Doctor Detective with Bryan Walsh


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In this week’s case study, Dr. Detective discovers an unsuspected cardiovascular risk marker in his apparently healthy patient, and guides the patient towards some nutritional solutions.

Eat less and exercise more. It’s generally a great prescription for improving health and improving body composition. However, it doesn’t always work.

Even with an awesome exercise plan and a rock-solid diet, some people suffer from mysterious symptoms and complaints that seem puzzling, given how much effort they put into their fitness and health.

When we meet clients who have problems that exercise and nutrition — not to mention their own doctors — can’t seem to solve, we know there are only a few experts on the planet to turn to.  One of them is Bryan Walsh.

Dr. Walsh has a sharp mind, a fitness background, a degree in naturopathic medicine, and extensive additional training and certifications. His wife is a naturopath too. (We bet his kids are the healthiest on the planet.)

When tough cases arise, Dr. Walsh turns from mild-mannered dad and husband into forensic physiologist. He pulls out his microscope, analyzes blood, saliva, urine, lifestyle – whatever he has to, in order to solve the medical mystery.

When Dr. Walsh volunteered to work on a regular case study feature with us, we jumped at the chance. By following along with these fascinating cases, you’ll see exactly how a talented practitioner thinks. You’ll also learn how to improve your own health.

In today’s case, we meet an apparently healthy man whose arteries may be secret saboteurs. Find out how Dr. Detective cracks this case.


Introduction – What is hypertension?

When your blood circulates, it exerts force on the walls of your arteries. The extent of this force is known as your blood pressure.

Of course, it’s important for your blood to circulate with some force; that’s how your body gets the nutrients it needs. But too much force can be dangerous, causing damage to the vessels.

Blood pressure is expressed in two numbers divided by a slash (e.g. 120/80). The top number (aka systolic blood pressure) is the pressure when your heart beats.  And the bottom number (aka diastolic blood pressure) is the pressure when your heart relaxes.

The higher these numbers, and the longer they are high, the more dangerous.

As you’ve probably heard, high blood pressure is known as a silent killer. In fact, according to the World Health Organization, it is the leading cause of death in North America.

Leading risks for death in North America (WHO, 2002)

Today’s case demonstrates how this risk factor is often missed, and why hypertension is indeed a silent killer.

The client

A 38-year-old male, Doug, came into our office for a general check-up. With no particular symptoms to address, he simply wanted to make sure he was doing all he could to maintain his apparent good health.

The client’s signs and symptoms

In a word – none!

Doug ate a good diet consisting of mostly whole organic food, and avoided gluten and dairy as much as possible. He exercised sporadically but was relatively lean. He reported some work and life stress, but there was nothing in particular that needed addressing.

The tests and assessments

Although he reported no troubling symptoms, we ran Doug’s blood chemistry and salivary hormone panel, along with a brief physical exam. We do this with most patients, and it’s amazing what we can learn from these simple tests.

The test results

Blood chemistry panel

Doug’s blood chemistry and salivary hormone profile looked good overall, with few markers requiring attention. So far, so good!

Physical exam

Just as you’d expect from his history, overall, Doug’s physical was unremarkable.

But one thing did stand out: his blood pressure reading — 158/73.

Now, as good detectives, we recognized this as a significant finding.

Not only did Doug have elevated systolic pressure (a potential problem in itself) but in addition, the gap between his systolic and diastolic numbers was unusually wide.

This gap is known as pulse pressure, and it’s a less well-known, but important aspect of healthy and unhealthy blood pressure.

Let’s explore the significance of this finding a little more.

The Third Blood Pressure Number

Blood pressure readings of approximately 120/80 mmHg are considered normal.

As we’ve mentioned, the top number represents the amount of pressure in arterial vessels while the heart is contracting and ejecting blood through those vessels. And the bottom number represents the pressure in the arteries when the heart is relaxing.

High blood pressure can be dangerous because its force can break off pieces of atherosclerotic plaque, which we all have to some extent or another.  And these, in turn, can obstruct blood flow to the heart or brain, potentially causing a heart attack or stroke.

If you’ve ever cranked open an old, seldom-used tap you’ll get the idea – clumps of rust and dirt rushing out with the water, followed by a hopelessly clogged drain. Yuck.

If we don’t want to end up like that sink, it’s safest to keep our systolic and diastolic readings within a certain range.

Table 1: Classification of blood pressure

Classification Systolic Diastolic
Normal <120 <80
Prehypertension 120-139 80-89
Stage 1 hypertension 140-139 90-99
Stage 2 hypertension ≥160 ≥100

What’s less well-recognized is that a third blood pressure number – pulse pressure – has been shown to be an independent risk factor for cardiovascular disease.

Digging deeper

Pulse pressure is calculated by subtracting the diastolic pressure from the systolic pressure. For example, someone with a normal blood pressure reading of 120/80 would have a pulse pressure of 40 mmHg (120 – 80 = 40).

Research suggests that a pulse pressure above 60 mmHg is an independent risk factor for cardiovascular disease. Why? We aren’t completely sure, but this number may indicate increased stiffness in the arteries.

When the heart contracts, it ejects blood into the arteries, which should stretch to compensate for the increased blood flow. However, if the arteries don’t stretch during cardiac systole, the pressure will rise. When the heart then relaxes in diastole, the pressure falls – and it may fall drastically.  You see, patency, or elasticity, does not contribute to the diastolic pressure as greatly as it does to systolic pressure.

The theory behind increased pulse pressure is that the arteries lack elasticity – either due to decreased elastic properties (i.e. elastin) and/or to increased stiffening resulting from arteriosclerosis.

Pulse pressure increases when arteries lack elasticity.

The prescription

Even though Doug seemed relatively healthy, with a pulse pressure of 84 mmHg – more than twice the normal reading – it seemed reasonable to assume that his arteries were probably on the stiff side – possibly because of excess arteriosclerosis. That put him at extra risk for a cardiovascular event sometime the future.

Dr. Detective to the rescue!

We decided to focus on two possible causes of arterial stiffness – decreased elasticity and increased calcification – and to address them both.

Here were our recommendations, with a brief explanation of each:

Vitamin C – Innate Response Vitamin C-400, six tablets a day in divided doses.
Rationale: Vitamin C is required for the formation of elastin and collagen, which are found in arterial walls.

Vitamin K – Allergy Research Full Spectrum K, two softgels daily in divided doses.
Rationale: Vitamin K has some emerging research showing it may help prevent atherosclerosis and in some cases, may even reverse it.

Serrapeptase – Two capsules twice daily on an empty stomach.
Rationale: As a proteolytic enzyme, it may have anti-inflammatory benefits. Anecdotal evidence suggests serrapaptase may reduce arteriosclerosis and improve vascular function, but more studies need to be performed.

Fish oil/Krill oil – Approximately 3 g per day of omega-3 fatty acids from fish oil and krill oil.
Rationale: EPA and DHA may reduce blood pressure, and DHA specifically may specifically reduce the systolic pressure. More studies are needed, but astaxanthin, a carotenoid found in krill oil, may reduce blood pressure as well.

CoQ10 – Designs for Health Ubiquinol – Two 50mg gel caps daily in divided doses.
Rationale: CoQ10 has antioxidant properties and may decrease blood pressure, possibly by reducing plasma viscosity.

The outcome

After his first office visit, Doug purchased a blood pressure cuff and continued monitoring his blood pressure once a week. After 30 days, his blood pressure had gone down to 146/72. Sixty days after starting the suggested protocol, his blood pressure had improved even further, to 128/71. He has since maintained this reading.

While greatly improved, Doug’s pulse pressure at 55 mgHg is still slightly elevated. Eventually, we would like to see that come down approximately 10 mmHg.

Summary

So what can we take away from Doug’s story?

  1. Just because you don’t have obvious symptoms doesn’t mean you don’t have an underlying health problem. Hypertension and increased pulse pressure have no significant symptoms . Visit your health provider regularly.
  2. Increased pulse pressure is an independent risk factor for a cardiovascular event and is likely due to decreased arterial patency or, increased arterial stiffness.
  3. Many nutritional products may help lower blood pressure, but it is important to target the specific mechanism involved.

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