I Have High Blood Pressure!

Man, oh man, it has been a fun few months! I’ve avoided COVID, but I don’t come out of these “unusual times” without a medical problem…

“So you’re saying that I get to lose money due to the lockdown, not see family or friends for months, have to work harder than ever, worry over my patients’ and community’s health, and all I get is this lousy T-Shirt?”

Yup, besides putting on the COVID-19 (nyuk nyuk) from stress eating pillow-sized bags of M&Ms and a general engorgement on comfort foods, it seems that my blood pressure is becoming a problem. I turn 40 this September, so kinda expected but mostly not.

If only I knew a guy that developed a comprehensive model for true holistic care who also happens to have set a new standard for supplement quality, maybe I could control my blood pressure “naturally!”

I go on and on about how the Wellness Pyramid is awesome for solving all YOUR problems, but it seems I’ve been not practicing what I preach.

As these things go, I’ve officially gotten my wake up call to act now. I’m not waiting until this COVID thing is over. No excuses. 

Today, I present to you how I’m using the Wellness Pyramid to get back on track. Hopefully demonstrating this process on a real victim case will help you better implement this in your life.

Charting Our Journey

We can’t plan our trip without first knowing where we’re starting from. We need a brief medical history to know what work needs to be done.

Here are some factoids about me:

  • 39 and three-quarters-year-old man
  • Exercise with strength training 3 days a week x 45 minutes 
  • Weight of 243 lbs, 6’2”
  • Diagnosed with paroxysmal atrial fibrillation, meaning I can go into an arrhythmia occasionally, normally if I ingest a lot of artificial sweeteners and get dehydrated. After time, it goes away on its own.
  • I take no medicine, just supplements of Probiotic Complete, Alaskan Omega 900 (3 daily), Vitamin D 2000 IU once daily, and Collagen Peptides 20g once daily when we smoothie it up.

I’ve been short of breath when I do basic exercises, which I attribute to this weight. I have noticed not feeling like myself, and since I’m cardio-savvy having a fib for 17 years now, I decided to check my blood pressure. It has been at or slightly over 140/90, which, according to guidelines could be considered treatment worthy or even “Stage 2 Hypertension.”

I recommend anyone interested in learning about high blood pressure check out this document, written by fellow pharmacy nerds for one of our textbooks. 

Setting Expectations

“Are we there yet?” 

As a dad of 4, I’m VERY tired of this question. In our house, the triplets don’t consider answers given to their siblings as relevant to them, so we often get the same question out of each one of them in rapid fashion. Still!!! They’re 10!

We’ve replaced our answer of “15 more minutes” to clear expectations before we start and a methodology for measuring progress against our expectations.

What the heck does that mean? That means before we start, we identify where we’re going and roughly how long it should take us to get there, making note of the current time. We make them figure out the ETA. I also taught them to read the mile markers and that we travel at about 1 mile per minute. 

This is what we need for any wellness plan. We need to know what we want to accomplish and we need the ability to self-evaluate our progress.

Here are the goals I set:

  • Weight needs to get in line. I’d like to shave the ham down until I hit a fighting weight of 210.
  • I’d like to optimize my nutrition and overall wellness, because I’ve let my emotions get the best of me during this hectic, scary, crazy time.
  • I want my blood pressure to be managed.

Since the BP is the thing that brought me to this point, I need to have the same conversation with me that I do with others: medications aren’t bad.

Depending on my risks, I may need meds no matter what. I may do all the right things and still require medication.

Medication isn’t bad; inappropriate medication is bad. Appropriate means the right dose of the safest choice with the right reasoning.

On the belly side of things, weight loss doesn’t happen overnight. A healthy, respectable loss is 1.5-2 lbs each week. That means that I have 23 weeks before I hit my goal. Put another way, I’ll only hit my goal with diligence over 23 weeks.

Optimizing my wellness means getting 80% or more compliant with the recommendations set by a comprehensive wellness plan.

My expectations, then, are:

  • I will need to be more diligent than before
  • With consistency, I can expect to hit my goal weight in about 23 weeks.
  • I may need medicine if the blood pressure doesn’t fall, or if my doctor says I’m high risk

Step 1: Healthier Lifestyle Choices

There are five components to the bottom of our Wellness Pyramid: nutrition, sleep, exercise, stress management, and environment.

In Step 1, we identify our gaps and work to close them. To keep things brief, here’s the rundown:

  • Nutrition: This is my biggest problem, which we’ll address completely
  • Sleep: Almost excellent, except for nights when I drink too much water after 8 pm
  • Exercise: Could use some cardio, but I do strength training 3 days a week
  • Stress: Dr. Dresdale’s my guy, and I see him twice a month!
  • Environment: All good here. Water filtration at the house and dealing with allergies like everyone else

By addressing these lifestyle choices first we are stating their most important and we’re stating how we know all other things—supplements and medicine—work better if these variables are addressed.

Dr. Neal’s Nutrition

I’m a junk food addict who eats high calories to deal with stress. I have obese “tendencies” as there is a VERY strong genetic component for obesity on both sides of my family. I can put food away.

In general, I follow the campfire modality: small frequent meals and snacks with proteins, healthy fats, and carbs. I overeat simple carbs, have WAY too big portion sizes, and am not afraid of adding a desert in there as one or more of the snacks.

Without a doubt, it’s a question of food choices and calories. In our article Calories In, Calories Out we talked about how weight loss generally comes down to reducing your calories. You do so by keeping track, which is a pain, but it’s obviously needed for me as I just constantly go off the reservation.

I need to shape my meals and snacks to fall within the calorie limits for my desired weight loss. I go to my favorite calorie calculator at Calculator.net.

I need to eat less than 2000 calories a day to lose 2lbs a week, and somewhere around 2300 to lose 1.5 lbs a week.

That’s actually not that hard. The hard part is getting accurate numbers, as I point out in the article. Therefore, I will target approximately 1900 calories a day as the absolute max, knowing I may be over or under day-to-day.

Most of weight and nutrition is around our habits and behaviors. I know, for me, chewing fast makes me overeat. On the weekends, when things tend to be more social, I overeat. I will have to show some serious restraint.

There are some general rules I will follow:

  • Bring simple carbs as close to 0 as possible. These things just feed my damn addiction, so it’s best to just eliminate them. This will result in a fast weight loss, as carb stores add additional water weight.
  • Eliminate junk food. Before I met my lovely wife, I actually HATED chocolate and candy, because it meant I had to work harder in the gym. That was a long time ago! It’s actually not hard for me to show control around chocolate, I mostly exaggerate for laughs.
  • One meal a week, I will go a little bit outside the bounds. I know that we’ll get takeout 1-2 nights a week (mostly to try to help my fellow business owners in our community and give my wife a break, though she does cook wonderfully!). I will try to follow my rules for all meals, but be ok with either a desert OR an extra serving once a week.
  • Once a month, I will allow myself a “cheat day” if results are met. I can’t not indulge on Thanksgiving or if my wife makes cookies! This requires more thoughtfulness of the schedule AND it requires results, first.

Here’s my nutrition plan:

  • Reduce calories to 1900 max per day
  • Breakfast: 1-2 eggs with cheese and sometimes extra protein (ham on workout days), and either sprouted grain bread or fruit.
  • Snack: 1 tablespoonful of peanut butter with some fruit
  • Lunch: Salad! Usually from some of the awesome restaurants around Woodstock: Yum Yum, Catskill Mountain Pizza, or Oriole 9! I’ll throw on a protein, typically chicken
  • Snack: Nut butter and fruit again!
  • Dinner: Some protein (pork, steak, or chicken typically in Casa Smoller), lots of veggies. Mrs. Big Mouth is making Mediterranean style salads lately!
  • Evening Snack: I’ve been rocking about 200 calories worth of popcorn and blueberries every night
  • Lots of fluids, not including booze. Cut back on cocktails to 1-2 nights a week, if that

The Greater Good

As I type the things I’m doing, I’m thinking, “Am I really enjoying life by making these ‘sacrifices’?” Then my brain kicks in and says, yes, you definitely can enjoy life, and you will be alive to actually enjoy it! 

This is the key. 

The greater purpose is not weight loss: it’s living a high quality of life, enjoying my wife, children, friends, and community. This is a strict plan to get to where I should be already. I’m exhibiting control of my unhealthy choices to exhibit the control where I can with my life expectancy. 

These wellness plans, even our comprehensive, no-nonsense approach, only work when we change our perspective from “losing weight” to being healthier.

Success isn’t 100% dependent upon the numbers. In fact, most of the requirements are around being more thoughtful. More thoughtful of my time, my weaknesses, my plan, and my progress against it.

Since we got derailed last week with the news of Vital Proteins selling out to Nestle, this article is releasing on my 8th day of the above nutritional plan. I’m happy to say that I’ve lost 6.5 lbs, weighing in at 236.5. Three or more of those pounds are probably from the reduced water weight, I know, but we are moving in the right direction.

Step 2: Strategic and Smart Supplement Use

This one is easy, as it just involves popping some pills. We want to pop the right ones, so all supplement strategies start with the Vital Five, or the five nutrients we almost all will benefit from, even if we have the best diets.

Then, we can utilize additional supplements to address any health issues we may have or want to prevent.

We measure “compliance” with the Vital Five first, by listing out the categories and listing the supplements I use that fall within that category. We then determine if those brands are low quality, if the doses and forms are appropriate, and if we are getting ripped off buying what we do.

Dr. Neal’s Vital Five Compliance

  • Omega-3: I take 3x Alaskan Omega-900
  • Probiotic: I take 1x Probiotic Complete 
  • Bone Support: Since I’m a dude, I focus on Vitamin D here. I take 2000 IU Vitamin D
  • Protein: I eat this and not supplement mostly, but occasionally we do a Collagen Peptides smoothie
  • Micronutrients: I don’t need this, as my diet is varied with enough fruit and vegetable servings (especially now)

I am compliant with the Vital Five. I take no other supplements for any other issues. Are there things I can do to address my blood pressure?

In our Heart Healthy Supplements article, I stressed the importance between lowering blood pressure, which some supplements can do, and preventing cardiac events BECAUSE of that lower blood pressure. I believe no supplement should be used to manage blood pressure, and instead, tried and true, safe medicines should be selected if required.

Steps 3: What’s Up, Doc?

At the top of the Pyramid rests conventional medical care. We can’t deny the importance of their education/expertise and the value of their assessments.

I spoke with my doc’s office regarding the raised blood pressure. They agreed with my lifestyle change plan, told me to watch the blood pressure (monitoring it daily), and at my physical will send me for bloodwork.

It’s difficult sometimes to deal with the medical world, and that’s mostly due to the economics of healthcare in this country. We have a number of suggestions for navigating the system in this article. I also would encourage you to listen to Woodstock’s community physician, Dr. Randy Rissman, who came on my podcast if you are unsure of the power a good, local doctor can have in your life.

All For One, One For All

True holistic care, as defined in our model the Wellness Pyramid, is comprehensive. Medicines aren’t taken without healthy choices. We don’t use supplements indiscriminately or prefer them over medicines, we use the best treatments, which often is both supplements and medicines.

All three components of the Wellness Pyramid are required to live our best lives.

Most of my work in helping people with their wellness isn’t teaching them the strategy/model, nor is it giving them the rules about what’s healthy to eat or do and what’s not. 

The work is understanding our own personal, psychological hang-ups that lead us down the unhealthy path of least resistance.

For me, it’s not a lack of motivation, but discipline. It’s fighting the urges for that dopamine hit. It’s not practicing what I preach.

I believe that my case isn’t hypocrisy, nor is it a fault. I think that’s why the Wellness Pyramid and my advice is so successful—it’s real. 

We all have ups and downs, vices and virtues, good days, and bad years. Some of us won the genetic lotto and can stay skinny regardless of calories consumed.

Most of us, though, have work to do. It’s important work, and our path to wellness starts with making important things important.

You can wait, as I have, until it hits a “critical point.” Your jeans don’t fit (heck, your sweatpants may be getting tight during COVID!), you get a bit winded doing simple things, or, something serious happens like your blood pressure elevates.

The truth is, we have no obligation to be the person we were yesterday. Begin again, right now, on your path to wellness by making healthy lifestyle choices, by using the right supplements for you more strategically, and having a team of conventional medical professionals whom you check in with regularly.

Just trying to keep it real…

Neal Smoller, PharmD
Owner, Pharmacist, Big Mouth

Dr. Neal Smoller, Holistic Pharmacist

About Neal Smoller

Dr. Neal Smoller, PharmD, is a licensed pharmacist: and owner of Village Apothecary, an independent pharmacy in the most famous small town in America—Woodstock, NY. He’s also the host of the popular wellness podcast, The Big Mouth Pharmacist.”


The Vital 5

Nutrients you shouldn’t live without
The Vital 5 Nutrients You Shouldn't Live Without