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A Client's Easy Solution to High Blood Pressure - Health Coaching Behind the Scenes · Doctor Turned Health Coach

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  Welcome to the doctor-turned-health-coach podcast.
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  My name is Dr. Ashori. I'm a board-certified family medicine physician with
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  my online health coaching practice and my private primary care practice here
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  in California. Everything's online.
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  And today I wanted to bring you guys, kind of take you behind the scenes of
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  a health coaching client.
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  There are many success stories, there are many stories that are still in the
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  making with my health coaching clients, but this one stood out to me.
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  And it's come up a couple of times in other versions, so I thought I would share this with you.
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  I'm going to change things around just a little bit so that I don't divulge
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  any private information.
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  So this gentleman came to me, very active, quite busy, online digital nomad like myself.
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  He's a traveler, goes all over the world, and his practice is online.
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  His business is online in the technology space. So he has tons of meetings,
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  tons of consultations, tons of different things that he has to do on a regular basis.
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  So there's a bit of stress, but never has he dealt with blood pressure,
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  with major blood pressure issues in the past.
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  So, at 40, oftentimes in Western medicine, we say, okay, well,
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  if you develop blood pressure problems, it's probably a little bit of what we
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  call essential hypertension.
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  And this is a condition where your blood pressure just naturally goes up as
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  the vessels stiffen, or at least that's the theory.
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  Of course, the way we treat this is with blood pressure medications so that
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  we can lower your risk of major cardiovascular events like atrial fibrillation,
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  heart attack, stroke, heart failure, kidney disease, you name it.
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  All of these things are affected by high blood pressure.
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  Of course, the definition of high blood pressure now is becoming a bit contentious.
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  The most recent JNC-8 has recommended that it should be in the 120 over 80 range or lower.
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  And some people, some health gurus will say, no, it should be 90 over 60 and
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  lower. Okay, well, we'll leave that aside for now.
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  But this gentleman suddenly started seeing blood pressures in the 170-some, over 111.
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  So, during this time, he was staying with some friends in another state,
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  and he was about to actually leave for another country.
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  He was going to be there for a few months before leaving for another country.
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  Now, during his stay with his friends, I asked him, you know,
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  what things were different, and we tried to identify a few things.
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  Nothing really stood out. He was always pretty active. He cooked a lot of his
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  own meals, but he ate out as well. But he would make good choices.
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  Never had any weight issues. His weight didn't change. His exercise regimen didn't change.
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  His stress level didn't change. He would still work during the day while his friends were out.
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  But when his friends came back, they would get together. They would have some
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  meals. They would have some chips.
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  They would have some alcohol, have some wine together.
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  And some things kind of stood out. we slowly kind of discovered that,
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  uh-oh, maybe he's having a little bit more wine and a little bit later at night.
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  Not a lot more, but a little bit more. Maybe it was the chips.
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  Maybe the food he was eating up was a little bit more rich.
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  So with that information, of course, you know, we did a bunch of other blood
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  tests to make sure nothing else was going on, but his blood pressure was persistent.
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  170 over 110.
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  183 over 115. He felt okay.
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  He even was open to try some blood pressure medications, but fortunately this
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  wasn't a long duration of blood pressure problem, so we tried a few other things.
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  Right before we were about to try one thing, he actually decided to go to this
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  new country sooner, because the job opportunity was there.
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  He wanted to get there, so he moved he moved to
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  this new country in europe for the next few months and
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  guess what as soon as he got there i had him buy a blood pressure cuff he was
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  using a blood pressure cuff by the way that was in his in this friend's house
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  that's why he even checked his blood pressure in the first place and the blood
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  pressure suddenly was 92 over 62 93 over 65.
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  90 over 53. He felt great. No problems, no issues. So what changed?
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  Was it jet lag? Was it that he was suddenly living a very different lifestyle
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  here in this new country? Well, as a matter of fact, it was.
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  It turned out that he would still have his glass of wine.
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  He sent me photos of the glass of wine. It was much smaller than the glasses
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  of wine he was consuming with his friends. And in fact, that's exactly what we were about to trial.
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  We were about to have him just cut back on the alcohol 50% and consume it a
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  little bit earlier in the day.
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  As soon as the friends come home from work, have your glass of wine,
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  chill, do the other stuff, continue, still have your chips, still have your
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  other food. Let's see what the blood pressure shows.
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  Long story short, it turned out that he was having just enough alcohol,
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  a little bit more than what his body mass index, his muscle mass, his liver could handle,
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  and so that alcohol wasn't cleared by the time he would go to bed,
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  and he was having it late enough that it was disrupting his sleep.
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  Both REM and deep sleep are affected by alcohol, caffeine, stress,
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  a lot of different things.
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  And in this situation, he wasn't getting the right amount of sleep.
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  Now, this is, he's not very much open to using sleep trackers and other devices.
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  And in my practice, I use them when they're absolutely necessary.
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  But as you can imagine, there's a lot of great tests that can do even better.
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  So we don't always use technology when it's not really going to give us more information.
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  But one of the best tests that we
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  could do is we move them out of that environment into a new environment.
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  He had rented an Airbnb or something.
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  I don't remember whether it was a hotel or Airbnb, but he was able to cook in
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  that space, so he was making his own meals, and he was having his glass of wine,
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  usually around 5 p.m. or 4 p.m.
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  And his blood pressure was fantastic. Now, he was just as active as before.
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  Of course, he was less car dependent because he was outside of the U.S.,
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  so he was biking everywhere in this new city. He was renting a bike or something like that.
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  And that's all it took. All it took for his blood pressure to change was the
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  decrease in alcohol intake.
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  Yes, I'm certain that the environment changed, the dietary change,
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  the activity level with the biking, that all contributed, but not going from 170 to 90. Unlikely.
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  And it goes to show you that sometimes when you start on a medication,
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  on a blood pressure medication, you do get a good result.
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  He would have had his blood pressure get much lower.
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  We were, in fact, talking about a thiazide diuretic, a common blood pressure
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  you guys might know, called hydrochlorothiazide.
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  And his blood pressure would have been better, but we would have never solved his actual problem.
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  And chances are his disrupted sleep would have but eventually caught up with
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  him while the blood pressure was being masked with a blood pressure medicine.
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  So I hope this is of value to you guys. Now, of course, the details of our coaching
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  and back and forth is more complicated. We had one hour sessions every week.
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  That's the way my coaching works. But we were exchanging a lot of text messages,
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  a lot of voice messages, photos he would send me, things I would send him,
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  articles I would send him, articles he would send me.
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  But in the end we figured it out and now
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  he's somebody who comes into my practice and goes he's
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  not always part of my practice he'll stay part of my practice for
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  a few months and then he's off in the wilderness and
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  then he comes back in but it's been a fantastic education point for me and for
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  him if you find this content useful please share it with somebody who might
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  benefit from this maybe you or a loved one are dealing with blood pressure issues
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  share this podcast episode with them,
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  go to my website, drashori.com.
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  The information is in the show descriptions, and thank you for listening.