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Integrative Co-Prescribing with Anti-Hypertensive Medications with Tracee Blythe · Wellness by Designs - Practitioner Podcast

• 0:12
  Speaker 1: This is Wellness by Designs, and I'm your host, amy Skilton, and joining us today is naturopath Tracey Blythe, and I'm very excited to be talking to her about co-prescribing with anti-hypertensive medications.
• 0:28
  Speaker 1: Co-prescribing with any pharmaceutical medication is a huge subject and she is absolutely the resident expert here on this.
• 0:36
  Speaker 1: But let me introduce her properly first.
• 0:40
  Speaker 1: Tracy is a naturopath of 19 years and has a goal for the community to have greater access to quality complementary medicines whilst receiving the best evidence-based advice from qualified practitioners.
• 0:54
  Speaker 1: Her career has been spent in health food stores and pharmacy, supporting patients with their health and educating and growing the practitioner supplement space in Western Australia, and more recently, in addition to all of that, tracey creates and delivers education to other practitioners Australia-wide.
• 1:14
  Speaker 1: Welcome to the podcast, tracey.
• 1:18
  Speaker 2: Thank you, Amy, and thank you for that wonderful introduction.
• 1:21
  Speaker 1: Oh, it's such a pleasure to have you here, and I will let everybody know upfront that we are very fortunate to have Tracy delivering a webinar for us in the not too distant future that actually covers the complementary medicine co-prescription framework, which you can use to support patients that are on blood pressure lowering medication and also reduce their risk of developing diabetes, and we're lucky, though, to have snagged her for a little pre-webinar chat where we're going to touch on some of those key points and why, if you are a practitioner working in this space of cardiovascular health or metabolic syndrome, that it's a must attend.
• 2:07
  Speaker 1: So, tracy, why don't we start with the challenges of high blood pressure, how prevalent it is and really what we're looking at as a society when it comes to, you know, things like diabetes and blood pressure and really the intersection where they meet for people?
• 2:28
  Speaker 2: Yeah, absolutely, amy.
• 2:29
  Speaker 2: It's an interesting topic, I think, because the prevalence is just that it's everywhere and most of the people that are experiencing it don't even know when we have high blood pressure.
• 2:41
  Speaker 2: We may not even feel it.
• 2:43
  Speaker 2: A lot of people's diagnosis comes on the end of sitting at the uh at the doctor's office and having their blood pressure measured and being told they have high blood pressure um, before that they're going about their business.
• 2:56
  Speaker 2: I think that it's something about a quarter of australians are currently um going around with uncontrolled hypertension as we speak.
• 3:06
  Speaker 2: So that's, on average, of patients walking into clinic, one in four of those may have hypertension and not even know it, and that this is a number that, whilst it's not rising, it's been the same for years, and it's something that has just not been addressed in terms of how do we help these people beyond giving them more and more and more medications.
• 3:34
  Speaker 1: It is really scary, when you put it like that, that a quarter of us are walking around without realising that there is this silent killer on board and I think, with the exception of really extreme hypertension, most people don't have symptoms, which is why, you know, sometimes people find out the hard way that it's been sitting in the background.
• 3:58
  Speaker 1: And I think that really highlights the importance of, you know, annual checkups, at a bare minimum, and making sure you request it to be done when you are seeing your doctor for annual blood tests.
• 4:10
  Speaker 1: And I think, furthermore, particularly since COVID but telehealth has been around for longer than that If you are, you know, as a clinician primarily working in telehealth, which is certainly the case for me I'm not able to take my client's blood pressure because they're not seeing me here in person.
• 4:29
  Speaker 1: So actually making sure that's on the intake form and there's regular you know diary reminders for assessing that, so that that important piece of information can be picked up, because that damage occurring in the background can create all kinds of other problems and for those that then like do have that picked up, as you said, it's often by accident, they might've arrived at the doctor for you know something else and the GP is like let's just check your blood pressure while you're here and then, whoie daisy, this is, you know, heading towards stroke territory immediately.
• 5:08
  Speaker 1: There is going to be a prescription written, and I understand this approach, by the way, and I think I'll just say up front that, regardless of what you do, we're all in agreement that addressing the root causes of high blood pressure and bringing your blood pressure down immediately are not mutually exclusive.
• 5:25
  Speaker 1: They both must be addressed, and what that means is medication initially may actually be the right step or it may be an alternative treatment, but regardless, what usually happens is people are confronted with a diagnosis of hypertension in the doctor's office and they're immediately given a prescription for you know, one or two medications, and I'd love to hear from you, like, really, what are you commonly seeing being prescribed at the moment?
• 5:54
  Speaker 1: There's a couple of different classes that get recommended, sometimes independently, sometimes together.
• 5:59
  Speaker 1: What's the landscape looking like at the moment?
• 6:03
  Speaker 2: Yeah, look, currently there are 37 different drugs that the doctor has to choose from in that situation.
• 6:11
  Speaker 2: Yeah, and they get grouped.
• 6:14
  Speaker 2: There's a few different ways, but essentially there's across five different drug classes.
• 6:18
  Speaker 2: You've got your ACE inhibitors, your angiotensin receptor blockers, your calcium channel blockers, your beta blockers, your angiotensin receptor blockers, your calcium channel blockers, your beta blockers, and then the good old favorites, the diuretics, which, for all of those, are actually groups within groups that are often prescribed.
• 6:33
  Speaker 2: And further to your comment, Amy, about when somebody has a diagnosis of hypertension and that the initial response being a prescription of medication, initial response being a prescription of medication, this is where and why I do what I do, as a naturopath who's passionate about everybody being informed and educated on these medicines and how complementary medicines intersect In the instance of somebody with uncontrolled very high blood pressure.
• 7:01
  Speaker 2: The interventions that I'll be talking in much more depth in the webinar but that we'll be discussing today, these interventions are eight week, 12 week, sometimes 24 week trials that are seeing, you know, some good benefits over that period of time.
• 7:16
  Speaker 2: We want responses quickly and that's why we need to know that what we can do is safe for our patients.
• 7:22
  Speaker 2: That we can.
• 7:23
  Speaker 2: A patient can come newly diagnosed with hypertension and, you know, one or, statistically, two drugs under their belt.
• 7:31
  Speaker 2: Come to see us that we can then safely intervene in a way that is an adjunct to their medicine, potentially with a long-term view of coming off that medicine, that to reduce their medicine load, potentially being able to come up with some of the complementary medicines we might be able to prescribe as well.
• 7:48
  Speaker 2: But it is an important first step is not to say throw those medicines out.
• 7:52
  Speaker 2: Let me give you some naturopathic support.
• 7:56
  Speaker 2: You don't need those medicines.
• 7:57
  Speaker 2: The statistics on serious cardiovascular events tell us that.
• 8:02
  Speaker 2: First, do no harm for our patients.
• 8:06
  Speaker 1: Absolutely.
• 8:07
  Speaker 1: Yeah, I think that's a really important point to make and, as you said, a swift response is, you know, paramount in those situations.
• 8:17
  Speaker 1: And then you can always look at a bit more of a medium long-term view, and I like that you mentioned there are a number of different long-term view, and I like that you mentioned there are a number of different, I guess, patient goals that can be set.
• 8:34
  Speaker 1: I know, for I'm generalizing here, but I imagine for a large majority of patients that see naturopaths, they would likely have a goal of I'd like to be able to manage this without medication, and for many people that is possible and for some it might not be.
• 8:47
  Speaker 1: It might simply be, you know, beyond beyond that scope and for some degree of pharmaceuticals might, might be necessary, but I liked how you put that you can also consider adjunctive treatment, which might allow you to manage your blood pressure with perhaps a lower dose, take a bit of pressure off the liver or the kidneys and therefore have better outcomes in that regard.
• 9:12
  Speaker 1: So not necessarily using one or the other, but a combined approach allows a lower dose overall.
• 9:18
  Speaker 1: One thing we haven't touched on yet, but we will, is the nutrient depletion, and I guess mitigating the side effects of medications might be another goal or outcome, and I think in a perfect world although this probably doesn't often happen, it's always nice to aim for.
• 9:38
  Speaker 1: Let's see if we can get you to not need anything, although I think in order to achieve that, it's a combination of many things, including very deep commitment on the patient's part.
• 9:50
  Speaker 1: Wouldn't you agree?
• 9:51
  Speaker 2: Yes, 100% and you do get those patients, those beautiful unicorns.
• 9:55
  Speaker 2: But we also get the full variety, the full spectrum of people where switching one pill for another is you know where there are less, less side effects.
• 10:10
  Speaker 2: And absolutely, when it comes to blood pressure medications, the statistics around being prescribed one and then shortly thereafter two, about being prescribed a third, even it's more than half, around half of the people that take a blood pressure medication actually take two or more.
• 10:27
  Speaker 2: That with that adjunctive therapies, we can ensure that we're being safe with our patients by using their medicine.
• 10:35
  Speaker 2: But, as you said, the less medicines we add, what we're able to do is absolutely the numbers tell us the lower dose or the less blood pressure medicine that you're taking, the less likely you are to develop significant or severe side effects.
• 10:52
  Speaker 2: And when it comes to nutrient depletions, that's a cause close to my heart.
• 10:55
  Speaker 2: I have to say, when I look at the evidence around depletions of nutrients from all sorts of different drugs, that the dose she makes the poison, that the higher the dose of the medicine, the more significant and severe the depletions are, and so keeping those doses lower also then reduces our need to be adding in a big laundry list of nutrients to just bring somebody back to an even keel, which is just good health for our patients.
• 11:24
  Speaker 2: It doesn't involve a long list of drugs, then a long list of supplements to ameliorate the side effects of those drugs.
• 11:32
  Speaker 1: And I think even across the board, not just in cardiovascular health that slippery slope of one medication inducing an issue that then requires another medication and another.
• 11:43
  Speaker 1: You know, we all see it.
• 11:45
  Speaker 1: You know friends, family, older patients, our own patients where you end up with a huge laundry list of medications that are all playing ring-a-ring-a-rosy with each other.
• 11:58
  Speaker 2: Yeah, and that's the.
• 11:59
  Speaker 2: I suppose that's the exciting part of this webinar that I can't wait to share with all the listeners, for Designs for Health is a particular start to that ring-a-rosy kind of thing that occurs with blood pressure medicines.
• 12:15
  Speaker 2: There's a couple of them where one of the side effects is a dysglycemia or poor response to insulin, insulin production which then leads to significantly increased rates of new onset diabetes.
• 12:30
  Speaker 2: And so there is what we know as the cardiometabolic triad, the statistics around patients who, once they develop hypertension, once they're diagnosed with high cholesterol or diabetes any of those three it's like the other two shortly follow, and medication for those two shortly follows that they are conditions that have common drivers, and so they're driven by some, you know, genetics or lifestyle or whatever that is driving those conditions.
• 13:05
  Speaker 2: But what can accelerate or exacerbate the triad of those three conditions forming?
• 13:13
  Speaker 2: For some things, it's the medicine itself, and so particularly the thiazide diuretics and the non-selective beta blockers particularly, have been found to have this impact of hastening or bringing on a diagnosis of diabetes, which is then, as you said earlier, that ring a rosy.
• 13:35
  Speaker 2: That that's what happens.
• 13:37
  Speaker 2: We go from one and maybe two blood pressure medicines and shortly thereafter, statistically it tells us that the incidence of development of diabetes just goes through the roof.
• 13:48
  Speaker 1: And what a shame to be confronted with a life-threatening issue in terms of high blood pressure and then the course of action that you take to address that then causes a second problem and then the dominoes fall from there.
• 14:04
  Speaker 1: And I think you know the area in which you provide the most amazing practitioner education is first of all the awareness around that.
• 14:12
  Speaker 1: You know.
• 14:13
  Speaker 1: Education is first of all the awareness around that.
• 14:17
  Speaker 1: You know um, if someone was fully informed, you know which, which is, I think, impossible to do in the current um landscape of allopathic medicine, um 15 minute consults, 10 minute consults you can't possibly talk someone through the benefits, risks.
• 14:29
  Speaker 1: You know the 37 different drugs, the classes within classes.
• 14:32
  Speaker 1: You just have to make a call as a doctor and be like, okay, let's just start here.
• 14:37
  Speaker 1: But I think, as a patient, if you knew that non-selective beta blockers and thiazide diuretics then set you up for dysglycemia and potentially diabetes down the track, would you make a different choice.
• 14:51
  Speaker 1: Or would you, if they were considered to be the best, then perhaps invest in a cgm continuous glucose monitor, or would you then begin to address some of the drivers, which of course is metabolic dysfunction and insulin issues?
• 15:07
  Speaker 1: Anyway, like it's very much, you know, um, you take the immediate emergency off the table but you create a bigger mess behind the scenes, without even originally addressing the original mess that created the high blood pressure in the first place.
• 15:24
  Speaker 1: But certainly in the space that you work in, this is something that you really understand very deeply and I know in the upcoming webinar you're going to talk about the nutrients that are depleted by medications and some of the other side effects or secondary unintended outcomes that can happen.
• 15:46
  Speaker 1: But when it comes to co-prescribing nutrients or herbs with pharmaceutical medications, this is certainly something that allopathic and naturopathic practitioners have to be very mindful of, because the intersection, maybe the amplification of you know the results changes with you know drug metabolism, for example.
• 16:09
  Speaker 1: There can be other unintended consequences.
• 16:13
  Speaker 1: So I'd love to ask you, just as a bit more of a broad and general question, like the evidence for co-prescribing nutrients and herbs to either mitigate side effects, replace nutrients, augment you know the, the intended outcome of the medication.
• 16:30
  Speaker 1: What does that look like in the scientific literature at the moment and also in clinical practice?
• 16:38
  Speaker 2: Yeah, look, when it comes to complementary medicines, whether it's herbal or nutritional medicine, we will first separate the two.
• 16:47
  Speaker 2: With herbal medicine, it's been around since before that herbal medicine was the original medicine, right?
• 16:53
  Speaker 2: It's been around since before Herbal medicine was the original medicine, right?
• 16:54
  Speaker 2: It's been around since before the scientific method was ever, ever etched onto a piece of paper to understand and follow, and so you know information being passed down and empirical knowledge, and so you know what we would now call clinical practice and experience is what has guided and defined herbs.
• 17:12
  Speaker 2: And so then, fitting retrofitting herbal medicine into the um, into a, into a framework of the scientific method and and clinical studies, it's kind of working uh from from, uh from the wrong end forward, kind of thing.
• 17:28
  Speaker 2: And so it means that the are we, are we at a gold standard of evidence for what, even just for safety, of what herbs are safe and what herbs are not, with every single drug that is released?
• 17:40
  Speaker 2: Absolutely not.
• 17:42
  Speaker 2: It would be great if there was a requirement for some of the key herbs that are just used widely when a new drug comes out, that they had to show safety, or they have to show safety with other things, so that we can understand.
• 17:51
  Speaker 2: Instead, what we have is an understanding on a scientific level of what for a lot of our herbs, what the active constituents, how they may up or down regulate things at the CYP450, and what impact that may have or what impact that herb has on kidney function and urinary excretion and output, and therefore, therefore, we can make extrapolative cautions unless we have known contraindications, and they usually come from case studies of experience.
• 18:22
  Speaker 2: Separate to that is, as I said, we need to separate nutritional research.
• 18:28
  Speaker 2: Nutrition is an emerging area of science.
• 18:31
  Speaker 2: We're still learning and discovering and uncovering a number of different aspects to all sorts of vitamins, minerals, other nutrients.
• 18:45
  Speaker 2: As things become available in Australia particularly then what we see is that research follows and also when it comes to clinical evidence when with a lot of drugs that's something I mentioned earlier about dosages, and so we see so for example, to know that there's a nutrient depletion with a drug.
• 19:05
  Speaker 2: One of the things I suggest any practitioner who goes on a pub med search on that is have a look at the dates on those studies.
• 19:13
  Speaker 2: Completely off topic, but the contraceptive pill, some of the studies in the 60s and 70s, which are what will show up on the top levels of Google if you're just Googling so your patients may see it these really significant nutrient depletions.
• 19:27
  Speaker 2: But we're seeing doses of the OCP being, you know, many multiples are stronger than what they are now, and so the more modern research shows that it's less.
• 19:37
  Speaker 2: I use that as an example to show that research continues to evolve and change over time and the evidence for these, and so when it comes to some drugs and we look at what nutrients are depleted by those drugs the list may not be exhaustive and it may change I did an upgrade to the full, comprehensive co-prescriber course.
• 19:59
  Speaker 2: That is a big, long process that I did an upgrade after two years because the file I keep in my computer of when there is new and different research that comes out, I pop that into the file to ensure that I can keep up to date with the information that I'm sharing with people.
• 20:16
  Speaker 2: And that file got so large I was like I need to redo the entire course because so much has changed.
• 20:21
  Speaker 2: Most of that changes in nutritional medicine.
• 20:23
  Speaker 2: Very few things have changed in herbal medicine because it's an emerging science that continues to emerge.
• 20:31
  Speaker 2: Yeah, that's so interesting.
• 20:35
  Speaker 1: And I think you make a really good point because, you know, with nutritional interventions I suppose to to define that a little more we of course have diet and we have macronutrient ratios and we have, you know, lots of different elements around a more um chunky approach to nutrition.
• 20:53
  Speaker 1: But then we also have the therapeutic and specific instrumentation of using nutrients as individual units or in combination for therapeutic value, and that is certainly I can see why that information would be rapidly shifting at times as it deepens and broadens.
• 21:14
  Speaker 1: And just to think that even in just a few short years you've had to update that whole course based on what's coming through is pretty eye-opening, because I think I speak for all clinicians and that is staying across and allopathic and naturopathic, staying across the evidence is like a whole other job.
• 21:36
  Speaker 1: It's a whole other job and so for the most part, we have to rely on the continuing education we choose to partake in each year to stay across what's happening.
• 21:49
  Speaker 1: But there's only so many hours in the day and when you're managing other elements, so now's probably a very good time to mention that, in addition to Tracy's webinar that she's going to be doing for Designs for Health on co-prescribing with antihypertensive medications, she actually has a full practitioner course on co-prescribing with insert common pharmaceutical medication.
• 22:15
  Speaker 1: Here and, for context, inside that course, the cardiovascular section is five hours alone.
• 22:25
  Speaker 1: It's five hours, so it's absolutely huge.
• 22:28
  Speaker 1: And I really think, allopathic and naturopathic clinicians, this is probably one of the most important areas we could be training in, because it's very uncommon to have someone come in who's not on a medication and so not knowing and understanding this or either that, or they've had a medication and they've unfortunately been impacted by unintended results from that medication nutrient depletion, just one example of how and why that would happen.
• 23:00
  Speaker 1: And understanding the mechanisms for which this happened allows us as clinicians, to identify far more quickly how do we repair this damage?
• 23:08
  Speaker 1: What does this person's body need in order to reestablish equilibrium and homeostasis?
• 23:14
  Speaker 1: So I'm so excited for this webinar.
• 23:17
  Speaker 1: It's just cardiovascular disease.
• 23:19
  Speaker 1: As you know, it's a leading cause of death in, you know, western world, industrialized countries, and you did mention that genetics are part of it, which, of course, we can't overlook, but so much of it is lifestyle diet, our modern you know, our modern day way of living.
• 23:40
  Speaker 2: And.
• 23:41
  Speaker 1: I guess my next question for you is knowing that, knowing that this is a not to simplify it and reduce it too much but that it's a lifestyle disease and acknowledging at the same time that hypertension needs to be immediately addressed.
• 24:01
  Speaker 1: We can't necessarily have someone spend six to 12 months fixing the underlying drivers while their blood vessels are being damaged and et cetera, et cetera.
• 24:11
  Speaker 1: But in terms of evidence for dietary interventions, lifestyle approach, therapeutic use of nutrients, medicinal herbs, you know we're not suggesting the goal should always be or would necessarily, you know, be successful every time to use them as an alternative.
• 24:30
  Speaker 1: But if we were to look at it from that standpoint, around using those things as alternatives, what is the, what is the evidence telling us at the moment on how successful that is?
• 24:43
  Speaker 2: yeah, look the evidence on what we look if we reduce and look at individual uh nutrients or individual interventions there there are studies that you know look at nutritional interventions of single food interventions and things that there are some surprising, you know.
• 25:01
  Speaker 2: I wouldn't say they're outliers at all, but have significant the evidence for the impact of using a therapeutic dose of garlic not so much garlic in the diet, but a therapeutic dose of your aged garlic has impacts on blood pressure that are considered to be similar to found in evidence to most blood pressure medicines.
• 25:24
  Speaker 2: So the outcome has been found to be similar that we wouldn't expect it to be a better dose, and that's often in clinical practice.
• 25:33
  Speaker 2: For myself that's uh, garlic is one of my first ports of call when we're looking to prevent the need for a dose increase or an additional medicine that rather we have.
• 25:43
  Speaker 2: Add the um the herb in as as the additional medicine instead, um, we then get the.
• 25:50
  Speaker 2: You know the benefits of of using garlic, that we have clinical evidence for all sorts of other benefits as well, including better blood sugar control as a nice neat little side effect.
• 26:02
  Speaker 2: Studies are done on that because the we talk about the lifestyle diseases of cardiovascular health that you know this the standard.
• 26:19
  Speaker 2: You know there's no safe level of alcohol, but the standard amount is, you know, no more than two standard drinks twice a week on non-consecutive days, though that kind of that number comes from a lot of research on on what then is going to pose a minimal risk to your cardiovascular health.
• 26:35
  Speaker 2: But how is that useful to your patient, who perhaps drinks a dozen cans a night and is coming to talk to you and you talk about?
• 26:43
  Speaker 2: Well, you can have three quarters of one beer twice a week.
• 26:47
  Speaker 2: Yes, that there's actually good evidence for relative reductions.
• 26:54
  Speaker 2: Reducing that, whatever the intake is when there's considered an excessive intake of alcohol, that reducing that intake by 50% and the amount that was standardised in the study was six standard drinks every night, and so it was reduced to three standard drinks every night, and again the outcome was once again similar to taking a blood pressure medicine, and that was with still taking what we consider to be a, on the evidence, separate to that, a high amount of alcohol.
• 27:25
  Speaker 2: But if it's a 50% reduction to the excessive use, it has a absolutely clinically significant outcome.
• 27:32
  Speaker 1: Wow, I mean, these examples you've just given us should stop people in their tracks to consider that the humble garlic clove obviously is a therapeutic medicinal form.
• 27:46
  Speaker 1: Not just eating more garlic, but just to think that that has a similar effect to hypotensive medications is jaw dropping.
• 27:55
  Speaker 1: And I think the lovely thing about the alcohol piece is you're right, certainly here in Australia.
• 28:01
  Speaker 1: I know we've got listeners all over the world, but in Australia alcohol is quite a big part of our culture, which of course, is very unfortunate from a health perspective and others.
• 28:14
  Speaker 1: But to be able to say that someone who was a big drinker, even just halving their intake, even though three standard drinks you know every night is still a lot is still having a similar result there to blood pressure medication, gives people a place to start and a strategy that will produce appreciable results.
• 28:38
  Speaker 1: It's not like you're getting a 5% improvement or a 10% improvement.
• 28:43
  Speaker 1: It's like, oh, it's not worth it.
• 28:44
  Speaker 1: I'd rather have my beer or my wine or whatever the case may be.
• 28:49
  Speaker 1: This is very measurable and significant.
• 28:53
  Speaker 1: Uh, and significant.
• 28:54
  Speaker 1: So I think, um, that is, and, and also those two things one supplement, one lifestyle change and those were individual statistics, by the way.
• 29:07
  Speaker 1: So using one or the other, and when we start to employ lifestyle strategies you know, several at a time, we're going to see just consecutive incremental shifts in that result in terms of blood pressure.
• 29:22
  Speaker 1: So obviously garlic is wearing the crown here as the hero, and you did say it's like an absolute go-to for you in clinic.
• 29:30
  Speaker 1: But I want to talk about a couple of the other heroes let's call them co-stars for garlic and the evidence behind those.
• 29:39
  Speaker 1: So where do we start?
• 29:41
  Speaker 1: Let's start with fish oil, because I just think that's a universal thing that pretty much everyone needs, unless they're eating deep sea cold water fish four or five times a week, which no one is.
• 29:49
  Speaker 1: So talk us through that, wouldn't that?
• 29:52
  Speaker 2: be ideal, uh, if we could, you know, all have, or locally sourced as well.
• 29:56
  Speaker 2: We don't want too many food miles, yes, um, but uh, the reality, the reality of life, is that that's not going to be what people are eating and the, you know, fish oil is.
• 30:08
  Speaker 2: It's something that when I have and have had conversations with many people from the allopathic side if we're going to call it sides of medicine, about complementary medicines, not having evidence, that's been a bugbear for me for the two decades of my clinical practice.
• 30:26
  Speaker 2: Because just because all evidence isn't gold standard which, by the way, the evidence for drugs isn't all gold standard either that it doesn't mean there is no evidence.
• 30:39
  Speaker 2: But my example always is what about fish oil?
• 30:40
  Speaker 2: The evidence for fish oil, the amount of Cochrane reviews that have been done, the studies that go into the tens to hundreds of thousands of participants, that go into the tens to multiple decades of years of interventions and show benefit, particularly for cardiovascular health.
• 30:55
  Speaker 2: We've got evidence for using fish oil for all sorts of conditions.
• 30:58
  Speaker 2: Anybody hears me talk about mental health stuff will hear a lot about fish oil from me as well.
• 31:02
  Speaker 2: But it's where we, when we look at, where the big body of evidence is.
• 31:07
  Speaker 2: It's in cardiovascular health and it's its benefits are found in in multiple ways, because it's working on underlying drivers that we're looking at Often.
• 31:18
  Speaker 2: We know that fish oil as the anti-inflammatory that it is, that reducing those inflammatory cascades, that what we're able to do is to mitigate the outcomes of an inflamed cardiovascular system.
• 31:31
  Speaker 2: Outcomes of an inflamed cardiovascular system allowing for more flexible vessels means that that, then, is what drops the blood pressure, but that also is what drops the risk of damage, the vascular damage and tissue damage.
• 31:45
  Speaker 2: That the benefits to improved viscosity and flow of the blood through those vessels that are now a little more relaxed.
• 31:55
  Speaker 2: That the junctions, that we're having smoother movement of the fluid through the junctions, so less accumulation, the risk of atherosclerosis go down.
• 32:04
  Speaker 2: That the benefits of using a fish oil, the important thing.
• 32:11
  Speaker 2: I go back to my days of helping patients, particularly older patients, in pharmacy and talking about fish oil, and you know oils ain't oils, that they're not all the same that we need to.
• 32:22
  Speaker 2: I'd always take the $10 fish oil out of their hand and say I'd rather you go spend some time with a friend, catch up with them for a coffee, spend that $10 and buy your mate a coffee rather than buying these fish oils, because it is important that we know purity a little bit like the fact that it's four to five times a week of deep sea cold fish that we need to know that our fish oil is coming from that level of quality as well.
• 32:46
  Speaker 2: So we need to know that about the post production testing that's done, we need to understand that what we're taking as an everyday supplement isn't going to be contributing to any heavy metal toxicity or anything like that, and that's the one part of the important uh piece.
• 33:02
  Speaker 2: The second uh important piece is then the strength of the omega-3 component uh, that it doesn't.
• 33:09
  Speaker 2: You know, one little capsule of of fish oil and that's all you take every day, of whatever it is that you've bought down at the local shop for the cheapest possible price is unlikely to have the therapeutic benefits that I talk about in all those clinical trials.
• 33:24
  Speaker 2: A lot of clinical trials that don't show benefit are where a low dose of fish oil has been used.
• 33:30
  Speaker 2: So we need to ensure that we're giving the right dose for our patients, and the summary of all the different things that we can be doing is ensuring that our patients are taking enough for different conditions.
• 33:42
  Speaker 2: It does vary, but somebody saying that fish oil did nothing.
• 33:47
  Speaker 2: I tried that it didn't work.
• 33:49
  Speaker 2: Always interrogate the dose, interrogate the length of time.
• 33:52
  Speaker 2: It's a long-term supplement to be taking, to be expecting a benefit.
• 33:56
  Speaker 2: These are the ones where, like I said, you know some of the longer trials the trials for cardiovascular benefit, for omegas, go on for years.
• 34:01
  Speaker 2: Uh, so we expect.
• 34:03
  Speaker 2: We expect at least a three months before a any kind of retesting.
• 34:08
  Speaker 2: But but that's the kind of supplement I expect my patient to be taking, ongoing if they've got cardiovascular issues.
• 34:15
  Speaker 1: Yes, yeah, I think you make a really important point there, like when you are looking at evidence, to be looking at it quite carefully.
• 34:22
  Speaker 1: And you know, confirmation bias is a sneaky little devil, and I think when you know if someone's made up their mind there's no evidence for fish oil and they just clearly didn't want to look for evidence for fish oil um, and so I think that's really important to bear in mind, because the dose absolutely matters, um, and so does the purity, and I think that's another thing that is so crucial, because if we are taking something on a daily basis the volume of what we're having we really have to consider what's coming alongside that.
• 34:56
  Speaker 1: And you know, even if people were eating deep sea cold water fish, you know man-made pollutants are abundant in the ocean and in some ways, not saying that taking fish oil is better than eating fish, because you can also source you know your local seafood really well also.
• 35:13
  Speaker 1: But one of the advantages of a supplement is that it has been through purification processes to remove heavy metals like arsenic, cadmium, lead, mercury and other you know man-made pollutants that could impact, you know, the oxidative values of the fish oil.
• 35:30
  Speaker 1: So, yeah, certainly it's an absolute favorite of mine across the board, because most people are not consuming enough seafood, if any actually, and therefore I'm missing out.
• 35:43
  Speaker 1: On EPA, dha conversion from other fatty acids into those is often limited and certainly with the ratio of omega-3 to omega-6 being what it is today in modern processed foods and in the typical australian diet, it really is a.
• 36:02
  Speaker 1: It really levels the playing field, I think a bit for for people's internal homeostasis.
• 36:09
  Speaker 1: The other one that I would really love to hear you riff on and I feel like I almost feel funny about mentioning it because I know it's just like everyone takes it and everyone's like it's good for everything.
• 36:23
  Speaker 1: But there's a reason magnesium is so popular.
• 36:29
  Speaker 2: Oh my gosh, isn't it?
• 36:30
  Speaker 2: I feel like it's some of these things that become so common.
• 36:36
  Speaker 2: They then lose their value because they are so common, right in that it's.
• 36:42
  Speaker 2: The cure-all Is magnesium, the modern snake oil, you know side note actually yes, sure, snake oil is a fraught conversation that we're not going to have today, but is it the cure-all that we, um, that we think of as, and I think that you know, speaking in more broad and general terms, that you know the magnesium depletion that occurs just from things that we do in our, in our diet, in the way we live our lives, the pace, high stress kind of lives that people lead that are very different to only a couple of generations gone past.
• 37:19
  Speaker 2: That you know, even without the addition of ablipersia medication or any medication, our magnesium status is likely to be inhibited from the outset.
• 37:32
  Speaker 2: And I have to say, alongside B vitamins, of all the drugs that I have done the deep dive into, I do feel like I'm a broken record where I get to the nutrient depletions part and almost every time, actually probably every time, magnesium features.
• 37:47
  Speaker 2: So not only are we depleted from our own diet and lifestyle if we get to the point of requiring a particularly a chronic use medication, that a medication for chronic conditions, sorry that we get further depletion from that medicine.
• 38:01
  Speaker 2: And then if we get involved in a cardiometabolic triad where we end up on medications for multiple conditions and they're all depleting it, we end up with significant issues.
• 38:11
  Speaker 2: Um and so when it comes to using magnesium and blood and supporting somebody's hypertension or supporting somebody who's taking a high antihypertensive medication, again, it's not the.
• 38:28
  Speaker 2: The reduction that we'd expect is is not quite as significant as we'd get with garlic and things, but it is significant.
• 38:36
  Speaker 2: It's considered to be a clinically significant result when we use it, but it's something that we get other additional knock-on benefits from taking it as well.
• 38:48
  Speaker 2: That when somebody you know, the old magnesium is used in 300 different actions and enzymatic reactions within the body, that living in a in a state of perpetual depletion, enhanced by your medication, means that your body is not functioning optimally.
• 39:04
  Speaker 2: If you're not sleeping well, your energy's not great.
• 39:07
  Speaker 2: What is your?
• 39:08
  Speaker 2: Your compliance to the regime change that your naturopaths put you on where you need to start doing exercise, for your blooduropaths put you on where you need to start doing exercise for your blood pressure, when you're barely slogging yourself out of bed in the morning that the knock-on benefits of magnesium to improve compliance to other things, the benefit of magnesium for better glycemic control that occurs on every level.
• 39:29
  Speaker 2: Every stage of glycemic control, from absorption of glucose through the digestive system through to the release of insulin and then the sensitivity of insulin on a cellular level, are all impacted by magnesium that the benefits that occur from being magnesium replete.
• 39:47
  Speaker 2: They just can't be overstated.
• 39:49
  Speaker 2: I don't believe, as I said, I've got some first lines of of uh of attack when somebody has uh hypertension and and garlic being a big number one, magnesium is.
• 40:02
  Speaker 2: It is absolutely in the top three of majority of of conditions that I that I treat with patients not everybody, of course, because there's nothing that's for everybody, but for lots and lots of people you do get a benefit for it.
• 40:17
  Speaker 2: So it's yeah, there's a good reason that everybody thinks it's just a magnesium everywhere.
• 40:24
  Speaker 1: Yeah, yeah, yeah.
• 40:26
  Speaker 1: It's earned its rightful place in everybody's cupboards at home for good reason.
• 40:29
  Speaker 1: Everybody's cupboards at home for good reason, wow, I just.
• 40:34
  Speaker 1: I mean, even from this chat alone.
• 40:36
  Speaker 1: You know, understanding those key elements and how impactful they can be, whether they're used as an adjunct or as an alternative for someone with high blood pressure, is just so incredible.
• 40:50
  Speaker 1: And, as you said, because of that cardiometabolic triad where there's a cascade with blood pressure into blood sugar issues and, of course, dyslipidemia also, knowing that those interventions garlic, fish oil and magnesium all also have benefits, kind of stamp out the you know the extra sort of fires that might spot, fires that might pop up is, you know, even that alone makes for a, you know, a really good rationale for adjunctive use.
• 41:20
  Speaker 1: And certainly I think this webinar is going to be absolutely brilliant.
• 41:26
  Speaker 1: But I just wanted to pick your brains on one last little thing, because we had a little chat prior to hitting record around the benefits of blood pressure monitoring and blood sugar monitoring and I think you know obviously you're going to dish out all of your knowledge in the webinar.
• 41:49
  Speaker 1: But I think this is a really lovely one to share.
• 41:52
  Speaker 1: Share, particularly because this podcast reaches quite a wide audience around things that can have a significant impact, that you kind of think, oh, what would that do?
• 42:00
  Speaker 1: So you want to take us through that?
• 42:04
  Speaker 2: oh, absolutely.
• 42:04
  Speaker 2: This is one of my favorite things that I uncovered, as one of the first blood pressure medications were the second.
• 42:11
  Speaker 2: Statins were my first and and then antihypertensive was the second that I ever did the deep dive into.
• 42:15
  Speaker 2: And I remember when I first read a paper on the benefits of home blood pressure monitoring and I'm like what are the benefits of it?
• 42:23
  Speaker 2: What benefit is there to be putting the cuff on?
• 42:26
  Speaker 2: What is that doing to cardiovascular health?
• 42:29
  Speaker 2: And so I went down the deep dive and found some really interesting studies that simply by regularly monitoring your blood pressure.
• 42:39
  Speaker 2: That there is data.
• 42:41
  Speaker 2: There's a study that was done in um uh, in the netherlands actually, and it was.
• 42:46
  Speaker 2: It was the paper was um released only a couple of years ago.
• 42:49
  Speaker 2: That just with no other intervention but regularly monitoring, and that was in that study.
• 42:55
  Speaker 2: I believe it was for a week that they measured morning and night and kept a record and after that it was only weekly where they had to actually put their data into the healthcare system over there.
• 43:09
  Speaker 2: That in over a period of time that I believe it was um 12 weeks that 60 of patients went from hypertensive to normotensive.
• 43:20
  Speaker 2: That with our intervention.
• 43:24
  Speaker 2: So that was the intervention was measuring their blood pressure now is is it the monitor?
• 43:29
  Speaker 2: Is it the monitor?
• 43:30
  Speaker 2: Is it the cuff?
• 43:31
  Speaker 2: Of course it's not.
• 43:32
  Speaker 2: What it is is is that it reminds people of this silent condition that they otherwise may conveniently choose to forget about.
• 43:41
  Speaker 2: What it does?
• 43:42
  Speaker 2: Is it helps people to be more aware that the condition exists?
• 43:45
  Speaker 2: That it improves compliance to, either because the studies are mostly done on people with taking medicine that it reminds them to take their medicine at the times that they're supposed that it reminds them to take their medicine at the times that they're supposed to.
• 43:55
  Speaker 2: Reminds them to take their supplements, reminds them to go out for their walk.
• 43:57
  Speaker 2: It may help prevent that reaching for that, you know, extra drink at the end of the day or even touch on cigarettes, but it may help with the choices around cigarettes.
• 44:08
  Speaker 2: That simple monitoring.
• 44:10
  Speaker 2: So what in practice I do for my patients is I ensure that they don't cost a lot of money these days, or I get them to hire them from the pharmacy or to borrow one from a friend is to have one at home and to measure first thing on rising, and then I say the so that.
• 44:26
  Speaker 2: And then the last one at night is.
• 44:27
  Speaker 2: I say to them when you're sitting on the couch at night and just before you get up and go to bed, and keep a record of those for two weeks and two weeks straight, and what you see is you get an accurate reading of what their blood pressure is like at rest and what you're ideally seeing is the higher blood pressure in the morning and the lower blood pressure in the evening.
• 44:43
  Speaker 2: But after that I tend to I tend to get them to measure it, not so not so closely monitoring.
• 44:50
  Speaker 2: I usually get, depending what's going on for the patient, but often a weekly.
• 44:54
  Speaker 2: I do a weekly morning and night.
• 44:56
  Speaker 2: Get them to choose a weekday because it's the majority of the week.
• 44:59
  Speaker 2: On Tuesdays, morning and night, you measure your blood pressure and then they keep their weekly log and and it's it's something that people that do it have far better outcomes than people that don't.
• 45:09
  Speaker 1: Clinically, Wow is just.
• 45:12
  Speaker 1: Isn't that such an interesting example of habitual behaviors and being cognizant of something?
• 45:18
  Speaker 1: It's a little bit like when people start working out.
• 45:20
  Speaker 1: As a side effect, they often start making better food choices because they're, you know, working towards something.
• 45:26
  Speaker 1: It's a little bit like food journaling.
• 45:27
  Speaker 1: Monitoring your blood pressure is a lovely reminder that this is something that matters, which then means every choice you make the rest of that day also could be, for better or worse, influencing your blood pressure.
• 45:41
  Speaker 1: And what's so lovely about that?
• 45:43
  Speaker 1: Aside from, obviously, renting or purchasing a blood pressure measuring device, whatever one you end up going for, it doesn't cost anything after that and could ultimately reduce your outgoings around medication and supplements, simply by acting as a regular reminder that your blood pressure is something you need to take care of and therefore might inform better choices the rest of the day Exactly.
• 46:13
  Speaker 2: I love it.
• 46:13
  Speaker 2: It's my favorite type of intervention.
• 46:15
  Speaker 1: Yeah, oh, my gosh, tracy, it's just so clear to me the depth and breadth of your knowledge and I and I just want to sign up to your course immediately, because it's been a while since I've looked at this specifically for myself too, and clearly a lot has evolved in the in the most recent years.
• 46:34
  Speaker 1: But for anyone listening, just a final reminder that there is an upcoming webinar for designs for health on cardiometabolic health and co-prescribing, which tracy will be taking us through, and, of course, for any practitioners interested in really getting across this, not just in the cardiovascular space but across the board, her co-prescriber course is also available.
• 46:56
  Speaker 1: And, tracy, just a huge thank you for sharing with us today.
• 47:01
  Speaker 1: Just what I know is just the tip of the iceberg of your knowledge, but so powerful all the same in just the conversation that we've had today.
• 47:11
  Speaker 2: Thank you so much for having me and thanks for giving me the opportunity to share what I think is such important information.
• 47:17
  Speaker 1: Thank you, yeah, absolutely so, so important.
• 47:21
  Speaker 1: Well, thanks again, tracey, and thank you for joining us today.
• 47:26
  Speaker 1: Remember you can find all of the show notes and other relevant podcasts and seminars on the Designs for Health website.
• 47:32
  Speaker 1: I'm Amy Skilton and this is Wellness by Designs.