I’ve had high blood pressure since med school.
It’s a spooky thing if you find things like kidney failure, stroke, and heart attack worrisome.
And being an overthinker, of course I worried.
But you’re a med student, they said. No surprise your BP is a little up there.
Once you get out from under the pulverizing grind of medical school, internship, and residency, the pressure will literally ease off.
I’m not sure what alternate reality my advisors lived in, but in my corner of the multiverse, the grind just changed shape. Life layers piled up, with marriage, children, professional advancement, and aging parents exponentially adding to the stress.
When I clocked my BP in clinic one day at over 200 for the top number (I forget the bottom number, I think I stopped paying attention once I saw the needle twitch at over 200 on the way down), I knew it was time for a change.
First, I tried exercise
In my 20s and 30s, I believed in fixing problems by doing more stuff. Friction with my fiancée: talk it through. Short on funds: work more hours.
High blood pressure? Do more cardio.
I started running an hour every morning, and my BP dropped about 50 points within 2 weeks, to around 150 for the top number.
A great (and atypical) improvement, but not enough for my sub-130 goal.
I added more cardio in the evenings after work, and 30-60 more minutes yielded a drop to 130.
But 90–120 minutes a day of pounding the pavement felt like a lot for my 200-pound frame. I wasn’t sure my joints could sustain that for the rest of my life.
So I turned to the diet
Long story short: after eliminating certain foods and adding others, my weight dropped and my BP stabilized. Without needing to run my knees off.
It was as much about not doing things as it was about adding other actions.
And modern medical science backs me up. The DASH Diet, for example, which significantly increases dietary sources of potassium (fresh fruits and vegetables, legumes, whole grains, and not too much salt), lowers blood pressure on average by 11 points — and sometimes more — on par with what a medication can achieve.
The target is 4,700 mg of food-source potassium a day.
• Avocado (1 medium): about 708 to 975 mg potassium
• Orange (1 medium): approximately 237 mg potassium
• Nectarine (1 medium): about 273–285 mg potassium
• Broccoli (1 cup, cooked): around 261 mg potassium
• Banana (1 medium): about 422–451 mg potassium
• Coconut water (1 cup, 8 oz): about 509 mg potassium
A cup of milk: about 380 mg; a cup of Greek yogurt, about 300 mg.
A cup of yogurt, a banana, and an orange is 1,000 mg, and so on.
It was a lot easier to eat “modestly and right” than to basically commute to and from work each day via Adidas.
Less really can be more — less weight, less processed foods, less stress — particularly in the health realm.
Time, tide, and war
Most of us have or will have high blood pressure.
If you’re 50 in the U.S., your odds are 50/50 of having hypertension, and basically go up more than 10% every decade. Between the ages of 60 and 80, your odds are around 65%, and if you’re over 80, the odds are 80%.
Leaning out and DASH-ing your diet are good ways to tilt the odds in your favor; cardio can help.
What has that got to do with being intensely active?
Everything is a 2-front war when you’re past 40.
I tell my patients that 40 is the health risk Rubicon: their risk of death has shifted, from death due to putting themselves in harm’s way — an alcohol-related car crash, a drug overdose, or a violent confrontation — to death from heart attack and cancer.
The Number One and Number Two causes of death.
My activity of choice is Gracie jiu-jitsu, sometimes called Brazilian jiu-jitsu. Getting a black belt in it takes years and years, usually a decade. And even then, like first-degree shōdan black belts in Japan, that’s just considered a fair start (shōdan means “first step”).
You need to marinate in the process for a long time: think sourdough starter, used daily for 500 weeks to get to a NOW YOU’RE TALKING stage, rain or shine, incorporating all your learnings and experiments along the way. Some rare birds have gotten their black belt in 3–5 years, but these are the exceptions. The journey is neither quick nor easy, there’s a mountain of experience to wade through, and processing it typically takes about a decade.
If you’re in something for the long haul, you kinda need to be around for the long haul.
Not dying prematurely becomes as necessary to NOW YOU’RE TALKING as showing up to the next 3,000 classes.
If it takes 10 years to get decent, and you keel over after 3 years because you didn’t plan for super common illness prevention, I mean… come on, man.
Maybe it’s not a problem when you’re 20.
But it’s definitely an agenda item for the Live Long Enough Subcommittee.
Working on your moves. And working on longevity.
2-front war.
Are these competing demands?
They can be.
I remember hearing about an anonymous survey of Olympic athletes: if they could take a drug that would guarantee them a gold medal in their sport but that would kill them in 5 years, a stunning percentage (52%) said they’d consider it.
You can get freakishly strong by lifting super-heavy weights and eating massive amounts of calories. You’ll resemble a cinder block, but your lifespan will be suspect.
You can maximize your lifespan by calorie restricting, supplementing, and carefully choreographing your strength training. But your ability to handle random acts of violence and physical challenges will probably be nil.
It’s a spectrum, a slider on the mixing board.
Everyone should set it where it best fits their needs. Hopefully, in a Venn diagram sweet spot where investments in lifespan overlap the investments in activity proficiency.
Besides, you CANNOT train all the time
A high-ranking aikido instructor once told me that even if it were possible to arrange your entire life around the study of the martial art, he wouldn’t recommend it.
“People get weird when all they do is aikido,” he said. “Three, four times a week is plenty; have a life.”
We all have different needs, and some of us really need to bang something out, and bang it badly. To groan, cry, and sweat profusely as we sacrifice ourselves on the altar of muscle failure.
Some of us prefer the model of John Wick, slo-mo walking away from the explosion. Getting so good that everyone else maxes themselves out, while we stay frosty.
And some of us just want to put in our time, learn something new, and repeat the cycle without getting too banged up for work, family, or doggos the next day (me).
Your ultimate goal may not be getting a certain degree black belt. Every endeavor has its versions of NOW YOU’RE TALKING, followed by ATTA BOY, and eventually YOU’RE SO AMAZING WE’RE NOT WORTHY.
Yours might be NICE SEEING YOU, IT’S GREAT YOU CAN KEEP UP, and YOU’RE REALLY AN ASSET, or THANKS FOR COMING MOMMY, YOU’RE THE BEST FOR WATCHING THE KIDS, and YOU’RE THE BEST GRANDMA EVER.
Whatever your ultimate goal, if it involves accumulating learning and physical resilience over a long time, self-care and health MUST be part of your plan.
Action items
If you aren’t seeing a primary care doctor, I humbly suggest that you find one and get a health assessment. MD, DO, functional medicine practitioner… being an MD physician, I have my biases, but connect with a healthcare provider who has dedicated their professional life to the complexities of the body (aka a 2 or 3-stripe black belt vs. your health and wellness white belt).
Identify what you’re at risk for; get screened.
The biggies are blood pressure, cholesterol, pre-diabetes, obesity, and all the collective cancer risks.
Work with them on the testing and treatment options, but don’t neglect the lifestyle modifications: nutrition, exercise, inner work/stress reduction, sleep, and socializing.
If you’ve got elevated BP — the odds are pretty good, here — discuss the DASH Diet, moderate exercise, and weight reduction. Very few doctors will object.
The next steps may be simple, or they may be complicated and involve prescription drugs. Weigh the risks and benefits, realizing that not acting has risks, too, and make your choice. Review your progress after a bit, and adjust accordingly. Repeat.
It’s true: your doctor doesn’t know everything. Neither do you, grasshopper. Put your heads together and figure out the best possible way forward. Pobody’s nerfect.
All this while working on your dedicated skill.
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