Recently, I interviewed Dr. Campbell and we discussed her inspiration for writing The Blood Pressure BluePrint, the connection between blood pressure, oral health, and thyroid function, insights into proper blood pressure measurement, the importance of holistic approaches in healthcare, supplements that can help with managing blood pressure, and more. If you would prefer to listen to the interview you can access it by Clicking Here.
Dr. Eric Osansky:
Dr. Campbell is a native Chicagoan and a graduate of the University of Illinois, The Kirksville College of Osteopathic Medicine, and the Medical College of Georgia. Board certified in family medicine for 30 years, she also holds certification from the American Board of Integrative Medicine.
She is a solo physician especially interested in interdisciplinary collaboration, functional medicine, reversing chronic disease, cardiovascular disease prevention, natural treatments for high blood pressure, and the many oral systemic connections.
She also enjoys live theater, gardening, healthy cooking, hiking, travel, and playtime with her husband and three adult daughters.
Thank you so much, Dr. Campbell. Great to have you here.
Dr. Ellie Campbell:
Thanks, Dr. Eric. It’s my pleasure to be here today.
Dr. Eric:
I just finished reading your book. It’s an amazing wealth of information. There is a lot of topics that you could write books on. Blood pressure is one of those things where a lot of people think it’s basic: high blood pressure or low blood pressure. Obviously, there is a lot more than medications, which we’ll talk about. Really interesting. Some topics I wouldn’t have guessed would have been in the book, like oral health. Very excited to talk to you about this.
I know I gave a little bit of your background with the bio. If you could dive a little bit deeper. What led you to write the book?
Dr. Ellie:
Thanks for the intro. I have bene a family physician for 30 years. One of my greatest joys is taking care of multiple generations in the same family.
When Cheryl came to see me, she originally wanted to have a baby. She was 42 years old, and she’d had one child but wanted to have another. She was a little bit old to be pursuing this, but she went to fertility doctors. They all told her that her and her husband’s genes were incompatible with each other, and they could never have a baby. She went, “That doesn’t make any sense to me because I have a perfectly healthy kid. We did it once, so we can do it again.”
To make a long story short, I worked with her using a functional medicine approach to her fertility, and we were able to get her successfully pregnant and have another beautiful baby boy.
At the end of that, she said, “You’re pretty good with hormones. I think my mother could use your help as well.” Now I am taking care of the two boys, the daughter, and now the grandmother.
The grandmother comes to see me. She has high blood pressure, and we take care of that with medication and therapeutic lifestyle changes. She has high cholesterol, so I have her on medication for that. Now she wants bioidentical hormone replacement therapy, so she can keep up with her much younger boyfriend, go line dancing, drive four wheelers, play with the grandkids, and do all these wonderful things that this spunky grandmother did. I did all of those things. I was managing her standard of care the way everyone in the community does.
One day, Cheryl calls me, devastated. She was crying. She said, “Mother did not show up to work today.” I went to her house, peeked in every door and window, and discovered her crumpled on the floor next to her computer. She’d had a massive stroke, and she was paralyzed on one side.
I felt devastated. I am the primary care doctor. It was my job to take care of her. Strokes are supposed to be preventable. We knew she had risk factors, but I thought we were managing them. She had an event anyhow. I felt somehow like my system had failed me.
She joked with me that she was going into rehab, and it was going to take a lot of therapy to help her start dancing again. Dragging one paralyzed leg behind her was really challenging.
About five days into her hospitalization, she had an unexpected but not that rare complication that happens in about 10-20% of strokes. That weakened blood vessel that had had the stroke burst. Dee had a brain hemorrhage, and she died.
I felt like I had been punched in the gut. It was my responsibility to take care of this lady, and we failed her. The system failed her.
I spent the next three years of my career studying everything I could about high blood pressure, high cholesterol, and stoke prevention. I finally feel like I cracked the code on it. Once I did that, I felt compelled to write this book, not only to help myself, but all the other patients I provide care for, and more importantly, to reach a larger audience.
There are so many DIY things that people can do to get their blood pressure and their cholesterol under control, and reduce their risk for cardiovascular events, which are the #1 killer in our country.
I was going to write a book. Spoiler alert. The #1 hidden risk factor to the #1 killer in our country and the problem that Dee had that I missed was a dental infection. It was a deep-seated dental abscess. Once I learned that, I wanted to write a book about how oral health can change your entire life. If you take better care of your mouth, you’ll take better care of your brain, your heart, your kidneys, your gut. You can’t have an unhealthy mouth and have a healthy body.
I wrote this book about oral systemic connections. Nobody wanted it. I pitched it to 82 publishers, and nobody would publish this book. It was really boring. Fast forward. This was right before the pandemic. I Googled what were the health topics that people were really interested in? Blood pressure came up to be the #1 thing that people wanted to know about. The top 10, 10 years in a row.
I thought that is indirectly connected to my message. I am going to flip it around. I will make it my message and teach people what they really need to know, which is they need to eat clean food, drink clean water, exercise, reduce stress, get good sleep, and have good oral health. If we get that message across, we will save so many lives.
I’m so grateful for you because those same fundamentals correct almost every chronic illness from hyperthyroid to hypothyroid to diabetes to obesity. If we get those fundamentals right, we can reduce the risk of every chronic disease and dramatically reduce our risk of the #1 killer in our country.
Dr. Eric:
I agree. Oral health is important. Even though I was surprised that you brought it up, I shouldn’t be because I talk every now and then about the importance of oral health. I interviewed my biological dentist Dr. Eric Kempter on the practice. I agree that having, whether it’s simply gingivitis, inflammation of the gums, but an abscess, an infection, mercury amalgams, there is a lot of issues we could have when it comes to the mouth. Most people think it just stays in the mouth, but it definitely doesn’t.
Dr. Ellie:
It definitely doesn’t. We know oxidative stress and inflammation are probably at the root of most chronic illnesses. Oral health is a primary driver of oxidative stress and inflammation. Beyond that, we now know we are supposed to have bacteria in us. We are a microbiome having a human experience. We need to have this microbiome. We use their genes to do all of our metabolic processes. We have to have a healthy microbiome.
When we get unhealthy, and we have a pathogenic burden, these pathogens do nasty things to us by driving inflammation. There is one in particular I’d like to mention. It has a long name: Porphyromonas gingivalis, PG for short. This particular bacteria lives off of blood. When it gets into your gums as a pathogen, it makes a really bloody gum inflammation. When you floss or brush, you get pink in the sink. PG is often present when you have that gingivitis or periodontal disease. It makes that bloody mess, so it has fuel for its own self to live.
Now, it’s really tricky. That PG bacteria buries itself inside the red blood cell and becomes a hitchhiker. Wherever in your body red blood cells go, which is everywhere, the PG can hitch a ride and land wherever that blood cell lands. Once it gets there, it secretes a little fatty molecule called phosphorylated dihydroceramide. It’s a wax. It’s a plaque. It makes plaque in your teeth.
If that blood cell lands in your brain, it can make plaque in your brain. That can lead to dementia and Alzheimer’s. If that PG bacteria lands in your neck artery, it can cause hardening of the arteries, corroded artery atherosclerosis. That leads to increased stroke risk. If that bacteria lands in the coronary arteries and makes phosphorylated dihydroceramide in that space, it makes plaque in your coronaries, increasing risk for heart attack.
Where did that bacteria come from? Your mouth. I can’t have my patients have a healthy brain or heart if their dentists and hygienists aren’t helping me to make their mouth healthy as well.
Dr. Eric:
You of course recommend regular checkups. Do you recommend for someone to see a holistic, biological dentist? Or just as long as they are getting regular checkups.
Dr. Ellie:
I think that first of all, a dentist who is not holistic is generally not educated in the fact that the mouth affects the rest of the body. They’re focusing on this part. They don’t really think about all the other connections.
Furthermore, I have blood tests that I do as part of my routine cardiovascular prevention. I didn’t know about this when I was working with Dee way back eight years ago, but I know this now. I do something called the fire panel. It includes markers of oxidative stress and inflammation.
One of them is called Lp-PLA2, Lipoprotein-associated phospholipase A2. It’s an enzyme. It’s made by white blood cells. When those white blood cells are in plaque in the arteries, and that plaque is inflamed, and those white blood cells are angry, Lp-PLA2 levels go up.
Turns out Lp-PLA2 is also found in white blood cells in gum tissue. I have a leading indicator in my cardiovascular bloodwork that tells me, “Dentist, I have a patient I need to send to you because I did their heart bloodwork, and they have a clue that they have a dental problem.” If you’re not using a biological or holistic dentist, they may not be educated, and you will take them this bloodwork, and they won’t know what to do with it.
You not only need a holistic dentist, but one who has been educated in what these markers mean, what they need to look for, and most importantly, how to correct the problems once they found them. Because we know that these mouth bacteria that cause this inflammation and lead to the plaque and oxidative stress that lead to increased risk are not easy to get rid of.
Of course, it requires good home hygiene. You have to be brushing your teeth and flossing and rinsing but not with the wrong mouthwashes because the wrong mouthwashes will decimate the good bacteria, actually raising your blood pressure, so we need to be careful about that. So good home hygiene.
Then a really good dental cleaning, often scaling and planing, deep cleaning. Those unfriendly bacteria are coming back in four hours unless you have done something to taint the terrain. We have to work with our biological dentist to talk about nutrition and pH and saliva flow and oral probiotics that are specifically targeted to help shift the balance of the unfriendly bacteria and chase them away and let the friendly bacteria that are supposed to live in our mouth flourish. That requires a complex, personalized, precision, individual medical dental care team working together.
Dr. Eric:
I want to discuss some other factors that can affect blood pressure. Before we do that, can we go over some of the basics, like what is considered to be normal versus optimal? How to measure blood pressure?
Dr. Ellie:
That is different. When I was in medical school, we were getting people by 160/100 if they were over 70. You have high blood pressure, it’s normal. Just because it’s common doesn’t mean it’s normal or healthy. It doesn’t mean you won’t have risks associated with that.
We now have determined that a normal blood pressure reading, believe this or not, is 119/79 or lower. That is a normal blood pressure. Even 120-129/80 is considered elevated.
In the old days, we used to call that pre-hypertension, but they took that diagnosis away. We just call it elevated blood pressure. The new guideline for hypertension, you are officially diagnosed with hypertension at 130/80-139/89. That is stage one hypertension.
If it’s 140/90 or higher, which was our old definition, that is now considered stage two hypertension, and a much higher health risk for the development of heart attacks, stroke, kidney failure, blindness, erectile dysfunction, and all of the other downstream organ damage that results from the pressure caused on those blood vessels from hypertension.
Recapping, we want our blood pressure to be less than 120/80. If we are more than 140/90, we probably need to be under the care of a medical provider to get that targeted and under control. Certainly, many things are DIY. There are so many things that people can do to get their blood pressure under control. First, we have to know how to measure it properly. I was doing it wrong for years.
We now have guidelines that tell us what is proper to measure your blood pressure. The first, most important thing is you’re not supposed to eat, drink, vape, or smoke 30 minutes before you go in to get your blood pressure checked. If you do that, the temperature changes. The physiologic processes of running digestion can alter your blood pressure. We are trying to standardize it, so everyone has the same guidelines, and we are comparing A to B to C to measure blood pressure. First, no eating or drinking.
Next, we have to make sure that the blood pressure cuff is the proper size, and it goes directly on your bare arm. You should not put your blood pressure cuff over clothing, especially not over a sweater. Even a T-shirt can affect your blood pressure five or ten points. A sweater can affect your blood pressure by 30 points and give you a false hypertension reading when all you really have is sweater pressure, and you don’t really have hypertension.
The next thing, and this is a mistake that we made in my office for decades because I wasn’t smart enough to know better, and the CDC hadn’t published their guidelines until 2019. You have to have an empty bladder when you check your blood pressure. Your bladder has very sensitive pain receptors. When it stretches, it stimulates those receptors, and it can raise your blood pressure. A painfully enlarged bladder can raise your blood pressure for three hours after you check it.
In my old days, we used to have the patients come into the waiting room, sit down. When they were ready to go back, we’d put them in the exam room, sit them down, take their history, check their blood pressure, and send them to the bathroom to get a urine specimen.
We don’t do it that way anymore. They come to the waiting room and are escorted to the bathroom first thing, and they empty their bladder before anything else is done because we want them to have an empty bladder. It is a very important part of measuring your blood pressure. Most offices, including myself, don’t do it properly.
The next thing, once we fitted your blood pressure for the proper cuff, we want to make sure that your arm is resting at heart level. You are not holding it up. You are not dangling it down. It is resting on an arm rest at heart level.
You are not allowed to talk. You are not even allowed to listen intently for five minutes. In our office, we always used to chitchat. How are you? How are the kids? How is the dog? How are things going? Hold on one second. Then we tell them to be quiet, so we can take their blood pressure. That chitchat can raise your blood pressure 10 points.
Even intently listening to that really interesting conversation that is happening in the medical office next to you can raise your blood pressure five or ten points. No talking, no chitchatting, no active listening while you are trying to get your blood pressure checked.
The next thing is you have to be seated properly with your bottom to the bottom and back to the back and feet on the floor. If you are using your back muscles to hold yourself up, you can raise your blood pressure 15 points. If your feet are dangling, like you are sitting on the edge of an exam table, you can raise your blood pressure 10 points.
I have a secret. I am vertically impaired. I am only five feet tall. I cannot sit in 90% of chairs with my bottom to the bottom and my back to the back and have my feet touch the floor at the same time. If your patients are vertically impaired like me, and you want to measure an accurate blood pressure, you need to offer them a foot stool to rest their feet, so their feet are not dangling, as dangling feet can raise blood pressure.
Never check blood pressure on an exam table. If you are a dentist, and you are a wonderful dentist who is checking blood pressure in the dental office, the patient can’t be laying supine in the dentist chair to check their blood pressure. That is also not an appropriate way to do it.
We did lots of things wrong when I was measuring blood pressure. Now that we have standardized it and follow these guidelines, we get much better, reliable data. We also want our patients to check their blood pressures at home with these guidelines, so they, too, can get proper blood pressure readings.
Dr. Eric:
Scary that there might be then some people on medication who are falsely diagnosed with blood pressure if they were doing multiple thing wrong. If they didn’t empty their bladder, if the doctor didn’t have them test with the bare arm. Maybe they were wearing a sweater or a T-shirt. If they weren’t resting for four or five minutes, if they just sat down right away. If they had three or four of these variables, maybe normally they would have had a blood pressure that is below the 120/80, but they read as higher.
You would assume they wouldn’t give blood pressure medication based on a single reading, but if that is the way they measured every single time the patient came in and didn’t have them do it on their own at home the proper way, some people might be on medication when they don’t need it.
Dr. Ellie:
You’re right. We also know that there is a component of white coat hypertension. This is a very real phenomenon. There’s something psychological, emotional that happens to people when they see the white coats or the doctor’s office sign. Their blood pressure will go up much higher than it ever does at home.
Those people deserve to have home blood pressure readings, just like we would never treat a diabetic based on a single reading of sugar that they get in our office. We should not really be treating hypertensive patients based on single readings we get in our office.
We need a lot of data. We want home blood pressure data or even a 24-hour ambulatory blood pressure monitor, where they’re wearing a same monitor for 24 hours, and every few minutes, it gives a reading. It’s uncomfortable and hard to sleep with.
But we can get a pretty decent reading with frequent at-homes. Sometimes, you’re stressed. Sometimes, you’re relaxed. When you’ve slept well. When you’re sleep-deprived. I want to see the whole gamut of readings.
Just as there are some people who have white coat hypertension, some people have something called masked hypertension. These are people who are really good at getting into their zen before they go to the doctor’s office, and their blood pressure looks perfect. When they get home and have a spat with their spouse or get into traffic, their blood pressure goes crazy high. The only way we would ever know this is if they are getting home data.
That is a message I want to bring to the audience: For anybody whose readings are not routinely 120/80 or less, they have a home blood pressure monitor and start checking some data at home. Get it at different times. Keep track of it. You don’t have to check every day or every hour, but you have to check some and keep the data going.
Dr. Eric:
How accurate are other devices? There are wrist cuffs compared to arm cuffs.
Dr. Ellie:
So far, we don’t think they’re ready for prime time. They don’t seem to correlate quite as well. I think they’re getting better as our technology gets better.
At this moment in time, I absolutely do not trust a phone app or a finger app. The wrist, maybe if you are holding it properly at heart level with your arm resting, maybe they are getting closer. I still think the gold standard is an arm cuff.
Dr. Eric:
Other causes of blood pressure. One that gets a bad rap and has for a long time is salt. If you could talk about that.
Dr. Ellie:
There are some people who are salt-sensitive. This is true. It’s not the majority of hypertensive patients. Furthermore, it’s been my clinical experience, and probably yours as well, that people who are nutrient-deficient, especially magnesium, potassium, manganese, iodine, are much more salt-sensitive. They eat a normal amount of salt, and their blood pressure goes up.
When we replete these micronutrients, they can handle salt, and it’s not such a problem anymore.
I think every patient who has been newly diagnosed as hypertensive or has long-standing hypertension deserves a trial to see if they are salt-sensitive. Go two weeks with very low salt, less than 2g/2,000mg. That pretty much means you can’t eat anything from a box or a can. You can’t eat anything from a restaurant for two weeks. You are cooking your food at home, and it’s pretty bland, unless you use lots of spices. You can use turmeric and Indian spices and Mexican spices and Asian spices. You just can’t use salt.
Take your blood pressure for two weeks with low salt. Then go heavy on the salt, and enjoy everything you like. Eat all the crazy salty stuff you want, and see what your blood pressure looks like.
If you are one of those people who has a 30-point differential between the no salt and high salt diets, you are probably salt-sensitive. Make sure you get yourself on magnesium, potassium, manganese, trace minerals, zinc, and iodine. Make sure all those things are replete first. Then you can tolerate your salt most likely with no problem.
Most people who are salt-sensitive are using the wrong salt. Just like we never in integrative medicine recommend that people eat foods made with white flour or white sugar, we want unrefined, natural, whole grains and unrefined sweeteners, we don’t want refined salt in a blue can that pours when it rains. That salt is highly refined. Sometimes, they add iodine back into it. Sometimes, they don’t. it’s highly refined.
Let’s use natural salt, full of minerals. It’s usually pink or gray. It’s Celtic or Mediterranean. Those salts are often much better tolerated than the refined white salt in the blue box.
Dr. Eric:
I agree. That’s what I use. I use the more natural salts, either Celtic sea salt or pink Himalayan salt. Glad you mentioned that.
How about thyroid? A lot of the audience is thyroid. Some might think if someone has low thyroid hormone, they will be more likely to have low blood pressure, not high. Maybe vice versa, if they have hyperthyroidism. I can’t say I see that in my practice. There are definitely people with hypothyroidism with high blood pressure, and people with hyperthyroidism with low blood pressure or normal blood pressure. I’m sure you see the same in your practice.
Dr. Ellie:
I do. I think they overlap a lot. I also think that probably there is more correlation between the underlying root causes. What is an underlying root cause of hypothyroidism? For many people, it’s nutritional or environmental or toxic. If we are living in a toxic soup, then our blood pressure is likely to be high, and we might have hypothyroid or hyperthyroid in that instance.
We want to work on a lifestyle of detoxification. We want to work on a lifestyle that doesn’t bring toxicants into our body. That means looking at our home environment. What are our cleaning products? What are our personal care products? What are our foods? How are they prepared? When we lower our toxic burden, our blood pressure is easy to control.
We have heavy metals. In heavy metal toxicity, you will often see thyroid dysfunction. I have seen hyperthyroid and hypothyroid from heavy metal toxicity. We work on chelating those metals one way or another, whether that’s oral, rectal, IV, however we are going to get these heavy metals out of the body. As we do that, the arteries get softer, and blood pressure is easier to control. The same underlying root causes for one condition can drive the other.
Dr. Eric:
Any other direct or indirect causes of high blood pressure?
Dr. Ellie:
Yeah. We have talked about the mouth. In Dee’s case, what caused her blood pressure to spike and caused her stroke was that she had a dental abscess. She actually had an appointment to have her tooth extracted a week after her stroke that killed her. She never made it. She never lived long enough to have that event.
I know that if the dentists knew what a medical emergency this was, and how it was driving her oxidative stress, we would have been on either stronger antibiotics or done the procedure sooner. We would have intervened in some way. Neither of us were smart enough at that time in our careers to make that call.
Now I’m smarter. Now when I see people with dental abscesses, it’s like a 911 dental emergency. We got to get you on anti-inflammatories. You want to take baby aspirin. We have to do things to get you prepared.
Oen of the probably #2 root causes that I have seen since I have been paying attention, and it’s also oral related, is sleep apnea. Many people have undiagnosed sleep apnea. I used to think I could look and tell. That person is morbidly obese. They have a size 17 or 18 neck. This Jabba the Hutt body composition. That person has sleep apnea. Often, they do, but not always.
Some people who are very slender, very tall, very athletically fit have horrible sleep apnea. One of my patients came to see me after his heart attack. He is a very strong, very fit triathlete. He had undiagnosed sleep apnea. He had undiagnosed familial hyperlipoidemia. He had undiagnosed insulin resistance. We got to all those root causes to try to make sure he never has another event.
Sleep apnea was a major contributor. His oxygen levels were dropping in the middle of the night down into the 80s. When that happens, one of the things that your body does besides waking you up at night to try to get some deep breaths to pull your oxygen level back up is that’s a physiologic stressor, and it raises your cortisol.
If you ever do a cortisol test, and you have your morning cortisol nailed to the ceiling with these very high AM cortisols, that is an important clue to me that you’re likely being woken up in the middle of the night by something. That something is commonly undiagnosed sleep apnea.
Most people with sleep apnea have obstructive sleep apnea. There is an obstruction in your airway. Either your nasal passages are clogged, your oral pharyngeal airway, their adenoids are too big. Their uvula is too large. Their palate is too soft. Their tonsils are too large. Or it could be down farther in the oral pharynx.
In my case, when I was a teenager, they pulled four teeth out. I had an overbite. They put me in headgear to pull my overbite back and make my teeth straight. That was lovely, except for one problem. By taking four teeth out, they narrowed my airway 15mm. I had no room for my tongue except to stick it in the back of my throat. When I laid down in bed, not only would I snore, but I would choke off my airway.
I developed sleep apnea as I got older. I developed a horrible snoring habit, which I didn’t know I had, but I found out when I spent the night with my sisters on vacation. When I asked my husband about it, he said, “You’ve been snoring for years.” “Why didn’t you tell me?” “I thought you knew.”
We need to have a conversation with our partners about this. Let’s find out if each other snores. If you snore, get a sleep test. Not all snorers have sleep apnea. Not all sleep apnea patients snore. If you wake up unrefreshed, you need a sleep test. If you have ADHD, you need a sleep test. If you wet the bed, or your child wets the bed after around age five, you need a sleep test. These are often symptoms of not getting deep, restorative sleep. One of the reasons is sleep apnea.
Some people have an upper airway condition, and they just need nose surgery, and their sleep apnea is cured. Some people need more than that. Some people do need CPAP. I don’t like to use CPAP as my first treatment of choice. I have about five other things we do before we ever talk about CPAP, except in the most severe cases.
I would say sleep apnea is a very common and underdiagnosed trigger for hypertension.
Dr. Eric:
You said you are not against CPAP, but you try four or five other things prior. If someone has to be on CPAP, do you look at it as temporary, just for a period of a few months?
Dr. Ellie:
When CPAP was first invented, it was intended to be a temporary bridge until we fixed their underlying root cause. Sometimes, we put patients on CPAP, and they get deep, restorative sleep and lose 25-30 pounds without trying. For the first time in their life, they are not making high cortisol. They don’t have a steroid burden. They are getting deep sleep. Everything calms down. They are not trying to keep themselves awake all day by eating extra calories or caffeine, driving their metabolic function, insulin resistance, etc. Sometimes, CPAP makes them lose weight, and then their sleep apnea goes away. Sometimes, 6-12 months on CPAP, and they are cured. They don’t need it anymore.
That doesn’t happen as often as I’d like it to, but it can happen. Often, when I see someone with sleep apnea who needs CPAP, I get them to see an oromyofunctional therapist. OMT is like physical therapy for the lips, jaw, and tongue. Sometimes, we can strengthen the soft palate. We can strengthen the lips and jaw. We can get that jaw pulled slightly forward, just by retraining. Those patients now don’t need CPAP the way that they used to.
In some cases, however, there can be a curative surgical procedure. For somebody like me, who had four teeth pulled, and they changed the shape of my jaw growing up, I was fortunately able to correct this wearing an oral device. It’s called a Vivos device. They put it in the roof of the mouth, and at the bottom of the jaw, there was a little key. I was advancing the key a couple of turns every couple of nights, spreading out my jaw. Painlessly, I might add.
Both my upper jaw and lower jaw, over two years’ time, I was able to expand my jaw and get back most of the 15mm I had lost when they pulled my teeth out. I had to wear Invisalign to close up the spaces that had been made in my teeth by widening my jaw. Now, I have straighter teeth again and no snoring and no sleep apnea. For me, that was curative.
If I had more moderate or severe sleep apnea, I might be on a CPAP while simultaneously wearing the oral device.
The final thing is pretty drastic, but it’s curative in 90% of cases of sleep apnea. It’s paid for by every insurance. Most people don’t know about it. It’s called a maxillary mandibular advancement surgery. It’s a really big deal. They cut your jaw in half on the top. They cut your jaw in half on the bottom. They push everything forward. They do bone grafts and make extra room, so your entire face moves forward. Now your tongue and jaw move forward and get out of your airway.
Is that my first or second or third choice? Not really. I would rather you had cured permanently your sleep apnea and not required to go to Tahiti with a CPAP suitcase than suffer from any kind of consequences of sleep apnea. If we can permanently cure it, and a surgery is the way to do it, it’s on the consideration table.
Dr. Eric:
Many cases, a last resort. But there is a time and place, just like with thyroid surgery. I am not a proponent of- It depends on the situation.
Dr. Ellie:
Sometimes, they need it.
Dr. Eric:
Exactly.
Dr. Ellie:
I think a really important point that is often not emphasized is the preventative nature. If we go back 1,000-2,000-10,000 years, we ate really nourishing food. We had to rip the meat off of our bones. We hadn’t invented knives and forks yet. We were using our hands and teeth to eat root tubers and strip the leaves off plants to get to the soft bark and the nutrients underneath.
That mastication, that chewing, that gnawing caused our cheek and jaw muscles to be really well developed. When we had really broad faces and broad jaws, we did really well from a perspective of not having a small, narrow airway that caused crooked teeth and obstructed airway disease.
Fast forward to today. What do we give our kids to eat? We don’t let them use a breast too often. We have them bottle fed. They don’t develop strong jaw muscles. We give them baby food that has already been pre-chewed. Babies do not develop the jaw muscles and grow their jaws the way that we need to.
Pediatricians have a responsibility now to talk to our bottle-fed babies about jaw exercises. Giving their kids specific pacifiers, something called a Myo Munchie, for example, that works those jaw muscles. It gets them to use those muscles, so these kids can grow.
We want to talk about an airway assessment before age five and make sure the kid doesn’t have a tongue tie, a lip tie. If a baby is not a good nurser, it is probably not the mom’s fault. It’s not that she is not good at this. The baby has a physiologic restriction because they were vitamin deficient during the pregnancy, or if they have this tether of tissue that is preventing the baby from getting their tongue in the right position.
The proper position of the tongue resting is not how it looks in our anatomy books, which is on the floor of our mouth. The proper position of the tongue is resting on the roof of our mouth when we are sitting at rest or sleeping. If a kid or adult can’t get the tongue on the roof of their mouth, they have a problem. That can lead to sleep apnea, which can lead to hypertension.
If we knew about it before the age of five, they wouldn’t ever need braces. Their jaws would be big. Their airways would be large. They wouldn’t have hypertension. We could prevent a whole litany of health problems in adulthood by addressing it in kids.
Dr. Eric:
This should be evaluated by a pediatrician over a dentist, or maybe both?
Dr. Ellie:
Ideally, it’s a pediatric dentist and pediatrician working together. Or a family physician and a pediatric dentist working together. Or a general dentist or general family physician who is particularly trained and educated in paying attention to this.
Dr. Eric:
How about certain supplements? I am thinking about licorice root. How concerning is that? I know if they have high blood pressure, it’s a concern. Is it a concern if someone has normal blood pressure?
Dr. Ellie:
Generally speaking, no. There is a component of glyceridic acid that is in the licorice supplement itself that is the problem. If it’s DGL, which is deglycyrrhizinated licorice, most people can tolerate that with no effect on their blood pressure. Most of the supplement companies make that DGL.
However, we do use licorice a lot. It’s a great sweetener. It’s an adaptogen. There are lots of advantages to licorice. Some people are very sensitive to it. I had one person develop profound edema. Gained 30 pounds of fluid and jacked up their blood pressure by taking licorice when we were treating something else.
We do have to respect it and be careful and know about it, but it’s reversible if you stop the supplement and pay attention and change to something else. You can get rid of it with no permanent problems by taking a short course of licorice.
Dr. Eric:
Most of the focus has been on hypertension. When is it a concern with hypotension, when blood pressure is too low?
Dr. Ellie:
It’s a concern when it causes symptoms. Many people run around with blood pressure of 90/40, and there are no symptoms whatsoever. Often, these are petite people, adults who are under five feet tall, under 100 pounds. They have a blood pressure of 90/40, and that is perfectly fine. They are getting perfectly good blood flow to their brain. They don’t have any symptoms if they change positions.
But if they get weak or dizzy when they stand up, that blood pressure is too low for them. It’s likely an indicator of a problem. That problem might be mitochondrial, nutritional, thyroid, adrenal.
Or we are seeing a lot of vascular damage post-COVID from postural orthostatic tachycardia syndrome, POTS. There is a lot that can be done to help those people. Retraining of their sympathetic/parasympathetic nervous system can be done, but it’s not easy to do. Often, they’re nutritionally not balanced either. Low blood pressure can be a problem when it causes symptoms.
That being said, if you have chronic kidney disease, and we are trying not to get you on dialysis, the lower the blood pressure, the better. It preserves the kidneys for a much longer period of time. As long as you are not having symptoms, and we keep your blood pressure low, that is what our goal is.
Dr. Eric:
I tend to be on the lower side. Sometimes, I will be 100/60 for example. I feel fine, so as long as symptom-wise I feel okay, I shouldn’t worry about it.
Dr. Ellie:
I wouldn’t worry about it. I would count yourself in the lucky box.
Dr. Eric:
Good deal. Let’s talk about some natural options. Of course, it comes down to addressing what you spoke about: oral health issues, thyroid, if someone is using refined salts instead of natural salts. I’ll let you take over. If someone is listening to this, what are some steps they can take to help with their high blood pressure?
Dr. Ellie:
In my experience, probably the #1 most common missing nutrietnt in hypertensive patients is magnesium. We have lots of different choices of magnesium out there. There is magnesium oxide, magnesium citrate, chelated magnesiums like magnesium glycinate or magnesium malate or magnesium threonate.
In general, for the most part, I don’t like to use magnesium oxide. It’s the cheapest one. It’s available at every hospital pharmacy. It’s available at every drugstore. It’s not very well absorbed, and it doesn’t get into the cells the same way that one that is chelated to amino acid does.
I would switch somebody if they are on magnesium to a magnesium malate or magnesium malate/glycinate combination. That is what I take myself every day. I take three capsules once a day. Every skeletal muscle cell requires calcium to make it contract and magnesium to make it relax. That is including the tiny muscles on the surface of our blood vessels. If they don’t have magnesium to relax, they will be stuck in a constricted state.
Magnesium is often super helpful as long as it’s inside the cells and not in your bowels and being pooped out, like magnesium citrate tends to do. Magnesium citrate is a wonderful laxative but not really great for your blood pressure. That’s why I like the malate or malate/glycinate combos.
I take three every day. They don’t make me sleepy. Some of my patients find they’re so relaxing that they can’t stay awake if they take them. I take mine in the morning. That’s when I take my magnesium. As long as I take it daily, I poop like a champ and sleep like an angel. Magnesium is my miracle. If I am stuck on a desert island, and I can only bring one supplement, I am bringing magnesium. That’s a simple one.
What if you really do have hypertension, but you don’t want to go to a medical doctor? You are going to be very diligent about checking your blood pressure and keeping your target above 120/80 or maybe 130/80. If you have end organ diseases, if you have heart disease, if you have diabetes, if you have kidney disease, if you’ve had a stroke or a heart attack, you probably should really aim for those lower readings, 120/80. If you have never had a problem, we can be a little softer with you. We can go up to 130/80 and not have to take anything for it.
What’s one of the best things you can take? One of the biggest bang for your buck supplements is hibiscus. It’s that pink flower that we see here in Georgia growing all over the place in the summertime. If you make a tea and drink hibiscus tea, hot or cold, you can make hot tea or sweet tea out of it. Everyone in Georgia drinks sweet tea in the summer.
I recommend you sweeten it with xylitol, not sugar. Xylitol is a polyol often made from birch bark. It also happens to be a prebiotic that supports oral health and lowers blood pressure just a little bit.
Hibiscus tea, three servings a day, can lower your blood pressure 20-25 points. It’s one of the biggest bang for our buck nutritional supplements. I really do like hibiscus.
There are many others. One of the common ones we think about is hawthorn. Both the berries and the root have antihypertensive properties. They also act a little bit like a beta blocker, so they tend to slow down a fast heart rate. If you’re one of those people who tends to run at 90-100 blood pulse rate, as well as high blood pressure, hawthorn berry might be a really good choice for you to help get both things under control.
There are many other supplements we can use. Ginger for example and cardamom. Parsley. These all have antihypertensive therapies. Each one will typically lower your blood pressure. Some are around 2-5 points, except for hibiscus. Hibiscus is the big bang for our buck one, in the 20-point range.
One thing I do want to mention is mouthwash. Traditional mouthwashes like Listerine that make that really napalm clean in your mouth have been shown to raise your blood pressure up to 5-7 points and persist for many hours after you use that mouthwash. Why would that be? How could that possibly affect something?
In the 1990s, there was a Nobel Prize awarded to three doctors for the discovery of a gaseous signal and molecule called nitric oxide. I like to call this “the miracle mouth molecule” because it has so many downstream effects.
As they were trying to turn their nitric oxide discoveries into a commercially available pharmaceutical, they were trying to make a blood pressure medicine. One of the things that nitric oxide does is opens and dilates blood vessels, thereby lowering blood pressure, which is a nice thing. They had this supplement, Sildenafil, they were trying to manufacture for blood pressure. It wasn’t working very well. They were getting real disappointed.
Man after man in this clinical study was coming in, “Guess what happened to me? I haven’t been able to get an erection for years. Since I started taking your blood pressure medicine, I get a good erection in the morning.” They discovered that this medication had nitric oxide benefits mostly in the pelvic floor, much more so than in the peripheral arteries. They turned it into Viagra. It was based on this nitric oxide research.
We now know that if we do the pathways a little bit differently and not try to trick Mother Nature and use Mother Nature’s nitric oxide instead of the drug company’s artificial one, we can get really big benefits.
Nitric oxide is made in every cell in your body, but it’s predominantly made by cells in the floor of your sinuses. There is an enzyme that is made in your tongue by friendly mouth bacteria. This nitric oxide synthase is annihilated when you use mouthwash. We want to use only mouthwashes that have been shown not to affect nitric oxide and make sure we’re supplementing with the things that drive nitric oxide pathway.
That includes nitrite-containing vegetables. Beet root and arugula are two of the biggest, most common ones. Leafy greens in general.
Supplements. Berkeley Life has one. N1o1 has one. They contain a little bit of B vitamins and some citrulline and beet root extract. They can be used to help our bodies make more nitric oxide.
As an aside, about 50% of Viagra non-responders, if they pre-treat with a nitric oxide lozenge, like Berkeley Life or N1o1 and then take Viagra, it works. Little tip and tidbit for controlling blood pressure but also increasing nitric oxide is to use these nitric oxide tablets.
I recently had the blessing and opportunity to go to Peru. I was in Cusco at 12,000 feet, where altitude sickness is a major problem. In part, your oxygen level is lower, and your cells don’t carry oxygen as well. Nitric oxide will improve the oxygen carrying capacity.
I use those nitric oxide lozenges for myself to prevent my altitude sickness. I don’t have any issues with blood pressure, but I didn’t get altitude sickness when I used my nitric oxide supports. It’s a nice thing to have in your tool chest at home.
Dr. Eric:
Interesting. I didn’t know there were nitric oxide lozenges, so that’s pretty interesting. How about CoQ10? What impact can that have on blood pressure?
Dr. Ellie:
We know there is an age-related decline in CoQ10 levels. This is one of our body’s natural antioxidants. There are different amounts in different organs in our body.
Our heart is one of the ones that has the most rapid decline in CoQ10 levels as we age. Utilizing CoQ10 to get those levels up to 20-year-old or 30-year-old levels can really make a difference in the resiliency of our heart and can lower blood pressure as well. You get five or seven points of blood pressure lowering by supplementing with CoQ10. It’s also heart-protective.
We know the same pathway, the HMG-CoA reductase pathway that turns mevalonic acid into cholesterol, that is the pathway we block with statin drugs. That same pathway makes CoQ10. When we block the production of cholesterol using Lipitor or Crestor, we also block the production of CoQ10. A consequence can be high blood pressure.
Supplementing with CoQ10 can reduce muscle aches and headaches and fatigue caused by lowering CoQ10 but can also improve blood pressure. CoQ10 is another great supplement to include.
Dr. Eric:
You shared a lot of amazing information. Really appreciate it. Before we wrap up, is there anything else that I should have asked you that I didn’t ask you? Any last words that you have?
Dr. Ellie:
Where can you get my book? The Blood Pressure Blueprint. It’s on Amazon on e-book and paperback. It will be coming out in 2024 as an audiobook.
Dr. Eric:
We were gonna get there, to where people can find out more about you. Definitely check out her book.
That’s great that it will be on audiobook. I listen to audiobooks. If it was on audiobook, I probably would have read it. As of recording this, there is only the print edition, so I wanted to read it before our interview. Appreciate you sending me a copy. Highly recommend reading it or listening to it later.
Can you remind people of your website and anywhere else people can find you?
Dr. Ellie:
Sure. I see patients in Georgia. I am accepting new patients. I am very proud to report that since I cracked the code on this root cause resolution approach to managing hypertension and cardiovascular risk reduction, we have had zero heart attacks or strokes in any patient for seven years.
I am taking new patients, even if you have already had a heart attack or stroke and don’t want to have another one. But you have to come to Georgia to see me. I can only see patients face to face the first time; we can do remote visits after that.
CampbellFamilyMedicine.com in suburban Atlanta. That is my practice.
The website for the book is just getting started. There is not a lot of information other than links to all the podcasts I have been on if you think I tell interesting stories or like what I talk about. There are a bunch of podcasts on TheBPBlueprint.com.
If you want me to come to your event and speak, DrEllieCampbellSpeaker.com is another website where people can find me.
Dr. Eric:
Wonderful. Thank you so much, Dr. Ellie. Appreciate you taking the time to talk about blood pressure. I’m sure the listeners learned a lot, and I learned a few things as well.
Dr. Ellie:
Thank you for having me. I appreciate it. We all work together. Everybody has their little niche. None of us can do everything. No cardiovascular prevention program is complete without a medical doctor, dentist, and hygienist on the team. We really have to work with interprofessional, interdisciplinary collaboration.
Another point, something I didn’t mention is chiropractic adjustment. I have seen many people normalize their blood pressure once we get their spine and posture in alignment. Don’t forget about that, too.
Dr. Eric:
Definitely glad you mentioned that. My background is as a chiropractor.
I agree. Working as a team and not just relying on a single healthcare practitioner, because no one practitioner has all the answers. You have a lot of knowledge. I do, too.
Dr. Ellie:
Then we’re better.
Dr. Eric:
Exactly. Thank you again. This really has been a great conversation.
Dr. Ellie:
You’re so welcome.
