Episode 4: Dr. Mark Houston, MD: Root Causes of High Blood Pressure

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SPEAKERS: Dr. Andrew Wong, Dr. Mark Houston

Welcome to the Capital Integrative Health podcast, a podcast dedicated to transforming the consciousness around what it means to be healthy and understanding the root causes of both disease and wellness. I am Dr. Andrew Wong, co-founder of Capital Integrative health, an integrated practice committed to expanding access to holistic root cause medicine to the global community.

We’re excited today to be joined by Dr. Mark Houston a specialist in cardiovascular disease and hypertension. Dr. Houston is the current director of the Hypertension Institute in Nashville, Tennessee, and is the author and teacher and act and really internationally known for his work with hypertension and cardiovascular disease and is very active in both clinic and research. And he has a background in human nutrition and functional medicine and I’m sure that intro doesn’t do justice. But I first ran into Dr. Houston as he was lecturing at the IFM back in 2012 and that was one of my first intros to

functional cardiology. Joined immediately after that the International Society that you had co-founded with your other colleagues and it’s just been a really amazing journey to start doing functional medicine myself over these past 10 years I’m really excited to interview you today and have a conversation with you Dr. Houston, about getting to the root cause of hypertension so if you struggle with high blood pressure or know someone with high blood pressure or cardiovascular issues this conversation is for you.

Dr. Wong:

So, welcome Dr. Houston.

Dr. Houston:

Thank you, Andrews. A pleasure to be with you, thank you so much.

Dr. Wong:

So you have written a new book called Controlling High Blood Pressure through nutrition supplements lifestyle and drugs that we are excited to talk to you about today and kind of get your kind of new insights into some of the wrinkles that you’ve discovered over the years and treating thousands of patients successfully with hypertension and other cardiovascular diseases. So, I think let’s start real basic first and then we’ll try to take a deep dive into this but let’s kind of start with, for the audience here what defines hypertension? I know from 2017 the ACC/AHA come up with some new guidelines so kind of where is that now in this whole?

Dr. Houston:

Well, the term hypertension for the layperson is really high blood pressure the two are synonymous unfortunately a lot of people think hypertension means you’re hyper tense but that is not the case. It means your blood pressures are constricted and you get high blood pressure. The definition of hypertension is a systolic which is the top number of 120 or greater and the bottom number the diastolic of 80 or greater so 120 over 80 is the set point for you start developing different stages of high blood pressure and so there’s stages one two three or four depending on what the levels are but clearly between 120 and 130 and 80 to 90 is considered an increasing risk per millimeter of mercury. So you don’t even want to have very mild hypertension because incremental increases in blood pressure will incrementally increase your risk for strokes, heart attacks, kidney failure and other vascular problems.

Dr. Wong:

Got it. So and I think that’s really important to know because even if someone doesn’t have hypertension after that 120 over 80s cutoff point you like you said you start getting that incremental risk. Now, is there some low number that you find can be potentially deleterious is it kind of like the three bears in the oatmeal where you know too high is bad but too low is bad and what does that cut off for you?

Dr. Houston:

Yeah, the opposite is if you get too low over blood pressure you will under perfuse your organs. So, if it’s your brain you can pass out or lose consciousness, give it your heart you can actually end up with a heart attack, kidneys you get kidney problems. So the lower limit, generally about 110 over 70 now occasionally you can drop a little lower short term but if you’re symptomatic certainly you need to reduce the medications. And most people, for example, they stand up too quick they get dizzy lightheaded they exercise their blood pressure falls and you just have to teach them how to check their pressure at home where the blood pressure cuff and then adjust the medicines accordingly.

Dr. Wong:

Got it. And what are some common contributing medical conditions to hypertension or to high blood pressure?

Dr. Houston:

There’s a whole list of secondary causes but obviously, about 90 percent of high blood pressure is actually genetic the other 10 are called secondary. So, there’s different types of adrenal problems. Pheochromocytoma which makes too much adrenaline, another one makes too much cortisol another one makes too much aldosterone all these are hormones that cause blood pressure to go up due to constriction of the arteries or increase in salt and water reabsorption. And then there’s a lot of drugs on the market that are over the counter but also prescription that can elevate blood pressure. So, you always look for the dietary things like too much sodium, not enough potassium. Obesity for example and there’s a lot of other causes but those are the main ones that people should be aware of.

Dr. Wong:

Now, is it the case that ninety percent of people with quote-unquote essential hypertension are more genetics that is it the case that the genes load the gun but the environment pulls the trigger? or is it sort of like people are going to get hypertension as kind of the vascular endothelial dysfunction progresses over time? What’s your thought on the interaction of lifestyle and vascular disease?

Dr. Houston:

Yeah, so there’s clearly two pieces to that equation. The genetics and then the genetic expression and we’ll get to the basics of why you have high blood pressure but when you have a hypertension gene and there’s a bunch of these and we measure those the expression of those genes is three basic responses. It’s inflammation oxidative stress and vascular immune dysfunction and so what happens early on is you get an arterial disease like endothelial dysfunction the arteries will get stiff they constrict. So, that the precursor for hypertension actually is vascular biology problems, vascular disease and then the blood pressure goes up as an end result of the vascular problem and that gene can penetrate early as a teenager or it can penetrate later usually in their 30s or 40s but you can modify the gene expression by doing certain environmental things and we talk about dietary things like sodium, magnesium, potassium, exercise weight reduction you know a lot of different techniques.

Dr. Wong:

So let’s take a deep dive into that because your book which is controlling high blood pressure through nutrition supplements lifestyle drugs. So nutrition is that the first piece there that you mentioned and, we know that food is medicine. We know that food can change genetic expression food is information. So when you talk about nutrition what nutrition recommendations do you recommend for say a patient with high blood pressure?

Dr. Houston:

The best-studied is called the DASH 2 diet that stands for dietary approaches to stop hypertension. It was published in the New England Journal and it’s basically low sodium, high potassium, high magnesium, high fiber, plenty of protein, low fat, particularly saturated fats, no trans fats but then increasing good fats like omega-3s monounsaturated like olive oil and the Mediterranean diet and the DASH two diet are actually very similar because they’re more of a plant-based diet with the right types of minerals and electrolytes in them and in the book that I just published we go through all the different types of high blood pressure diets available, but we really give the hypertension institute diet. It’s called HIP.

Dr. Wong:

We all want to be hip, so yes.

Dr. Houston:

The HIP program and so if you want to be hip there’s a lot of information in the book, particularly two chapters that I wrote with my nutritionist Lee Bell on what you do to manage blood pressure with good nutrition and good dietary means.

Dr. Wong:

Yeah, I think we all want to be hip and stay with the times here. So, we’ve already read that. I just ordered the here on Amazon but I would like to talk about a little bit about, some a little bit of tangents here with the olive oil. Because I know there’s some people that say, you know don’t cook with olive oil you know there could be a lower smoke point. Curious what your thoughts are on you know cooked versus uncooked olive oil and is that even an issue?

Dr. Houston:

I personally do not think that’s a big issue, in fact, most Europeans do cook with olive oil and they think Americans are really not very smart not to use it but look if you believe it’s not good that’s fine. I have no problem, but you can still use a low point of heat for olive oil or you can cook it in something else and then pour the olive oil on your food after that. But it’s good for you either way.

Dr. Wong:

And great, and in our clinic, we also really emphasize the balance of the Autonomic Nervous System. This idea of sympathetic and parasympathetic and we know now with Covid. You know, unfortunately, there’s a lot of, you know, with the pandemic there’s not only a lot of you know, deaths hospitalizations a lot of physical but also mental, emotional and even spiritual stressors you know going on and I think this is a collective trauma in some ways but how does the autonomic nervous system affect blood pressure you know everyone is stressed right now in some cases?

Dr. Houston:

It’s really important because the Sympathetic Nervous System is the fight or flight reaction which causes arteries to constrict, blood pressure to go up, heart rate to go up, and all kinds of other problems. Palpitations and heart and so forth. And if your parasympathetic system is balanced which is kind of slow yourself down, relax, lower blood pressure, lower heart rate. If those two are out of whack the sympathetic is going to cause problems heart attacks, strokes, and high blood pressure. Parasympathetic on the other hand, reduces all that risk and you can alter those by doing breathing techniques meditation, relaxation, breathing through a machine called a respirator, or you can just teach yourself how to take deep breaths to inhale and exhale on a regular basis.

Dr. Wong:

And that’s so important. I think this is something that is often under potentially under conscious control. Meaning breathing and you know affecting the ANS but we often forget to do that so it’s really important to kind of remind ourselves about that. I’m curious. This is more of a clinical question. Now, as you know having a clinic here as well. Curious about your, you know your protocol for measuring blood pressure when patients come in we know that there’s been studies. I know one from Belgium where it’s like there’s a 20-point difference between when they came in at first and maybe they had white coat hypertension and then you know at the end of that visit it dropped that systolic dropped about 20 points so. I’m curious do you do that in your practice? Do you find that to be really helpful to kind of measure at different time points?

Dr. Houston:

Yeah, we have a very set protocol for every patient when they come in for blood pressure checks and then we have another protocol for a new patient so let me do the new patient first and this is something that every physician or nurse practitioner or healthcare provider needs to learn how to do. First of all, read the American Heart Association guidelines they’re in the book actually and tell you how to actually do a correct blood pressure measurement. But, just simple things like be sure they’re sitting in a chair feet are on the floor, their arm is level with their heart not down or up, and that the machine has right over the artery if it’s electronic or if it’s digital or if it’s your stethoscope be sure it’s all over the brachial artery. So, the first visit of a new hypertensive patient, you check the pressure lying sitting and standing with a simultaneous heart rate or pulse you check both arms to see if there was a difference and you check the leg pressure because that can pick up a coarctation of aortas or secondary obstruction in an artery. So, you’re going to have multiple readings and you record those because you’ll pick up for example autonomic dysfunction by doing the different readings and positions. That’s a new patient. Now once you’ve done that on return visits the nurse checks the pressure in the left arm, they sit and rest for at least five to ten minutes. I, then go in and check it in the right arm. We always be sure we check it in both sides for two reasons. One to be sure the arms are still equal but also the difference between when they first come in and they rest and the pressure typically goes down after resting five minutes now they’ve been in the waiting room obviously for a while but that’s very stressful so quiet room you’re not supposed to smoke you’re not supposed to drink alcohol or caffeine. Supposed to be in a quiet relaxed room every time you check pressure and typically the five-minute reading is the best one to get.

Dr. Wong:

Got it. So, I imagine you don’t allow smoking or alcohol in your clinic. And you find a systolic blood pressure drop of about how much typically with that five minutes?

Dr. Houston:

I’ll have people that come in they can be hypertensive like 140, 160 you know over 90 and I come in five minutes later 10 minutes later and check them and that may be normal. Know there’s, they walk in they’re not resting or they do have white coat now if they’re really a white coat hypertensive. Their pressure may stay up even when I check it but often it will change even with that five-minute risk with white coat hypertensives.

Dr. Wong:

And that is huge because it definitely would change your management do you add or decrease their medications you know sometimes if they’re seemingly high but then it drops back to normal you’re not going to need to do that. And I think the other question I have about that we’ll move on to some of these other topics here. But I do think about white coat hypertension and my understanding is that there is still an increased risk of MI in different aspects even with white coat exactly.

Dr. Houston:

Yeah, that’s a good point to make. So, let’s put it in three groups. Totally normal tensive both outpatient and inpatient in the office or with ambulatory monitoring or whatever you’re using as your criteria then there’s the white coat hypertensives and then there’s the true chronic hypertensives. The white coat hypertensives have an in-between risk of the two so they do have an increased risk and most people now would say that if it’s white coat it probably needs to be treated. But the aggressiveness of the therapy is less because they may go home, it’s dropping and if you give them too much medication it’s too low.

Dr. Wong:

Would you say it’s almost kind of like a normal glycemia normal blood sugar versus pre-diabetes, diabetes? There’s some spectrum of blood pressure that it would depend on the situation.

Dr. Houston:

And the other one Andrew, that’s important. People probably don’t even know about this was called masked hypertension m-a-s-k-e-d masked hypertension. That means their blood pressure is higher at home than it is in the office. That occurs in 10 percent of hypertensives and you won’t pick that up unless you’re having people monitor their pressure at home so they’ll get pressures that are high at home but they come into your office and it’s normal and you say well you must not be checking it correctly. So, then you have to have them bring in their cuff and make sure they’re doing it correctly. And if once you teach them to do it correctly and they go home they still have high blood pressure at home then you say, well you may be a masked hypertension.

Dr. Wong:

But what causes that masked hypertension?

Dr. Houston:

If you, there’s seen a lot of times with people who have salt sensitivity. Okay, there are probably other reasons as well but it’s a phenomenon we just began to recognize when we started doing 24-hour blood pressure monitoring.

Dr. Wong:

Got it. And let’s go on to a really major topic of this book and hypertension root causes in general which is endothelial dysfunction or ED. So, we talk about ED a lot of people talk about, think about erectile dysfunction but really ED you know erectile dysfunction is almost like a secondary downstream symptom a lot of times the endothelial dysfunction in general. So, let’s talk about what endothelial dysfunction is. I think you talked about a little bit about the root cause of that. And how is that related to high blood pressure?

Dr. Houston:

So, every blood vessel is lined with a monolayer of cells called the endothelium and the endothelium is sort of like the air traffic control system of your entire blood vessel. It mitigates what happens in the blood vessel lumen with your white cells and your red cells but it also mitigates what happens in the arterial wall. So, it’s communicating in both directions. So, the bi-directional communication endothelium determines whether or not you have a healthy artery or not. So if the endothelium makes a lot of things but the most important is nitric oxide. And nitric oxide is a gas that causes your arteries to dilate prevents atherosclerosis and a lot of other inflammatory problems in the artery. So, if the endothelium is damaged it’s called endothelial dysfunction which means the endothelial dysfunction lowers nitric oxide the arteries constrict and you get hypertension it’s interesting that endothelial dysfunction actually precedes elevations and blood pressure sometimes by decades. That’s why I said earlier we think now that it’s actually artery disease, endothelial disease, endothelial dysfunction that actually precedes the manifestation of high blood pressure in patients by decades.

Dr. Wong:

So, just as a context for the listeners here how many people is it estimated now that have frank hypertension that’s you know diagnosed maybe they’re on medications? What is that general percentage and then is there any data on endothelial dysfunction? Because it’s kind of like a tip of the iceberg you know kind of thing here potentially.

Dr. Houston:

So, the statistics. Since they changed the normals recently from pre-hypertension, hypertension. There’s well, over 50 million people in the United States that are hypertensive and when you’re younger, you typically have more of a diastolic elevation that’s the bottom number and then you get systolic and diastolic, and then as you get older it’s predominantly systolic elevation and the dye stock tends to actually fall. So there are really different types of high blood pressure and different pathologies and different pathophysiologies and so they’re actually treated differently. Maybe a different approach with lifestyle and supplements but also the drugs that are used.

Dr. Wong:

But even for the younger people with the elevation and diastolic. For instance, are we still talking about endothelial dysfunction as one of the major?

Dr. Houston:

All patients who have hypertension have endothelial dysfunction but as you get older it’s compounded by endothelial dysfunction and more stiffness of the arteries so that when your heart pumps the vessel doesn’t dilate well it’s very stiff and the top number goes really high and when the heart relaxes the bottom number plummets.

Dr. Wong:

That pulse pressure you have.

Dr. Houston:

Pulse pressure changes you can have a pressure of like you know 180 over 60 and it’s very difficult to treat.

Dr. Wong:

Well, I do want to get into some of the nutraceuticals and things that you recommend for this and I have some burning questions. Because I have some patients ask me about this. So, I do want to get to this. But before we get to that, I know you thought to talk about the I think maybe the thousands of different insults that eventually you know lead to inflammation oxidative stress, and vascular dysfunction. Vascular autoimmune or immune dysfunction. Let’s talk about micronutrient deficiencies because I know you had done that study with the micronutrients and now that’s a very well-known study about how micronutrient repletion can actually help you know blood pressure and even normalize really hard to treat blood pressure. So, maybe if you want to talk about that and kind of what are the common micronutrient deficiencies that people should be aware of? and how we can kind of augment that in our diet and nutraceuticals?

Dr. Houston:

Now, one of the driving forces of the environmental piece for hypertension is your nutrition, specifically micronutrients but also macronutrients. So, the micronutrients would be things like coenzyme Q10 lipoic acid what’s called green tea extract or EGCG. You have electrolytes like potassium, magnesium, chloride but there’s different companies that measure micronutrients and this is routine in the hypertension institute that we measure micronutrients. There’s about 30 that we measure and what’s interesting when you have one of those deficiencies if you replace it the blood pressure often goes to normal. The more you have the more likely you are to be able to replace them and get the pressure down and then we get what’s called supraphysiologic dosing of the micronutrients. For example let’s just pick one. Let’s just say that your coenzyme Q10 level is very very low. If we give you high doses of coQ10 it replaces what’s missing but also there’s an effect of giving more than you need to get to normal so take it up to higher levels same thing’s true with things like magnesium.

Dr. Wong:

Now is that because you’re pushing more like kind of more orthomolecular into the cell or is it just like in the serum and it’s doing its job there where’s the mechanism happening actually?

Dr. Houston:

Yeah. Each of the micronutrients has an independent effect that’s variable. I mean for example all of the different micronutrients act like drugs. So, like magnesium, for example, is like a normal calcium channel blocker it validates the arteries yeah lipoic acid is an antioxidant so it reduces the oxidative stress which is another cause of hypertension. So they have myriad effects and when you start putting the different micronutrients together you get a synergy and reducing blood pressure.

Dr. Wong:

That’s a beautiful tapestry that you can weave naturally to help with the blood pressure. We’ll talk about medications later. But I do want to talk about when you decide to do the lifestyle nutriceuticals? When you decide to add on the medications? But, I do want to get to that. I do want to ask about toxic metals. You know we’ve been checking lead and mercury and you know different things in the practice here. And how do toxic metals affect blood pressure? and are they a significant cause of hypertension?

Dr. Houston:

Toxic metals definitely cause high blood pressure and they’re more common than people recognize because they haven’t been checked like they should be. Almost all of us are toxic burdens with mercury, lead, arsenic, cadmium other different things pesticides, organocytes, so that we check metals and pesticides and other organic substances in every patient and I don’t know the percentage you know nationwide but I would say in my practice we’ll find probably 25 or 30 percent of the patients with hypertension that have heavy metal or pesticide intoxication.

Dr. Wong:

We’re not checking on everyone but the people we check we don’t find anyone unscathed you know everyone has either blood or mercury or OP or organophosphates, organic pesticides. Yeah, I think and what is your treatments for the toxic metals? Is it like avoidance of certain food? You know we know that there’s this issue with seafood and mercury-like. Let’s talk about that maybe how would you address those types of things?

Dr. Houston:

Well, let’s just. Let’s whatever metal you find you want to remove where it’s coming from so, for example, it’s mercury you got to check their teeth, water source, food sources, exposure in the environment that kind of thing. And then we recommend chelation for the heavy metals. Yeah, the pesticides, Oragnocides as you know are very difficult to treat.

Dr. Wong:

Yes, yes. They are. Have you had any experience or success with sauna for any of the environmental chemicals?

Dr. Houston:

Yes. Red, dry sauna, infrared sauna, wet sauna. Any type of sauna is detoxifying and we recommend that.

Dr. Wong:

Yeah, and then maybe a shower afterward that kind of thing. Great. And then, I think we also you know think about wellness modalities like acupuncture massage I think there is some research on acupuncture massage for high blood pressure any thoughts about those modalities.

Dr. Houston:

Yeah. They are effective. Acupuncture actually as you know, Andrew can reset the parasympathetic nervous system.

Dr. Wong:

Absolutely.

Dr. Houston:

Probably does a lot of other things is too but it does work. Some people better than others. Any kind of relaxation technique whether it’s massage therapy meditation is very effective.

Dr. Wong:

There was a study I came across think looking at acupuncture research from Taiwan where they have acupuncture as part of their insurance covered you know everyone gets acupuncture. There 20, 000 people with fibromyalgia and one of the things they found was not only that acupuncture reduced FMS or fibromyalgia syndrome but it also decreased the risk of CBD by 50 percent. So I thought that was really interesting and the only thing I could think of was the, it’s decreasing inflammation somehow maybe there’s something with that.

Dr. Houston:

It probably does because when you increase parasympathetic activity inflammation does go down.

Dr. Wong:

Got it. Okay, that makes sense that makes sense. So we’re gonna get to. Let’s go a little bit more into nutraceuticals since we’re kind of talking about nutrition a bit. But, actually, before we get to that I do want to touch on the mic the macronutrient so you mentioned the micronutrients things like magnesium, potassium, and coQ10 and where do you find it, where do you see the macronutrients between protein fats, and carbs? You know, where are you on all that and I know there’s different diets out there you’ve mentioned DASH two and everything, and the Mediterranean diet obviously is very well researched but you know should people be looking at a certain percentage of macronutrients or where are you on all that and then I think.

Dr. Houston:

So let’s do it by groups. Carbohydrates refined carbohydrates will increase blood pressure so refined sugars and starches so bread, pasta, white rice, desserts, sodas. Stay away from those completely.

Dr. Wong:

And I see a lot of people that I hear a lot of people they say, they tell me I don’t need sugar. I just eat bread and pasta. So, I think that’s we have to be really clear like a lot of these highly refined pulverized grains that turn into sugar quickly may increase insulin which then will drive up hypertension.

Dr. Houston:

And fruits for example. Sucrose, fructose I mean. You’re gonna get sugar from fruits. You gotta be careful there as well. Now, complex carbohydrates which is primarily vegetables, fiber. You have all that you want. So a lot of fresh organic vegetables of different color and I would usually recommend at least eight servings a day a the servings which you get in the palm of your hand.

Dr. Wong:

Yeah, yeah. Actually, well it is summertime and the berries are glistening at all the farms. So how many servings? People are going to ask this. So how many servings of fruit would you recommend a day and if so what kind of fruits?

Dr. Houston:

Yeah. So, we recommend eight servings of vegetables and four servings of fruits and we recommend mostly berries.

Dr. Wong:

Berries. Yeah. They have a lower glycemic index. Yes there are many health benefits to berries and I think one of them is to increase the endothelial health. Correct?

Dr. Houston:

Yes. They’re great antioxidants. The second group are the fats and they’re a little more complicated. Everybody’s confused. The worst fats are the long-chain saturated fats and by that I mean a carbon length of C12 or longer and then also trans fats are bad those will increase blood pressure.

Dr. Wong:

The long chain C12 that’s like a steak or things like that.

Dr. Houston:

It would be. Yeah. Be things like well, of course, the steak is like lard it’s all the things you don’t want to eat like butter. Okay, you know lard fat from red meat that.

Dr. Wong:

I got truly healthy paleo diets. Probably not a bacon double cheeseburger right? That’s not.

Dr. Houston:

Not truly. But the good fats though are omega-3 fatty acids that’s what you get from cold-water fish or a supplement and monounsaturated fats be like nuts and olive oil those are good fats.

Dr. Wong:

I know there’s some. I won’t say who but there’s definitely some in the functional medicine space that are more in the paleo and it’s like it’s okay to eat your you know steak if it’s grass-fed and you do some of the vegetables that neutralize the mouth. So, I’m kind of curious about your thoughts on kind of the paleo community that’s low-carb is that and you know there are some studies and I think there’s maybe controversy over this like, what’s good? what’s not good? Certainly not too much saturated fat for someone with CAD that’s documented. You may want to reduce that saturated fat what about someone that’s just sort of healthy and maybe they don’t have a high calcium score or something like that is saturated that bad for them.

Dr. Houston:

I think you should stay away from long-chain fat saturated fats but if you eat meat from organic sources that are cows that don’t eat corn. But yeah, gray’s own grass. Yeah, their meat’s not got the bad fats in it.

Dr. Wong:

They’re omega-3, they’re eating the grasses. Got it, okay that makes sense.

Dr. Houston:

Yeah. So, that’s okay. And the last group is protein. Protein of good sources again. High-quality protein. Organic, no pesticides and Organocides or hormones lower blood pressure. Their natural amino acid lengths look like an ACE inhibitor.

Dr. Wong:

Got it, so yeah. And I think whether it’s proteins from so so fish but also chicken.

Dr. Houston:

It could be vegetable protein. It could be an animal protein. Okay, so kind of like any of those are good.

Dr. Wong:

Great, great. Sorry.

Dr. Houston:

Sardines.

Dr. Wong:

Yes. Sardines. Maybe with a little lemon and olive oil would be good. Anyway, any thoughts on protein powders? You know, I think there’s a lot of protein powders on the market there.

Dr. Houston:

You want to be careful with the protein powders to be sure they’re high quality and they’re organic-based. The only protein powder that I recommend on our on a regular basis is whey protein. But also, if you don’t, can’t take away your dairy allergy or whatever pea protein is a reasonable substitute that’s ice protein maybe.

Dr. Wong:

And then lifestyle. You know, we know that lifestyle has the ability to reverse disease and to optimize wellness and there’s many aspects to lifestyle. But what lifestyle and stress reduction habits do you recommend as a clinician? As someone who has a lot of you know experience with this, seeing this a lot with hypertension? But I think even to prevent hypertension.

Dr. Houston:

Well, we screened them first to identify which ones are at risk for high blood pressure with exercise or have issues with arrhythmias with exercise. So, once they’re screened if they’re good to go we start them on a very slow graduated exercise program and the end result is we recommend four hours. Excuse me, you got four hours a week or four times, one hour times four days and you do probably about maybe 40 minutes of resistance training with weights and about 20 minutes of aerobic training so it’s a two to one ratio. That’s what’s been shown to keep down heart disease and blood pressure and that’s actually in the book too. We actually describe the, we call it the ABCT exercise program which you can go from being a couch potato and it tells you exactly what to do, how to do it, when to do it, up through Olympic athletes. So, you can pick your program and do that so exercise. We recommend eight hours of sleep every night some sort of meditation relaxation program and then obviously reducing the ideal body fat, particularly getting their visceral fat to normal. So for a female, it’s below 22 and for a male, it’s below 16.

Dr. Wong:

Yeah. Well, I have some work to go. I’ve gained some muscle mass back and lost some fat post, the worst of COVID. But hopefully, it’s been the worst of covered. But certainly, it’s been tough you know and I think that you know a lot of us often think about how do we prevent disease? and you know, how do we help with our own lifestyles? But it’s just so interesting to hear the research that says you need four hours of exercise you know meditation more of a HIP diet, you know HIP nutrition plan. A lot of these things are not necessarily part of the standard. You know, we talk about what’s called the standard American diet or sad diet in a way, and you know even that word standard it implies that well everyone’s doing it so it’s got to be normal it’s got it accepted. What are your thoughts of the standard American diet? The hearties or the burger king? or you know whatever.

Dr. Houston:

It is. It’s a pretty awful diet. I mean you’re getting.

Dr. Wong:

But it’s standard.

Dr. Houston:

It’s standard because it’s common.

Dr. Wong:

Yes, but it doesn’t mean it’s not bad.

Dr. Houston:

It’s standard. Yeah, so we should call it bad sad.

Dr. Wong:

Bad sad. Yeah, so we’d rather be HIP than bad and sad.

Dr. Houston:

HIP is the way to go, right yes.

Dr. Wong:

What kind of exercise are you thinking for resistance training? Is that like body weights? Is that more like using iron-pumping iron and things?

Dr. Houston:

Yeah, there’s a lot of ways to do resistance training. Yoga will actually give you good resistance training. But if you really want to build muscle mass which you need to do, because you lose it after about age 40. You can either go to a gym and do light weights or you can buy some you know 5, 10, 20-pound handbells and do your own gym at home, and then your lean muscle mass is important to maintain insulin sensitivity but also to maintain normal blood pressure because those two are related.

Dr. Wong:

Yes, and then we know about it in terms of you know fat mass, lean muscle mass, etc. that you know body impedance often gives us more data than a BMI.

Dr. Houston:

Right.

Dr. Wong:

And so, we can have people can have normal BMI. I was reading something the other day that was saying that in the 1940s. BMI was 22 and we were getting nine hours of sleep at night before cell phones right? so it’s kind of you know, it’s like that was normal and everyone was eating organic because there probably weren’t as many pesticides you know that those things. So definitely this can really tell us the truth about where we are in terms of visceral fat and look at that body impedance analysis. Do you find that to be helpful in your practice?

Dr. Houston:

We have a BIA in our office and all the patients come in and get that done. They would put them in a really good nutrition weight loss program and we track them on a regular basis. And we’ve got people on our program that have lost a hundred pounds in six months so.

Dr. Wong:

That’s amazing! Yeah, that is really amazing. Then I guess you know people would probably want to know about the top two, three supplements would you say. If someone had high blood pressure, what are your go-to’s? I know you’ve talked some about some of the products that had algae in it that helped the endothelium. But I’m kind of curious about your kind of lace?

Dr. Houston:

There’s about I’d say three or four that are absolutely consistently good with lowering blood pressure. The first one is a nitric oxide booster called Neo40. It’s a beetroot extract.

Another one’s called Arteriosil, which is a glycocalyx builder. The third, is whey protein and the fourth is coQ10 and the fifth is magnesium chelates.

Dr. Wong:

Let’s get into the glycocalyx a little bit. Because I think the audience may not know as much about that one. We talked a little about nitric oxide. I think Neo40 is great also the glycocalyx. What is that? and why is that so important in arterial endothelial health?

Dr. Houston:

The glycocalyx is a monolayer of cells that actually sits on top of the endothelium and it protects the endothelium. It has actually very similar functions it can make nitric oxide reduce inflammation, reduce oxidative stress and immune dysfunction and it protects the endothelium. So if your glycocalyx is damaged then your endothelium gets damaged so you want both of them to be healthy. So by using Neo40 and or tear cell together, you enhance the integrity of both of those layers and you have less arterial stiffness better endothelial function, and lower blood pressure. We’ve got clinical trials with both that’s separately and independently.

Dr. Wong:

Independently. Okay, and then any trials together yet or?

Dr. Houston:

Not yet. We’re working on that.

Dr. Wong:

Okay. All right. So we’ll talk about that. Maybe we need to talk about in our time anything else that you can do to build up the endothelium and glycocalyx through, say nutrition or lifestyle that you found.

Dr. Houston:

I think the plant-based diet is important in getting on high AC, high antioxidants, and a low inflammatory diet. Those will help and obviously, you know following what’s in the book related to the, either the Mediterranean or DASH 2 diet. But as far as supplements go, hands down Neo40 and our tear cell have the best results.

Dr. Wong:

Yeah. Those are great. I have used those too. So start using those more as well. And then I think the other question is on medication. So when do you decide to use medications? What is that trigger point there?

Dr. Houston:

This is one of the most important questions and I really want the audience to understand this. When you have defined hypertension with a 24-hour blood pressure monitor and several office readings and you are sure they have chronic hypertension you do not wait for the blood pressure to come down to normal by saying, okay let’s give you six months on whatever nutrition or low sodium. You need to start medication on day one because of a clinical trial that showed if you wait you never catch up. If you have arterial damage during that three months or six months the patients never do as well that never has good control. So, our rule of thumb is you identify hypertension, and what kind they have. You get them on all the things in the book about lifestyle and supplements and so forth. Nutrition, exercise, and weight loss, but you start medication at the same time to get their pressure normalized and let them then achieve their goal later, and then you can try to reduce or stop the medication.

Dr. Wong:

That’s a great rule of thumb. I think that’s a really huge point, is that this is important to even if you want to repeat that, I mean like the clock is ticking it sounds like once you’re bad diagnosis and you want to try to stop the, not stop the bleeding is not right, the right analogy for this. But you know stop that dysfunction from happening because that inflammation is just going to keep on snowballing. It sounds like. Then I wanted to ask a question. I know some people have asked me that before about arterial calcification someone has a let’s say calcium score of 300 maybe 400. They’re a bit overweight, they’re working on the lifestyle. The TLC, the nutraceuticals may be on some medications they’re doing, the diet and exercise. Is there a way that you’ve seen and I know maybe Ornish has done this as well. But, you know to really have you seen people have sort of arterial calcification reversal from some of the things that you’ve done.

Dr. Houston:

So, let this a very controversial topic actually right now. But in the Hypertension Institute, I think we’ve solved the problem, and we kind of know what to do. Even though there may be controversy in the literature, I don’t really have any controversy in my head. So, I’ll tell you what it means and what we do CAC (Coronary Artery Calcification) should be done in every patient now it’s very cheap, it’s fifty dollars to do a CAC so it’s reasonable.

Dr. Wong:

Automatic. The CAT Scan.

Dr. Houston:

Is a college C. It’s called a Coronary Calcification, it’s not a CT Scan.

Dr. Wong:

Oh, okay.

Dr. Houston:

Very different. Yeah. So, there’s no amount of radiation. It’s inexpensive. It’s fifty dollars, and we do it on all the patients that come in. When you have a high calcium score it can be the calcium in the wall of the artery or it could be calcium in a plaque that’s inside the arterial lumen causing an obstruction. You can’t tell from the CAC which of those it is. So, if you get the calcium score and it’s elevated, again you can define that a lot of ways but the score should be zero. Every time it goes up there’s increased risk. If it gets over 100 you know, you usually have a problem but the higher the score the more likelihood.

Dr. Wong:

So, just to clarify is this a blood test or is this something?

Dr. Houston:

It’s an actual scan, it’s a coronary artery scan. It’s called a CAC, calcium score scan.

Dr. Wong:

Got it.

Dr. Houston:

Okay. It looks like a CT scanner but it’s not really. Not a scanning of a CT scanner.

Dr. Wong:

Got it.

Dr. Houston:

It’s not a CTA.

Dr. Wong:

And so is this something that’s available through regular radiology?

Dr. Houston:

Yeah. Every, almost, every radiology department can do this. Anywhere in the country.

Dr. Wong:

That’s great.

Dr. Houston:

So, if you get a high calcium score you have to figure out where is the calcium and the way you can do that is with additional testing. Find out if it’s a blockage or it’s in the wall. So, you end up doing like things, like exercise echoes nuclear medicine, scans and occasionally an arteriogram because you can’t tell if they have chest pain or shortness of breath, high calcium score, you got to rule out you know chronic heart disease with blockages now.

Dr. Wong:

I know this is about hypertension. But, I know, here we talk about how if the CAC scores normal. We would maybe start some other things for high cholesterol besides a statin. Is that how you work in the practice? or do you start people in the statin?

Dr. Houston:

Yeah. Let’s go back just for a second though. Because if you get a calcium score of let’s say zero or 10, which is low. It doesn’t mean you don’t have chronic heart disease. It only means you don’t have calcific plaque. Got it a lot of people have soft black, no calcium, and the plaque can be you know eighty percent but it won’t show up on a calcium score and that’s the one that’s really dangerous because they can have a rupture and have a heart attack.

Dr. Wong:

He doesn’t really put you out of danger, it sounds like.

Dr. Houston:

Yeah. You know, you have to play the odds. Now, if you have a patient with a high calcium score and they have a high cholesterol then you’ve got to deal with that. Now, we use LDL particle number lipid profiling which is advanced lipid testing because the routine lipid profiling is not that accurate. So LDL particle number and small LDL size drive risk for calcium score but also for plaque and we have the ability now and we do we’ve done this for almost a decade to reduce not only calcium score but also reduce plaque formation with our program.

Dr. Wong:

Nice. So you have found it’d be helpful and I think do you feel like it’s a combination of the nutrition, the nutraceuticals, the medications lifestyle it’s all combined.

Dr. Houston:

You have to really use an integrative approach. You really can’t be anti-statin, you can’t be anti-nutraceutical. You really have to look at the data and define what works and put that together for the best interest of your patient.

Dr. Wong:

We’re thinking real quick on that arterial calcification question is. Where are you on Vitamin K and Vitamin K2, K1, K2, MK4, MK7?

Dr. Houston:

Vitamin K is very important for arterial health and bone health. Vitamin K2, MK7 have been shown to reduce arterial calcification and also build bone. The dose of vitamin K2, MK7 minimum is 360 micrograms a day.

Dr. Wong:

Which I think, it is pretty commonly found in various supplements that you can find professional-grade. You know, supplements that certainly and we know that just for the listeners out there that are trying to increase their D right now, you got to take that vitamin K2 with the D that’s typically would recommend it.

Dr. Houston:

The combination. The triad is vitamin K, D, and A, maintain arterial and bone health.

Dr. Wong:

Nice. Okay and then usually you know we talk about some some fun questions. But I think if you don’t mind, if you want to share with us your morning routine. Do you have any morning routine? You like playing around with a different conversation?

Dr. Houston:

It’s like being in the marine corps, unfortunately. So, a lot of people wouldn’t want my morning routine. So, i’ll tell you what it is that you ask and you want to have a little fun here with me. I’m up at 3:45 in the morning.

Dr. Wong:

It’s very inspirational for all of us.

Dr. Houston:

Yeah, so 3 45 a.m out of bed go to my exercise room. I have it in my house. I have no excuse not to. I do one hour of exercise every day, seven days a week. I don’t even take a day off. Weights, ABCT exercise program just like I described it and during the time I’m doing that. I have an energy drink which I actually described in the book.

Dr. Wong:

Okay.

Dr. Houston:

It’s got all kinds of goodies in it d-ribose plant-based powders, fruit-based powders, calcium, magnesium, potassium. I mean it’s just full of goodies and Hershey’s chocolate. You drink all that. It’s really tasty while you’re exercising and then you go have a nice hearty breakfast. And I usually have smoked salmon, cajun, egg, oatmeal, grapefruit, and fresh orange juice. Rarely have much bread though but occasionally and because you really have to have kind of a balanced breakfast to get all the protein and good carbs and fats back in your system after that kind of an exercise program.

Dr. Wong:

Yeah, and you’re exercising that much seven days a week. Your body is going to be more insulin sensitive when you do that and it’s going to take in those nutrients a lot better.

Dr. Houston:

It helps to build a muscle back very quickly when you eat good after exercising.

Dr. Wong:

Well, you are the author of many books and publications and your new book is called Controlling High Blood Pressure through nutrition, supplements, diet and lifestyle, drugs and you wrote it with your nutritionist Lee Bell I believe, yes.

Dr. Houston:

Yes, that’s correct.

Dr. Wong:

And this is on Amazon and I guess other places as well.

Dr. Houston:

Yeah, Amazon. Probably most bookstores carry it now and it’s actually, it’s only been out for about six weeks. So, it’s hot off the press. All the information in it is cutting edge in fact some of it’s actually advanced beyond what’s in the literature already.

Dr. Wong:

Great! Well, I look forward to reading. I just bought it. There were less than 10 copies left so I had to get it.

Dr. Houston:

Good.

Dr. Wong:

Yes, and speaking of books. Since you are an author. What books have you read recently? or books that you’ve kind of been enjoying recently that you could recommend to the audience? and anything that you kind of have read.

Dr. Houston:

Well, I’m going to be probably self-serving here and recommend the book that I wrote or edited. I should say it’s probably the leading cardiovascular textbook right now. That’s truly integrative. It’s called personalized and precision. Excuse me, personalized and precision cardiovascular medicine. It’s got about 40 different chapters and 40 high qualified authors. I edited this. It’s only about a year old and it has all the information needed about everything related to blood pressure, cholesterol, heart attack, heart failure, prevention, treatment, lifestyle, drugs, you name it it’s all in there.

Dr. Wong:

Great. Well, I look forward to reading that as well. I’m curious about the kind of interplay and this is a little bit of a broader question I would say. But you know between sort of the integrative functional cardiology world and the conventional cardiology world. Where are the cardiology colleagues that you kind of interact with and I know, you know there’s different perspectives out there and all of that’s fine. But I’m curious why this is not more mainstream yet? You know, maybe it’s coming. I’d love for this to be more mainstream than it is. But, or is it becoming more mainstream?

Dr. Houston:

It’s not actually. Most cardiologists are trained in their traditional fashion, in medical schools and universities and there’s not a lot of nutrition talk. Supplements are not taught. Some of the tests that we do in the hypertensive institute are not done like checking for endothelial function. This, all those things and most of the tests are treadmills, nuclear medicine scans, MRIs, and then catheterizations. It’s interventional. So, stents, bypass craft, that’s the way the training is. What we do is look at the entire spectrum of everything that you need to prevent, but also treat. So, there’s not very many integrative cardiovascular folks in the United States.

Dr. Wong:

There needs to be more like you for sure. So, thank you so much for the work you do and all the research and advocacy and I think one other. So, thank you again Dr. Houston for joining us. Please check out Dr. Houston’s new book which is again called Controlling High Blood pressure through nutrition, supplements, lifestyle, and drugs with his nutritionist Lee Bell. And if you enjoy this conversation please take a moment to leave us a review. It helps our podcast to reach more listeners and thank you for taking the time to be with us today and thank you very much Mark for being on the podcast and look forward to having you back again soon.

Dr. Houston:

I will. Thank you, Andrew. Have a great day. Thanks again for the invitation.

Dr. Wong:

Thank you.