An Integrative Approach to Hypertension with Dr. Mark Houston: Rational Wellness Podcast 352
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Dr. Mark Houston discusses An Integrative Approach to Hypertension with Dr. Ben Weitz.
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Podcast Highlights
3:20 Hypertension. What causes high blood pressure are three finite vascular responses, which are inflammation of the arteries, oxidative stress in the arteries, and immune dysfunction in the arteries. And those lead to endothelial dysfunction, glycocalyx dysfunction, vascular and cardiac smooth muscle dysfunction, the arteries become very stiff, non-elastic and therefore, the amount of flow going through an artery is going to increase the pressure by simple physical principles of stiffness with increased blood flow. So, that’s the basic physiology of hypertension. And at the Hypertension Institute we measure a series of genes that may play a role in causing hypertension and helps you to treat hypertension with either a drug or nutrition or a supplement.
4:59 Hypertension is blood pressure higher than 120 over 80 but several large cohort studies show that the risk starts at 110 over 70. But no committee’s going to recommend 110 over 70 because it is so difficult to achieve 120 over 80 and very few can achieve 110 over 70. It used to be thought that you did not need to worry about blood pressure until it went above 130 over 90, but we now know that there is an incremental risk for every one millimeter increase of either systolic or diastolic blood pressure.
6:28 Untreated hypertension. A number of patients have elevated blood pressure and don’t treat it because they don’t feel bad and they don’t want to take medication. But this is a bad idea because it’s going to damage every organ that requires a blood vessel going to it, which is everything in your body. The biggest negative effects of uncontrolled hypertension are ischemic stroke, myocardial infarction, congestive heart failure, kidney disease and aortic aneurysms.
7:15 Proper way to measure blood pressure. Most doctors and nurses do not do blood pressure measurements correctly. You should tell your patients not to smoke, drink coffee or alcohol or do other things before they come into your office. They should be seated in a chair with their feet on the ground, their back supported and they should rest for five minutes. The patient’s arm should be extended at the level of the heart and supported and the pressure should be checked with a cuff. You should check both arms and both legs. You should also do a sitting, standing, and lying pressure on the first visit.
9:58 White Coat Hypertension. Clinical studies show that having white coat hypertension–high blood pressure elevated while in the doctor’s office, but normal blood pressure at home–is not benign but actually increases the risk of heart disease. If you have high blood pressure when in the office means that whenever you are stressed your blood pressure will go up.
10:58 Genetic Factors. Dr. Houston has developed a gene test (the Cardia X profile) with Vibrant America that looks at 25 different SNPS, including some genes for high blood pressure, dyslipidemia, coronary heart disease, and diabetes genes. This helps to personalize the treatment, including which drugs will work best for that patient.
11:50 Plasma renin activity and serum aldosterone levels help guide care for patients with hypertension. You need to measure plasma renin activity and serum aldosterone since these numbers tell you the type of hypertension that patients have physiologically and this tells you which drugs will work best in that patient. For example, if you have high renin hypertension, the best drugs will be ACE inhibitors, ARBs and direct renin inhibitors, while if it’s low renin hypertension, it’s a diuretic and a calcium channel blocker.
13:57 Diet and Lifestyle. There are four main diet factors that affect hypertension: 1. Low sodium–below 1.5 gms per day, 2. High potassium–at least 5 gm per day, 3. High magnesium–at least 1,000 mg per day, and 4. at least 12 servings of fruits and vegetables per day. If you do these four things you will typically see a drop of 12-15 on the top and 6 to 8 on the bottom. While it has become popular in the Functional Medicine world to think that sodium is actually a good thing, esp. since the book, The Salt Fix by Dr. James DiNicolatonio, but Dr. Houston disagrees and he feels that sodium is toxic in any form. Not only will sodium raise your blood pressure, but it gets into your arteries and makes them stiff and then that leads to stroke, heart attack, heart failure, and kidney failure, proteinuria in the kidney. It also reduces nitric oxide levels, which makes your vessels even stiffer. Dr. Houston has developed a version of a healthy diet that he calls the HIP diet for the Hypertension Institute Program, which is a modified DASH2 diet with a little Mediterranean flavor thrown in. It is low sodium, high potassium, high magnesium, lots of fruits and vegetables, includes high quality protein, and gets rid of refined carbohydrates.
16:48 Toxins. Toxins drive hypertension and also coronary heart disease and heart attack. You need to measure the big ones: arsenic, lead, mercury, and then pesticides and organicides. And if those are elevated, you do your best to get rid of them.
17:11 Micronutrients. Micronutrient deficiencies can drive hypertension and coronary heart disease, arterial stiffness, and all kinds of problems including endothelial and glycocalyx dysfunction. Dr. Houston measures micronutrients with Vibrant America labs, which measures both intracellular and extracellular micronutrients.
17:48 Exercise. Dr. Houston recommends a combination of aerobic and resistance training for one hour per day, six days per week. Exercise improves arterial elasticity, raises nitric oxide, and reduces stroke and heart attack risk. Regular training will reduce blood pressure by about 12 over 6.
18:25 Endothelial dysfunction. Endothelial dysfunction and glycocalyx dysfunction occurs decades before you get hypertension. This can be identified using noninvasive vascular testing including the EndoPAT test and the computerized arterial pulse wave analysis. The first step is that the glycocalyx, which is outside the endothelium, gets damaged and then the vascular smooth muscle wall gets damaged, and finally the endothelium, which reduces nitric oxide and cause the three finite responses of inflammation, oxidative stress and vascular immune dysfunction, and then those feed into stiffness of the arteries. Then the artery wall gets thickened and the lumen gets narrowed and the long-term effect is reduced blood flow and oxygen through the artery to the organ. What you want to do is to promote the health of the glycocalyx by taking Arterosil by Calroy Labs. The other product is Vascanox, which is another product from Calroy that stimulates nitric oxide production and it is five times more potent than any other nitric oxide product on the market. Using these two products together improves glycocalyx endothelial function and also improve arterial function. The artery wall and the elasticity gets better and relaxes and the pressure starts to fall. The two ways to measure endothelial function besides the machines are to test asymmetric dimethylarginine (ADMA) through Quest and to use the nitric oxide test strips that measure nitric oxide in the saliva.
24:12 Nutrients. Potassium and magnesium are helpful in lowering blood pressure. The most impactful supplements are those that support nitic oxid and the glycocalyx, which are Arteriosil and Vascanox. Then you’ve Co-enzyme Q10, Kyolic garlic, alpha-lipoic acid, and Taurine. There are about 15 different nutrients that have been clinically studied to help lower blood pressure. Dr. Houston recommends a product called CardioSirt BP that he developed with Biotics that contains six grams of taurine along with magnesium and several other nutrients. Some nutrients work synergistically with medications, including R-Lipoic acid with an ACE inhibitor and Magnesium with a calcium channel blocker. But the key is to make sure whatever you’re doing gets the pressure down normal and pretty quick.
27:32 Medications. In order to select the most effective medications for that individual, it is helpful to do both genetic testing and the plasma renin and aldosterone levels. The top classes of drugs that Dr. Houston likes to use are ACE inhibitors, angiotensin receptor blockers, one or two of the calcium blockers like amlodipine or nifedipine. The best beta blockers are nebivolol, which is Bystolic, or Coreg, which is carvedilol. The only diuretic that I use is indapamide. He does not use Hydrochlorothiazide anymore since it does nothing to reduce cardiovascular events and you run the risk of type II diabetes and of kidney disease. It also causes homocysteine to go up and potassium to go down. Also if you put hydrochlorothiazide with what we would call a good medication like an ACE inhibitor or a ARB, it counterbalances the good effect of the other drug. If the patient has the CYP11B2 gene that responds to aldosterone over-synthesis, this can only be blocked with a serum aldosterone receptor antagonists like spironolactone, KERENDIA or eplerenone. But spironolactone can cause gynecomastia, so it is usually used only in women.
31:00 Niacin. Dr. Stanley Hazen, the doctor and researcher from Cleveland Clinic who developed the theory about TMAO as being a risk factor for cardiovascular disease, has published a paper claiming that consuming additional niacin from fortification or supplementation is potentially damaging for your heart. This paper was published in Nature, which is a very respected journal: Ferrell, M., Wang, Z., Anderson, J.T. et al. A terminal metabolite of niacin promotes vascular inflammation and contributes to cardiovascular disease risk. Nat Med 30, 424–434 (2024). This paper looked at metabolites of niacin (2PY and 4PY) that were considered to be toxic, but in order for these to get formed, you have to have a certain genetic SNP, which is not very common. And patients need to take high dose niacin, such as 1,500 to 2,000 mg per day, to have elevated levels of 2PY and 4PY. Then Hazen and the other researchers quoted some bad clinical studies that were previously refuted by the following article that Dr. Houston wrote with Dr. Pizzorno in 2014: “Niacin Doesn’t Work and Is Harmful!” Proclaim the Headlines. Yet Another Highly Publicized Questionable Study to Discredit Integrative Medicine. Here is Dr. Houston’s message for the readers: “Don’t listen to the news media reporting on medicine, because they never get it right. If you’re going to say, “I don’t want to use niacin and I don’t believe in niacin,” and get all upset about it, go read the study. Read the study, read the methods, and decide for yourself, “Oh, that’s totally flawed. I’m not believing that.” And move on.”
Dr. Mark Houston is the director of the Hypertension Institute in Nashville, Tennessee and he is the go to expert on cardiovascular disease in the Functional Medicine world. Dr. Houston is tripled board certified in hypertension as an American Society of Hypertension (ASH) specialist and Fellow of the American Society of Hypertension (FASH), Internal Medicine (ABIM) and Anti-aging medicine (ABAARM). He also has a Masters degree in Human Nutrition from the University of Bridgeport, Connecticut and a Masters of Science degree in Functional and Metabolic Medicine from the University of South Florida in Tampa. Dr. Houston teaches doctors around the world about cardiovascular medicine as part of the A4M programs. Dr. Houston is also a very prolific author, having written many books, the latest two being Precision and Personalized Integrative Cardiovascular Medicine and Controlling High Blood Pressure through Nutrition, Nutritional Supplements, Lifestyle, and Drugs. Dr. Houston’s web site is HypertensionInstitute.com.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.
Hello, Rational Wellness podcasters. Today our topic is an integrative approach to hypertension with Dr. Mark Houston. From today’s discussion, I hope to gain a better understanding of what causes hypertension, why it’s so important to treat it properly, how to test for it, and the pluses and minuses of the various treatment options with a focus on diet, lifestyle, and nutritional supplements.
Hypertension means that you have high blood pressure, and as Dr. Houston points out in his latest book, this does not mean that you are overly tense. High blood pressure means that your blood pressure is more than 120 over 80. According to the CDC in 2021, hypertension was a primary or contributing cause to 691,000 deaths in the US, and nearly half of adults are defined as having hypertension, 48.1%. And apparently in 2021, they’re defining hypertension as blood pressure greater than 130 over 80 or taking medication for hypertension.
Dr. Mark Houston’s the director of the Hypertension Institute in Nashville, Tennessee, and he’s the go-to expert on cardiovascular disease in the functional medicine world. Dr. Houston is triple board certified in hypertension, and as an American Society of Hypertension specialist and Fellow of the American Society of Hypertension, Internal Medicine, and Anti-aging Medicine. He also has a master’s degree in human nutrition as well as a master’s of science degree in functional and metabolic medicine. Dr. Houston teaches doctors around the world about cardiovascular medicine as part of the A4M program. Dr. Houston is also a very prolific author, having written many papers and books, the latest two being Precision and Personalized Integrative Cardiovascular Medicine, and Controlling High Blood Pressure through Nutrition, Nutritional Supplements, Lifestyle and Drugs. Dr. Houston, thank you so much for joining us.
Dr. Houston: Thank you, Ben, and thank you for the kind introduction. It’s good to be with you again.
Dr. Weitz: Yeah, by the way, this book is great.
Dr. Houston: Thank you.
Dr. Weitz: It’s really incredible. It’s got everything a clinician would want to understand hypertension better. So, help us understand-
Dr. Houston: That was one year out of my life writing that.
Dr. Weitz: I bet it was, and I thank you for that. So, tell us what is hypertension and what causes it?
Dr. Houston: Hypertension has really not been well-defined in the past by most of the hypertension world. So, the book was designed to allow people to understand what really causes high blood pressure. Everybody thinks, “Oh, it is my genes. That’s what causes high blood pressure.” Well, yeah, there’s clearly genetic reasons for high blood pressure, but there’s a lot of environmental influences that contribute to those genetic expressions of high blood pressure. So, if you break down into three simple things, three finite vascular responses cause high blood pressure. Inflammation of the arteries, oxidative stress in the arteries, and immune dysfunction in the arteries. And those lead to endothelial dysfunction, glycocalyx dysfunction, vascular and cardiac smooth muscle dysfunction, the arteries become very stiff, non-elastic and therefore, the amount of flow going through an artery is going to increase the pressure by simple physical principles of stiffness with increased blood flow. So, that’s the basic physiology of hypertension. And then if you start looking at genetics and we measure all that in the Hypertension Institute, we can determine what gene may be causing the hypertension and how to treat it with either a drug or nutrition or a supplement.
Dr. Weitz: Okay. Well, let’s make sure we get into that in a few minutes. So, currently, hypertension is blood pressure higher than 120 over 80. Is 120 over 80 ideal? For example, is 110 over 70 better?
Dr. Houston: There are several large cohort studies that have said the risk actually starts at 110 over 70.
Dr. Weitz: Oh, okay.
Dr. Houston: But no committee’s going to recommend that because no one can achieve 120 over 80. So, they’re not going to say [inaudible 00:05:32] 110 over 70, but you’re pretty good at 120 over 80. The risk doesn’t increase dramatically. But the thing I think everyone needs to know is there’s an incremental increase in risk for every one millimeter of systolic and diastolic. So, if you’re 121 over 81, you’re increased risk over the 120 over 80, and it goes up proportional to that. So, to set some arbitrary level, let’s say it’s 130 over 90, misses the whole point of, well, there’s a people between 120 over 80 and 130 over 90. You have incremental increase in risk.
Dr. Weitz: And that was kind of the rule for a number of years was, yeah, it’s okay if it’s up till 130 over 90, you don’t really need to treat it until then, right?
Dr. Houston: Yeah. It turns out that is not the case.
Dr. Weitz: Right. Now, a lot of patients have elevated blood pressure and let it go because they don’t feel bad and they don’t really want to take medication, and I think they don’t realize how dangerous it is. So, why is elevated blood pressure so damaging?
Dr. Houston: Well, it’s going to damage every organ that requires a blood vessel going to it, which is everything in your body.
Dr. Weitz: Right.
Dr. Houston: The big ones are ischemic stroke, myocardial infarction, congestive heart failure, kidney disease, aortic aneurysms, and that’s usually the organ damage that is manifest under the cardiovascular consequences of hypertension.
Dr. Weitz: Now, what’s the proper way to measure blood pressure? My experience is you go to the doctor, maybe you’re standing in the hallway or you’re sitting, your arm’s down. They measure your blood pressure once in one arm, but that’s ideally not the best way to do it, correct?
Dr. Houston: No. No. 99% of the time you go into a office, the nurse and/or the doctor don’t do blood pressure measurements correctly. I’ve seen it. I know it happens. So, let me tell you how you should do it. You tell your patients when they’re coming in for their visit, not to smoke, not to drink coffee and not to drink alcohol or take any other things that could raise their blood pressure. They come in hopefully having a good night’s sleep as well, and they have to sit in a chair with their feet on the ground and they’re back supported, and they rest for five minutes. And then you check their pressure with a cuff, with their arm extended right at the level of the heart, and supported. You do both arms and you do the leg pressures. You do a sitting, standing and lying blood pressure and a leg pressure on the first visit. That’s routine. After that-
Dr. Weitz: I don’t think I’ve ever been to a doctor or hospital anywhere that-
Dr. Houston: No. You won’t get that unless you go to a hypertension specialist probably. But on the subsequent visits, assuming all those were okay, you can do just one arm blood pressure in the proper position with the arm extended. And you got to teach people how to do it if they do home blood pressures because most people don’t do it right.
Dr. Weitz: And then ultimately, a 24-hour blood pressure is probably the most beneficial, right? Most significant.
Dr. Houston: Yeah. Once you’ve identified an office reading that’s high, you confirm that with a 24-hour ABM because you not only get the average pressure, but you also get other things that are important, like what’s the dipping pattern? What’s the nocturnal blood pressure? Are there morning surges? So, all of these things factor into risk, but also when and what medicines to treat them with.
Dr. Weitz: What’s the ideal way to do the 24-hour blood pressure? Do you have a specific product that you like to use?
Dr. Houston: We have several that we’ve used. The one we use mostly is either Spacelabs or Hewlett-Packard.
Dr. Weitz: Okay. Now, I read in your book I was surprised to read about white coat hypertension. So, what that means is you go to the doctor’s office, your blood pressure’s elevated, you go home, it’s not. And I think the thought among most people is, “Well, that’s no big deal. I was just stressed out, so I don’t have to worry about it.” But they really do need to worry about it. Correct?
Dr. Houston: That is correct. Used to we just blew off white coat hypertension as nothing but stress in the doctor’s office. Turns out clinical studies, and there’s many of them now having done thousands of patients, show that white coat hypertension has a risk that is in between being totally normal and having sustained high blood pressure. So, you are at risk and you probably need to be treated for white coat hypertension, because if you do that in the office and you get stressed out coming in there, you’re probably increasing your pressure all day every time you get under stress.
Dr. Weitz: Right. So, let’s get into, well, you mentioned genetic factors. So, you like to do genetic testing. How does the genetic testing help you to manage patients?
Dr. Houston: We developed a gene test with Vibrant labs in San Francisco that has 25 SNPs, including high blood pressure genes, dyslipidemia, coronary heart disease, and diabetes genes. And what has really helped us is when we get those hypertension genes back, you know exactly what’s driving the high blood pressure genetically and specifically what drugs you can use. And you don’t have to guess. Rather than saying, “Well, let’s just try this drug or try that drug.” You know exactly which drug is going to work the best.
Dr. Weitz: One thing you mentioned in your book was stratifying hypertension into these two different types, and you do this by measuring plasma renin and aldosterone. And I’d never heard of a doctor doing that. It sounds like that’s something that could be really beneficial, but I don’t think that’s being done by hardly anybody today.
Dr. Houston: You’re probably right. We’re one of the few institutes that actually does it, but also we’ve studied how much help it is in selecting therapy. So, it’s easy to do. You have the patients come in, they don’t have to reduce their salt intake or drink a lot of fluid. It’s just random. You get a plasma renin activity, it’s called a PRA, and a simultaneous serum aldosterone level. And they can’t be on medication, obviously, when they do this because that messes up the numbers. And then whatever those numbers are tells you the type of hypertension that they have physiologically, not genetically, but physiologically, and it tells you what drug classes are most important. So, the two classes are high renin and low renin. So, the plasma renin activity over 0.65 is high renin hypertension. If it’s below 0.65, it’s low renin hypertension. Now, the reason you do an aldosterone level with it is sometimes the PRA will come back right on the borderline and you can’t really tell which one it is. And then you do a ratio called the aldo-renin ratio, ARR, and that ratio will nail it like 99% of the time, and you know exactly what to do. So, if it’s, for example, high renin hypertension your best drugs are ACE inhibitors, ARBs, and direct renin inhibitors, but if it’s low renin hypertension, it’s a diuretic and a CCB or calcium channel blocker.
Dr. Weitz: Okay. Cool. Let’s get into diet and lifestyle. What are some of the most important lifestyle factors that can help to lower hypertension?
Dr. Houston: There’s three that are the most important. Well, actually four. Low sodium, below 1.5 grams per day. High potassium, at least five grams per day. High magnesium, like 1,000 milligrams a day, and at least 12 servings of fruits and vegetables per day. If you do those right there, that will drop your blood pressure typically about 12 to 15 on the top and 6 to 8 on the bottom.
Dr. Weitz: Now, the sodium thing is controversial. It’s gone back and forth in terms of how important it is. A lot of doctors say, “Well, only a percentage of patients are sodium sensitive.” How many patients do you think respond to reducing sodium?
Dr. Houston: So, what you just said that these doctors are saying that sodium is not important if you’re quote, “salt sensitive” is another major myth that we need to presently dispel ever-
Dr. Weitz: Okay.
Dr. Houston: … in the mind of your listeners. Sodium is toxic in any form.
Dr. Weitz: Okay.
Dr. Houston: Once you get over 1.5 grams per day, it’s not all about blood pressure. Your blood pressure may or may not be salt sensitive, but it gets into your arteries and it makes them stiff. And when you get that, then it leads to stroke, heart attack, heart failure, and kidney failure, proteinuria in the kidney. All those are related to sodium intake. It also reduces nitric oxide levels, which makes your vessels even stiffer. So, sodium is important. It is toxic, and the more you eat, the worse you will be, whether your blood pressure goes up or not. Now, you balance the sodium problems with potassium and magnesium.
Dr. Weitz: Right. And what type of dietary approach is best for controlling hypertension?
Dr. Houston: So, in my book that you just showed there, we use what’s called the HIP diet, H-I-P. It was a cute name for Hypertension Institute Program. And what it is, it’s a modified DASH 2 diet with a little Mediterranean flavor thrown in, with the qualifications of sodium, potassium, magnesium, the fruits and vegetables, high quality protein, and getting rid of refined carbohydrates. And if you do that and follow the HIP program, we’ve got recipes in the book, two chapters on nutrition. You can pretty well get that program going easily.
Dr. Weitz: What role do toxins play in hypertension?
Dr. Houston: Huge. Toxins drive, not just hypertension, but also coronary heart disease and heart attack. So, you got to measure the big ones, arsenic, lead, mercury, and then pesticides and organicides. And if those are elevated, you do your best to get rid of them.
Dr. Weitz: Okay. What about micronutrients?
Dr. Houston: So, micronutrient deficiencies can drive hypertension and coronary heart disease, arterial stiffness, all kinds of problems including endothelial and glycocalyx dysfunction. We use micronutrient testing from Vibrant labs out of San Francisco, which is the same company that we do the genetic testing. I like it because it measures both intracellular and extracellular micronutrients.
Dr. Weitz: Right. Correct. Yeah, I love that test. What about the importance of exercise?
Dr. Houston: Very important. You need to do a combined aerobic and resistance training program for one hour a day, six days a week. When you do that program, the exercise reduces inflammation, it improves arterial elasticity, it raises nitric oxide, reduces stroke and heart attack risk. And typically once you’re training, the blood pressure will drop about 12 over 6 once you’re in good condition.
Dr. Weitz: Now, a lot of the way to understand blood pressure has to do with the arterial walls and the lining of the arteries, the endothelium. How do we address that? And maybe you can talk about the importance of the endothelial lining and the glycocalyx of the arteries.
Dr. Houston: Right. So, endothelial dysfunction and glycocalyx dysfunction occur decades before you get hypertension. I’m talking sometimes two or three decades. So, being able to identify those with noninvasive vascular testing is very important. So, the glycocalyx is outside the endothelium, so it’s the one that gets hit first. Once it’s damaged then the endothelium gets damaged. And once it’s damaged, then the vascular smooth muscle wall gets damaged. So, think of it this way, the first thing that happens is functional changes in the endothelium, the glycocalyx, that reduce nitric oxide and cause the three finite responses of inflammation, oxidative stress and vascular immune dysfunction, and then those feed into stiffness of the arteries.
Now you’ve got structural changes. The artery wall not only is stiff, but it starts to get thickened and the lumen gets narrowed, and then you have what’s called a narrow medial lumen ratio. And what’s happening there in essence is the artery is trying to protect the organ from damage by constricting to reduce that pressure that’s going into the organ. But when that happens, the long-term effect is you reduce blood flow and oxygen through the artery to the organ, and now you get ischemia. Well, if it’s a brain, it’s a stroke. If it’s your heart, it’s angina or heart attack.
So, what you want to do is back up and start treating everything at the beginning so you don’t get to those bad things later. So, for the glycocalyx, you use a glycocalyx promoter, and there’s only one out there that I think is really powerful and proven in clinical trials. And that’s Arterosil, which is made by Calroy Labs.
Dr. Weitz: I think the guy who developed that for Calroy went on his own now and developed a newer product. Do you know about that one?
Dr. Houston: I have looked at all the products that are glycocalyx promoters, okay?
Dr. Weitz: Okay.
Dr. Houston: And I’ve looked at the science. And I will tell you that I don’t know the political history about who did what with where. I just know that the Arterosil by Calroy is superior to any other on the market by a landslide. So, that’s the only one I’d recommend. It’s two capsules a day, one in the morning, one at night. Then you add to that a nitric oxide promoter, and once again, Calroy has the best one on the market, it’s called Vascanox. It’s five times more potent than any other nitric oxide on the market.
Dr. Weitz: Now, you used to recommend the Neo40, correct?
Dr. Houston: Yeah, Neo40 was a great product, the problem is it’s very short-lived, it only lasts about six hours, whereas Vascanox lasts for 24 hours and it stays above the magical threshold for arterial elasticity, which is around 200.
Dr. Weitz: What does it have in it that allows it to do that?
Dr. Houston: The Vascanox?
Dr. Weitz: Yeah.
Dr. Houston: Well, it has a lot of things in it that are nitrate, nitrite-like, but it also has hydrogen sulfide, which is a PDE5 inhibitor. So, you get a bidirectional hit that really jacks up the nitric oxide levels.
Dr. Weitz: Interesting.
Dr. Houston: So, if you use those two together, you can really improve glycocalyx endothelial function. And then interestingly, both of them together also improve the arterial function. The actual artery wall and the elasticity over time gets better, relaxes, and now the pressure actually starts to fall with those two products independent of a medication.
Dr. Weitz: Are there any lab tests that indicate that early endothelial glycocalyx dysfunction?
Dr. Houston: Yeah, there’s a couple. If you want to do blood tests, it’s asymmetric dimethylarginine, ADMA. You can get that from Cleveland Heart, which is part of Quest. You can also do the strips, you know, that go under your tongue?
Dr. Weitz: Okay.
Dr. Houston: Those strips are really good to see if your levels are high. And then of course, we have two machines that measure endothelial dysfunction. One of them is called EndoPAT, and the other one’s called computerized arterial pulse wave analysis. Both of those will measure endothelial dysfunction. And the pulse wave analysis gives you that and arterial stiffness in one test.
Dr. Weitz: Cool. What about any of the other lab tests like myeloperoxidase, or any of the other tests that are trying to pick up inflammation in the arteries?
Dr. Houston: Yeah, you should do a panel that looks at all those finite responses like with inflammation, C-reactive protein.
Dr. Weitz: Sure.
Dr. Houston: Interleukins, TNF alpha, oxidative stress molecules. You got a whole bunch of blood and urine tests for that. Myeloperoxidase is a great one for looking at oxidative stress, for example.
Dr. Weitz: Okay. So, you mentioned a couple of nutrients, potassium, magnesium. What other nutritional supplements help move the needle for patients with hypertension?
Dr. Houston: Well, the most important and most powerful is the nitric oxide and glycocalyx. They outweigh anything else you can do.
Dr. Weitz: Okay.
Dr. Houston: Then you’ve got a bunch of other things that have looked at clinically. You’ve got co-enzyme Q10, Kyolic garlic, alpha-lipoic acid, magnesium chelates.
Dr. Weitz: Taurine.
Dr. Houston: Taurine. Yeah. There’s about probably 15 really good nutrients that have been clinically studied that help to lower blood pressure.
Dr. Weitz: How do you decide which ones to recommend? How many do you recommend at a time?
Dr. Houston: Well, I measure what’s missing. So-
Dr. Weitz: So, you’re doing a micronutrient test.
Dr. Houston: Micronutrient test to see what’s missing and-
Dr. Weitz: So, start there. Yeah.
Dr. Houston: … then you replace those. Now, if it’s all normal, then you go by what’s got the best bang for the buck and replace those first based on the clinical studies.
Dr. Weitz: So, if you were going to put somebody … Let’s say the micronutrient test is normal and you want to put them on let’s say, four or five supplements, what would be the biggest bang for your buck?
Dr. Houston: All right. So, I definitely would do Vascanox and Arterosil in combination.
Dr. Weitz: Okay.
Dr. Houston: Then I’d probably add magnesium chelates, then co-enzyme Q10, and taurine. Now, there’s a really great product that I developed with Biotics. It’s called CardioSirt BP, and we’ve done a clinical trial with it. It’s a powder and it’s got a lot of taurine in it along with magnesium. So, you can get a lot of that just by doing the CardioSirt BP. It’s really good. It’s one scoop a day in water, and we got pressure reductions of like 12 over 6 with that one.
Dr. Weitz: And you got to go a fairly high dosage of taurine, right? What kind of dosage?
Dr. Houston: So, in that one we have six grams a day.
Dr. Weitz: Okay. And is that typically about the amount you’re going to recommend more or less?
Dr. Houston: Yeah. The peak effect of taurine on blood pressure is six grams.
Dr. Weitz: Okay. Cool. And you also list in your book certain supplements that when taken with hypertensive medications enhance the effectiveness of the medications.
Dr. Houston: So, there’s synergy or at least additive effects with a lot of the nutrients in the drugs. For example, I’ll give you a couple, R-lipoic acid with an ACE inhibitor. Very, very good together. Magnesium with a calcium channel blocker. So, you can look at the nutrient, sometimes add that if your blood pressure is not controlled just with the medication, without having to do a second medication. But the key is to make sure whatever you’re doing gets the pressure down normal and pretty quick.
Dr. Weitz: So, when it comes to medications, you mentioned that you no longer use most of the diuretics. Which medications do you typically find to be the most effective?
Dr. Houston: So, after we do our genetic testing and our plasma renin and aldosterone, the top classes of drugs are ACE inhibitors, angiotensin receptor blockers, one or two of the calcium blockers like amlodipine or nifedipine. And then the best beta blockers are nebivolol, which is Bystolic, or Coreg, which is carvedilol. The only diuretic that I use is indapamide. And indapamide is the best. Hydrochlorothiazide, no, don’t use that one anymore. [inaudible 00:28:23].
Dr. Weitz: I still see a lot of patients on that.
Dr. Houston: Yeah, it’s one of those things that’s gotten ingrained in the medical pharmaceutical industry and once it gets in the pill, they can’t seem to get it out and people keep prescribing. But there’s data that HCTZ absolutely does nothing to reduce your cardiovascular events. And here’s the really bad thing about it. If you give HCTZ by itself, you run a risk of type 2 diabetes and kidney disease that gets worse and worse by the year. Not to mention homocysteine going up, potassium going down, and other things. But if you put hydrochlorothiazide with what we would call a good medication like an ACE inhibitor or a ARB, it counterbalances the good effect of the other drug.
Dr. Weitz: Oh, wow.
Dr. Houston: So, you get something that’s halfway there. Not good.
Dr. Weitz: Another drug I see a lot of patients on is spironolactone.
Dr. Houston: Yes. Spironolactone, eplerenone, and KERENDIA are all serum aldosterone receptor antagonists or SARAs, and they are all very effective in most people with blood pressure. But particularly when you do the genetic testing, there’s a couple of genes that respond only to that class of drugs. CYP11B2, for example, is the gene that responds to aldosterone over-synthesis. And the only way you can block it is with spironolactone, KERENDIA or eplerenone.
Dr. Weitz: Yeah. I don’t know any doctors other than one or two, like yourself, who are doing those genetic tests.
Dr. Houston: Yeah. We need to get people doing genetic testing because that’s the only way you can personalize and do precision medicine in cardiovascular disease, particularly high blood pressure.
Dr. Weitz: Right. It seems like that spironolactone is the preferred drug for women, for some reason.
Dr. Houston: Yeah, well, there’s a good reason for that. Spironolactone causes gynecomastia.
Dr. Weitz: Oh, okay.
Dr. Houston: So, men don’t like it, but women like it. Right?
Dr. Weitz: Great. I think those are the main things that I wanted to discuss. I think we covered a lot in a short period of time.
Dr. Houston: Yeah, you got those questions lined up and banged them out. There must be a pretty smart guy back there.
Dr. Weitz: I’m thinking maybe we should try that controversial topic I asked you about before we started. There is a new controversy in cardiovascular medicine that’s hit the news. Apparently, Dr. Stanley Hazen, who’s the guy who developed the theory about TMAO as being a risk factor for cardiovascular disease, has started a controversy and people are now nervous about taking niacin because of this paper that he published.
Dr. Houston: Well, let me comment on the paper. I have read the paper ad nauseum. It’s published in Nature. Nature’s a pretty good journal.
Dr. Weitz: Very respected journal. Yeah.
Dr. Houston: Very good journal. It’s not a real clinical journal, it’s more of a research journal. So, let’s say that upfront. So, they take studies that are considered pretty high science and otherwise they don’t get published. So, having said that, I don’t have any issues with Nature. I don’t have any issues with the fact that the study is in Nature and the study says what it says. Now, then you get to what does the study really say and how did people take it out of context to blow niacin off the map again, very inappropriately? So, without getting too detailed, I’ll give you the big picture. The study was designed to look at some metabolites of niacin, and those metabolites were not considered very nice metabolites. They were thought to be toxic metabolites of niacin and you don’t want them. But in order to get those metabolites, you had to have a certain genetic SNP. So, how many people have that genetic SNP? Well, I don’t know, but it can’t be very common. And so, if you don’t have the SNP, you probably don’t get those metabolites. So, it’s not a universal issue by any means. It’s probably a very small part of the population.
The second piece was it was high-dose niacin. We’re talking 1,500, 2,000 milligrams a day. Well, we don’t do that anymore. I mean, I haven’t prescribed that much in a decade. If I give niacin, it’s like 250 twice a day. You’re not going to get in trouble at that dose with metabolites because it’s low-dose niacin and you may not even have the SNP. So, the study was taken totally out of context by a lot of people, not so much Dr. Hazen, but other people said, “Oh my God, look, it’s going to cause you to die from coronary heart disease and you can’t use niacin anymore. It’s terrible.” And they start quoting clinical studies that are bad studies. So, they’re taking a study out of context and then tying it to a previously bad study to prove the point, which makes it even worse.
Dr. Weitz: Right.
Dr. Houston: And we’ve already gone through that controversy seven or eight years ago, and that was all taken out of context as well. So, there’s a lot of things niacin does. It’s good. I mean, all the clinical trials with niacin using correct doses showed improvements in HDL, triglycerides, LDL, LDL particle number, coronary heart disease risk, MI risk. But you got to know what you’re doing and you got to know when to use it and what to combine it with. So, my message, after having said all that is, niacin is alive and well. You don’t need to stop niacin. You need to use low doses of niacin and know what you’re doing. And the only people that might get into trouble, and it’s probably not big, is if you gave high doses of niacin to those people with that genetic SNP, but not in the general population. Niacin is one of a few things that actually improves HDL dysfunction. [inaudible 00:35:08].
Dr. Weitz: And also lowers lipoprotein A.
Dr. Houston: Yeah, LP little a. So, it’s got a lot of good uses, so you don’t want to throw it out just because of one little study that wasn’t designed to even answer the question that people are all upset about now.
Dr. Weitz: It’s funny how this simple vitamin, which you and I and a bunch of other especially integrative doctors have been using for years with all sorts of benefits, is getting attacked again, and I don’t quite know why, but…
Dr. Houston: I can’t begin to understand why they keep picking on niacin. I mean, it’s a nutrient. It’s vitamin B3. It’s pretty benign. It’s in our food for goodness gracious. I just think we need to back off a little bit. Here’s my message for your readers. Don’t listen to the news media reporting on medicine, because they never get it right. If you’re going to say, “I don’t want to use niacin and I don’t believe in niacin,” and get all upset about it, go read the study. Read the study, read the methods, and decide for yourself, “Oh, that’s totally flawed. I’m not believing that.” And move on.
Dr. Weitz: Right. Thank you, Dr. Houston.
Dr. Houston: Okay.
Dr. Weitz: How can our listeners and viewers find out about your books and more about you if they want to work with you?
Dr. Houston: So, you can go to the Hypertension Institute website. We got all kinds of information there you can download for free, and you can also make appointments to see us as a cardiovascular consult. The books are all on Amazon, so they’re easy to find. You just put in my name and it’ll pull up all the books that we’ve-
Dr. Weitz: How many books do you have? It’s a lot.
Dr. Houston: I think I’m up to 10 now.
Dr. Weitz: Okay.
Dr. Houston: Yeah.
Dr. Weitz: Thank you so much, Dr. Houston.
Dr. Houston: Thank you, Ben. I appreciate being on your show.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, autoimmune diseases, cardio-metabolic conditions, or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395 3111, and we’ll set you up for a new consultation for functional medicine. And I look forward to speaking to everybody next week.
