March 13, 2025 • 47 mins
Did you know that one in four Australians could be silently battling hypertension without even realizing it? In this compelling episode, we dive deep with experienced naturopath Tracee Blythe into the often-overlooked relationship between blood pressure, diabetes, and the transformative potential of integrative medicine approaches.
With nearly two decades of clinical expertise, Tracee unveils the concerning statistics behind Australia's hypertension crisis while offering fellow naturopaths a fresh perspective on co-prescribing strategies that bridge conventional and natural medicine. You'll discover how commonly prescribed anti-hypertensive medications can deplete essential nutrients in your patients—and how targeted natural interventions can effectively address these imbalances.
This episode delivers practice-changing insights on:
- Evidence-based natural interventions, including garlic and omega-3 supplements that rival pharmaceutical outcomes
- How to confidently integrate complementary approaches alongside conventional treatments
- Patient-centred strategies for home monitoring that dramatically improve clinical outcomes
- The critical nutritional considerations often missed in conventional treatment plans
- Practical frameworks for co-prescribing that enhance your clinical effectiveness
Whether you're supporting patients with established hypertension or focusing on preventative care, this conversation offers actionable protocols that expand your clinical toolkit. The scientific evidence is clear: lifestyle and nutritional interventions can produce results comparable to medications—knowledge that empowers your practice and transforms patient outcomes.
Don't miss Tracee's upcoming educational webinar designed specifically for naturopathic practitioners looking to master the art of co-prescribing in hypertension management.
Register for Tracee's webinar here: Webinar: Integrative Co-Prescribing Anti-Hypertensive Medications
Connect with Tracee: Tracee Blythe Consulting
Subscribe to the podcast and leave a review to help us spread the word about this critical health conversation!
Shownotes and references are available on the Designs for Health website
Register as a Designs for Health Practitioner and discover quality practitioner- only supplements at www.designsforhealth.com.au
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DISCLAIMER: The Information provided in the Wellness by Designs podcast is for educational purposes only; the information presented is not intended to be used as medical advice; please seek the advice of a qualified healthcare professional if what you have heard here today raises questions or concerns relating to your health
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:12):
This is Wellness by Designs, and I'm your host, amy
Skilton, and joining us today isnaturopath Tracey Blythe, and
I'm very excited to be talkingto her about co-prescribing with
anti-hypertensive medications.
Co-prescribing with anypharmaceutical medication is a
huge subject and she isabsolutely the resident expert
(00:35):
here on this.
But let me introduce herproperly first.
Tracy is a naturopath of 19years and has a goal for the
community to have greater accessto quality complementary
medicines whilst receiving thebest evidence-based advice from
qualified practitioners.
Her career has been spent inhealth food stores and pharmacy,
(00:58):
supporting patients with theirhealth and educating and growing
the practitioner supplementspace in Western Australia, and
more recently, in addition toall of that, tracey creates and
delivers education to otherpractitioners Australia-wide.
Welcome to the podcast, tracey.
Speaker 2 (01:18):
Thank you, Amy, and thank you for that wonderful
introduction.
Speaker 1 (01:21):
Oh, it's such a pleasure to have you here, and I
will let everybody know upfrontthat we are very fortunate to
have Tracy delivering a webinarfor us in the not too distant
future that actually covers thecomplementary medicine
co-prescription framework, whichyou can use to support patients
(01:43):
that are on blood pressurelowering medication and also
reduce their risk of developingdiabetes, and we're lucky,
though, to have snagged her fora little pre-webinar chat where
we're going to touch on some ofthose key points and why, if you
are a practitioner working inthis space of cardiovascular
(02:03):
health or metabolic syndrome,that it's a must attend.
So, tracy, why don't we startwith the challenges of high
blood pressure, how prevalent itis and really what we're
looking at as a society when itcomes to, you know, things like
diabetes and blood pressure andreally the intersection where
(02:25):
they meet for people?
Speaker 2 (02:28):
Yeah, absolutely, amy .
It's an interesting topic, Ithink, because the prevalence is
just that it's everywhere andmost of the people that are
experiencing it don't even knowwhen we have high blood pressure
.
We may not even feel it.
A lot of people's diagnosiscomes on the end of sitting at
(02:48):
the uh at the doctor's officeand having their blood pressure
measured and being told theyhave high blood pressure um,
before that they're going abouttheir business.
I think that it's somethingabout a quarter of australians
are currently um going aroundwith uncontrolled hypertension
as we speak.
So that's, on average, ofpatients walking into clinic,
(03:10):
one in four of those may havehypertension and not even know
it, and that this is a numberthat, whilst it's not rising,
it's been the same for years,and it's something that has just
not been addressed in terms ofhow do we help these people
beyond giving them more and moreand more medications.
Speaker 1 (03:34):
It is really scary, when you put it like that, that
a quarter of us are walkingaround without realising that
there is this silent killer onboard and I think, with the
exception of really extremehypertension, most people don't
have symptoms, which is why, youknow, sometimes people find out
(03:56):
the hard way that it's beensitting in the background.
And I think that reallyhighlights the importance of,
you know, annual checkups, at abare minimum, and making sure
you request it to be done whenyou are seeing your doctor for
annual blood tests.
And I think, furthermore,particularly since COVID but
telehealth has been around forlonger than that If you are, you
(04:19):
know, as a clinician primarilyworking in telehealth, which is
certainly the case for me I'mnot able to take my client's
blood pressure because they'renot seeing me here in person.
So actually making sure that'son the intake form and there's
regular you know diary remindersfor assessing that, so that
that important piece ofinformation can be picked up,
(04:41):
because that damage occurring inthe background can create all
kinds of other problems and forthose that then like do have
that picked up, as you said,it's often by accident, they
might've arrived at the doctorfor you know something else and
the GP is like let's just checkyour blood pressure while you're
here and then, whoie daisy,this is, you know, heading
(05:04):
towards stroke territoryimmediately.
There is going to be aprescription written, and I
understand this approach, by theway, and I think I'll just say
up front that, regardless ofwhat you do, we're all in
agreement that addressing theroot causes of high blood
pressure and bringing your bloodpressure down immediately are
(05:24):
not mutually exclusive.
They both must be addressed,and what that means is
medication initially mayactually be the right step or it
may be an alternative treatment, but regardless, what usually
happens is people are confrontedwith a diagnosis of
hypertension in the doctor'soffice and they're immediately
given a prescription for youknow, one or two medications,
(05:48):
and I'd love to hear from you,like, really, what are you
commonly seeing being prescribedat the moment?
There's a couple of differentclasses that get recommended,
sometimes independently,sometimes together.
What's the landscape lookinglike at the moment?
Speaker 2 (06:03):
Yeah, look, currently there are 37 different drugs
that the doctor has to choosefrom in that situation.
Yeah, and they get grouped.
There's a few different ways,but essentially there's across
five different drug classes.
You've got your ACE inhibitors,your angiotensin receptor
blockers, your calcium channelblockers, your beta blockers,
(06:24):
your angiotensin receptorblockers, your calcium channel
blockers, your beta blockers,and then the good old favorites,
the diuretics, which, for allof those, are actually groups
within groups that are oftenprescribed.
And further to your comment, Amy, about when somebody has a
diagnosis of hypertension andthat the initial response being
a prescription of medication,initial response being a
(06:47):
prescription of medication, thisis where and why I do what I do
, as a naturopath who'spassionate about everybody being
informed and educated on thesemedicines and how complementary
medicines intersect In theinstance of somebody with
uncontrolled very high bloodpressure.
The interventions that I'll betalking in much more depth in
the webinar but that we'll bediscussing today, these
(07:07):
interventions are eight week, 12week, sometimes 24 week trials
that are seeing, you know, somegood benefits over that period
of time.
We want responses quickly andthat's why we need to know that
what we can do is safe for ourpatients.
That we can.
A patient can come newlydiagnosed with hypertension and,
you know, one or, statistically, two drugs under their belt.
(07:31):
Come to see us that we can thensafely 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 tocome up with some of the
complementary medicines we mightbe able to prescribe as well.
But it is an important firststep is not to say throw those
(07:52):
medicines out.
Let me give you somenaturopathic support.
You don't need those medicines.
The statistics on seriouscardiovascular events tell us
that.
First, do no harm for ourpatients.
Speaker 1 (08:06):
Absolutely.
Yeah, I think that's a reallyimportant point to make and, as
you said, a swift response is,you know, paramount in those
situations.
And then you can always look ata bit more of a medium
long-term view, and I like thatyou 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
(08:33):
be set.
I know, for I'm generalizinghere, but I imagine for a large
majority of patients that seenaturopaths, they would likely
have a goal of I'd like to beable to manage this without
medication, and for many peoplethat is possible and for some it
might not be.
It might simply be, you know,beyond beyond that scope and for
some degree of pharmaceuticalsmight, might be necessary, but I
(08:54):
liked how you put that you canalso consider adjunctive
treatment, which might allow youto manage your blood pressure
with perhaps a lower dose, takea bit of pressure off the liver
or the kidneys and thereforehave better outcomes in that
regard.
So not necessarily using one orthe other, but a combined
(09:15):
approach allows a lower doseoverall.
One thing we haven't touched onyet, but we will, is the
nutrient depletion, and I guessmitigating the side effects of
medications might be anothergoal or outcome, and I think in
a perfect world although thisprobably doesn't often happen,
(09:35):
it's always nice to aim for.
Let's see if we can get you tonot need anything, although I
think in order to achieve that,it's a combination of many
things, including very deepcommitment on the patient's part
.
Wouldn't you agree?
Speaker 2 (09:51):
Yes, 100% and you do get those patients, those
beautiful unicorns.
But we also get the fullvariety, the full spectrum of
people where switching one pillfor another is you know where
there are less, less sideeffects.
And absolutely, when it comesto blood pressure medications,
(10:14):
the statistics around beingprescribed one and then shortly
thereafter two, about beingprescribed a third, even it's
more than half, around half ofthe people that take a blood
pressure medication actuallytake two or more.
That with that adjunctivetherapies, we can ensure that
we're being safe with ourpatients by using their medicine
(10:35):
.
But, as you said, the lessmedicines we add, what we're
able to do is absolutely thenumbers tell us the lower dose
or the less blood pressuremedicine that you're taking, the
less likely you are to developsignificant or severe side
effects.
And when it comes to nutrientdepletions, that's a cause close
(10:55):
to my heart.
I have to say, when I look atthe evidence around depletions
of nutrients from all sorts ofdifferent drugs, that the dose
she makes the poison, that thehigher the dose of the medicine,
the more significant and severethe depletions are, and so
keeping those doses lower alsothen reduces our need to be
(11:15):
adding in a big laundry list ofnutrients to just bring somebody
back to an even keel, which isjust good health for our
patients.
It doesn't involve a long listof drugs, then a long list of
supplements to ameliorate theside effects of those drugs.
Speaker 1 (11:32):
And I think even across the board, not just in
cardiovascular health thatslippery slope of one medication
inducing an issue that thenrequires another medication and
another.
You know, we all see it.
You know friends, family, olderpatients, our own patients
where you end up with a hugelaundry list of medications that
(11:53):
are all playingring-a-ring-a-rosy with each
other.
Speaker 2 (11:58):
Yeah, and that's the.
I suppose that's the excitingpart of this webinar that I
can't wait to share with all thelisteners, for Designs for
Health is a particular start tothat ring-a-rosy kind of thing
that occurs with blood pressuremedicines.
There's a couple of them whereone of the side effects is a
(12:20):
dysglycemia or poor response toinsulin, insulin production
which then leads tosignificantly increased rates of
new onset diabetes.
And so there is what we know asthe cardiometabolic triad, the
statistics around patients who,once they develop hypertension,
(12:41):
once they're diagnosed with highcholesterol or diabetes any of
those three it's like the othertwo shortly follow, and
medication for those two shortlyfollows that they are
conditions that have commondrivers, and so they're driven
by some, you know, genetics orlifestyle or whatever that is
(13:04):
driving those conditions.
But what can accelerate orexacerbate the triad of those
three conditions forming?
For some things, it's themedicine itself, and so
particularly the thiazidediuretics and the non-selective
beta blockers particularly, havebeen found to have this impact
(13:26):
of hastening or bringing on adiagnosis of diabetes, which is
then, as you said earlier, thatring a rosy.
That that's what happens.
We go from one and maybe twoblood pressure medicines and
shortly thereafter,statistically it tells us that
the incidence of development ofdiabetes just goes through the
roof.
Speaker 1 (13:48):
And what a shame to be confronted with a
life-threatening issue in termsof high blood pressure and then
the course of action that youtake to address that then causes
a second problem and then thedominoes fall from there.
And I think you know the areain which you provide the most
amazing practitioner educationis first of all the awareness
(14:12):
around that.
You know.
Education is first of all theawareness around that.
You know um, if someone wasfully informed, you know which,
which is, I think, impossible todo in the current um landscape
of allopathic medicine, um 15minute consults, 10 minute
consults you can't possibly talksomeone through the benefits,
risks.
You know the 37 different drugs, the classes within classes.
(14:32):
You just have to make a call asa doctor and be like, okay,
let's just start here.
But I think, as a patient, ifyou knew that non-selective beta
blockers and thiazide diureticsthen set you up for dysglycemia
and potentially diabetes downthe track, would you make a
different choice.
Or would you, if they wereconsidered to be the best, then
(14:56):
perhaps invest in a cgmcontinuous glucose monitor, or
would you then begin to addresssome of the drivers, which of
course is metabolic dysfunctionand insulin issues?
Anyway, like it's very much,you know, um, you take the
immediate emergency off thetable but you create a bigger
mess behind the scenes, withouteven originally addressing the
(15:20):
original mess that created thehigh blood pressure in the first
place.
But certainly in the space thatyou work in, this is something
that you really understand verydeeply and I know in the
upcoming webinar you're going totalk about the nutrients that
are depleted by medications andsome of the other side effects
(15:41):
or secondary unintended outcomesthat can happen.
But when it comes toco-prescribing nutrients or
herbs with pharmaceuticalmedications, this is certainly
something that allopathic andnaturopathic practitioners have
to be very mindful of, becausethe intersection, maybe the
(16:01):
amplification of you know theresults changes with you know
drug metabolism, for example.
There can be other unintendedconsequences.
So I'd love to ask you, just asa bit more of a broad and
general question, like theevidence for co-prescribing
nutrients and herbs to eithermitigate side effects, replace
(16:25):
nutrients, augment you know the,the intended outcome of the
medication.
What does that look like in thescientific literature at the
moment and also in clinicalpractice?
Speaker 2 (16:38):
Yeah, look, when it comes to complementary medicines
, whether it's herbal ornutritional medicine, we will
first separate the two.
With herbal medicine, it's beenaround since before that herbal
medicine was the originalmedicine, right?
It's been around since beforeHerbal medicine was the original
medicine, right?
It's been around since beforethe scientific method was ever,
ever etched onto a piece ofpaper to understand and follow,
(17:01):
and so you know informationbeing passed down and empirical
knowledge, and so you know whatwe would now call clinical
practice and experience is whathas guided and defined herbs.
And so then, fittingretrofitting herbal medicine
into the um, into a, into aframework of the scientific
(17:21):
method and and clinical studies,it's kind of working uh from
from, uh from the wrong endforward, kind of thing.
And so it means that the are we, are we at a gold standard of
evidence for what, even just forsafety, of what herbs are safe
and what herbs are not, withevery single drug that is
released?
Absolutely not.
(17:42):
It would be great if there wasa requirement for some of the
key herbs that are just usedwidely when a new drug comes out
, that they had to show safety,or they have to show safety with
other things, so that we canunderstand.
Instead, what we have is anunderstanding on a scientific
level of what for a lot of ourherbs, what the active
constituents, how they may up ordown regulate things at the
(18:03):
CYP450, and what impact that mayhave or what impact that herb
has on kidney function andurinary excretion and output,
and therefore, therefore, we canmake extrapolative cautions
unless we have knowncontraindications, and they
usually come from case studiesof experience.
Separate to that is, as I said,we need to separate nutritional
(18:27):
research.
Nutrition is an emerging areaof science.
We're still learning anddiscovering and uncovering a
number of different aspects toall sorts of vitamins, minerals,
other nutrients.
As things become available inAustralia particularly then what
(18:50):
we see is that research followsand also when it comes to
clinical evidence when with alot of drugs that's something I
mentioned earlier about dosages,and so we see so for example,
to know that there's a nutrientdepletion with a drug.
One of the things I suggest anypractitioner who goes on a pub
med search on that is have alook at the dates on those
(19:13):
studies.
Completely off topic, but thecontraceptive pill, some of the
studies in the 60s and 70s,which are what will show up on
the top levels of Google ifyou're just Googling so your
patients may see it these reallysignificant nutrient depletions
.
But we're seeing doses of theOCP being, you know, many
multiples are stronger than whatthey are now, and so the more
(19:35):
modern research shows that it'sless.
I use that as an example toshow that research continues to
evolve and change over time andthe evidence for these, and so
when it comes to some drugs andwe look at what nutrients are
depleted by those drugs the listmay not be exhaustive and it
may change I did an upgrade tothe full, comprehensive
(19:58):
co-prescriber course.
That is a big, long process thatI did an upgrade after two
years because the file I keep inmy computer of when there is
new and different research thatcomes out, I pop that into the
file to ensure that I can keepup to date with the information
that I'm sharing with people.
And that file got so large Iwas like I need to redo the
(20:19):
entire course because so muchhas changed.
Most of that changes innutritional medicine.
Very few things have changed inherbal medicine because it's an
emerging science that continuesto emerge.
Yeah, that's so interesting.
Speaker 1 (20:35):
And I think you make a really good point because, you
know, with nutritionalinterventions I suppose to to
define that a little more we ofcourse have diet and we have
macronutrient ratios and we have, you know, lots of different
elements around a more um chunkyapproach to nutrition.
But then we also have thetherapeutic and specific
(20:57):
instrumentation of usingnutrients as individual units or
in combination for therapeuticvalue, and that is certainly I
can see why that informationwould be rapidly shifting at
times as it deepens and broadens.
And just to think that even injust a few short years you've
(21:18):
had to update that whole coursebased on what's coming through
is pretty eye-opening, because Ithink I speak for all
clinicians and that is stayingacross and allopathic and
naturopathic, staying across theevidence is like a whole other
job.
It's a whole other job and sofor the most part, we have to
(21:40):
rely on the continuing educationwe choose to partake in each
year to stay across what'shappening.
But there's only so many hoursin the day and when you're
managing other elements, sonow's probably a very good time
to mention that, in addition toTracy's webinar that she's going
to be doing for Designs forHealth on co-prescribing with
(22:04):
antihypertensive medications,she actually has a full
practitioner course onco-prescribing with insert
common pharmaceutical medication.
Here and, for context, insidethat course, the cardiovascular
section is five hours alone.
(22:25):
It's five hours, so it'sabsolutely huge.
And I really think, allopathicand naturopathic clinicians,
this is probably one of the mostimportant areas we could be
training in, because it's veryuncommon to have someone come in
who's not on a medication andso not knowing and understanding
(22:46):
this or either that, or they'vehad a medication and they've
unfortunately been impacted byunintended results from that
medication nutrient depletion,just one example of how and why
that would happen.
And understanding the mechanismsfor which this happened allows
us as clinicians, to identifyfar more quickly how do we
(23:07):
repair this damage?
What does this person's bodyneed in order to reestablish
equilibrium and homeostasis?
So I'm so excited for thiswebinar.
It's just cardiovasculardisease.
As you know, it's a leadingcause of death in, you know,
western world, industrializedcountries, and you did mention
(23:28):
that genetics are part of it,which, of course, we can't
overlook, but so much of it islifestyle diet, our modern you
know, our modern day way ofliving.
Speaker 2 (23:40):
And.
Speaker 1 (23:41):
I guess my next question for you is knowing that
, knowing that this is a not tosimplify it and reduce it too
much but that it's a lifestyledisease and acknowledging at the
same time that hypertensionneeds to be immediately
addressed.
We can't necessarily havesomeone spend six to 12 months
(24:04):
fixing the underlying driverswhile their blood vessels are
being damaged and et cetera, etcetera.
But in terms of evidence fordietary interventions, lifestyle
approach, therapeutic use ofnutrients, medicinal herbs, you
know we're not suggesting thegoal should always be or would
(24:25):
necessarily, you know, besuccessful every time to use
them as an alternative.
But if we were to look at itfrom that standpoint, around
using those things asalternatives, what is the, what
is the evidence telling us atthe moment on how successful
that is?
Speaker 2 (24:43):
yeah, look the evidence on what we look if we
reduce and look at individual uhnutrients or individual
interventions there there arestudies that you know look at
nutritional interventions ofsingle food interventions and
things that there are somesurprising, you know.
I wouldn't say they're outliersat all, but have significant
(25:04):
the evidence for the impact ofusing a therapeutic dose of
garlic not so much garlic in thediet, but a therapeutic dose of
your aged garlic has impacts onblood pressure that are
considered to be similar tofound in evidence to most blood
pressure medicines.
So the outcome has been foundto be similar that we wouldn't
(25:29):
expect it to be a better dose,and that's often in clinical
practice.
For myself that's uh, garlic isone of my first ports of call
when we're looking to preventthe need for a dose increase or
an additional medicine thatrather we have.
Add the um the herb in as asthe additional medicine instead,
um, we then get the.
(25:50):
You know the benefits of ofusing garlic, that we have
clinical evidence for all sortsof other benefits as well,
including better blood sugarcontrol as a nice neat little
side effect.
Studies are done on that becausethe we talk about the lifestyle
diseases of cardiovascularhealth that you know this the
(26:18):
standard.
You know there's no safe levelof alcohol, but the standard
amount is, you know, no morethan two standard drinks twice a
week on non-consecutive days,though that kind of that number
comes from a lot of research onon what then is going to pose a
minimal risk to yourcardiovascular health.
But how is that useful to yourpatient, who perhaps drinks a
(26:39):
dozen cans a night and is comingto talk to you and you talk
about?
Well, you can have threequarters of one beer twice a
week.
Yes, that there's actually goodevidence for relative
reductions.
Reducing that, whatever theintake is when there's
considered an excessive intakeof alcohol, that reducing that
(27:01):
intake by 50% and the amountthat was standardised in the
study was six standard drinksevery night, and so it was
reduced to three standard drinksevery night, and again the
outcome was once again similarto taking a blood pressure
medicine, and that was withstill taking what we consider to
be a, on the evidence, separateto that, a high amount of
(27:24):
alcohol.
But if it's a 50% reduction tothe excessive use, it has a
absolutely clinicallysignificant outcome.
Speaker 1 (27:32):
Wow, I mean, these examples you've just given us
should stop people in theirtracks to consider that the
humble garlic clove obviously isa therapeutic medicinal form.
Not just eating more garlic,but just to think that that has
a similar effect to hypotensivemedications is jaw dropping.
(27:55):
And I think the lovely thingabout the alcohol piece is
you're right, certainly here inAustralia.
I know we've got listeners allover the world, but in Australia
alcohol is quite a big part ofour culture, which of course, is
very unfortunate from a healthperspective and others.
But to be able to say thatsomeone who was a big drinker,
(28:18):
even just halving their intake,even though three standard
drinks you know every night isstill a lot is still having a
similar result there to bloodpressure medication, gives
people a place to start and astrategy that will produce
appreciable results.
It's not like you're getting a5% improvement or a 10%
(28:42):
improvement.
It's like, oh, it's not worthit.
I'd rather have my beer or mywine or whatever the case may be
.
This is very measurable andsignificant.
Uh, and significant.
So I think, um, that is, and,and also those two things one
supplement, one lifestyle changeand those were individual
(29:05):
statistics, by the way.
So using one or the other, andwhen we start to employ
lifestyle strategies you know,several at a time, we're going
to see just consecutiveincremental shifts in that
result in terms of bloodpressure.
So obviously garlic is wearingthe crown here as the hero, and
(29:27):
you did say it's like anabsolute go-to for you in clinic
.
But I want to talk about acouple of the other heroes let's
call them co-stars for garlicand the evidence behind those.
So where do we start?
Let's start with fish oil,because I just think that's a
universal thing that pretty mucheveryone needs, unless they're
eating deep sea cold water fishfour or five times a week, which
(29:49):
no one is.
So talk us through that,wouldn't that?
Speaker 2 (29:52):
be ideal, uh, if we could, you know, all have, or
locally sourced as well.
We don't want too many foodmiles, yes, um, but uh, the
reality, the reality of life, isthat that's not going to be
what people are eating and the,you know, fish oil is.
It's something that when I haveand have had conversations with
(30:13):
many people from the allopathicside if we're going to call it
sides of medicine, aboutcomplementary medicines, not
having evidence, that's been abugbear for me for the two
decades of my clinical practice.
Because just because allevidence isn't gold standard
which, by the way, the evidencefor drugs isn't all gold
standard either that it doesn'tmean there is no evidence.
(30:39):
But my example always is whatabout fish oil?
The evidence for fish oil, theamount of Cochrane reviews that
have been done, the studies thatgo into the tens to hundreds of
thousands of participants, thatgo into the tens to multiple
decades of years ofinterventions and show benefit,
particularly for cardiovascularhealth.
We've got evidence for usingfish oil for all sorts of
conditions.
Anybody hears me talk aboutmental health stuff will hear a
(31:01):
lot about fish oil from me aswell.
But it's where we, when we lookat, where the big body of
evidence is.
It's in cardiovascular healthand it's its benefits are found
in in multiple ways, becauseit's working on underlying
drivers that we're looking atOften.
We know that fish oil as theanti-inflammatory that it is,
(31:22):
that reducing those inflammatorycascades, that what we're able
to do is to mitigate theoutcomes of an inflamed
cardiovascular system.
Outcomes of an inflamedcardiovascular system allowing
for more flexible vessels meansthat that, then, is what drops
the blood pressure, but thatalso is what drops the risk of
damage, the vascular damage andtissue damage.
(31:45):
That the benefits to improvedviscosity and flow of the blood
through those vessels that arenow a little more relaxed.
That the junctions, that we'rehaving smoother movement of the
fluid through the junctions, soless accumulation, the risk of
atherosclerosis go down.
That the benefits of using afish oil, the important thing.
(32:11):
I go back to my days of helpingpatients, particularly older
patients, in pharmacy andtalking about fish oil, and you
know oils ain't oils, thatthey're not all the same that we
need to.
I'd always take the $10 fishoil out of their hand and say
I'd rather you go spend sometime with a friend, catch up
with them for a coffee, spendthat $10 and buy your mate a
(32:31):
coffee rather than buying thesefish oils, because it is
important that we know purity alittle bit like the fact that
it's four to five times a weekof deep sea cold fish that we
need to know that our fish oilis coming from that level of
quality as well.
So we need to know that aboutthe post production testing
that's done, we need tounderstand that what we're
(32:52):
taking as an everyday supplementisn't going to be contributing
to any heavy metal toxicity oranything like that, and that's
the one part of the important uhpiece.
The second uh important pieceis then the strength of the
omega-3 component uh, that itdoesn't.
You know, one little capsule ofof fish oil and that's all you
take every day, of whatever itis that you've bought down at
(33:16):
the local shop for the cheapestpossible price is unlikely to
have the therapeutic benefitsthat I talk about in all those
clinical trials.
A lot of clinical trials thatdon't show benefit are where a
low dose of fish oil has beenused.
So we need to ensure that we'regiving the right dose for our
patients, and the summary of allthe different things that we
(33:38):
can be doing is ensuring thatour patients are taking enough
for different conditions.
It does vary, but somebodysaying that fish oil did nothing
.
I tried that it didn't work.
Always interrogate the dose,interrogate the length of time.
It's a long-term supplement tobe taking, to be expecting a
benefit.
These are the ones where, likeI said, you know some of the
longer trials the trials forcardiovascular benefit, for
(34:00):
omegas, go on for years.
Uh, so we expect.
We expect at least a threemonths before a any kind of
retesting.
But but that's the kind ofsupplement I expect my patient
to be taking, ongoing if they'vegot cardiovascular issues.
Speaker 1 (34:15):
Yes, yeah, I think you make a really important
point there, like when you arelooking at evidence, to be
looking at it quite carefully.
And you know, confirmation biasis a sneaky little devil, and I
think when you know ifsomeone's made up their mind
there's no evidence for fish oiland they just clearly didn't
want to look for evidence forfish oil um, and so I think
(34:39):
that's really important to bearin mind, because the dose
absolutely matters, um, and sodoes the purity, and I think
that's another thing that is socrucial, because if we are
taking something on a dailybasis the volume of what we're
having we really have toconsider what's coming alongside
that.
And you know, even if peoplewere eating deep sea cold water
(34:59):
fish, you know man-madepollutants are abundant in the
ocean and in some ways, notsaying that taking fish oil is
better than eating fish, becauseyou can also source you know
your local seafood really wellalso.
But one of the advantages of asupplement is that it has been
through purification processesto remove heavy metals like
(35:21):
arsenic, cadmium, lead, mercuryand other you know man-made
pollutants that could impact,you know, the oxidative values
of the fish oil.
So, yeah, certainly it's anabsolute favorite of mine across
the board, because most peopleare not consuming enough seafood
, if any actually, and thereforeI'm missing out.
(35:43):
On EPA, dha conversion fromother fatty acids into those is
often limited and certainly withthe ratio of omega-3 to omega-6
being what it is today inmodern processed foods and in
the typical australian diet, itreally is a.
It really levels the playingfield, I think a bit for for
(36:06):
people's internal homeostasis.
The other one that I wouldreally love to hear you riff on
and I feel like I almost feelfunny about mentioning it
because I know it's just likeeveryone takes it and everyone's
like it's good for everything.
But there's a reason magnesiumis so popular.
Speaker 2 (36:29):
Oh my gosh, isn't it?
I feel like it's some of thesethings that become so common.
They then lose their valuebecause they are so common,
right in that it's.
The cure-all Is magnesium, themodern snake oil, you know side
note actually yes, sure, snakeoil is a fraught conversation
(36:49):
that we're not going to havetoday, but is it the cure-all
that we, um, that we think of as, and I think that you know,
speaking in more broad andgeneral terms, that you know the
magnesium depletion that occursjust from things that we do in
our, in our diet, in the way welive our lives, the pace, high
(37:12):
stress kind of lives that peoplelead that are very different to
only a couple of generationsgone past.
That you know, even without theaddition of ablipersia
medication or any medication,our magnesium status is likely
to be inhibited from the outset.
And I have to say, alongside Bvitamins, of all the drugs that
(37:37):
I have done the deep dive into,I do feel like I'm a broken
record where I get to thenutrient depletions part and
almost every time, actuallyprobably every time, magnesium
features.
So not only are we depletedfrom our own diet and lifestyle
if we get to the point ofrequiring a particularly a
chronic use medication, that amedication for chronic
(37:57):
conditions, sorry that we getfurther depletion from that
medicine.
And then if we get involved ina cardiometabolic triad where we
end up on medications formultiple conditions and they're
all depleting it, we end up withsignificant issues.
Um and so when it comes tousing magnesium and blood and
(38:19):
supporting somebody'shypertension or supporting
somebody who's taking a highantihypertensive medication,
again, it's not the.
The reduction that we'd expectis is not quite as significant
as we'd get with garlic andthings, but it is significant.
It's considered to be aclinically significant result
(38:40):
when we use it, but it'ssomething that we get other
additional knock-on benefitsfrom taking it as well.
That when somebody you know, theold magnesium is used in 300
different actions and enzymaticreactions within the body, that
living in a in a state ofperpetual depletion, enhanced by
(39:00):
your medication, means thatyour body is not functioning
optimally.
If you're not sleeping well,your energy's not great.
What is your?
Your compliance to the regimechange that your naturopaths put
you on where you need to startdoing exercise, for your
blooduropaths put you on whereyou need to start doing exercise
for your blood pressure, whenyou're barely slogging yourself
out of bed in the morning thatthe knock-on benefits of
(39:20):
magnesium to improve complianceto other things, the benefit of
magnesium for better glycemiccontrol that occurs on every
level.
Every stage of glycemic control,from absorption of glucose
through the digestive systemthrough to the release of
insulin and then the sensitivityof insulin on a cellular level,
are all impacted by magnesiumthat the benefits that occur
(39:46):
from being magnesium replete.
They just can't be overstated.
I don't believe, as I said,I've got some first lines of of
uh of attack when somebody hasuh hypertension and and garlic
being a big number one,magnesium is.
It is absolutely in the topthree of majority of of
(40:07):
conditions that I that I treatwith patients not everybody, of
course, because there's nothingthat's for everybody, but for
lots and lots of people you doget a benefit for it.
So it's yeah, there's a goodreason that everybody thinks
it's just a magnesium everywhere.
Speaker 1 (40:24):
Yeah, yeah, yeah.
It's earned its rightful placein everybody's cupboards at home
for good reason.
Everybody's cupboards at homefor good reason, wow, I just.
I mean, even from this chatalone.
You know, understanding thosekey elements and how impactful
(40:45):
they can be, whether they'reused as an adjunct or as an
alternative for someone withhigh blood pressure, is just so
incredible.
And, as you said, because ofthat cardiometabolic triad where
there's a cascade with bloodpressure into blood sugar issues
and, of course, dyslipidemiaalso, knowing that those
interventions garlic, fish oiland magnesium all also have
(41:06):
benefits, kind of stamp out theyou know the extra sort of fires
that might spot, fires thatmight pop up is, you know, even
that alone makes for a, you know, a really good rationale for
adjunctive use.
And certainly I think thiswebinar is going to be
absolutely brilliant.
But I just wanted to pick yourbrains on one last little thing,
(41:30):
because we had a little chatprior to hitting record around
the benefits of blood pressuremonitoring and blood sugar
monitoring and I think you knowobviously you're going to dish
out all of your knowledge in thewebinar.
But I think this is a reallylovely one to share.
(41:52):
Share, particularly becausethis podcast reaches quite a
wide audience around things thatcan have a significant impact,
that you kind of think, oh, whatwould that do?
So you want to take us throughthat?
Speaker 2 (42:04):
oh, absolutely.
This is one of my favoritethings that I uncovered, as one
of the first blood pressuremedications were the second.
Statins were my first and andthen antihypertensive was the
second that I ever did the deepdive into.
And I remember when I firstread a paper on the benefits of
home blood pressure monitoringand I'm like what are the
benefits of it?
What benefit is there to beputting the cuff on?
(42:26):
What is that doing tocardiovascular health?
And so I went down the deepdive and found some really
interesting studies that simplyby regularly monitoring your
blood pressure.
That there is data.
There's a study that was done inum uh, in the netherlands
actually, and it was.
(42:46):
It was the paper was umreleased only a couple of years
ago.
That just with no otherintervention but regularly
monitoring, and that was in thatstudy.
I believe it was for a weekthat they measured morning and
night and kept a record andafter that it was only weekly
where they had to actually puttheir data into the healthcare
(43:08):
system over there.
That in over a period of timethat I believe it was um 12
weeks that 60 of patients wentfrom hypertensive to
normotensive.
That with our intervention.
So that was the intervention wasmeasuring their blood pressure
now is is it the monitor?
(43:29):
Is it the monitor?
Is it the cuff?
Of course it's not.
What it is is is that itreminds people of this silent
condition that they otherwisemay conveniently choose to
forget about.
What it does?
Is it helps people to be moreaware that the condition exists?
That it improves compliance to,either because the studies are
(43:50):
mostly done on people withtaking medicine that it reminds
them to take their medicine atthe times that they're supposed
that it reminds them to taketheir medicine at the times that
they're supposed to.
Reminds them to take theirsupplements, reminds them to go
out for their walk.
It may help prevent thatreaching for that, you know,
extra drink at the end of theday or even touch on cigarettes,
but it may help with thechoices around cigarettes.
That simple monitoring.
(44:10):
So what in practice I do for mypatients is I ensure that they
don't cost a lot of money thesedays, or I get them to hire them
from the pharmacy or to borrowone from a friend is to have one
at home and to measure firstthing on rising, and then I say
the so that.
And then the last one at nightis.
I say to them when you'resitting on the couch at night
and just before you get up andgo to bed, and keep a record of
(44:32):
those for two weeks and twoweeks straight, and what you see
is you get an accurate readingof what their blood pressure is
like at rest and what you'reideally seeing is the higher
blood pressure in the morningand the lower blood pressure in
the evening.
But after that I tend to I tendto get them to measure it, not
so not so closely monitoring.
I usually get, depending what'sgoing on for the patient, but
(44:53):
often a weekly.
I do a weekly morning and night.
Get them to choose a weekdaybecause it's the majority of the
week.
On Tuesdays, morning and night,you measure your blood pressure
and then they keep their weeklylog and and it's it's something
that people that do it have farbetter outcomes than people
that don't.
Speaker 1 (45:09):
Clinically, Wow is just.
Isn't that such an interestingexample of habitual behaviors
and being cognizant of something?
It's a little bit like whenpeople start working out.
As a side effect, they oftenstart making better food choices
because they're, you know,working towards something.
It's a little bit like foodjournaling.
Monitoring your blood pressureis a lovely reminder that this
(45:31):
is something that matters, whichthen means every choice you
make the rest of that day alsocould be, for better or worse,
influencing your blood pressure.
And what's so lovely about that?
Aside from, obviously, rentingor purchasing a blood pressure
measuring device, whatever oneyou end up going for, it doesn't
(45:53):
cost anything after that andcould ultimately reduce your
outgoings around medication andsupplements, simply by acting as
a regular reminder that yourblood pressure is something you
need to take care of andtherefore might inform better
choices the rest of the dayExactly.
Speaker 2 (46:13):
I love it.
It's my favorite type ofintervention.
Speaker 1 (46:15):
Yeah, oh, my gosh, tracy, it's just so clear to me
the depth and breadth of yourknowledge and I and I just want
to sign up to your courseimmediately, because it's been a
while since I've looked at thisspecifically for myself too,
and clearly a lot has evolved inthe in the most recent years.
But for anyone listening, justa final reminder that there is
(46:37):
an upcoming webinar for designsfor health on cardiometabolic
health and co-prescribing, whichtracy will be taking us through
, and, of course, for anypractitioners interested in
really getting across this, notjust in the cardiovascular space
but across the board, herco-prescriber course is also
available.
And, tracy, just a huge thankyou for sharing with us today.
(47:01):
Just what I know is just thetip of the iceberg of your
knowledge, but so powerful allthe same in just the
conversation that we've hadtoday.
Speaker 2 (47:11):
Thank you so much for having me and thanks for giving
me the opportunity to sharewhat I think is such important
information.
Speaker 1 (47:17):
Thank you, yeah, absolutely so, so important.
Well, thanks again, tracey, andthank you for joining us today.
Remember you can find all ofthe show notes and other
relevant podcasts and seminarson the Designs for Health
website.
I'm Amy Skilton and this isWellness by Designs.
This is Wellness by Designs, and I'm your host, amy
Skilton, and joining us today isnaturopath Tracey Blythe, and
I'm very excited to be talkingto her about co-prescribing with
anti-hypertensive medications.
Co-prescribing with anypharmaceutical medication is a
huge subject and she isabsolutely the resident expert
(00:35):
here on this.
But let me introduce herproperly first.
Tracy is a naturopath of 19years and has a goal for the
community to have greater accessto quality complementary
medicines whilst receiving thebest evidence-based advice from
qualified practitioners.
Her career has been spent inhealth food stores and pharmacy,
(00:58):
supporting patients with theirhealth and educating and growing
the practitioner supplementspace in Western Australia, and
more recently, in addition toall of that, tracey creates and
delivers education to otherpractitioners Australia-wide.
Welcome to the podcast, tracey.
Speaker 2 (01:18):
Thank you, Amy, and thank you for that wonderful
introduction.
Speaker 1 (01:21):
Oh, it's such a pleasure to have you here, and I
will let everybody know upfrontthat we are very fortunate to
have Tracy delivering a webinarfor us in the not too distant
future that actually covers thecomplementary medicine
co-prescription framework, whichyou can use to support patients
(01:43):
that are on blood pressurelowering medication and also
reduce their risk of developingdiabetes, and we're lucky,
though, to have snagged her fora little pre-webinar chat where
we're going to touch on some ofthose key points and why, if you
are a practitioner working inthis space of cardiovascular
(02:03):
health or metabolic syndrome,that it's a must attend.
So, tracy, why don't we startwith the challenges of high
blood pressure, how prevalent itis and really what we're
looking at as a society when itcomes to, you know, things like
diabetes and blood pressure andreally the intersection where
(02:25):
they meet for people?
Speaker 2 (02:28):
Yeah, absolutely, amy .
It's an interesting topic, Ithink, because the prevalence is
just that it's everywhere andmost of the people that are
experiencing it don't even knowwhen we have high blood pressure
.
We may not even feel it.
A lot of people's diagnosiscomes on the end of sitting at
(02:48):
the uh at the doctor's officeand having their blood pressure
measured and being told theyhave high blood pressure um,
before that they're going abouttheir business.
I think that it's somethingabout a quarter of australians
are currently um going aroundwith uncontrolled hypertension
as we speak.
So that's, on average, ofpatients walking into clinic,
(03:10):
one in four of those may havehypertension and not even know
it, and that this is a numberthat, whilst it's not rising,
it's been the same for years,and it's something that has just
not been addressed in terms ofhow do we help these people
beyond giving them more and moreand more medications.
Speaker 1 (03:34):
It is really scary, when you put it like that, that
a quarter of us are walkingaround without realising that
there is this silent killer onboard and I think, with the
exception of really extremehypertension, most people don't
have symptoms, which is why, youknow, sometimes people find out
(03:56):
the hard way that it's beensitting in the background.
And I think that reallyhighlights the importance of,
you know, annual checkups, at abare minimum, and making sure
you request it to be done whenyou are seeing your doctor for
annual blood tests.
And I think, furthermore,particularly since COVID but
telehealth has been around forlonger than that If you are, you
(04:19):
know, as a clinician primarilyworking in telehealth, which is
certainly the case for me I'mnot able to take my client's
blood pressure because they'renot seeing me here in person.
So actually making sure that'son the intake form and there's
regular you know diary remindersfor assessing that, so that
that important piece ofinformation can be picked up,
(04:41):
because that damage occurring inthe background can create all
kinds of other problems and forthose that then like do have
that picked up, as you said,it's often by accident, they
might've arrived at the doctorfor you know something else and
the GP is like let's just checkyour blood pressure while you're
here and then, whoie daisy,this is, you know, heading
(05:04):
towards stroke territoryimmediately.
There is going to be aprescription written, and I
understand this approach, by theway, and I think I'll just say
up front that, regardless ofwhat you do, we're all in
agreement that addressing theroot causes of high blood
pressure and bringing your bloodpressure down immediately are
(05:24):
not mutually exclusive.
They both must be addressed,and what that means is
medication initially mayactually be the right step or it
may be an alternative treatment, but regardless, what usually
happens is people are confrontedwith a diagnosis of
hypertension in the doctor'soffice and they're immediately
given a prescription for youknow, one or two medications,
(05:48):
and I'd love to hear from you,like, really, what are you
commonly seeing being prescribedat the moment?
There's a couple of differentclasses that get recommended,
sometimes independently,sometimes together.
What's the landscape lookinglike at the moment?
Speaker 2 (06:03):
Yeah, look, currently there are 37 different drugs
that the doctor has to choosefrom in that situation.
Yeah, and they get grouped.
There's a few different ways,but essentially there's across
five different drug classes.
You've got your ACE inhibitors,your angiotensin receptor
blockers, your calcium channelblockers, your beta blockers,
(06:24):
your angiotensin receptorblockers, your calcium channel
blockers, your beta blockers,and then the good old favorites,
the diuretics, which, for allof those, are actually groups
within groups that are oftenprescribed.
And further to your comment, Amy, about when somebody has a
diagnosis of hypertension andthat the initial response being
a prescription of medication,initial response being a
(06:47):
prescription of medication, thisis where and why I do what I do
, as a naturopath who'spassionate about everybody being
informed and educated on thesemedicines and how complementary
medicines intersect In theinstance of somebody with
uncontrolled very high bloodpressure.
The interventions that I'll betalking in much more depth in
the webinar but that we'll bediscussing today, these
(07:07):
interventions are eight week, 12week, sometimes 24 week trials
that are seeing, you know, somegood benefits over that period
of time.
We want responses quickly andthat's why we need to know that
what we can do is safe for ourpatients.
That we can.
A patient can come newlydiagnosed with hypertension and,
you know, one or, statistically, two drugs under their belt.
(07:31):
Come to see us that we can thensafely 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 tocome up with some of the
complementary medicines we mightbe able to prescribe as well.
But it is an important firststep is not to say throw those
(07:52):
medicines out.
Let me give you somenaturopathic support.
You don't need those medicines.
The statistics on seriouscardiovascular events tell us
that.
First, do no harm for ourpatients.
Speaker 1 (08:06):
Absolutely.
Yeah, I think that's a reallyimportant point to make and, as
you said, a swift response is,you know, paramount in those
situations.
And then you can always look ata bit more of a medium
long-term view, and I like thatyou 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
(08:33):
be set.
I know, for I'm generalizinghere, but I imagine for a large
majority of patients that seenaturopaths, they would likely
have a goal of I'd like to beable to manage this without
medication, and for many peoplethat is possible and for some it
might not be.
It might simply be, you know,beyond beyond that scope and for
some degree of pharmaceuticalsmight, might be necessary, but I
(08:54):
liked how you put that you canalso consider adjunctive
treatment, which might allow youto manage your blood pressure
with perhaps a lower dose, takea bit of pressure off the liver
or the kidneys and thereforehave better outcomes in that
regard.
So not necessarily using one orthe other, but a combined
(09:15):
approach allows a lower doseoverall.
One thing we haven't touched onyet, but we will, is the
nutrient depletion, and I guessmitigating the side effects of
medications might be anothergoal or outcome, and I think in
a perfect world although thisprobably doesn't often happen,
(09:35):
it's always nice to aim for.
Let's see if we can get you tonot need anything, although I
think in order to achieve that,it's a combination of many
things, including very deepcommitment on the patient's part
.
Wouldn't you agree?
Speaker 2 (09:51):
Yes, 100% and you do get those patients, those
beautiful unicorns.
But we also get the fullvariety, the full spectrum of
people where switching one pillfor another is you know where
there are less, less sideeffects.
And absolutely, when it comesto blood pressure medications,
(10:14):
the statistics around beingprescribed one and then shortly
thereafter two, about beingprescribed a third, even it's
more than half, around half ofthe people that take a blood
pressure medication actuallytake two or more.
That with that adjunctivetherapies, we can ensure that
we're being safe with ourpatients by using their medicine
(10:35):
.
But, as you said, the lessmedicines we add, what we're
able to do is absolutely thenumbers tell us the lower dose
or the less blood pressuremedicine that you're taking, the
less likely you are to developsignificant or severe side
effects.
And when it comes to nutrientdepletions, that's a cause close
(10:55):
to my heart.
I have to say, when I look atthe evidence around depletions
of nutrients from all sorts ofdifferent drugs, that the dose
she makes the poison, that thehigher the dose of the medicine,
the more significant and severethe depletions are, and so
keeping those doses lower alsothen reduces our need to be
(11:15):
adding in a big laundry list ofnutrients to just bring somebody
back to an even keel, which isjust good health for our
patients.
It doesn't involve a long listof drugs, then a long list of
supplements to ameliorate theside effects of those drugs.
Speaker 1 (11:32):
And I think even across the board, not just in
cardiovascular health thatslippery slope of one medication
inducing an issue that thenrequires another medication and
another.
You know, we all see it.
You know friends, family, olderpatients, our own patients
where you end up with a hugelaundry list of medications that
(11:53):
are all playingring-a-ring-a-rosy with each
other.
Speaker 2 (11:58):
Yeah, and that's the.
I suppose that's the excitingpart of this webinar that I
can't wait to share with all thelisteners, for Designs for
Health is a particular start tothat ring-a-rosy kind of thing
that occurs with blood pressuremedicines.
There's a couple of them whereone of the side effects is a
(12:20):
dysglycemia or poor response toinsulin, insulin production
which then leads tosignificantly increased rates of
new onset diabetes.
And so there is what we know asthe cardiometabolic triad, the
statistics around patients who,once they develop hypertension,
(12:41):
once they're diagnosed with highcholesterol or diabetes any of
those three it's like the othertwo shortly follow, and
medication for those two shortlyfollows that they are
conditions that have commondrivers, and so they're driven
by some, you know, genetics orlifestyle or whatever that is
(13:04):
driving those conditions.
But what can accelerate orexacerbate the triad of those
three conditions forming?
For some things, it's themedicine itself, and so
particularly the thiazidediuretics and the non-selective
beta blockers particularly, havebeen found to have this impact
(13:26):
of hastening or bringing on adiagnosis of diabetes, which is
then, as you said earlier, thatring a rosy.
That that's what happens.
We go from one and maybe twoblood pressure medicines and
shortly thereafter,statistically it tells us that
the incidence of development ofdiabetes just goes through the
roof.
Speaker 1 (13:48):
And what a shame to be confronted with a
life-threatening issue in termsof high blood pressure and then
the course of action that youtake to address that then causes
a second problem and then thedominoes fall from there.
And I think you know the areain which you provide the most
amazing practitioner educationis first of all the awareness
(14:12):
around that.
You know.
Education is first of all theawareness around that.
You know um, if someone wasfully informed, you know which,
which is, I think, impossible todo in the current um landscape
of allopathic medicine, um 15minute consults, 10 minute
consults you can't possibly talksomeone through the benefits,
risks.
You know the 37 different drugs, the classes within classes.
(14:32):
You just have to make a call asa doctor and be like, okay,
let's just start here.
But I think, as a patient, ifyou knew that non-selective beta
blockers and thiazide diureticsthen set you up for dysglycemia
and potentially diabetes downthe track, would you make a
different choice.
Or would you, if they wereconsidered to be the best, then
(14:56):
perhaps invest in a cgmcontinuous glucose monitor, or
would you then begin to addresssome of the drivers, which of
course is metabolic dysfunctionand insulin issues?
Anyway, like it's very much,you know, um, you take the
immediate emergency off thetable but you create a bigger
mess behind the scenes, withouteven originally addressing the
(15:20):
original mess that created thehigh blood pressure in the first
place.
But certainly in the space thatyou work in, this is something
that you really understand verydeeply and I know in the
upcoming webinar you're going totalk about the nutrients that
are depleted by medications andsome of the other side effects
(15:41):
or secondary unintended outcomesthat can happen.
But when it comes toco-prescribing nutrients or
herbs with pharmaceuticalmedications, this is certainly
something that allopathic andnaturopathic practitioners have
to be very mindful of, becausethe intersection, maybe the
(16:01):
amplification of you know theresults changes with you know
drug metabolism, for example.
There can be other unintendedconsequences.
So I'd love to ask you, just asa bit more of a broad and
general question, like theevidence for co-prescribing
nutrients and herbs to eithermitigate side effects, replace
(16:25):
nutrients, augment you know the,the intended outcome of the
medication.
What does that look like in thescientific literature at the
moment and also in clinicalpractice?
Speaker 2 (16:38):
Yeah, look, when it comes to complementary medicines
, whether it's herbal ornutritional medicine, we will
first separate the two.
With herbal medicine, it's beenaround since before that herbal
medicine was the originalmedicine, right?
It's been around since beforeHerbal medicine was the original
medicine, right?
It's been around since beforethe scientific method was ever,
ever etched onto a piece ofpaper to understand and follow,
(17:01):
and so you know informationbeing passed down and empirical
knowledge, and so you know whatwe would now call clinical
practice and experience is whathas guided and defined herbs.
And so then, fittingretrofitting herbal medicine
into the um, into a, into aframework of the scientific
(17:21):
method and and clinical studies,it's kind of working uh from
from, uh from the wrong endforward, kind of thing.
And so it means that the are we, are we at a gold standard of
evidence for what, even just forsafety, of what herbs are safe
and what herbs are not, withevery single drug that is
released?
Absolutely not.
(17:42):
It would be great if there wasa requirement for some of the
key herbs that are just usedwidely when a new drug comes out
, that they had to show safety,or they have to show safety with
other things, so that we canunderstand.
Instead, what we have is anunderstanding on a scientific
level of what for a lot of ourherbs, what the active
constituents, how they may up ordown regulate things at the
(18:03):
CYP450, and what impact that mayhave or what impact that herb
has on kidney function andurinary excretion and output,
and therefore, therefore, we canmake extrapolative cautions
unless we have knowncontraindications, and they
usually come from case studiesof experience.
Separate to that is, as I said,we need to separate nutritional
(18:27):
research.
Nutrition is an emerging areaof science.
We're still learning anddiscovering and uncovering a
number of different aspects toall sorts of vitamins, minerals,
other nutrients.
As things become available inAustralia particularly then what
(18:50):
we see is that research followsand also when it comes to
clinical evidence when with alot of drugs that's something I
mentioned earlier about dosages,and so we see so for example,
to know that there's a nutrientdepletion with a drug.
One of the things I suggest anypractitioner who goes on a pub
med search on that is have alook at the dates on those
(19:13):
studies.
Completely off topic, but thecontraceptive pill, some of the
studies in the 60s and 70s,which are what will show up on
the top levels of Google ifyou're just Googling so your
patients may see it these reallysignificant nutrient depletions
.
But we're seeing doses of theOCP being, you know, many
multiples are stronger than whatthey are now, and so the more
(19:35):
modern research shows that it'sless.
I use that as an example toshow that research continues to
evolve and change over time andthe evidence for these, and so
when it comes to some drugs andwe look at what nutrients are
depleted by those drugs the listmay not be exhaustive and it
may change I did an upgrade tothe full, comprehensive
(19:58):
co-prescriber course.
That is a big, long process thatI did an upgrade after two
years because the file I keep inmy computer of when there is
new and different research thatcomes out, I pop that into the
file to ensure that I can keepup to date with the information
that I'm sharing with people.
And that file got so large Iwas like I need to redo the
(20:19):
entire course because so muchhas changed.
Most of that changes innutritional medicine.
Very few things have changed inherbal medicine because it's an
emerging science that continuesto emerge.
Yeah, that's so interesting.
Speaker 1 (20:35):
And I think you make a really good point because, you
know, with nutritionalinterventions I suppose to to
define that a little more we ofcourse have diet and we have
macronutrient ratios and we have, you know, lots of different
elements around a more um chunkyapproach to nutrition.
But then we also have thetherapeutic and specific
(20:57):
instrumentation of usingnutrients as individual units or
in combination for therapeuticvalue, and that is certainly I
can see why that informationwould be rapidly shifting at
times as it deepens and broadens.
And just to think that even injust a few short years you've
(21:18):
had to update that whole coursebased on what's coming through
is pretty eye-opening, because Ithink I speak for all
clinicians and that is stayingacross and allopathic and
naturopathic, staying across theevidence is like a whole other
job.
It's a whole other job and sofor the most part, we have to
(21:40):
rely on the continuing educationwe choose to partake in each
year to stay across what'shappening.
But there's only so many hoursin the day and when you're
managing other elements, sonow's probably a very good time
to mention that, in addition toTracy's webinar that she's going
to be doing for Designs forHealth on co-prescribing with
(22:04):
antihypertensive medications,she actually has a full
practitioner course onco-prescribing with insert
common pharmaceutical medication.
Here and, for context, insidethat course, the cardiovascular
section is five hours alone.
(22:25):
It's five hours, so it'sabsolutely huge.
And I really think, allopathicand naturopathic clinicians,
this is probably one of the mostimportant areas we could be
training in, because it's veryuncommon to have someone come in
who's not on a medication andso not knowing and understanding
(22:46):
this or either that, or they'vehad a medication and they've
unfortunately been impacted byunintended results from that
medication nutrient depletion,just one example of how and why
that would happen.
And understanding the mechanismsfor which this happened allows
us as clinicians, to identifyfar more quickly how do we
(23:07):
repair this damage?
What does this person's bodyneed in order to reestablish
equilibrium and homeostasis?
So I'm so excited for thiswebinar.
It's just cardiovasculardisease.
As you know, it's a leadingcause of death in, you know,
western world, industrializedcountries, and you did mention
(23:28):
that genetics are part of it,which, of course, we can't
overlook, but so much of it islifestyle diet, our modern you
know, our modern day way ofliving.
Speaker 2 (23:40):
And.
Speaker 1 (23:41):
I guess my next question for you is knowing that
, knowing that this is a not tosimplify it and reduce it too
much but that it's a lifestyledisease and acknowledging at the
same time that hypertensionneeds to be immediately
addressed.
We can't necessarily havesomeone spend six to 12 months
(24:04):
fixing the underlying driverswhile their blood vessels are
being damaged and et cetera, etcetera.
But in terms of evidence fordietary interventions, lifestyle
approach, therapeutic use ofnutrients, medicinal herbs, you
know we're not suggesting thegoal should always be or would
(24:25):
necessarily, you know, besuccessful every time to use
them as an alternative.
But if we were to look at itfrom that standpoint, around
using those things asalternatives, what is the, what
is the evidence telling us atthe moment on how successful
that is?
Speaker 2 (24:43):
yeah, look the evidence on what we look if we
reduce and look at individual uhnutrients or individual
interventions there there arestudies that you know look at
nutritional interventions ofsingle food interventions and
things that there are somesurprising, you know.
I wouldn't say they're outliersat all, but have significant
(25:04):
the evidence for the impact ofusing a therapeutic dose of
garlic not so much garlic in thediet, but a therapeutic dose of
your aged garlic has impacts onblood pressure that are
considered to be similar tofound in evidence to most blood
pressure medicines.
So the outcome has been foundto be similar that we wouldn't
(25:29):
expect it to be a better dose,and that's often in clinical
practice.
For myself that's uh, garlic isone of my first ports of call
when we're looking to preventthe need for a dose increase or
an additional medicine thatrather we have.
Add the um the herb in as asthe additional medicine instead,
um, we then get the.
(25:50):
You know the benefits of ofusing garlic, that we have
clinical evidence for all sortsof other benefits as well,
including better blood sugarcontrol as a nice neat little
side effect.
Studies are done on that becausethe we talk about the lifestyle
diseases of cardiovascularhealth that you know this the
(26:18):
standard.
You know there's no safe levelof alcohol, but the standard
amount is, you know, no morethan two standard drinks twice a
week on non-consecutive days,though that kind of that number
comes from a lot of research onon what then is going to pose a
minimal risk to yourcardiovascular health.
But how is that useful to yourpatient, who perhaps drinks a
(26:39):
dozen cans a night and is comingto talk to you and you talk
about?
Well, you can have threequarters of one beer twice a
week.
Yes, that there's actually goodevidence for relative
reductions.
Reducing that, whatever theintake is when there's
considered an excessive intakeof alcohol, that reducing that
(27:01):
intake by 50% and the amountthat was standardised in the
study was six standard drinksevery night, and so it was
reduced to three standard drinksevery night, and again the
outcome was once again similarto taking a blood pressure
medicine, and that was withstill taking what we consider to
be a, on the evidence, separateto that, a high amount of
(27:24):
alcohol.
But if it's a 50% reduction tothe excessive use, it has a
absolutely clinicallysignificant outcome.
Speaker 1 (27:32):
Wow, I mean, these examples you've just given us
should stop people in theirtracks to consider that the
humble garlic clove obviously isa therapeutic medicinal form.
Not just eating more garlic,but just to think that that has
a similar effect to hypotensivemedications is jaw dropping.
(27:55):
And I think the lovely thingabout the alcohol piece is
you're right, certainly here inAustralia.
I know we've got listeners allover the world, but in Australia
alcohol is quite a big part ofour culture, which of course, is
very unfortunate from a healthperspective and others.
But to be able to say thatsomeone who was a big drinker,
(28:18):
even just halving their intake,even though three standard
drinks you know every night isstill a lot is still having a
similar result there to bloodpressure medication, gives
people a place to start and astrategy that will produce
appreciable results.
It's not like you're getting a5% improvement or a 10%
(28:42):
improvement.
It's like, oh, it's not worthit.
I'd rather have my beer or mywine or whatever the case may be
.
This is very measurable andsignificant.
Uh, and significant.
So I think, um, that is, and,and also those two things one
supplement, one lifestyle changeand those were individual
(29:05):
statistics, by the way.
So using one or the other, andwhen we start to employ
lifestyle strategies you know,several at a time, we're going
to see just consecutiveincremental shifts in that
result in terms of bloodpressure.
So obviously garlic is wearingthe crown here as the hero, and
(29:27):
you did say it's like anabsolute go-to for you in clinic
.
But I want to talk about acouple of the other heroes let's
call them co-stars for garlicand the evidence behind those.
So where do we start?
Let's start with fish oil,because I just think that's a
universal thing that pretty mucheveryone needs, unless they're
eating deep sea cold water fishfour or five times a week, which
(29:49):
no one is.
So talk us through that,wouldn't that?
Speaker 2 (29:52):
be ideal, uh, if we could, you know, all have, or
locally sourced as well.
We don't want too many foodmiles, yes, um, but uh, the
reality, the reality of life, isthat that's not going to be
what people are eating and the,you know, fish oil is.
It's something that when I haveand have had conversations with
(30:13):
many people from the allopathicside if we're going to call it
sides of medicine, aboutcomplementary medicines, not
having evidence, that's been abugbear for me for the two
decades of my clinical practice.
Because just because allevidence isn't gold standard
which, by the way, the evidencefor drugs isn't all gold
standard either that it doesn'tmean there is no evidence.
(30:39):
But my example always is whatabout fish oil?
The evidence for fish oil, theamount of Cochrane reviews that
have been done, the studies thatgo into the tens to hundreds of
thousands of participants, thatgo into the tens to multiple
decades of years ofinterventions and show benefit,
particularly for cardiovascularhealth.
We've got evidence for usingfish oil for all sorts of
conditions.
Anybody hears me talk aboutmental health stuff will hear a
(31:01):
lot about fish oil from me aswell.
But it's where we, when we lookat, where the big body of
evidence is.
It's in cardiovascular healthand it's its benefits are found
in in multiple ways, becauseit's working on underlying
drivers that we're looking atOften.
We know that fish oil as theanti-inflammatory that it is,
(31:22):
that reducing those inflammatorycascades, that what we're able
to do is to mitigate theoutcomes of an inflamed
cardiovascular system.
Outcomes of an inflamedcardiovascular system allowing
for more flexible vessels meansthat that, then, is what drops
the blood pressure, but thatalso is what drops the risk of
damage, the vascular damage andtissue damage.
(31:45):
That the benefits to improvedviscosity and flow of the blood
through those vessels that arenow a little more relaxed.
That the junctions, that we'rehaving smoother movement of the
fluid through the junctions, soless accumulation, the risk of
atherosclerosis go down.
That the benefits of using afish oil, the important thing.
(32:11):
I go back to my days of helpingpatients, particularly older
patients, in pharmacy andtalking about fish oil, and you
know oils ain't oils, thatthey're not all the same that we
need to.
I'd always take the $10 fishoil out of their hand and say
I'd rather you go spend sometime with a friend, catch up
with them for a coffee, spendthat $10 and buy your mate a
(32:31):
coffee rather than buying thesefish oils, because it is
important that we know purity alittle bit like the fact that
it's four to five times a weekof deep sea cold fish that we
need to know that our fish oilis coming from that level of
quality as well.
So we need to know that aboutthe post production testing
that's done, we need tounderstand that what we're
(32:52):
taking as an everyday supplementisn't going to be contributing
to any heavy metal toxicity oranything like that, and that's
the one part of the important uhpiece.
The second uh important pieceis then the strength of the
omega-3 component uh, that itdoesn't.
You know, one little capsule ofof fish oil and that's all you
take every day, of whatever itis that you've bought down at
(33:16):
the local shop for the cheapestpossible price is unlikely to
have the therapeutic benefitsthat I talk about in all those
clinical trials.
A lot of clinical trials thatdon't show benefit are where a
low dose of fish oil has beenused.
So we need to ensure that we'regiving the right dose for our
patients, and the summary of allthe different things that we
(33:38):
can be doing is ensuring thatour patients are taking enough
for different conditions.
It does vary, but somebodysaying that fish oil did nothing
.
I tried that it didn't work.
Always interrogate the dose,interrogate the length of time.
It's a long-term supplement tobe taking, to be expecting a
benefit.
These are the ones where, likeI said, you know some of the
longer trials the trials forcardiovascular benefit, for
(34:00):
omegas, go on for years.
Uh, so we expect.
We expect at least a threemonths before a any kind of
retesting.
But but that's the kind ofsupplement I expect my patient
to be taking, ongoing if they'vegot cardiovascular issues.
Speaker 1 (34:15):
Yes, yeah, I think you make a really important
point there, like when you arelooking at evidence, to be
looking at it quite carefully.
And you know, confirmation biasis a sneaky little devil, and I
think when you know ifsomeone's made up their mind
there's no evidence for fish oiland they just clearly didn't
want to look for evidence forfish oil um, and so I think
(34:39):
that's really important to bearin mind, because the dose
absolutely matters, um, and sodoes the purity, and I think
that's another thing that is socrucial, because if we are
taking something on a dailybasis the volume of what we're
having we really have toconsider what's coming alongside
that.
And you know, even if peoplewere eating deep sea cold water
(34:59):
fish, you know man-madepollutants are abundant in the
ocean and in some ways, notsaying that taking fish oil is
better than eating fish, becauseyou can also source you know
your local seafood really wellalso.
But one of the advantages of asupplement is that it has been
through purification processesto remove heavy metals like
(35:21):
arsenic, cadmium, lead, mercuryand other you know man-made
pollutants that could impact,you know, the oxidative values
of the fish oil.
So, yeah, certainly it's anabsolute favorite of mine across
the board, because most peopleare not consuming enough seafood
, if any actually, and thereforeI'm missing out.
(35:43):
On EPA, dha conversion fromother fatty acids into those is
often limited and certainly withthe ratio of omega-3 to omega-6
being what it is today inmodern processed foods and in
the typical australian diet, itreally is a.
It really levels the playingfield, I think a bit for for
(36:06):
people's internal homeostasis.
The other one that I wouldreally love to hear you riff on
and I feel like I almost feelfunny about mentioning it
because I know it's just likeeveryone takes it and everyone's
like it's good for everything.
But there's a reason magnesiumis so popular.
Speaker 2 (36:29):
Oh my gosh, isn't it?
I feel like it's some of thesethings that become so common.
They then lose their valuebecause they are so common,
right in that it's.
The cure-all Is magnesium, themodern snake oil, you know side
note actually yes, sure, snakeoil is a fraught conversation
(36:49):
that we're not going to havetoday, but is it the cure-all
that we, um, that we think of as, and I think that you know,
speaking in more broad andgeneral terms, that you know the
magnesium depletion that occursjust from things that we do in
our, in our diet, in the way welive our lives, the pace, high
(37:12):
stress kind of lives that peoplelead that are very different to
only a couple of generationsgone past.
That you know, even without theaddition of ablipersia
medication or any medication,our magnesium status is likely
to be inhibited from the outset.
And I have to say, alongside Bvitamins, of all the drugs that
(37:37):
I have done the deep dive into,I do feel like I'm a broken
record where I get to thenutrient depletions part and
almost every time, actuallyprobably every time, magnesium
features.
So not only are we depletedfrom our own diet and lifestyle
if we get to the point ofrequiring a particularly a
chronic use medication, that amedication for chronic
(37:57):
conditions, sorry that we getfurther depletion from that
medicine.
And then if we get involved ina cardiometabolic triad where we
end up on medications formultiple conditions and they're
all depleting it, we end up withsignificant issues.
Um and so when it comes tousing magnesium and blood and
(38:19):
supporting somebody'shypertension or supporting
somebody who's taking a highantihypertensive medication,
again, it's not the.
The reduction that we'd expectis is not quite as significant
as we'd get with garlic andthings, but it is significant.
It's considered to be aclinically significant result
(38:40):
when we use it, but it'ssomething that we get other
additional knock-on benefitsfrom taking it as well.
That when somebody you know, theold magnesium is used in 300
different actions and enzymaticreactions within the body, that
living in a in a state ofperpetual depletion, enhanced by
(39:00):
your medication, means thatyour body is not functioning
optimally.
If you're not sleeping well,your energy's not great.
What is your?
Your compliance to the regimechange that your naturopaths put
you on where you need to startdoing exercise, for your
blooduropaths put you on whereyou need to start doing exercise
for your blood pressure, whenyou're barely slogging yourself
out of bed in the morning thatthe knock-on benefits of
(39:20):
magnesium to improve complianceto other things, the benefit of
magnesium for better glycemiccontrol that occurs on every
level.
Every stage of glycemic control,from absorption of glucose
through the digestive systemthrough to the release of
insulin and then the sensitivityof insulin on a cellular level,
are all impacted by magnesiumthat the benefits that occur
(39:46):
from being magnesium replete.
They just can't be overstated.
I don't believe, as I said,I've got some first lines of of
uh of attack when somebody hasuh hypertension and and garlic
being a big number one,magnesium is.
It is absolutely in the topthree of majority of of
(40:07):
conditions that I that I treatwith patients not everybody, of
course, because there's nothingthat's for everybody, but for
lots and lots of people you doget a benefit for it.
So it's yeah, there's a goodreason that everybody thinks
it's just a magnesium everywhere.
Speaker 1 (40:24):
Yeah, yeah, yeah.
It's earned its rightful placein everybody's cupboards at home
for good reason.
Everybody's cupboards at homefor good reason, wow, I just.
I mean, even from this chatalone.
You know, understanding thosekey elements and how impactful
(40:45):
they can be, whether they'reused as an adjunct or as an
alternative for someone withhigh blood pressure, is just so
incredible.
And, as you said, because ofthat cardiometabolic triad where
there's a cascade with bloodpressure into blood sugar issues
and, of course, dyslipidemiaalso, knowing that those
interventions garlic, fish oiland magnesium all also have
(41:06):
benefits, kind of stamp out theyou know the extra sort of fires
that might spot, fires thatmight pop up is, you know, even
that alone makes for a, you know, a really good rationale for
adjunctive use.
And certainly I think thiswebinar is going to be
absolutely brilliant.
But I just wanted to pick yourbrains on one last little thing,
(41:30):
because we had a little chatprior to hitting record around
the benefits of blood pressuremonitoring and blood sugar
monitoring and I think you knowobviously you're going to dish
out all of your knowledge in thewebinar.
But I think this is a reallylovely one to share.
(41:52):
Share, particularly becausethis podcast reaches quite a
wide audience around things thatcan have a significant impact,
that you kind of think, oh, whatwould that do?
So you want to take us throughthat?
Speaker 2 (42:04):
oh, absolutely.
This is one of my favoritethings that I uncovered, as one
of the first blood pressuremedications were the second.
Statins were my first and andthen antihypertensive was the
second that I ever did the deepdive into.
And I remember when I firstread a paper on the benefits of
home blood pressure monitoringand I'm like what are the
benefits of it?
What benefit is there to beputting the cuff on?
(42:26):
What is that doing tocardiovascular health?
And so I went down the deepdive and found some really
interesting studies that simplyby regularly monitoring your
blood pressure.
That there is data.
There's a study that was done inum uh, in the netherlands
actually, and it was.
(42:46):
It was the paper was umreleased only a couple of years
ago.
That just with no otherintervention but regularly
monitoring, and that was in thatstudy.
I believe it was for a weekthat they measured morning and
night and kept a record andafter that it was only weekly
where they had to actually puttheir data into the healthcare
(43:08):
system over there.
That in over a period of timethat I believe it was um 12
weeks that 60 of patients wentfrom hypertensive to
normotensive.
That with our intervention.
So that was the intervention wasmeasuring their blood pressure
now is is it the monitor?
(43:29):
Is it the monitor?
Is it the cuff?
Of course it's not.
What it is is is that itreminds people of this silent
condition that they otherwisemay conveniently choose to
forget about.
What it does?
Is it helps people to be moreaware that the condition exists?
That it improves compliance to,either because the studies are
(43:50):
mostly done on people withtaking medicine that it reminds
them to take their medicine atthe times that they're supposed
that it reminds them to taketheir medicine at the times that
they're supposed to.
Reminds them to take theirsupplements, reminds them to go
out for their walk.
It may help prevent thatreaching for that, you know,
extra drink at the end of theday or even touch on cigarettes,
but it may help with thechoices around cigarettes.
That simple monitoring.
(44:10):
So what in practice I do for mypatients is I ensure that they
don't cost a lot of money thesedays, or I get them to hire them
from the pharmacy or to borrowone from a friend is to have one
at home and to measure firstthing on rising, and then I say
the so that.
And then the last one at nightis.
I say to them when you'resitting on the couch at night
and just before you get up andgo to bed, and keep a record of
(44:32):
those for two weeks and twoweeks straight, and what you see
is you get an accurate readingof what their blood pressure is
like at rest and what you'reideally seeing is the higher
blood pressure in the morningand the lower blood pressure in
the evening.
But after that I tend to I tendto get them to measure it, not
so not so closely monitoring.
I usually get, depending what'sgoing on for the patient, but
(44:53):
often a weekly.
I do a weekly morning and night.
Get them to choose a weekdaybecause it's the majority of the
week.
On Tuesdays, morning and night,you measure your blood pressure
and then they keep their weeklylog and and it's it's something
that people that do it have farbetter outcomes than people
that don't.
Speaker 1 (45:09):
Clinically, Wow is just.
Isn't that such an interestingexample of habitual behaviors
and being cognizant of something?
It's a little bit like whenpeople start working out.
As a side effect, they oftenstart making better food choices
because they're, you know,working towards something.
It's a little bit like foodjournaling.
Monitoring your blood pressureis a lovely reminder that this
(45:31):
is something that matters, whichthen means every choice you
make the rest of that day alsocould be, for better or worse,
influencing your blood pressure.
And what's so lovely about that?
Aside from, obviously, rentingor purchasing a blood pressure
measuring device, whatever oneyou end up going for, it doesn't
(45:53):
cost anything after that andcould ultimately reduce your
outgoings around medication andsupplements, simply by acting as
a regular reminder that yourblood pressure is something you
need to take care of andtherefore might inform better
choices the rest of the dayExactly.
Speaker 2 (46:13):
I love it.
It's my favorite type ofintervention.
Speaker 1 (46:15):
Yeah, oh, my gosh, tracy, it's just so clear to me
the depth and breadth of yourknowledge and I and I just want
to sign up to your courseimmediately, because it's been a
while since I've looked at thisspecifically for myself too,
and clearly a lot has evolved inthe in the most recent years.
But for anyone listening, justa final reminder that there is
(46:37):
an upcoming webinar for designsfor health on cardiometabolic
health and co-prescribing, whichtracy will be taking us through
, and, of course, for anypractitioners interested in
really getting across this, notjust in the cardiovascular space
but across the board, herco-prescriber course is also
available.
And, tracy, just a huge thankyou for sharing with us today.
(47:01):
Just what I know is just thetip of the iceberg of your
knowledge, but so powerful allthe same in just the
conversation that we've hadtoday.
Speaker 2 (47:11):
Thank you so much for having me and thanks for giving
me the opportunity to sharewhat I think is such important
information.
Speaker 1 (47:17):
Thank you, yeah, absolutely so, so important.
Well, thanks again, tracey, andthank you for joining us today.
Remember you can find all ofthe show notes and other
relevant podcasts and seminarson the Designs for Health
website.
I'm Amy Skilton and this isWellness by Designs.
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