May 20, 2025 • 18 mins
In this episode of The Health Pulse Podcast, we reveal how insulin resistance may be the hidden cause behind many cases of high blood pressure. Up to 75% of people with hypertension also have insulin resistance—even if they don’t have diabetes—making this metabolic dysfunction a major factor in cardiovascular health.
We break down the science: how elevated insulin levels increase sodium retention, blood vessel constriction, and impair nitric oxide production, all of which raise blood pressure. You'll also learn how lifestyle interventions like low-carb eating, intermittent fasting, exercise, better sleep, and stress management can significantly improve insulin sensitivity and reduce blood pressure—often within weeks.
🎧 Tap play to learn how treating insulin resistance may be the key to lowering your blood pressure naturally and effectively.
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Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Nicolette (00:01):
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Rachel (00:25):
Think about this Nearly half of all adults have high
blood pressure.
It's so incredibly common.
It really is.
We often just focus on, youknow, managing those numbers.
But what if that condition isactually a signal?
Mark (00:39):
The signal pointing to something deeper, exactly.
Rachel (00:42):
Maybe a less obvious but more fundamental issue
happening in our bodies.
Mark (00:47):
That's really the key question we're tackling today,
because, well, there's a lot ofresearch now indicating that a
major driver of primaryhypertension is insulin
resistance.
Rachel (00:56):
Hypertension without a clear secondary cause right.
Mark (00:59):
Right, and Dr Gerald Riven , who is a real pioneer here,
put it very clearly.
He basically said insulinresistance isn't just about
blood sugar.
Rachel (01:06):
Okay.
Mark (01:07):
It has these really profound effects on blood
pressure, how we handle fats andeven inflammation levels.
Rachel (01:13):
Okay, let's unpack this then.
So our deep dive today is allabout exploring that scientific
link insulin resistance and highblood pressure.
Mark (01:20):
Yeah, we want to understand how this often sort
of silent metabolic issue canpush blood pressure up.
Rachel (01:27):
And, crucially, what we can maybe do about it.
Through lifestyle changes Canwe potentially reverse this.
Mark (01:34):
Precisely.
We'll be looking at the medicalliterature, expert insights, to
help you understand thisimportant connection.
Rachel (01:41):
Now most of us, I think.
We hear insulin and weimmediately think blood sugar
control.
Mark (01:46):
That's the primary role, yes, helping cells take in
glucose.
Rachel (01:50):
But it sounds like it's doing a lot more.
Mark (01:52):
Oh, absolutely.
Insulin also has a significantinfluence on our kids.
Rachel (01:58):
OK, this is where it gets really interesting.
How does this extra insulinactually make blood pressure go
up?
Let's dig into the specifics.
Mark (02:05):
Okay, so one of the main ways is through sodium retention
.
Rachel (02:09):
Sodium like salt.
Mark (02:11):
Yes, High insulin levels basically tell the kidneys to
hang on to more sodium and water.
Some groundbreaking work backin the early 80s really
highlighted this.
Rachel (02:20):
So more retained fluid means more volume in the blood.
Mark (02:23):
And higher pressure Exactly, and this can be a
pretty rapid change actually.
Rachel (02:28):
So it's not just how much salt you eat, but how your
kidneys handle it, based oninsulin.
Mark (02:33):
That's a key connection many people miss yeah.
Rachel (02:35):
Wow, so our kidneys are getting the wrong message.
What else is happening?
Mark (02:38):
Insulin also seems to stimulate our sympathetic
nervous system.
Rachel (02:43):
The fight or flight system.
Mark (02:45):
Kind of yeah, Research back in the early 90s showed
this activation leads to afaster heart rate and,
importantly, a tightening of ourblood vessels.
Rachel (02:54):
Both things that raise blood pressure.
Mark (02:55):
Right, it's like the body is stuck in a more, you know,
heightened state of alert.
Rachel (02:59):
Hmm, that doesn't sound good for our arteries long term.
Mark (03:03):
It's not ideal.
Insulin resistance also messeswith the function of the inner
lining of our blood vessels, theendothelium.
Rachel (03:10):
How so.
Mark (03:11):
Well other work by Riven showed.
It impairs their ability torelax and widen.
It does this by reducing theavailability of a really
important molecule called nitricoxide.
Rachel (03:21):
Nitric oxide helps vessels relax.
Mark (03:24):
Exactly so.
Less nitric oxide means Nitricoxide helps vessels relax.
Exactly so.
Less nitric oxide means lessflexibility in the arteries.
It's called endothelialdysfunction.
Your vessels get stiffer.
There's more resistance toblood flow.
Rachel (03:34):
So it's not just a sugar issue.
It's actively making arteriesstiffer.
Mark (03:37):
Yes, it's directly impacting the mechanics of your
blood vessels.
Rachel (03:41):
And I guess inflammation probably plays a role too.
Mark (03:44):
Absolutely Elevated insulin tends to promote a sort
of low-grade chronicinflammation throughout the body
.
Rachel (03:50):
And that damages blood vessels.
Mark (03:52):
Over time.
Yes, it contributes to thatarterial stiffness we just
talked about.
It's really a multi-prongedattack on the circulatory system
.
Rachel (04:00):
It's kind of unsettling, isn't it, to think high blood
pressure might be an earlywarning sign of this metabolic
imbalance.
Mark (04:07):
It really is.
Rachel (04:08):
Showing up, maybe even before blood sugar goes
completely out of whack.
Mark (04:11):
That's a really crucial insight.
Hypertension can definitely bean early clue that things are
metabolically off balance.
Rachel (04:19):
Okay, so we get the how, but what's the actual evidence?
How strong is the link betweeninsulin resistance and
hypertension in the real world?
Mark (04:31):
The evidence is actually quite compelling.
Foundational work, again byRiven, and lots of studies on
metabolic syndrome consistentlyshow a really substantial
overlap.
How substantial we're talking?
Maybe 50 to 75 percent.
So half to three quarters ofpeople with primary hypertension
are also insulin resistant.
Rachel (04:48):
Wow, that's.
That's a huge percentage.
It is.
Mark (04:51):
And another study I think it was in the Journal of
Clinical Hypertension back in 97, found insulin resistance was
common in most patients withhigh blood pressure, regardless
of whether they were overweight.
Rachel (05:00):
Regardless of weight.
That's really important.
Mark (05:02):
Yes, it strongly suggests it's a metabolic thing, not just
tied to body weight.
Regardless of weight, that'sreally important.
Rachel (05:05):
Yes, it strongly suggests it's a metabolic thing,
not just tied to body weight,so even lean people could have
high blood pressure because ofinsulin resistance.
Mark (05:11):
Exactly.
And what's also fascinating isresearch in healthy people.
It found that even higherlevels of fasting insulin still
within the quote unquote normalrange.
Those higher levels areassociated with higher blood
pressure readings, moreresistance in the blood vessels
and the kidneys not excretingsodium as well.
Rachel (05:30):
So even slight increases in insulin might be having an
effect.
Mark (05:33):
It seems so, and maybe the most convincing part is the
intervention studies.
What do?
Rachel (05:38):
they show.
Mark (05:38):
Studies where they actively improved insulin
sensitivity, maybe throughlow-carb diets or certain
medications like metformin orpioglitazone.
Rachel (05:46):
Okay.
Mark (05:46):
They often show a drop in blood pressure that goes along
with it, even if there wasn'tmuch weight loss.
Rachel (05:52):
That really points towards a direct link, doesn't
it?
Mark (05:54):
It strongly suggests causality.
Yes, and there was this onestudy in the journal
Hypertension, I think around2004.
It showed people with insulinresistance had significant blood
pressure improvements afterjust four weeks of cutting carbs
.
Rachel (06:07):
Four weeks, that's fast.
Mark (06:09):
And importantly, this happened without changes in
weight or overall calories.
Rachel (06:14):
takeaway here seems to be insulin resistance isn't just
some risk factor for diabetesdown the road.
For many people it could be aroot cause of their high blood
pressure right now.
Precisely by tackling insulinresistance you're potentially
hitting hypertension at itsmetabolic source.
Okay, so we understand howinsulin resistance drives up
blood pressure.
(06:35):
Let's flip it now.
How does improving insulinsensitivity bring those numbers
down?
Mark (06:42):
right, it's basically like reversing those negative
effects we talked about okay sofirst, as insulin sensitivity
gets better, those highcirculating insulin levels start
to drop makes sense andremember dr defranzo's work on
the kidneys.
Lower insulin allows thekidneys to get better at
excreting sodium ah, so lesssodium, less sodium, retention.
Exactly.
Less.
Sodium means less retainedfluid, lower blood volume and
(07:03):
therefore lower blood pressure.
Rachel (07:05):
And this can happen quickly.
Mark (07:06):
It often does.
People starting low-carb orfasting often see a drop in
blood pressure within, say, one,two weeks, and that's often
attributed to this improvedkidney function.
Rachel (07:17):
That rapid response must be really encouraging for
people.
Mark (07:26):
What about the nervous system effect?
That calms down too.
Lower insulin levels helpreduce that sympathetic nervous
system overdrive.
Some research in the early 90sshowed this leads to less
constriction of blood vesselsand a slower heart rate.
Rachel (07:33):
So it lowers baseline pressure but maybe also helps
with those stress-related spikes.
Mark (07:38):
Exactly, it can help smooth things out.
Rachel (07:40):
Okay, so we're kind of resetting that fight-or-flight
tendency in the blood vesselsand the stiff arteries.
Does that improve?
Mark (07:47):
Yes, that endothelial function gets better too.
As insulin sensitivity improves, the ability of that inner
lining to produce nitric oxideis restored.
Some work from the mid-'90sdemonstrated this.
Rachel (08:00):
And nitric oxide means more relaxed, flexible vessels.
Mark (08:02):
Right.
More flexible arteries.
Lower overall resistance toblood flow.
Rachel (08:06):
Makes perfect sense, and the inflammation piece does
that get better as well?
Mark (08:10):
It usually does.
By reducing thathyperinsulinemia, we often see
inflammatory markers likeC-reactive protein or CRP go
down.
Rachel (08:18):
CRP measures inflammation right.
Mark (08:20):
Yes, and less inflammation means less contribution to
arterial stiffness and maybeslowing down that long-term
damage to blood vessels.
Rachel (08:29):
So it really is a comprehensive improvement across
the whole system.
Do we see this play out in realworld results?
Mark (08:35):
Oh yeah, absolutely.
Clinical experience and studiesshow people adopting low-carb
diets often see blood pressuredrops of, say, 10 to 15 points
millimHg, sometimes within justfour to eight weeks 10 to 15
points is significant.
It really is and even modestweight loss maybe 5 to 10
percent of body weight.
That's linked to better insulinsensitivity and improvements in
(08:56):
both the top and bottom bloodpressure numbers.
Rachel (08:59):
And you mentioned, sometimes blood pressure
improves before major weightloss.
Mark (09:02):
Yes, Some research, like studies from the late 90s,
showed exactly that, which againpoints to the reduction in
insulin itself being a keydriver, not just the weight loss
.
Rachel (09:12):
That's really powerful, and these improvements can
happen alongside medication useor even lead to needing less
medication.
Mark (09:18):
That's often a critical outcome, Because these lifestyle
changes are getting at theunderlying cause.
People frequently find they canreduce their dosage or maybe
even the number of bloodpressure pills they take.
Rachel (09:29):
Under medical supervision, of course.
Mark (09:31):
Absolutely Always.
But it underscores that this isa root cause approach.
You're not just maskingsymptoms.
Rachel (09:37):
OK, this is incredibly insightful.
Let's get really practical now.
What are some specific diet andlifestyle things that you, the
listener, could actuallyconsider doing to lower insulin
resistance and potentiallyimprove blood pressure?
Mark (09:49):
Yeah, the good news is there are several effective
strategies.
Probably one of the mostimpactful is shifting towards a
low carbohydrate or maybe even aketogenic diet.
Rachel (09:59):
How does that work?
Mark (10:00):
By cutting back significantly on carbs, you just
lower the demand for insulin.
Your body doesn't need toproduce as much.
This allows your cells togradually become more sensitive
again.
Rachel (10:09):
And the benefits.
Mark (10:10):
Well, research consistently shows lower fasting
insulin, lower glucose, lowertriglycerides that's a type of
blood fat, plus often weightloss, especially that dangerous
visceral fat around the organs.
Rachel (10:23):
And better blood pressure and vessel function.
Mark (10:25):
Exactly.
There was a 12-week keto dietstudy showing significant drops
in both HbA1c, which is averageblood sugar, and systolic blood
pressure, and that wasindependent of just cutting
calories.
Rachel (10:38):
So it's the type of calories, not just the amount.
What about timing?
Does when we eat matter?
Mark (10:43):
It definitely can.
Intermittent fasting ortime-restricted eating are also
really powerful tools.
How do they help?
By having dedicated periodswhere you're not eating, you
naturally reduce insulinsecretion, gives your cells a
break, allows them to becomemore responsive when you do eat.
Rachel (10:59):
Any examples.
Mark (11:00):
Even something like early time-restricted feeding say,
eating all your food between 8am and 4 pm has been shown in
studies to improve glucosemetabolism and lower blood
pressure.
Rachel (11:10):
Interesting.
So it's not just what, but when.
Okay, exercise, we know it'sgood, but how does it
specifically help here?
Mark (11:17):
Different types offer different benefits.
Resistance training, liftingweights, bodyweight exercises
that helps your muscles pull inmore glucose, making them more
insulin sensitive.
Then aerobic exercise walking,jogging, cycling that improves
how well your mitochondria work,those energy factories in your
cells, and boosts overallvascular health.
Rachel (11:35):
So a mix is good.
Mark (11:37):
Definitely, and even just moderate activity like taking a
walk after meals can help bluntthose post-meal spikes in
glucose and insulin.
Rachel (11:45):
What's a general recommendation?
Mark (11:47):
The American College of Sports Medicine suggests aiming
for at least 150 minutes a week,combining aerobic and strength
work.
That's been shown to improveinsulin sensitivity and can
lower systolic blood pressure byan average of 5 to 8 points.
Rachel (12:00):
Good to know.
What about other lifestylefactors like sleep and stress?
We hear about those a lot.
Mark (12:05):
Yeah, they're huge.
Poor sleep is independentlylinked to both insulin
resistance and high bloodpressure.
Not getting enough qualitysleep can ramp up cortisol, your
stress hormone, and increasethat sympathetic nervous system
activity.
Both of those impair howinsulin works.
So aim for generally seven tonine hours a night, ideally
trying to keep a consistentsleep-wake schedule.
(12:26):
And stress Chronic stress doesa similar thing elevates
cortisol.
Rachel (12:30):
Which contributes to insulin resistance and high
blood pressure.
Mark (12:33):
Right, so finding ways to manage stress is key.
Rachel (12:36):
Yeah.
Mark (12:36):
Things like deep breathing , meditation, yoga, tai chi.
These can help lower bothinsulin and that sympathetic
overdrive.
Rachel (12:44):
It really sounds like a whole body.
Holistic approach is needed.
Mark (12:48):
It truly is the most effective way.
Rachel (12:49):
Are there specific things people can track, like
blood markers, to see if they'reactually improving their
insulin sensitivity?
Mark (12:55):
Yes, definitely, tracking can be really motivating.
You can look at fasting insulinlevels.
That's a direct measure.
Okay, there's something calledHEAIRIR, which is a calculation
based on fasting glucose andinsulin, giving a good score for
insulin resistance.
Rachel (13:09):
NomiIR got it.
Mark (13:10):
The triglyceride to HDL cholesterol ratio is another
useful one.
Lower is generally better forinsulin sensitivity.
Rachel (13:17):
Triglyceride to HDL ratio.
Mark (13:19):
Okay, and waist circumference is a simple but
good proxy for visceral fat, andtracking C-reactive protein,
crp, can show changes ininflammation.
Rachel (13:29):
So monitoring.
These can give real feedback onprogress.
Mark (13:32):
Exactly.
It provides insights into howthe changes you're making are
impacting your metabolic healthand cardiovascular risk.
Rachel (13:39):
This gives people tangible things to aim for.
Now, let's be realistic.
Sometimes medication is stillneeded, right?
Mark (13:45):
Absolutely.
It's really important toacknowledge that For some people
, especially with very highblood pressure or other health
conditions, medication willstill be essential.
But the encouraging part isthat improving your underlying
insulin resistance can actuallymake those medications work
better.
Rachel (14:00):
Ah, so they can complement each other.
Mark (14:03):
Precisely.
It might allow for lower dosesor maybe fewer different types
of medication, always workingwith your doctor, of course.
Rachel (14:10):
That's a key point lifestyle and meds working
together.
Are there any meds that targetboth insulin resistance and
blood pressure?
Mark (14:17):
Yes, there are some interesting ones with dual
benefits.
Metformin, commonly used forblood sugar, can also improve
insulin sensitivity and mightmodestly lower blood pressure in
people with insulin resistance.
Rachel (14:29):
Okay, metformin.
Mark (14:30):
Then there are newer classes like GLP-1 receptor
agonist drugs like semaglutideor liraglutide.
They help with blood sugar,often cause weight loss and have
been shown to reduce bloodpressure too.
Rachel (14:41):
GLP-1s right.
Mark (14:42):
And SGLT-2 inhibitors like empagliflozin or dapagliflozin.
They lower blood sugar bymaking you excrete more glucose
in urine, but they also lowerblood pressure, reduce fluid
retention and have shown majorcardiovascular benefits.
Rachel (14:56):
So those are kind of hitting multiple pathways
related to metabolic health andblood pressure.
Mark (15:00):
Exactly.
They're interesting becausethey address some of the
underlying issues we've beendiscussing.
Rachel (15:05):
What about the more traditional blood pressure pills
like ACE inhibitors or ARBs?
Mark (15:11):
Even with those standard medications, things like
lisinopril or lisartan, peoplewho improve their insulin
sensitivity through diet andexercise often find they respond
better.
Rachel (15:20):
Meaning they might need lower doses.
Mark (15:22):
Yes, potentially lower doses for the same effect and
maybe fewer side effects.
Interestingly, some of thosetraditional meds like ACE
inhibitors and ARBs actuallyhave some favorable effects on
insulin signaling themselves.
Rachel (15:34):
So it's not really an either.
Mark (15:36):
Not at all.
Think of medication as asupportive tool.
Improving your metabolic healthcan make that tool even more
effective.
It's definitely not a sign thatlifestyle changes have failed
if you still need medication.
Rachel (15:48):
That's a really helpful perspective.
Mark (15:50):
Yeah.
Rachel (15:51):
So, OK, let's try and bring this all together.
The really key insight here isthat high blood pressure for
many, many people isn't justthis isolated issue.
Mark (16:01):
No, it's very often a downstream consequence of that
underlying metabolic problemInsulin resistance.
Rachel (16:07):
Right.
All the research we've talkedabout points to this idea that
when our bodies don't respondwell to insulin, it triggers
these effects.
Mark (16:14):
Yeah, the increased sodium retention by the kidneys, more
low-grade inflammation, thattightening and stiffening of
blood vessels, while drivingblood pressure up.
Exactly.
Rachel (16:22):
But the really optimistic part of this whole
conversation is that it's notnecessarily a one-way street.
Mark (16:27):
That's the crucial message .
Rachel (16:28):
Yeah.
Mark (16:29):
This process seems to be reversible for many people by
directly targeting the insulinresistance, using those
strategic dietary changes maybelower carb, maybe focusing on
whole foods, getting regularexercise, including strength
training.
Rachel (16:43):
Exploring time-restricted eating, managing
sleep and stress.
Mark (16:47):
By doing those things, many people have the potential
to significantly lower theirblood pressure, maybe reduce or
even get off their medicationseventually.
Rachel (16:57):
While improving their overall metabolic health at the
same time.
Mark (17:00):
Exactly, it's a win-win.
Rachel (17:01):
So it really boils down to getting at the root cause,
doesn't it, rather than justmanaging the symptom, the high
number?
Mark (17:08):
That's the fundamental shift in thinking addressing the
underlying physiology.
Rachel (17:12):
So maybe the final thought for you, the listener,
is this Could managing yourmetabolic health be the real key
to long-term blood pressurecontrol and just better overall
well-being?
Mark (17:23):
It's definitely worth considering.
Rachel (17:24):
Maybe it's time to get curious about your own fasting
insulin levels, that HOMA-IRscore, those other markers we
mentioned.
Mark (17:30):
It could really offer a completely different perspective
on managing your health journey.
Nicolette (17:41):
Thanks for tuning into the Health Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics, visit us online at
wwwquicklabmobilecom.
Stay informed, stay healthy andwe'll catch you in the next
episode.
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Rachel (00:25):
Think about this Nearly half of all adults have high
blood pressure.
It's so incredibly common.
It really is.
We often just focus on, youknow, managing those numbers.
But what if that condition isactually a signal?
Mark (00:39):
The signal pointing to something deeper, exactly.
Rachel (00:42):
Maybe a less obvious but more fundamental issue
happening in our bodies.
Mark (00:47):
That's really the key question we're tackling today,
because, well, there's a lot ofresearch now indicating that a
major driver of primaryhypertension is insulin
resistance.
Rachel (00:56):
Hypertension without a clear secondary cause right.
Mark (00:59):
Right, and Dr Gerald Riven , who is a real pioneer here,
put it very clearly.
He basically said insulinresistance isn't just about
blood sugar.
Rachel (01:06):
Okay.
Mark (01:07):
It has these really profound effects on blood
pressure, how we handle fats andeven inflammation levels.
Rachel (01:13):
Okay, let's unpack this then.
So our deep dive today is allabout exploring that scientific
link insulin resistance and highblood pressure.
Mark (01:20):
Yeah, we want to understand how this often sort
of silent metabolic issue canpush blood pressure up.
Rachel (01:27):
And, crucially, what we can maybe do about it.
Through lifestyle changes Canwe potentially reverse this.
Mark (01:34):
Precisely.
We'll be looking at the medicalliterature, expert insights, to
help you understand thisimportant connection.
Rachel (01:41):
Now most of us, I think.
We hear insulin and weimmediately think blood sugar
control.
Mark (01:46):
That's the primary role, yes, helping cells take in
glucose.
Rachel (01:50):
But it sounds like it's doing a lot more.
Mark (01:52):
Oh, absolutely.
Insulin also has a significantinfluence on our kids.
Rachel (01:58):
OK, this is where it gets really interesting.
How does this extra insulinactually make blood pressure go
up?
Let's dig into the specifics.
Mark (02:05):
Okay, so one of the main ways is through sodium retention
.
Rachel (02:09):
Sodium like salt.
Mark (02:11):
Yes, High insulin levels basically tell the kidneys to
hang on to more sodium and water.
Some groundbreaking work backin the early 80s really
highlighted this.
Rachel (02:20):
So more retained fluid means more volume in the blood.
Mark (02:23):
And higher pressure Exactly, and this can be a
pretty rapid change actually.
Rachel (02:28):
So it's not just how much salt you eat, but how your
kidneys handle it, based oninsulin.
Mark (02:33):
That's a key connection many people miss yeah.
Rachel (02:35):
Wow, so our kidneys are getting the wrong message.
What else is happening?
Mark (02:38):
Insulin also seems to stimulate our sympathetic
nervous system.
Rachel (02:43):
The fight or flight system.
Mark (02:45):
Kind of yeah, Research back in the early 90s showed
this activation leads to afaster heart rate and,
importantly, a tightening of ourblood vessels.
Rachel (02:54):
Both things that raise blood pressure.
Mark (02:55):
Right, it's like the body is stuck in a more, you know,
heightened state of alert.
Rachel (02:59):
Hmm, that doesn't sound good for our arteries long term.
Mark (03:03):
It's not ideal.
Insulin resistance also messeswith the function of the inner
lining of our blood vessels, theendothelium.
Rachel (03:10):
How so.
Mark (03:11):
Well other work by Riven showed.
It impairs their ability torelax and widen.
It does this by reducing theavailability of a really
important molecule called nitricoxide.
Rachel (03:21):
Nitric oxide helps vessels relax.
Mark (03:24):
Exactly so.
Less nitric oxide means Nitricoxide helps vessels relax.
Exactly so.
Less nitric oxide means lessflexibility in the arteries.
It's called endothelialdysfunction.
Your vessels get stiffer.
There's more resistance toblood flow.
Rachel (03:34):
So it's not just a sugar issue.
It's actively making arteriesstiffer.
Mark (03:37):
Yes, it's directly impacting the mechanics of your
blood vessels.
Rachel (03:41):
And I guess inflammation probably plays a role too.
Mark (03:44):
Absolutely Elevated insulin tends to promote a sort
of low-grade chronicinflammation throughout the body
.
Rachel (03:50):
And that damages blood vessels.
Mark (03:52):
Over time.
Yes, it contributes to thatarterial stiffness we just
talked about.
It's really a multi-prongedattack on the circulatory system
.
Rachel (04:00):
It's kind of unsettling, isn't it, to think high blood
pressure might be an earlywarning sign of this metabolic
imbalance.
Mark (04:07):
It really is.
Rachel (04:08):
Showing up, maybe even before blood sugar goes
completely out of whack.
Mark (04:11):
That's a really crucial insight.
Hypertension can definitely bean early clue that things are
metabolically off balance.
Rachel (04:19):
Okay, so we get the how, but what's the actual evidence?
How strong is the link betweeninsulin resistance and
hypertension in the real world?
Mark (04:31):
The evidence is actually quite compelling.
Foundational work, again byRiven, and lots of studies on
metabolic syndrome consistentlyshow a really substantial
overlap.
How substantial we're talking?
Maybe 50 to 75 percent.
So half to three quarters ofpeople with primary hypertension
are also insulin resistant.
Rachel (04:48):
Wow, that's.
That's a huge percentage.
It is.
Mark (04:51):
And another study I think it was in the Journal of
Clinical Hypertension back in 97, found insulin resistance was
common in most patients withhigh blood pressure, regardless
of whether they were overweight.
Rachel (05:00):
Regardless of weight.
That's really important.
Mark (05:02):
Yes, it strongly suggests it's a metabolic thing, not just
tied to body weight.
Regardless of weight, that'sreally important.
Rachel (05:05):
Yes, it strongly suggests it's a metabolic thing,
not just tied to body weight,so even lean people could have
high blood pressure because ofinsulin resistance.
Mark (05:11):
Exactly.
And what's also fascinating isresearch in healthy people.
It found that even higherlevels of fasting insulin still
within the quote unquote normalrange.
Those higher levels areassociated with higher blood
pressure readings, moreresistance in the blood vessels
and the kidneys not excretingsodium as well.
Rachel (05:30):
So even slight increases in insulin might be having an
effect.
Mark (05:33):
It seems so, and maybe the most convincing part is the
intervention studies.
What do?
Rachel (05:38):
they show.
Mark (05:38):
Studies where they actively improved insulin
sensitivity, maybe throughlow-carb diets or certain
medications like metformin orpioglitazone.
Rachel (05:46):
Okay.
Mark (05:46):
They often show a drop in blood pressure that goes along
with it, even if there wasn'tmuch weight loss.
Rachel (05:52):
That really points towards a direct link, doesn't
it?
Mark (05:54):
It strongly suggests causality.
Yes, and there was this onestudy in the journal
Hypertension, I think around2004.
It showed people with insulinresistance had significant blood
pressure improvements afterjust four weeks of cutting carbs
.
Rachel (06:07):
Four weeks, that's fast.
Mark (06:09):
And importantly, this happened without changes in
weight or overall calories.
Rachel (06:14):
takeaway here seems to be insulin resistance isn't just
some risk factor for diabetesdown the road.
For many people it could be aroot cause of their high blood
pressure right now.
Precisely by tackling insulinresistance you're potentially
hitting hypertension at itsmetabolic source.
Okay, so we understand howinsulin resistance drives up
blood pressure.
(06:35):
Let's flip it now.
How does improving insulinsensitivity bring those numbers
down?
Mark (06:42):
right, it's basically like reversing those negative
effects we talked about okay sofirst, as insulin sensitivity
gets better, those highcirculating insulin levels start
to drop makes sense andremember dr defranzo's work on
the kidneys.
Lower insulin allows thekidneys to get better at
excreting sodium ah, so lesssodium, less sodium, retention.
Exactly.
Less.
Sodium means less retainedfluid, lower blood volume and
(07:03):
therefore lower blood pressure.
Rachel (07:05):
And this can happen quickly.
Mark (07:06):
It often does.
People starting low-carb orfasting often see a drop in
blood pressure within, say, one,two weeks, and that's often
attributed to this improvedkidney function.
Rachel (07:17):
That rapid response must be really encouraging for
people.
Mark (07:26):
What about the nervous system effect?
That calms down too.
Lower insulin levels helpreduce that sympathetic nervous
system overdrive.
Some research in the early 90sshowed this leads to less
constriction of blood vesselsand a slower heart rate.
Rachel (07:33):
So it lowers baseline pressure but maybe also helps
with those stress-related spikes.
Mark (07:38):
Exactly, it can help smooth things out.
Rachel (07:40):
Okay, so we're kind of resetting that fight-or-flight
tendency in the blood vesselsand the stiff arteries.
Does that improve?
Mark (07:47):
Yes, that endothelial function gets better too.
As insulin sensitivity improves, the ability of that inner
lining to produce nitric oxideis restored.
Some work from the mid-'90sdemonstrated this.
Rachel (08:00):
And nitric oxide means more relaxed, flexible vessels.
Mark (08:02):
Right.
More flexible arteries.
Lower overall resistance toblood flow.
Rachel (08:06):
Makes perfect sense, and the inflammation piece does
that get better as well?
Mark (08:10):
It usually does.
By reducing thathyperinsulinemia, we often see
inflammatory markers likeC-reactive protein or CRP go
down.
Rachel (08:18):
CRP measures inflammation right.
Mark (08:20):
Yes, and less inflammation means less contribution to
arterial stiffness and maybeslowing down that long-term
damage to blood vessels.
Rachel (08:29):
So it really is a comprehensive improvement across
the whole system.
Do we see this play out in realworld results?
Mark (08:35):
Oh yeah, absolutely.
Clinical experience and studiesshow people adopting low-carb
diets often see blood pressuredrops of, say, 10 to 15 points
millimHg, sometimes within justfour to eight weeks 10 to 15
points is significant.
It really is and even modestweight loss maybe 5 to 10
percent of body weight.
That's linked to better insulinsensitivity and improvements in
(08:56):
both the top and bottom bloodpressure numbers.
Rachel (08:59):
And you mentioned, sometimes blood pressure
improves before major weightloss.
Mark (09:02):
Yes, Some research, like studies from the late 90s,
showed exactly that, which againpoints to the reduction in
insulin itself being a keydriver, not just the weight loss
.
Rachel (09:12):
That's really powerful, and these improvements can
happen alongside medication useor even lead to needing less
medication.
Mark (09:18):
That's often a critical outcome, Because these lifestyle
changes are getting at theunderlying cause.
People frequently find they canreduce their dosage or maybe
even the number of bloodpressure pills they take.
Rachel (09:29):
Under medical supervision, of course.
Mark (09:31):
Absolutely Always.
But it underscores that this isa root cause approach.
You're not just maskingsymptoms.
Rachel (09:37):
OK, this is incredibly insightful.
Let's get really practical now.
What are some specific diet andlifestyle things that you, the
listener, could actuallyconsider doing to lower insulin
resistance and potentiallyimprove blood pressure?
Mark (09:49):
Yeah, the good news is there are several effective
strategies.
Probably one of the mostimpactful is shifting towards a
low carbohydrate or maybe even aketogenic diet.
Rachel (09:59):
How does that work?
Mark (10:00):
By cutting back significantly on carbs, you just
lower the demand for insulin.
Your body doesn't need toproduce as much.
This allows your cells togradually become more sensitive
again.
Rachel (10:09):
And the benefits.
Mark (10:10):
Well, research consistently shows lower fasting
insulin, lower glucose, lowertriglycerides that's a type of
blood fat, plus often weightloss, especially that dangerous
visceral fat around the organs.
Rachel (10:23):
And better blood pressure and vessel function.
Mark (10:25):
Exactly.
There was a 12-week keto dietstudy showing significant drops
in both HbA1c, which is averageblood sugar, and systolic blood
pressure, and that wasindependent of just cutting
calories.
Rachel (10:38):
So it's the type of calories, not just the amount.
What about timing?
Does when we eat matter?
Mark (10:43):
It definitely can.
Intermittent fasting ortime-restricted eating are also
really powerful tools.
How do they help?
By having dedicated periodswhere you're not eating, you
naturally reduce insulinsecretion, gives your cells a
break, allows them to becomemore responsive when you do eat.
Rachel (10:59):
Any examples.
Mark (11:00):
Even something like early time-restricted feeding say,
eating all your food between 8am and 4 pm has been shown in
studies to improve glucosemetabolism and lower blood
pressure.
Rachel (11:10):
Interesting.
So it's not just what, but when.
Okay, exercise, we know it'sgood, but how does it
specifically help here?
Mark (11:17):
Different types offer different benefits.
Resistance training, liftingweights, bodyweight exercises
that helps your muscles pull inmore glucose, making them more
insulin sensitive.
Then aerobic exercise walking,jogging, cycling that improves
how well your mitochondria work,those energy factories in your
cells, and boosts overallvascular health.
Rachel (11:35):
So a mix is good.
Mark (11:37):
Definitely, and even just moderate activity like taking a
walk after meals can help bluntthose post-meal spikes in
glucose and insulin.
Rachel (11:45):
What's a general recommendation?
Mark (11:47):
The American College of Sports Medicine suggests aiming
for at least 150 minutes a week,combining aerobic and strength
work.
That's been shown to improveinsulin sensitivity and can
lower systolic blood pressure byan average of 5 to 8 points.
Rachel (12:00):
Good to know.
What about other lifestylefactors like sleep and stress?
We hear about those a lot.
Mark (12:05):
Yeah, they're huge.
Poor sleep is independentlylinked to both insulin
resistance and high bloodpressure.
Not getting enough qualitysleep can ramp up cortisol, your
stress hormone, and increasethat sympathetic nervous system
activity.
Both of those impair howinsulin works.
So aim for generally seven tonine hours a night, ideally
trying to keep a consistentsleep-wake schedule.
(12:26):
And stress Chronic stress doesa similar thing elevates
cortisol.
Rachel (12:30):
Which contributes to insulin resistance and high
blood pressure.
Mark (12:33):
Right, so finding ways to manage stress is key.
Rachel (12:36):
Yeah.
Mark (12:36):
Things like deep breathing , meditation, yoga, tai chi.
These can help lower bothinsulin and that sympathetic
overdrive.
Rachel (12:44):
It really sounds like a whole body.
Holistic approach is needed.
Mark (12:48):
It truly is the most effective way.
Rachel (12:49):
Are there specific things people can track, like
blood markers, to see if they'reactually improving their
insulin sensitivity?
Mark (12:55):
Yes, definitely, tracking can be really motivating.
You can look at fasting insulinlevels.
That's a direct measure.
Okay, there's something calledHEAIRIR, which is a calculation
based on fasting glucose andinsulin, giving a good score for
insulin resistance.
Rachel (13:09):
NomiIR got it.
Mark (13:10):
The triglyceride to HDL cholesterol ratio is another
useful one.
Lower is generally better forinsulin sensitivity.
Rachel (13:17):
Triglyceride to HDL ratio.
Mark (13:19):
Okay, and waist circumference is a simple but
good proxy for visceral fat, andtracking C-reactive protein,
crp, can show changes ininflammation.
Rachel (13:29):
So monitoring.
These can give real feedback onprogress.
Mark (13:32):
Exactly.
It provides insights into howthe changes you're making are
impacting your metabolic healthand cardiovascular risk.
Rachel (13:39):
This gives people tangible things to aim for.
Now, let's be realistic.
Sometimes medication is stillneeded, right?
Mark (13:45):
Absolutely.
It's really important toacknowledge that For some people
, especially with very highblood pressure or other health
conditions, medication willstill be essential.
But the encouraging part isthat improving your underlying
insulin resistance can actuallymake those medications work
better.
Rachel (14:00):
Ah, so they can complement each other.
Mark (14:03):
Precisely.
It might allow for lower dosesor maybe fewer different types
of medication, always workingwith your doctor, of course.
Rachel (14:10):
That's a key point lifestyle and meds working
together.
Are there any meds that targetboth insulin resistance and
blood pressure?
Mark (14:17):
Yes, there are some interesting ones with dual
benefits.
Metformin, commonly used forblood sugar, can also improve
insulin sensitivity and mightmodestly lower blood pressure in
people with insulin resistance.
Rachel (14:29):
Okay, metformin.
Mark (14:30):
Then there are newer classes like GLP-1 receptor
agonist drugs like semaglutideor liraglutide.
They help with blood sugar,often cause weight loss and have
been shown to reduce bloodpressure too.
Rachel (14:41):
GLP-1s right.
Mark (14:42):
And SGLT-2 inhibitors like empagliflozin or dapagliflozin.
They lower blood sugar bymaking you excrete more glucose
in urine, but they also lowerblood pressure, reduce fluid
retention and have shown majorcardiovascular benefits.
Rachel (14:56):
So those are kind of hitting multiple pathways
related to metabolic health andblood pressure.
Mark (15:00):
Exactly.
They're interesting becausethey address some of the
underlying issues we've beendiscussing.
Rachel (15:05):
What about the more traditional blood pressure pills
like ACE inhibitors or ARBs?
Mark (15:11):
Even with those standard medications, things like
lisinopril or lisartan, peoplewho improve their insulin
sensitivity through diet andexercise often find they respond
better.
Rachel (15:20):
Meaning they might need lower doses.
Mark (15:22):
Yes, potentially lower doses for the same effect and
maybe fewer side effects.
Interestingly, some of thosetraditional meds like ACE
inhibitors and ARBs actuallyhave some favorable effects on
insulin signaling themselves.
Rachel (15:34):
So it's not really an either.
Mark (15:36):
Not at all.
Think of medication as asupportive tool.
Improving your metabolic healthcan make that tool even more
effective.
It's definitely not a sign thatlifestyle changes have failed
if you still need medication.
Rachel (15:48):
That's a really helpful perspective.
Mark (15:50):
Yeah.
Rachel (15:51):
So, OK, let's try and bring this all together.
The really key insight here isthat high blood pressure for
many, many people isn't justthis isolated issue.
Mark (16:01):
No, it's very often a downstream consequence of that
underlying metabolic problemInsulin resistance.
Rachel (16:07):
Right.
All the research we've talkedabout points to this idea that
when our bodies don't respondwell to insulin, it triggers
these effects.
Mark (16:14):
Yeah, the increased sodium retention by the kidneys, more
low-grade inflammation, thattightening and stiffening of
blood vessels, while drivingblood pressure up.
Exactly.
Rachel (16:22):
But the really optimistic part of this whole
conversation is that it's notnecessarily a one-way street.
Mark (16:27):
That's the crucial message .
Rachel (16:28):
Yeah.
Mark (16:29):
This process seems to be reversible for many people by
directly targeting the insulinresistance, using those
strategic dietary changes maybelower carb, maybe focusing on
whole foods, getting regularexercise, including strength
training.
Rachel (16:43):
Exploring time-restricted eating, managing
sleep and stress.
Mark (16:47):
By doing those things, many people have the potential
to significantly lower theirblood pressure, maybe reduce or
even get off their medicationseventually.
Rachel (16:57):
While improving their overall metabolic health at the
same time.
Mark (17:00):
Exactly, it's a win-win.
Rachel (17:01):
So it really boils down to getting at the root cause,
doesn't it, rather than justmanaging the symptom, the high
number?
Mark (17:08):
That's the fundamental shift in thinking addressing the
underlying physiology.
Rachel (17:12):
So maybe the final thought for you, the listener,
is this Could managing yourmetabolic health be the real key
to long-term blood pressurecontrol and just better overall
well-being?
Mark (17:23):
It's definitely worth considering.
Rachel (17:24):
Maybe it's time to get curious about your own fasting
insulin levels, that HOMA-IRscore, those other markers we
mentioned.
Mark (17:30):
It could really offer a completely different perspective
on managing your health journey.
Nicolette (17:41):
Thanks for tuning into the Health Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics, visit us online at
wwwquicklabmobilecom.
Stay informed, stay healthy andwe'll catch you in the next
episode.
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