Several Updates: Blood Pressure, Time-Restricted Eating, Personalized Lipidology, Jet-Lag Diet, Licenses

Happy Mother’s Day!

I’ve got several updates for you this week:

Blood Pressure
Time-Restricted Eating
Personalized Lipidology
Argonne “Jet-Lag Diet”
California Medical License

I hope you enjoy.

All the best,

Steve

1. Blood Pressure Update

There are many cases in which it is uncontroversial to prescribe blood pressure lowering medications. However, the idea of taking medications to lower blood pressures that most of the medical world consider acceptable is a controversial one.

Anyone who supports such a strategy should have a good rationale for doing so. To this end, I’ve nearly completed part two of my blood pressure article series in which I will present the evidence both for and against lowering normal and “elevated” blood pressure in otherwise “low-risk” individuals.

Here’s a preview of the major assertions:

It is uncontroversial that people with lower blood pressures live longer and have fewer heart attacks and strokes than their counterparts with higher blood pressure.
This is true down to pressures at least as low as 100 mm Hg systolic and 60 mm Hg diastolic, maybe lower.
The cardiovascular system matures between the ages of 6 and 14.
It’s during this time that hypertension can start to develop.
The pressure of the blood as it pulses through the arteries has a negative and cumulative effect on the integrity of the arteries with an unknown floor both in time and magnitude.
It’s unclear to what extent this damage is reversible.
This damage is one major contributory factor in the development of vascular diseases like heart attacks and strokes.
The pharmacologic lowering of blood pressure with a target below 120 mm Hg systolic is safe and effective at saving lives by decreasing heart attacks and strokes in patients at high-risk.
It’s possible that an individual can develop blood pressures up to 139 mm Hg systolic and 89 mm Hg diastolic as early as their teen years. If this person is otherwise healthy, they can reach the age of 65 (for a man) or 71 (for a woman) before guidelines will recommend pharmacologic treatment for hypertension.
Thus, an individual who falls within this category may undergo 50-60 years during which they could have been treated with blood pressure lowering medications, but were not.
This might be a missed opportunity for extending lifespan and healthspan.

If these ideas interest you, I suggest reading “Blood Pressure Part One: What is ‘normal?’” in preparation for the release of part two, which I hope to complete next week.

2. Time-Restricted Eating

Last week, I published an article that covered the new NEJM study on time-restricted eating.

The NEJM study was covered (poorly) by the New York Times, and so it got lots of attention in the health & wellness, nutrition, and medical world, but for all the wrong reasons.

You can read my coverage here: Time-Restricted Eating Doesn’t Work?

3. Personalized Lipidology

In my practice, I use detailed lipid tests and biomarkers to assess and manage cardiovascular risk. For a little more than a year, I’ve also been using GBInsight genetic testing to help personalize this care even further.

GB Insight’s tests can reveal interesting genetic variants that help guide monitoring and therapy. For instance, a patient might have elevated LDL-cholesterol because of a genetic variation in the LDL-receptor, the ApoB protein, PCSK9, sterol absorption proteins, or some combination thereof. Knowing the cause of elevated LDL-cholesterol can help guide therapy.

In many cases, the first-line treatment for lowering LDL-cholesterol is a statin drug. But genetic testing can also tell us which patients are likely to be susceptible to statin-myopathy, which would make them a poor candidate for statin drugs. Such a patient might have better results and fewer side effects with a PCSK9 inhibitor.

I recently had the pleasure of attending a webinar in which Dr. Michael Davidson, one of the world’s experts in preventive cardiology, presented cases from his lipidology clinic in which genetic testing was key in guiding therapy.

It’s exciting that I’m able to offer the same testing that’s used by one of the top experts in preventive cardiology.

The GB Insight testing also informs risk assessment for Alzheimer’s (ApoE genotype), type I and Type II Diabetes, obesity, hypertriglyceridemia, and nutritional genomics.

4. Argonne “Jet-Lag Diet”

The Argonne “Jet-Lag Diet” is something I’ve been familiar with for a few years. It was designed to help military personnel avoid jet-lag while crossing time zones.

The diet was developed by Dr. Ehret at the Argonne National Laboratory in Illinois in the late 70s, published in “Overcoming Jet Lag” in 1983, covered by the New York Times also in 1983, and then published in Military Medicine in 2002.

I was reminded of this diet just a few days ago when I was speaking with a new friend, Dr. Eric Fine. Dr. Fine is fellowship trained in Aerospace Medicine and is in the process of starting a medical practice that is designed to care for pilots.

Part of our discussion was about sleep and nutrition for pilots. Good quality sleep is hard to come by for many people, but especially for those who have shift work or who frequently cross time-zones. Pilots have both problems.

While this was on my mind, I thought I’d share the Argonne “Jet-Lag Diet” with you.

The idea is to shift your circadian rhythm before traveling across three or more time zones by adjusting your nutrient timing. One of the central ideas is fasting while traveling until it’s breakfast time at your destination. At that time, wherever you are, you consume a large protein based breakfast to help set your circadian rhythm. This is just one element of the diet. If you’re interested, I recommend reading either the research article, the New York Times piece, or both.

Here is the central graphic from the original research article that summarizes the strategy:

5. California Medical License

I’m in the process of applying for my California medical license. I’m currently licensed in South Carolina, Maryland, and Pennsylvania. If you’re located in one of these states and you’re interested in a consultation, please contact me.

Ways you can contact me:

Reply to this email
Use the contact page on my website
Schedule a free call