High blood pressure / Hypertension

[audreyh1]

I'm surprised it's not higher than 88%. It seems like everyone is always eating unhealthy food, going out to restaurants/fast food to eat, getting tator tots with gravy or biscuits and gravy for breakfast. Even if they get eggs, they usually get a a couple pieces of toast to go with it.

12% is the number for adult Americans with optimal metabolic health - that is meeting all this 5 criteria. 88% not meetings all criteria seems pretty high to me considering that it includes young adults.

Metabolic Syndrome a.k.a Insulin resistance has traditionally been diagnosed if you fail to meet 3 of the criteria. Although if you develop type 2 diabetes or fatty liver you have clearly had insulin resistance for a while.

 

[GenXguy]

12% is the number for adult Americans with optimal metabolic health - that is meeting all this 5 criteria. 88% not meetings all criteria seems pretty high to me considering that it includes young adults.

Ahhh, yeah, it's 88% of adults now, but many of the other 12% will fail to meet the 5 criteria as they get older. I wonder how high that percentage would be of everyone who eventually doesn't meet all the criteria. Upper 90's% probably.

 

[Alan]

My 7 day average is 142/81. This morning’s reading was 141/83 about average. Then I lifted weights and ran 3 miles for the first time in a week. Took bp again 121/79. Verifies what I believe was posted here that bp goes down immediately after exercise.

This is exactly my situation. I got my HR up high with a vigorous walk uphill today and my BP was 123/75 shortly after. Doesn’t stop the average being over 140 since the “low” BP doesn’t last long after exercise.

 

[audreyh1]

Ahhh, yeah, it's 88% of adults now, but many of the other 12% will fail to meet the 5 criteria as they get older. I wonder how high that percentage would be of everyone who eventually doesn't meet all the criteria. Upper 90's% probably.

I saw those numbers somewhere, and 50+ meeting all those criteria I think was like 2%.

It’s in that study. See table 2. >=60 only 2.1% meet optimal metabolic health criteria, so 98% don’t.
https://www.liebertpub.com/doi/10.1089/met.2018.0105

 

[Ronstar]

This is exactly my situation. I got my HR up high with a vigorous walk uphill today and my BP was 123/75 shortly after. Doesn’t stop the average being over 140 since the “low” BP doesn’t last long after exercise.

You're right - and it would be almost impossible for the doc to catch the lowest of our bp readings. It's not like we're in the doc's office for a checkup just after exercise.

Here's the weird thing. I checked my 2020 nuclear stress test report. They took bp at each stage of the test (when they increased speed and incline) and at 2 , 4, and 6 minutes after getting off the treadmill. I never did get down to the 120's after the stress test unless it was more than 6 minutes after finishing.

I did have some pvc's during the test and still may have some after exercising. I don't think that my home bp machine has picked up any pvc's lately. Does your home monitor report any anomalies?

 

[6miths]

I saw those numbers somewhere, and 50+ meeting all those criteria I think was like 2%.

It’s in that study. See table 2. >=60 only 2.1% meet optimal metabolic health criteria, so 98% don’t.
https://www.liebertpub.com/doi/10.1089/met.2018.0105

Happy to be in the 2% here! 'Good metabolic health' is immediately excluded if on a BP or lipid medicine. BP meds being used much more commonly with new Guidelines (although this study pre-dates the changes) and cholesterol lowering agents were being given out like candy. Study said 56% of people on a BP med and 53% on a cholesterol lowering drug in the over 60 group.

The cutoffs are arbitrary obviously and a little iffy. They are shifting to HbA1c as the insulin resistance measurement which is likely good as the fasting glucose isn't that reproducible.

 

[audreyh1]

Happy to be in the 2% here! 'Good metabolic health' is immediately excluded if on a BP or lipid medicine. BP meds being used much more commonly with new Guidelines (although this study pre-dates the changes) and cholesterol lowering agents were being given out like candy. Study said 56% of people on a BP med and 53% on a cholesterol lowering drug in the over 60 group.

The cutoffs are arbitrary obviously and a little iffy. They are shifting to HbA1c as the insulin resistance measurement which is likely good as the fasting glucose isn't that reproducible.

Good points. The cutoffs are based on current guidelines. Particularly IMO triglycerides of 150 is a rather high bar, and 100 perhaps a better limit.

Unfortunately elevated HbA1C is very very late for detecting insulin resistance, and 15 years of serious damage can already be done to the vascular system before the pancreas starts to give out and blood sugar rises enough for a problem to be detected.

That is why acting on things that occur earlier like hypertension and high triglycerides and central body thickening/fatty liver is so important.

What gives a much earlier direct detection is high fasting blood insulin, which is not a standard test, but hyperinsulinemia is a precursor to other insulin resistance symptoms, and is likely the cause as well. This test is easy and not that expensive to order online for a local lab visit. A doctor will usually not order it because it’s not a standard screening test and the doctor has not been trained in how to interpret the results/what actions to take. We are not at a point yet where most doctors look at screening tests or other criteria, diagnose insulin resistance and provide the correct dietary advice and monitoring needed to reverse it.

 

[TrvlBug]

... ...
Speaking of salt shakers, they say "Put it away." I disagree with this. I think the real problem is processed foods and restaurant food. That's where you get ridiculous amounts.

... ...

I have been on HBP meds for years. During a conversation with my PCP a number of years ago about salt where I had concerns because I was a bit heavy handed with the salt shaker, she stated "The salt shaker is not your problem, but the processed food you eat is. Stay away from it and enjoy your salt shaker."

 

[Alan]

You're right - and it would be almost impossible for the doc to catch the lowest of our bp readings. It's not like we're in the doc's office for a checkup just after exercise.

Here's the weird thing. I checked my 2020 nuclear stress test report. They took bp at each stage of the test (when they increased speed and incline) and at 2 , 4, and 6 minutes after getting off the treadmill. I never did get down to the 120's after the stress test unless it was more than 6 minutes after finishing.

I did have some pvc's during the test and still may have some after exercising. I don't think that my home bp machine has picked up any pvc's lately. Does your home monitor report any anomalies?

Sometimes the monitor indicates irregular rhythm but the follow-up ekg with my Kardia device always indicates normal sinus rhythm but I think I can see an extra beat or two in the trace, but really I know nothing. Last week I had a full ekg and blood test and see the doc in 9 days time. The blood test is normal (I can view the results online) and the nurse who did the ekg said it was normal, so I expect the doc will be going off the 7 day average of 3 times a day BP readings I did. I will take in my BP machine as I’m sure she will also take my BP as well.

 

[Ronstar]

^ Excellent - normal is good.

 

[GenXguy]

What gives a much earlier direct detection is high fasting blood insulin, which is not a standard test, but hyperinsulinemia is a precursor to other insulin resistance symptoms, and is likely the cause as well. This test is easy and not that expensive to order online for a local lab visit. A doctor will usually not order it because it’s not a standard screening test and the doctor has not been trained in how to interpret the results/what actions to take. We are not at a point yet where most doctors look at screening tests or other criteria, diagnose insulin resistance and provide the correct dietary advice and monitoring needed to reverse it.

I'm on BP and high cholesterol medication and recently had blood tests and reviewed with my doctor. He mentioned that triglycerides were good, blood glucose was good, and cholesterol figures were within the target range. But I've never heard my doctor even utter the words "insulin resistance", "fatty liver", or "metabolic syndrome", even when I was overweight and had triglycerides over 200 along with being on BP medication and cholesterol medication, and none of those terms were mentioned in any of the flyers/printouts I would get for an annual employee fitness screening that I did that contained various educational material about maintaining good health. I only see that on these retirement forums or if I then specifically start searching for the info online.

 

[RAE]

What gives a much earlier direct detection is high fasting blood insulin, which is not a standard test, but hyperinsulinemia is a precursor to other insulin resistance symptoms, and is likely the cause as well. This test is easy and not that expensive to order online for a local lab visit. A doctor will usually not order it because it’s not a standard screening test and the doctor has not been trained in how to interpret the results/what actions to take. We are not at a point yet where most doctors look at screening tests or other criteria, diagnose insulin resistance and provide the correct dietary advice and monitoring needed to reverse it.

I always ask for the fasting insulin test to be ordered when I get my yearly lab tests done, and my PCP has never had a problem with doing that. My insurance covers it, as well. I agree that this is one test almost everyone should have done. As you say, damage could be happening years before some of the other tests (like HbA1C) detect a problem, and by then it may be too late.

 

[audreyh1]

I'm on BP and high cholesterol medication and recently had blood tests and reviewed with my doctor. He mentioned that triglycerides were good, blood glucose was good, and cholesterol figures were within the target range. But I've never heard my doctor even utter the words "insulin resistance", "fatty liver", or "metabolic syndrome", even when I was overweight and had triglycerides over 200 along with being on BP medication and cholesterol medication, and none of those terms were mentioned in any of the flyers/printouts I would get for an annual employee fitness screening that I did that contained various educational material about maintaining good health. I only see that on these retirement forums or if I then specifically start searching for the info online.

That is typical. Even though insulin resistance at the core of numerous western chronic diseases has been researched extensively and been well established for decades now, doctors simply aren’t trained in detecting and treating it. Standard of care is to treat symptoms with drugs, not to find the root cause and reverse it. It’s the sorry state of western medicine while chronic diseases continue to balloon, occurring earlier and earlier in life, and consume more and more (most) health care resources.

 

[skyking1]

Thanks I have a blood work order for ~3 weeks from now and will ask the doctor if she can add that to the order. Because of the diet I am on, I doubt it will be high. It would be good to have a baseline going forward.

 

[audreyh1]

Thanks I have a blood work order for ~3 weeks from now and will ask the doctor if she can add that to the order. Because of the diet I am on, I doubt it will be high. It would be good to have a baseline going forward.

Normal upper limits are given by labs as something like under 20 or 25 mIU/mL, but for good health according to many sources I have read it should really be under 10, maybe even under 8 to rule out insulin resistance.

 

[braumeister]

I agree with 8 or below.

Here's one reference:

You show no insulin resistance if ... Fasting insulin is between 3–8 uIU/mL (18–48 pmol/L).

https://diabetestalk.net/insulin/fasting-insulin-normal-range

 

[RAE]

That is typical. Even though insulin resistance at the core of numerous western chronic diseases has been researched extensively and been well established for decades now, doctors simply aren’t trained in detecting and treating it. Standard of care is to treat symptoms with drugs, not to find the root cause and reverse it. It’s the sorry state of western medicine while chronic diseases continue to balloon, occurring earlier and earlier in life, and consume more and more (most) health care resources.

All very true. This is why I give my PCP a list of blood tests I would like done, and then I basically interpret them myself (which is not all that difficult, if you have done the research). Western medicine may be good for trauma care, and that sort of thing, but with regard to most chronic conditions, you really need to become informed on your own and then stick to a diet and lifestyle regime which reduces your risk for metabolic issues as you age. Having a doctor prescribe a pill for heart problems or hypertension, without making any lifestyle changes that caused those issues in the first place, is just not going to work well.

 

[euro]

Normal upper limits are given by labs as something like under 20 or 25 mIU/mL, but for good health according to many sources I have read it should really be under 10, maybe even under 8 to rule out insulin resistance.

Agreed, in fact, my personal goal is <4. The large "normal" range just illustrates how far out of whack our metabolic health is on a population level.

 

[googily]

That is typical. Even though insulin resistance at the core of numerous western chronic diseases has been researched extensively and been well established for decades now, doctors simply aren’t trained in detecting and treating it. Standard of care is to treat symptoms with drugs, not to find the root cause and reverse it. It’s the sorry state of western medicine while chronic diseases continue to balloon, occurring earlier and earlier in life, and consume more and more (most) health care resources.

It's looking like another early detection option without extra tests for metabolic syndrome is the Triglyceride/HDL ratio. Just divide TG by HDL and if it's under 2, you're good. 2-4 is warning territory, and above 4 is not good.

Note that LDL and total cholesterol aren't mentioned.

Good piece on it here, but googling will give lots of links to papers on it.

https://www.cooperinstitute.org/201...or-determining-risk-of-coronary-heart-disease

(Might be worth a separate thread)

 

[GenXguy]

Having a doctor prescribe a pill for heart problems or hypertension, without making any lifestyle changes that caused those issues in the first place, is just not going to work well.

The only lifestyle change I can recall my doctor recommending to me is to take fish oil pills, which I did for a while. I took the initiative to exercise and cutting back on my eating to lose 40+ pounds on my own. When he put me on BP medication, he said it was pretty normal at my age and that he had to start taking it also, as if it's just one of those expectations in life.

Also, my triglycerides were normal this year, but they were over 200 a couple ago, and he didn't make a big deal out of that, either. He mentioned that he's seen a lot higher. That's actually what he recommended the fish oil for. It might have helped some the first year, but what really seemed to bring it down is the diet and exercise, which I started after stopping the fish oil. Still not exactly a healthy diet since I use artificial sweeteners in my coffee and still have too much processed foods, but I'm consuming a lot less. The processed food includes a lot of packets/cans of salmon/tuna. The only cereal I eat is regular Cheerios.

 

[audreyh1]

It’s easy to drop triglycerides drastically by reducing starchy carbs particularly avoiding highly processed food.

My PCP also only mentioned fish oil for reducing triglycerides. Later she mentioned that of course my triglycerides were now low because of my keto diet. I don’t think many of them want to encourage carbohydrate restriction fearing that will cause other problems maybe. Even though it generally also lowers blood pressure, raises HDL, and resolves a host of additional metabolic problems commonly associated with aging.

Canned fish is a minimally processed food, no problem. Boxed cereal is an ultra processed food and someone with metabolic issues may have trouble with it. Carb intolerance is a very individual thing. If you don’t have any blood sugar issues or other metabolic issues, then enjoy your cereal.

It’s unfortunate that high triglycerides is not a huge red flag to a doctor that their patient is metabolically in trouble, but I suspect it’s because the only real treatment is diet.

I’ve also read about many instances of a doctor saying NAFLD (non alcoholic fatty liver disease) is no big deal, or not even passing along the diagnosis for NAFLD from a scan. It’s often not taken seriously.

 

[GenXguy]

Sounds good. Thanks.

 

[skyking1]

Thanks for the Triglyceride/HDL ratio.
As Audrey mentioned, my Triglycerides are very low due to the keto diet.
I'll still be asking for that fasting insulin test. I've not seen it on blood work before.

 

[braumeister]

Thanks for the Triglyceride/HDL ratio.
As Audrey mentioned, my Triglycerides are very low due to the keto diet.
I'll still be asking for that fasting insulin test. I've not seen it on blood work before.

Many doctors are not familiar with the fasting insulin test, so most just look at your blood glucose (and some will check your A1C if the glucose reading is high).

Note that it is still possible to have insulin resistance with normal glucose and normal fasting insulin results, so it's not a perfect test, but still a very good one.

 

[skyking1]

What I am gathering is that tracking fasting insulin is the direct way to see and possibly get a jump on the problem, rather than wait till it shows up more globally.
My A1C was 5.3 and has gone down to 4.9 on this diet. That may not mean much.