When I was a teenager, I went to the doctor only once, and only to confirm that I had a tongue that was rightside up. It was, but I didn’t know it and it didn’t really matter. But as I got older, my mother’s concern and doctor’s scrutiny over my health issues grew increasingly intense. So, even though I’ve never had much health insurance, and haven’t had the money to pay for my own doctors and specialists, I’ve always gone to them, because I knew I needed to. The more I got into the business of medicine, the more I understood what my parents knew all along: sometimes, you have to go to the doctor.
A doctor who has a doctorate in a medical field, but is not a doctor, like a doctoral level nurse, doctor, or doctorate level medical student. The medical doctor has the education and knowledge to treat and diagnose disease, and the knowledge to pursue and engage in the profession of medicine. Their education and experience usually takes many years to obtain a doctorate degree. (Articles search on Author: “Spencer Nadolsky”)
What “Doctor Detective” Spence Nadolsky does: I am a doctor who uses my skills and expertise to help solve crimes that have yet to be solved. My work can help law enforcement agencies solve cases that would otherwise be unsolved. If you have a tip or have information that might help me solve a crime, then please contact me at Detective Spence Nadolsky
Dr. Detective examines a healthy guy with high blood pressure in this week’s case study and finds the issues with medical self-diagnosis.
Eat less calories and exercise more. It’s a fantastic prescription for boosting health and body composition in general. It does not, however, always work.
Even with a great workout routine and a well-balanced diet, some individuals have strange symptoms and complaints, especially considering how much effort they put into their fitness and health.
We know there are just a few specialists on the world to turn to when we encounter customers who have issues that exercise and diet — not to mention their own physicians — can’t seem to cure. Spencer Nadolsky is one of them.
Dr. Nadolsky is an osteopathic physician with a background in exercise physiology and nutrition. He was an academic All-American wrestler in college and is now an enthusiastic exerciser and smart physician who does what he teaches to patients by treating avoidable illnesses with lifestyle changes first (instead of prescription drugs).
Dr. Nadolsky transforms from a happy, athletic doctor to a rigorous, no-holds-barred forensic physiologist when clients have nowhere else to turn. He takes out his microscope and examines blood, saliva, urine, lifestyle – anything it takes to solve the medical puzzle.
We leapt at the opportunity to collaborate with Dr. Nadolsky on a regular case study segment. You’ll learn how a skilled practitioner thinks by following along with these interesting examples. You’ll also learn how to take better care of yourself.
We’ll encounter a healthy guy with elevated blood pressure in today’s example. Dr. Detective analyzes his own faults and “blinders” while researching this strange scenario, and reminds himself that the “obvious” answer… may not always be the right one.
Drew, a 54-year-old man, visited my office for his annual physical.
Drew’s medical history was quite clear, apart from a surgery to remove his appendix, and he had no specific health problems. I usually give him some preventive advise and check for any brewing illnesses when I see people like him.
Symptoms and indications of the client
Drew may not have been in pain, but I saw a few red flags when I checked his vital signs before entering the examination room.
His BMI of 27 put him in the “overweight” category, and his waist circumference was somewhat higher than normal at 39′′ (99 cm). (Anything above 39-40′′ is considered a cardiovascular disease risk factor.) Even more concerning, his blood pressure was slightly elevated at 152/95, which was considerably higher than the “normal” threshold of 120/80.
I quickly looked up Drew’s prior year’s visit record and found that his blood pressure was 127/84 at the time. Hmm. My detective’s bloodhound nose detected a possible issue.
But nothing about the patient’s looks concerned me as I went into the room to meet him.
Drew informed me about his routines and the events of the year while I examined him. He wasn’t on any medicines at the time. He never smoked, drank alcohol in moderation, had a 9-to-5 cubicle job, was happily married, and went to church on a regular basis.
It’s important to inquire about these lifestyle choices in order to evaluate stress and other variables that may lead to high blood pressure. But I wasn’t learning anything that would assist me understand his issue thus far.
(A remark on going to church: spiritual people are less stressed.) This does not imply that you must attend church; rather, it implies that you may benefit from some kind of spirituality.)
|Symptoms / Signs||My views on the subject – possible problems|
|Blood pressure that is too high||Problems with weight, stress, and sleep, as well as atherosclerosis, kidney disease, thyroid, and adrenal dysfunction|
|Increased body mass index||Lifestyle variables are likely to be thyroid-related, although this is unlikely.|
Going a step farther
I didn’t have much information at the time. But, as usual, I inquired about his eating, exercise, and sleeping habits.
Drew ate three times each day. His meals sounded like an overabundance of manufactured starches on a normal American plate. On the plus side, he wasn’t consuming excessive amounts of calorie-dense drinks (including alcohol), which I appreciated.
Drew’s fitness routine comprised 20 minutes on the elliptical once a week, one game of racquetball once a week, and one circuit-style weights workout utilizing the machines once a week.
I was worried Drew had sleep apnea, but he said he never snored and slept comfortably for 7 hours each night.
Putting on blindfolds
Even the best investigators make errors from time to time: we focus on the most apparent answer and ascribe all issues to it. It’s referred to in medicine as “going in blind.”
And, with my blinders on, I went directly to Drew’s diet in order to “cure” him. He seemed to be consuming much too many carbs, in my opinion. His high blood pressure would miraculously vanish if he gave up those and dropped weight.
Okay, OK. I was making hasty judgments. However, in my defense, weight reduction alone does not often cure high blood pressure.
For this appointment, I advised Drew to boost his lean protein intake and reduce his carb intake in half, substituting green vegetables for what was lacking.
(This is quite similar to PN’s My Plate, and if you’ve read any of my prior instances, you’ll see that these dietary recommendations are very typical for me.)
I also ordered several routine labs, both to check for potential secondary reasons and to identify them. Following his weight reduction experiment, we would review these labs at his next appointment.
The exams and evaluations
I expected Drew’s labs to be normal based on his medical history, physical exam, and lifestyle behaviors, with the exception of his cholesterol panel and fasting blood sugar. Drew didn’t have his bloodwork done until a few days before his follow-up appointment, a month after his first visit.
The results of the tests
Drew’s important lab results are as follows:
|Marker||Result||Reference Range in the Laboratory||Thoughts|
|glucose levels after a fast||89 mg/dL||65-99||Not too shabby. There are no indications of insulin resistance in this area.|
|Sodium||144 mEq/L||134-144||Although it is rather high, it is not always a cause for worry.|
|Potassium||2.8 mEq/L||3.6-5.0||The level is low and alarming. Hyperaldosteronism in conjunction with a high sodium level is a possibility.|
|Creatinine||0.9 mg/dL||0.6-1.2||At first look, the kidneys seem to be in good shape.|
|HDL||50 mg/dL||40-90||Not terrible, either. It might be more, but I’ll take it.|
|Triglycerides||90 mg/dL||40-150||It’s not bad. These were most likely considerably higher before he began his new eating habits.|
|Cholesterol total||208 mg/dL||Less than 200 (although this isn’t a must)||Elevated, but not to the point of becoming a major issue. At 158 mg/dL, his non-HDL cholesterol is normal.|
Drew had been following my dietary recommendations, as shown by his cholesterol and lipid panels. I wish we had a baseline panel to compare his latest findings to, but we have to make do with what we have.
Electrolytes and aldosterone are two clues.
I was worried about Drew’s sodium and potassium levels, despite his overall good test results. These figures were typical the prior year. The findings now pointed to a potential case of hyperaldosteronism (high aldosterone).
The adrenal glands produce the hormone aldosterone. It regulates sodium and potassium levels in the body. Your sodium levels rise while your potassium levels fall when you have high amounts of aldosterone. Low potassium levels may cause your heart’s electrical and, as a result, its rhythm to be disrupted, which can be hazardous. That’s not good!
Hypokalemia (low potassium) may be caused by a variety of things, but given Drew’s blood pressure and test findings, the high aldosterone theory appeared to be the most likely.
High levels of aldosterone, on the other hand, may be caused by a variety of factors. So I wanted to find out not just whether elevated aldosterone was Drew’s issue, but also what was causing it if it was.
I quickly reviewed his records and recalled that he hadn’t mentioned any medicines or a family history of genetic illness or malignancies. I needed to request additional tests since I had so little information.
I contacted Drew to inform him of the findings and to write him a prescription for a low-dose potassium supplement, as well as to refer him for further testing. I would have sent him to the hospital for cardiac monitoring if his potassium had been much lower, since the heart arrhythmias caused by hypokalemia may be very hazardous.
A morning plasma aldosterone:renin ratio was the test I requested. I recommend the PN Certification to anyone interested in learning more about this topic, although I was simply testing to see:
- Drew’s aldosterone levels were too high.
- If so, was it due to adrenal gland overproduction or was it caused by anything else?
I also wanted to check Drew’s magnesium levels, since magnesium and potassium are in a delicate balance, and if his magnesium was off, it might explain his low potassium.
Drew agreed to my recommendations and agreed to take his exam the following morning.
Round 2 of the test results
The story develops with the help of a blood chemical panel.
|Marker||Result||Reference Range in the Laboratory||Thoughts|
|Magnesium||2.3 mg/dL||1.8-3.0||Drew’s potassium deficiency was not caused by him.|
|Aldosterone||2.0 ng/dL||6-22||Definitely not high.|
|Renin||0.2 ng/mL per hour||0.29-1.9||Low|
Drew had low aldosterone instead of high aldosterone! What was happening on here?
The only explanation was that something else in his body was imitating aldosterone. In an attempt to restore “balance,” his system was now decreasing his normal aldosterone levels.
Drew had to return to the workplace for some further inquiry!
Drew returned four weeks after his first visit.
Drew has lost 5 pounds as a result of his new eating habits. As he showed me how his belt was now buckled tighter, with extra leather at the end, I could see he was pleased of his accomplishment. I naturally complimented him.
After that, I had a look at his blood pressure. The temperature is still in the 150s/90s. I’d assumed as much since, unlike most others, I was now certain that his weight wasn’t the cause of his high blood pressure.
But what was it, exactly?
Why is his aldosterone level so low? It didn’t make any sense. Something must have changed in the last year.
Drew’s facial expression abruptly changed as I puzzled aloud about this.
He admitted, “Well, I’ve been taking a new supplement.”
The mystery has been solved.
Drew had apparently read an article about adrenal fatigue a year before and concluded that he had the condition. As a result of the article’s recommendation for licorice root as a treatment, he began taking it in extremely high doses.
But his problems were finally beginning to make sense at this point in his tale.
Glycyrrhizin is an ingredient found in licorice root. Glycyrrhizin stops cortisol from being broken down in the kidneys. It can assist those with adrenal issues, but it shouldn’t be used without first being tested and getting a proper diagnosis. Higher cortisol levels in individuals without adrenal issues will act in the kidneys like aldosterone.
Drew’s body acted as if he had high aldosterone (pseudohyperaldosteronism) while having low aldosterone levels due to his kidneys’ inability to break down cortisol. This resulted in high blood pressure, high salt, and low potassium.
The answer was now self-evident. However, there were certain lessons that could be applied to anybody.
The treatment plan
Fix #1: Eliminate the licorice root.
Licorice root is a potent therapy, but just because it’s a supplement doesn’t mean it’s without adverse effects. If a supplement is effective as a therapy, it may also be harmful if it is taken improperly. Before using licorice root, consult your physician (osteopath, allopath, or naturopath).
Fix #2 – Maintain your healthy eating habits.
Drew had achieved significant weight reduction progress. Even though his weight did not seem to be the cause of his high blood pressure, he would be considerably healthier in the long term if he lost weight.
The end result
Drew came every week for the following several weeks to have his blood pressure checked. His readings started to drop towards the 140s/90s after he stopped using licorice root and have now stabilized in the 120s/80s range.
Also, a few weeks after he stopped using licorice root, I tested his salt and potassium levels, and they were normal. He was also able to discontinue his regular potassium dose.
Drew was proud of his ongoing weight reduction and was looking for a better workout plan to help him gain “larger muscles.” He was fixated on improving his appearance… and that of his wife. Success!
What can we learn from Drew’s experience?
- Always, always, always, always, always, always, always, always, always, always, always, always, always, always, always, always, always, always, always, always, always, always, always They may not explicitly inquire about them, therefore it’s critical that you bring it up. (I’m embarrassed that I didn’t ask!)
- Excess weight isn’t necessarily the cause of high blood pressure (although excess weight is often the cause). Stress reduction and weight loss should lower blood pressure in most cases, but if they don’t, there may be an underlying reason.
Find out more.
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In this episode of Doctor Detective with Spencer Nadolsky, Spencer visits the clinic of a local physician who’s treating a patient with extreme, unrelenting pain. The doctor is puzzled. The patient has no history of injury or illness. He can’t find anything on his medical records, so he pulls up the patient’s past tests. The doctor is amazed. The tests showed an extremely high level of ketones, indicating severe, lifelong starvation. Spencer investigates further.. Read more about spencer nadolsky steadymd and let us know what you think.
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