Episode Transcript
[00:00:04] Speaker A: Hello and welcome to a Wonder Care podcast. My name is Sheena Mitchell. I am a pharmacist, mum of three, and here to guide you through all of your family health care needs. This week, I want to talk about something really, really important for women's health, particularly women who are in. Their topic is huge. So today I'm just going to talk about one aspect of it. As mothers, we are often the last people that we think about. It's a busy time and it's very easy to forget about yourself. A scary fact is that one in four women in Ireland die from heart disease and stroke. Women are actually six times more likely to die from cardiovascular disease than they are from breast cancer. I'm reflecting on this maybe because I am in my very, very early 40s, but from about my age and before and after, for some women, a woman's risk of heart disease and stroke increases. And this is because you're moving towards the menopause. Menopause itself doesn't cause heart disease and stroke, but it does cause a decline in oestrogen, and this causes stiffening and weakening of the blood vessels. It can also cause increased cholesterol, increased blood pressure, and hot flushes all the rest of the typical menopausal symptoms that we're aware of. But actually, today, what I want to talk about is high blood pressure. I'm not just talking about it in the context of the menopausal woman. I more just wanted to flag that this actually is more of a women's issue than tradition and history would have you believe. Typically, cardiovascular disease has been associated with men. It's men's disease, but no, it very much is not.
You might know your blood pressure readings, it might be fine, you might not know them, you might never have gotten it checked. But the one thing that we know is that high blood pressure is a major, major risk factor for heart attack and stroke. High blood pressure can be a silent killer. There is generally no symptoms. So the only way that you will know if you've high blood pressure is if you actually go and get it checked. And that requires being proactive. And that's what I wanted to flag today. Women, particularly mothers, we find it really hard to be proactive about our own health. So today, if the only thing that you take from this whole episode is to go and get your blood pressure checked, well, that would be absolutely amazing. The scary thing about cardiovascular disease is that we don't have studies on women. Traditionally, women have been treated as small men. Now, when you think about the physiological differences between men and women. And you think about the fact that we have different body organs and different hormones, it's kind of ridiculous that we're using men as a benchmark for the treatment and prevention of cardiovascular disease in women. The gender exclusion of women, for various reasons from medical studies, is, quite frankly, terrifying. You'd kind of think that inequality wouldn't be so glaringly obvious when it comes to the most fundamental core of health protection and medical research. So today I'll be talking about how we can improve our blood pressure, and I'll be talking about a lot of ways we can do this naturally, or even safeguarding our blood pressure for the future by what we eat and the actions we take. Now, I find it interesting that, as a collective, people in general are quite happy to accept and yearn for the use of GLP, one analogues like ozempic, to support and treat obesity. But we don't seem to have the same ambition and motivation for hypertension. Now, these are two completely separate issues, obviously, and while they're interlinked and are both risk factors for cardiovascular disease, I'm not taking away from the genuine need for ozempic in obese patients. In fact, I do hail progress in this area of medicine as remarkable and life changing, and I really look forward to the day where these medicines are more readily available and to be able to be used in combination with lots of other nonmedical supports to help treat obesity. But today, from the perspective of hypertension, you have to ask yourself, do you care less about hypertension because you can't physically see it? Are we that vain that we're excited about the possibility of removing one cardiovascular disease risk factor because it also happens to be visual. Well, I kind of think, and I'm included in this, I'm not preaching, but we need to cop on, we need to care about hypertension, because whilst we can't see it, it's causing very ugly damage to our health inside of our skin. So, first of all, what is blood pressure?
Well, there's two numbers used to measure the level of your blood pressure. There's systolic and diastolic. Don't let the terminology scare you. Systolic pressure is the pressure that is measured when your heart muscle beats to pump blood to the rest of your body. So that makes sense. It's the higher number because obviously, your heart has to beat really hard to get blood to flow all over your body, and then the diastolic pressure, which is the lower number, this is the pressure that is in your heart when your heart relaxes in between beats. So we know that normal levels of blood pressure are usually around 120 over 80. So that's 120 systolic and 80 diastolic. Why does that matter? Well, if your blood pressure becomes high, there's actually a greater risk of heart attack, stroke, heart failure, kidney failure, dementia, and some forms of blindness.
Optimal blood pressure is anywhere where the systolic is under 130 and the diastolic is under 185. High normal is if it goes to 130 to one three nine over 85 to 89. And if grade one hypertension is when it's between 141, five nine for the systolic and 90 and 99 for the diastolic. Grade two hypertension is if it's over 160 over 100. I know it's hard in a podcast to take in figures, but I will pop that information into a graphic on my instagram as well. Unfortunately, the gender inequality doesn't just happen when we're talking about medical research. It also impacts the likelihood of a correct diagnosis when a woman shows up with a heart attack in a medical setting. It's also known that women typically arrive at hospital later than men when they're having a heart attack. We're just a bit too hardcore, but this contributes to delays in treatment. It is a medical emergency, and delays in treatment put women's lives at risk. I'm just going to give you the brief symptoms of a heart attack. Obviously, you can start to get signs of central chest pain or discomfort that doesn't go away. It might feel like pressure, like someone standing on your chest or your chest is tight or has a squeezing feeling. You can get pain down your left arm or both arms, or to your neck or jaw back or stomach. You can also start to feel sick, sweaty, lightheaded, or short of breath. So a woman could have symptoms like nausea and feeling sweaty and pain in the jaw, and not realize that that actually could be the symptoms of a heart attack. What I'm saying is, keep an open mind, because it's not always definitely going to be the hand to chest, dramatic pain, and really obvious radiating pain down your left arm that we associate with heart attack. That isn't always how it presents. Okay, so now that we know the risks of high blood pressure, how do we prevent it and how do we treat it? Today, I'm not going to talk about all the different pharmacological treatments, so all of the different types of prescription drugs, because there are a lot of different kinds. And if it gets to a point where you need to see the doctor about your blood pressure and they suggest treatment. Well, that's a chat you'll be able to have then and with your community pharmacist at the time. So for the purposes of today, I'm going to talk about ways that we can actually reduce our risk of developing high blood pressure over our entire lifetime. Because, believe it or not, our actions now and the whole way back to our extreme youth, impact our risk of developing hypertension in the future.
There's some really interesting information. I know everyone is aware that they should eat healthily and exercise more, but actually there's a lot of really good information on more specifics, and I thought that might be more interesting for us to cover today. I've seen a lot of posts on Instagram lately saying that moderate exercise, like going for a walk or whatever, is just as good for you as vigorous exercise. And I think that it's really important to define what's misinformation and what's not. So if you are someone who is walking that is considered moderate intensity, it's really important to realize that you can't be strolling for that walk. You actually have to be walking quite briskly and you need to be getting your heart rate up. You should be pretty much breaking a sweat when you're walking at moderate intensity. If you're walking, you need to be doing it for two and a half to 5 hours per week. If you are doing a more vigorous intensity, such as jogging or running, then you need to be doing it for 1 hour 15 to two and a half hours a week. So I suppose what I'm highlighting here is that if you're walking for half an hour, four days a week, that's actually not enough exercise if you're only doing moderate intensity. So you might actually need to relook at it and think, okay, I need to get more vigorous exercise into my week so that I don't have to spend 5 hours exercising at a moderate intensity. Like even just as parents, in terms of time efficiency, exercising for 5 hours a week is quite a big demand. And when you compare that to the requirement of only 1 hour, 15 to two and a half hours of vigorous exercise, if you can do more vigorous exercises, it's a lot more achievable when you've got a lot going on in your life. I will put up some infographics as well about what counts as moderate intensity exercise and what counts as vigorous exercise to give you a better idea. I don't want to bore you with all that now. The other thing to realize is that you should also include resistance exercise on at least two days a week. That is muscle strengthening. There are different ways of doing that. Things like pilates, isometric stretching, dynamic stretches. Isometric stretches are basically ones where you are not moving the joints. So think things like the plank, or when you're up against a wall and you go down into a squat position and you're just holding that position. All of these things are isometric stretches and they are good. Dynamic stretches are stretches that you do, like lunges when you're moving and stretching at the same time. So it's not that you should just be doing cardio, you should be doing cardio and strengthening. This is for everyone between 18 and 64 years of age. It changes a little for older adults, but for the context of today, I just want to throw the light on what is actually required to rely on exercise as a way to benefit your health. Now, if you're listening to this and you're currently inactive, I absolutely do not recommend going out and doing 5 hours brisk walking this week. You'd be wrecked. So you do what you can and you build up. And if you want to consider taking up a more vigorous sport like jogging, well, I have exciting news coming soon on that, but I will update you about that top secret mission in another week or two. Right, going to move on from exercise and talk about the most interesting parts of nutrition. So we know that a good diet is really important. It is actually considered a treatment for blood pressure control. We need to start thinking of diet in terms of something that can be prescribed. And one of the most recognized diets for the control of high blood pressure and for maintenance of good health is the dash diet. So dash diet. So this can basically lower your blood pressure, cholesterol, and also your risk of lots of chronic diseases. The key points of the dash diet are pretty obvious, but eating lots of fruit, veg, whole grains and pulses, and also include low fat dairy foods, nuts, fish and skinless poultry. There's a requirement in it to limit your salt, and I'll talk more about that in a minute. Also limit saturated fat, sugar and processed foods. But I suppose it's really quite a simple Diet, and it's about eating more of what's good for you and less of what's bad for you. So I always try and think about diet as a Positive. So how you can improve your Diet, what more you can eat that's Healthy rather than what you need to restrict. Everybody has a Diet. Diet is not a bad word. It's just that you either have a Healthy Diet or an unhealthy Diet, or you can fall somewhere in the middle. And this has become seriously confused in what's known as diet culture, where diet is thought of as a bad word and it's restrictive. And actually, that's not true. We should be trying to eat lots of food that are rich in potassium, calcium, magnesium, fiber. And okay, yes, we should be limiting foods that are high in fat and sugars and high in sodium. But in essence, when we're talking about exercise, it's really easy to understand that we need to fuel our bodies. Like you wouldn't put dirty diesel in a petrol car. It would break. So we need to start thinking about our bodies and our diet in a really positive way and think how we can fuel our body to work at its best. So the first thing I want to talk about is salt. The World Health Organization say that globally, we need to reduce average salt intake in the population by 30%. And what's interesting is about 80% of the salt intake actually comes from manufactured and processed foods. High sodium consumption is defined as over 2 grams of sodium a day. And just to give a context, in about one teaspoon of salt, there are 2 grams of sodium. Anything over this amount will increase your blood pressure. And it's the leading dietary risk factor for death. Now, you might say to yourself, I don't actually add a lot of salt to my diet. But nowadays, because of marketing, it's actually really, really hard to limit your salt if you're not eating food that you've cooked from scratch. Kind of brings me on to processed foods. There are, in Essence, four different groups of foods. So you have whole foods, which are just your plain veg, milk, fruit, eggs. So these are foods that have not been impacted by processing companies and are literally in their original form. Then in group two, you have culinary ingredients. So this would include things like salt, herbs, oils, et cetera. In group three, these are foods that are processed. In essence, they're a combination of group one and two foods. So it could be things like canned goods, frozen veg, that kind of stuff. And then number four is ultraprocessed. Ultraprocessed foods contain artificial flavors, colors, thickeners, and other additives which make the food really flavorsome and tasty. But they cause gut health imbalance and systemic inflammation. They actually cause a 50% higher risk of cardiovascular death. And that's only if you have one serving a day. So one serving a day of ultraprocessed food increases your risk of cardiovascular death by 50%.
That's kind of mind boggling, really. On a side note, it also increases the risk of anxiety by 53%. Ultraprocessed foods are high in calories, sugar, and this is where it relays to the salt. They have added sodium. They also have low fiber. We know that they obviously can increase your blood pressure because of the salt, et cetera, but they can also contribute to weight gain. So obesity, diabetes, which are also other risk factors. And the more risk factors you have of cardiovascular disease, the more likely it is that it will kill you. Now, we know we can't control the food market and we can't control the food manufacturers, but we do still have choice. You can choose to compare products and pick ones which have less processing. So you can look at the salt in the back and see where it lies. In the context of the maximum recommendation of 2 grams of sodium a day, you can make simple swaps so you can have plain yogurt with fruit instead of flavored yogurt. I actually need to do that one myself. You can focus on cooking meals from scratch, and I know it's not easy, and we are all really busy. And actually, I think that's where the demand for ultraprocessed food has come. You just want to pick something up that's quick to cook because we're all working and we're all busy, and our children have a gazillion activities, and you're only in the door and you're out again and you're kind of left wondering, when am I meant to find time to cook? But whether it be batch cooking at the weekend or cooking enough two days a week, that'll keep the family fed for four days. Whatever it is, we have to try and make an effort. Like, even if you can't do it every day, but you can do it most days, we can make a real difference to our health and our children's health. We can try and steer ourselves and our children away from sweetened drinks and try and get them drinking water 90% of the time instead of getting a takeaway when we're frazzled at the end of the day, we could ring a local cafe or potentially restaurant where they're less likely to use ultraprocessed foods and they're more likely to cook using whole ingredients and ask them to prepare something to take away. I know it seems impossible to make all of these changes, but we really do have to start somewhere with all of the health issues that we're now facing in modern times because of our adaption, our attempted adaption to ultraprocessed food. We need to review that. It's not working. We're becoming more and more unhealthy. Maybe with time, then the food market will change in response to demand. The only way to make healthy food more popular is to continue to pursue and chase it. Personally, I think they should make it really easy and affordable for people to make simple, healthy meals. And I think that should happen by supporting our local farmers and food producers and by taxing ultraprocessed foods. I think it should be really cheap to cook healthy foods. And I think our government could play a much larger role in that. And I think all they have to do in terms of generating income to subsidize our local food producers is to use the tax on the ultraprocessed companies like the ultraprocessed manufacturers are making money off our vulnerabilities. And I hate that. Absolutely hate that. Because being healthy is not hard. It's simple in terms of it's the basics, it's the eating healthy and it's the moving more. But what is hard is finding the time and the ability. So I think we need to be given packages like that whole hellofresh thing. And I'm not saying hello fresh. I'm saying every supermarket. Why can't the government just make loads of easy, really quick to cook food recipes, throw them up on their website, and then subsidize all of the ingredients in the supermarkets for all of those foods, for every family in Ireland, so that you can just go in and pick up your cheap ingredients, look online and figure out how to cook a nice, simple, healthy meal for your family. Like the money is there to do that. If we target processing manufacturers and we support our farmers, it's just so much more sustainable as well. Anyway, that is just my little thoughts. Takeaway point. Limit your sodium levels to 2 grams daily. Next thing I want to talk about is what we're getting from those vegetables and fruits that I'm telling you to eat. And that is an increased potassium intake. So the dash diet recommends around 4.7 grams of potassium per day. And that is known to have a blood pressure lowering effect, which is amazing. We can get a reduced risk of stroke, cardiovascular disease and death in patients. Potassium is available in fruits, veg, legumes, fat free or low dairy products. So we should be targeting these foods and thinking of these as fuel. Think about topping up our potassium levels and using potassium salts instead of sodium salts.
I'm just going to pause for a.
[00:21:26] Speaker B: Second to give a big shout out to my supporters. Salon plus. Salon plus is the world's 1st 100% natural dry salt therapy device. It's clinically proven to relieve a wide range of allergens and respiratory conditions. The salt therapy method has been trusted for generations and is now hugely popular worldwide. More and more people are recognizing the superb results achieved from a natural and noninvasive method. This device helps you to breathe easier and sleep better.
[00:21:58] Speaker A: So, potassium good, sodium bad. Basically, you can actually swap out regular sodium salt for potassium enriched salts. And these are commercially available. So if you love salt, that's an option to reduce your sodium intake without completely getting rid of salt in your diet. Ideally, if we could make sure that the food processing companies use potassium salts instead of sodium salts, well, that would actually make the whole world a healthier place. Okay, moving on from salt to sugar. So, when we're talking about sugar, generally, we're talking about refined sugar. And obviously, it's in a lot of processed foods. So again, it's hiding. And it can be hard to realize just how much that you're eating. Sugar has a lot of impact on your cardiometabolic health. So that is things like your cholesterol readings, your good cholesterol, and your bad cholesterol. But I will talk about cholesterol in a different episode. So, lots of consumption of sugary foods and drinks high in fructose and high glycemic foods, which include white potato, white rice, basically can lead to nonalcoholic fatty acid disease, and that is strongly associated with hypertension. Not only that, we know that sugar is connected to overweight and obesity. And that is, as I said already, another risk factor that we need to avoid. So sugar should be limited in both its raw and processed forms. So you can have a look at the labels of the products you're buying and try and identify ones which are low in sugar. And the scary thing about this is that the more you eat a lot of salt and a lot of sugar, the more that your body absorbs a lot of sugar and a lot of salt. It's known as greedy gut, and it's the same kind of thing in your kidneys, where they'll reabsorb sugar and sodium, which is not good for your cardiovascular system. What about fiber? Why do we need to increase our fiber intake? Well, dietary fibers are carbohydrates, which basically aren't digested or absorbed in the small intestine. And if we're not eating enough whole grains, fruits, nuts, seeds, vegetables, and overall fiber, then we have an increased risk of cardiovascular disease. High fiber intake reduces all cause and cardiovascular mortality by about 15% to 30%. So it has a really important role. We should be taking in around 25 to 29 grams per day to reduce risk. But actually, you can take more than that and you'll just have additional benefits. Most people consume, on average less than 20 grams a day of fiber. So we need to be more aware of it and kind of be chasing high fiber foods, particularly those that are high in fermentable fiber, because it has a really good effect on your microbiome. Good sources of fiber are lentils. There's about 16 grams per cup. And beans are also a good source of fiber. So are kale, cabbage, cauliflower, broccoli, which all have about 5 grams of fiber per cup, blueberries, 4 grams per cup, avocado, 10 grams per cup, and whole grains. And you can always do some baking with some high fiber flowers to increase your fiber intake. Right, next is alcohol. So I'm not going to harp on about this, but we know that alcohol intake increases your blood pressure. And I know there's a lot of confusion about whether a small amount of alcohol, like a glass of wine a day, is good for you. Red wine seems to get that good name. But actually the studies show that there is no support for the protective effect of moderate alcohol consumption. And the lowest risks for cardiovascular disease are in people who have no alcohol at all. So in essence, alcohol consumption should be zero. For best cardiovascular outcomes, however, we know we have to live as well. So everything is about risk balance. The recommended daily upper limit for alcohol consumption is two standard drinks for men and one for women a day. And this cannot be stored up and used at the weekend, so you can't binge drink. Basically, it's not good for you and it should be avoided. And I know that's bad news on the alcohol. However, I've got good news. Good news coming. Good news coming. Coffee and caffeinated drinks such as tea have beneficial effects on blood pressure and overall cardiovascular health. Wa and not only that, the greatest benefits are seen with three cups of coffee a day or two to six cups of green or black tea. This is the best thing that I have read in a long time. That's amazing. But you shouldn't drink more than three cups for a lot of reasons. But you don't really get any more benefit for your cardiovascular health. So probably max it out at three cups, otherwise you will get the jitters and anxiety. Another thing that I actually was really interested to read was about beetroot juice. Now, you might be wondering why in hell, I'm talking about beetroot juice. Beetroot juice is known to improve performance in the sporting world. And I keep hearing about it during my marathon training. I keep hearing people say, yeah, and then I'll start taking the beetroot juice the week before the race. And I'm like, why are they taking beetroot juice? But it turns out that beetroot is nitrate rich and it can actually have a blood pressure lowering effect. And another juice that has the same effect is pomegranate. So that is positive news. And I still haven't seen beetroot juice anywhere, but I haven't looked very hard either because I'm not sure it sounds very nice, but look, if it's going to make me run faster, I'll take it.
Intermittent fasting, that's the other buzzword at the moment. So what is this all about? Well, fasting is the voluntary abstance or restriction of food and or drink for long or short periods. So it has been used across the world for hundreds and hundreds and hundreds of years as part of cultural, traditional, for religious or even health reasons. And more recently, the use of short term intermittent fasting has become popular strategy for weight loss and improving metabolic health. There are different forms of doing it, including alternate days fasting, where your calorie intake varies on different days or time restricted fasting. This is where you're doing all your eating within, say an eight hour window and abstinence for the remaining hours in the day. So it's interesting, obviously, when looking at the advice on this, it is acknowledged that fasting is adopted for multiple reasons. There is actually a LacK, unfortunately, at the moment, of adequately poWered, long term randomized control trials about intermittent fasting. But the official recommendations are that, first of all, for religious reasons like Ramadan or Lent, it's generally safe and low risk in moderate risk populations. And there is some information that intermittent fasting with calorie restrictions can be beneficial for weight loss and blood pressure reduction, but it's no better than general calorie restricted diet. So really it comes down to patient preference. Bosch. Long and short of it is that there is no huge advantage to doing intermittent fasting versus just a normal diet with restricted calorie intake. Important to be aware of that. So that's kind of all the nutrients that come from Food that can have an impact on hypertension. But another few things, omega three. So omega three polyunsaturated fat c acids can have a positive effect on blood pressure, and omega three s should be taken at a dose of two to 4 grams per day. We also know that larginine. So larginine is an ingredient in revive active actually, and it is a semi essential amino acid. And we know that larginine can also have a positive effect on blood pressure. Magnesium supplementation is another thing that can help to reduce blood pressure, and the recommended dose for that is 368 milligrams a day. Remember, with your potassium, ideally you're going to get it through your foods, so through your veg and your fruit. But if you are taking supplementation, that is possible and it is in a lot of mulTivitamins. The only thing I'd say is, if you're taking supplements of potassium, do be careful if you have kidney failure or if you're taking diuretics already, particularly potassium sparing diuretics. If you're not sure about potassium, then do talk to your doctor or your community pharmacist before taking supplementation for that. One other thing that is useful to know is that soy isoflavones can be useful in supporting a reduction in blood pressure in perimenopausal women. So all of those are, I suppose, supplements and additional things to a healthy, balanced diet that can help to reduce blood pressure. Okay, this episode is getting so long and I have so much more to cover. However, this episode has covered exercise, diet and why it's so important to use these to treat hypertension. I will do another episode next week where I talk about the impact and the importance of stress reduction, sleep, which is definitely an important one for parents to hear, smoking, exposure to pollution and its impact on high blood pressure. And I'll also explain the difference between measuring your blood pressure with a regular blood pressure machine and then in getting a 24 hours monitor fitted and when that might be needed. So I will catch up again with you soon. And I'm just really glad that we've started this conversation, because it is ridiculous that there is inequality in the way that women are treated compared to men when it comes to cardiovascular disease. And it is ridiculous that women are dying unnecessarily and are going around carrying excess risk for absolutely no reason when it comes to cardiovascular disease. So we have the potential to change this. And again, like with everything, and I know I'm always saying this, but education is power. Once we know what we need to do, and we know how important it is to look after ourselves, well, then maybe we can start making small choices every day that do just that. And that will make us not only better women, but better parents, better friends, better daughters, cousins, nieces, grandparents, better everything. So as mothers, we need to realize that we need to worry about ourselves, because minding ourselves allows us to be here for longer, to care for the people that we love in our lives. And I'm just saying that because there's probably a lot of people out there who won't do the change for themselves, but they'll do it for other people. So whatever your motivation, just make time to mind yourself. You are so worth it. Thank you for listening.
