molecules themselves, are less atherogenic than otherwise.
So, those are the overall conclusions. A pretty simple study with pretty simple outcomes, but I think powerful. Where people fear, one of the reasons they fear saturated fat is this idea that it's going to be contributing to to to risk factors relevant to heart disease, namely elevated blood pressure and elevated or dyslipidemia. So, changes in lipids that are not good. And in fact, this study suggests it's quite the opposite. The high-fat DASH group, which was eating more fat but eating less refined carbohydrates, which was an important part of the study, and what I would argue is the more relevant part of the DASH diet in general, they had the equal reduction in blood pressure and a better, a better, a more favorable change in blood lipids compared to the typical low-fat DASH diet.
So, anytime a dietitian is telling someone, we need to adopt a DASH diet to improve your blood pressure, now we have a bit more of another dimension to that, which is, yeah, sure, adopt a DASH diet, it'll help your blood pressure a few points. Um, but you may as well have a high-fat DASH diet because it does it even better. And that's, that's the conclusion. So, so let's, uh, let's stop fearing fat in the context of the DASH diet, which, which many people are taught, um, to this day. And there's certainly some value compared to the standard diet, but the evidence suggests that a high-fat version of it may be even better.
Now, wouldn't it have been fun if they would have done an actual low-carb version of the DASH diet, which these guys didn't really? Because the carbohydrate consumption was still at 40% of calories, which really doesn't fit any definition of low carb. And they weren't intending it to be low carb, they just intended it to be high fat, which can also be kind of high carb. But nevertheless, it challenges the dogma and helps us understand that if the DASH diet works to any degree, it's not because it's low fat.
When was this study done, Ben? Yeah, it was done in 2016. So, just a few years ago, published in the American Journal of Clinical Nutrition, which is a very good journal.
Hey Ben, Ben, who's pushing this narrative of, uh, saturated fat is so bad for us? Is this, I mean, are we the only voices out there that's not pushing this narrative? Yeah, well, there are, of course, there are more and more voices all the time. Um, so, so the, the fear of saturated fat was born from, um, the work of decades ago looking at, which it was the rise of the diet-heart hypothesis. Which was not that fat's a problem, not even at the time, they weren't even saying cholesterol is a problem because there was no evidence to suggest it was. They were saying it's saturated fat that's the problem. And that was based on surveys done across a variety of countries, most especially Greece, where they basically were having people answer questionnaires about what they were eating and noticing in that population that there was a fairly low level of heart disease. Um, of course, we know now in hindsight, there was cherry-picking of data that they only were publishing the data from select countries and not all of them. But even within the countries they chose, like Greece, for example, which was such a, a poster child for this, this evidence for this, that these people eat relatively little meat and thus little saturated fat and have low instance of heart, evidence of heart disease. They were conducting these surveys in Greece during the time of Lent. And as any faithful Catholic knows, that's a time where you typically are avoiding meat as just part of the dietary practice. But they knew it at the time, the scientists, if I used that term, which I hate to do in this case, because I would argue they weren't really seeking truth, they were just seeking to confirm their own biases. But they knew they were doing this during Lent, and yet they did it anyway. They were asking these questions about what they were eating during this very unique period of time when they were avoiding meat, and then they took that conclusion as part of their evidence for the avoidance of saturated fat is a primary reason people have a less lower instance of heart disease when, when it was really just sort of cooking the books. Yeah.
Well, then from a practical standpoint, when we coach our clients on our Insulin IQ protocol, I mean, everybody's triglycerides drop, their LDL improves, their HDL improves. Um, they're, they're, I mean, they're off their hypertension medications almost within weeks of starting the program. So, we have all the evidence we need. Yeah. In fact, Rich, we published some of that evidence working with on an Insulin IQ protocol. We put, I would encourage anyone to look into this. Just go to Google Scholar and type in, uh, Rich's last name and my last name, heart and Bickman, in, in the word ketogenic, and you'll find the study immediately. Over just 90 days of putting women who had type 2 diabetes on a ketogenic diet, their blood pressure, among many other things, dropped significantly. I think it was like a 15-point drop in systolic pressure and a five or six-point drop in diastolic. And that was significantly better than what they were seeing even in this study that I just cited.
I think there is, this would be a topic or a discussion for another time because there's so much to it. But insulin, insulin resistance and the in the corresponding hyperinsulinemia are the most common drivers of hypertension. It's not your salt consumption. It's what insulin is telling your kidneys to do with the salt. The kidneys want to dump salt from the blood as readily as any time. But if insulin is elevated, that's one of the mechanisms. But there are many others where the kidneys are changed where insulin is forcing the kidneys to hold on to the salt. And then that's forcing the body to hold on to its water, which keeps blood volume up and blood pressure up. But there are honest-to-goodness four distinct mechanisms in and of themselves. And I'll do this as a paper another time or a classroom topic for another time. But if someone has hypertension, it is almost certainly a consequence of elevated insulin.
Hey Ben, so, uh, our good friend Amy Berger and Nina, uh, retweeted this. Amy says on Twitter this morning, "Makes me sad to think of all of the people trying to live on bland, low-sodium diets when for many people, it's not the sodium, it's the carbs." Yep. That's exactly right. And when you strict, there was a study done in humans. It was, it was a correlational study, unfortunately, which always has limited value. But it was, it was so compelling. They split people up into five, into quintiles of how much sodium or salt they were eating. And at the high end of the salt consumption group, they were eating, in some instances, a hundred times more salt than the low-sodium or low-salt consumers. So, a massive disparity at the ends of this spectrum. And they split the people up then into people who were overweight and people who were normal weight. In the normal weight group, there were no, no differences at all in any cardiovascular-related outcome. No increased mortality from heart disease, no increased hypertension, dyslipidemia, anything in the normal weight people eating 10 times or more salt than another people than others in that same group. However, in the overweight, obese group, now there was a correlation. The people eating the most salt did have a higher risk of these cardiovascular problems. But of course, the underlying issue there is what was their insulin resistance? What was happening? What was the other, the the ratios of their macronutrients? What was happening in their diet independent of the salt?
And there is such a thing as salt-sensitive hypertensives. That is a real thing. But it's also, once again, we have to point the finger not at the salt, but what the insulin resistance is making the kidneys do with the salt. Because the average person will eat a salty meal, and blood pressure may climb for a month, for a little brief period of time, and the kidneys regulate it, and blood pressure goes right back to normal. But we have known for about a hundred years of of the the water-retaining effect of dietary carbohydrates. We have seen this in humans and animals for about a century, in totally independent of of salt. If insulin is up, the body is changing in numerous ways to increase blood pressure. And so, yeah, all the, don't, don't fear the salt. Don't worry about the salt. Worry about the carbs and what that's doing to your insulin, because that will initiate multiple processes, one of which will affect salt, all of which are combining to increase blood pressure.
You know, it's interesting, Ben, when we put people on our InBody machine here, and they've got, they get a really influx of of lean body mass or or or really even muscle mass. All know that they cheated that week because they ate carbs. And the machine is showing a dramatic increase in in in their water. And so I'm like, "Hey, you cheated, didn't you?" Like, "How did you know that?" Because your water uptake just skyrocketed about four pounds as well. It's shocking. Yep. It is shocking.
When I, um, I every night on my right ring finger, I'll wear a sleep tracker ring. And it's, uh, which is always a bit depressing because I always sleep so terribly, so I don't know why I do that to myself. But it's just one more thing to worry about. But I can't help it. But I notice in the morning when I wake up and I'm taking my ring off, if I have, every time without fail, if I have indulged that previous night in some insulin-spiking snacks or treats, I will have a harder time pulling that ring off than if I haven't done that. I've been smart and I kind of was low carb throughout and I didn't snack or have treats in the evening, that ring will just come off nice and easy that next morning.
I myself have been to a heart doctor for, um, some edema that I would get in my ankles, who told me to get off salt. So, I did that. Didn't see any change in my ankles. I then, you know, a year or two later, found Rich and Insulin IQ and started on this program. And instantly, within like two days, my ankles were normal. And a couple years after the fact, I went back to this heart doctor for some other stuff. And, um, I told him, "Hey, by the way, when you suggested that I got off salt, I did that. Didn't see improvement. I stopped eating carbs and and instantaneously I got my ankles back." And he said, "Oh, no, it's just because you lost weight. You probably lost weight, right?" And I said, "Yeah, I lost in two, in two days. But the ankles, well, before the weight loss, like, you can't deny that." And he just would not have it. Like, he wouldn't hear me. Which is crazy. It challenges dogma. Yeah. People. Yep. Yeah. They don't want to, they don't want to see data if it upsets their dogma, unfortunately.
And really, we see everybody that we see, um, if they, if they say they have hypertension, hypertension, and they're on, um, blood pressure medication, that's one of the first things I warn them of, that you have to be really careful. So, everybody who's listening, if you have hypertension and you're starting to go low carb, make sure you talk to your doctor. Because if your medication is lowering your blood pressure, and now your diet is doing it as well, a lot of people will get too low if they're not careful and wean themselves off that medication. So, that's definitely something to look at. But every one of our clients see an improvement there as they're increasing their salt. So, they're eating more salt now, um, and, and seeing their blood pressure go down. In fact, that is a topic as a follow-up. What happens to insulin resistance when you cut salt too much? And in fact, the spoiler is not good.
Carly, what, what percentage of our clients that come in are suffering from some, some hypertension or just have completely wrong, have misperceptions about hypertension? To me, almost everyone has a complete misunderstanding of this. It's one of the big paradigms that we have to try and help people re- um, learn. I think the whole salt issue is one of three or four paradigms that have to be shattered in order to adopt this lifestyle. Um, but I would say probably at least 50% are on medication for high blood pressure. Yeah. I believe so. Maybe more than that. It's a lot. Yeah.
And Jack, it, it, it's amazing how fast the physicians are taking these these clients off of their meds. I mean, it is happening quickly, within weeks, within weeks. Yeah. Yeah. And they've been on, they've been on medications for years and years, and within weeks, they're off their meds. Yeah. And that's because the medication never solves the problem in this case of insulin resistance and hypertension. The medication is simply trying to undo some of what the insulin resistance is doing. Which means, as long as the person is insulin resistant, the medication will only be trying to fight that, never, never doing it successfully, never solving the problem. But when you actually solve the problem, which everyone hears us say so often, then the medication becomes, well, less relevant. I'll say that, I'll put it that way, to be diplomatic about it.
Yeah, and like, like Ben explained, um, salt will raise your blood pressure, I've heard for about 30 minutes is all. So, whenever I always tell people, if you're feeling, because it's kind of tricky, if you have blood pressure as an issue and you're, you're lowering your insulin and depleting your electrolytes, it's kind of tricky to kind of figure out what am I feeling? Because those two things will feel very similar. Headache, lightheadedness, dizziness, that's what you're gonna feel with both. So, I always tell people, take some salt, make sure it's a real salt with all the electrolytes, not just sodium in it, a good sea salt or pink salt. And if, if you feel crummy continuously, even if you're keeping your salt elevated, then your blood pressure is probably getting too low, and you need to lower your medication or talk to your doctor about that.
Well, yeah, and, and again, I know Carly just reiterated it, always speak with your physician. We're not your doctors, right? Insulin IQ is not your doctor. So, consult with your doctor before making any changes in medications.