Chasing Life

Welcome to Paging Dr. Gupta. This is the place we get to tackle the questions that matter the most to you. And today, you're going to hear a great question from a loyal listener. But first, we wanted to start with some health news that affects millions of people out there. Kyra is back with us. Please tee us up.

Hey, Sanjay. Okay, so our office was buzzing about these new recommendations on how to control blood pressure. And so I'm curious, what's different than before and what do we need to know now?

Yeah, so I've been thinking about this a lot. I've gotten a ton of questions about the blood pressure guidelines. So let's start with this, just a little bit of context. First of all, this is the first time the guidelines have been updated since 2017. Really important. And if you look at the United States as a whole, close to half, right around half the people have hypertension. Okay, so, I want you to have this context. These recommendations typically come from a collection of health organizations. Such as the American Heart Association, the American College of Cardiology. These groups meet and occasionally they will release an update if they agree that there's enough new evidence that demands it. So again, this is the first update since 2017 and they thought it was important enough to publish this report. I'm gonna tell you what it says right after the break.

'So one of the big things about these new blood pressure guidelines that a lot of people paid attention to is that they essentially recommend abstinence from alcohol, okay? So this is a surprise, I think, for a lot people because the conventional wisdom has been a drink a day or two drinks a day if you're a guy is okay. This is much clearer. And to be fair, there's been a lot back and forth on alcohol for a long time. Even going back to the 1800s. But more recently, you see increasing evidence about the association of alcohol with all sorts of things, heart disease, dementia, even. And in addition to that, there seemed to be this real trend toward not drinking in general, a sober curious movement. From 1997 to 2023, about 60% of Americans reported drinking alcohol. It's 54% today. So about half of people in the United States drink alcohol. Go back to the 70s and it was around 70%. So this is a really interesting trend, one that we should pay attention to. And in addition to that, a Gallup poll found that a majority of Americans, 53%, say drinking in moderation or one or two drinks a day is bad for one's health. Okay, so again, I start with the alcohol part of these guidelines because that got a lot of attention. Now, one of the other big changes when it came to blood pressure, treating hypertension earlier. Hypertension, stage one, is 130 to 139. That's the top number. Okay, so if you're below 120 over 80, that's considered normal. As you start to get above that, that's consider high. So especially 130 to 139, the recommendations are lifestyle changes first -- healthy weight, reduce salt, exercise. But then, if no changes, after three to six months of lifestyle changes, consider adding a medication. In the past, the recommendation was that anyone who had a blood pressure above 140 should be prescribed lifestyle changes and medication. Again, now it's 130. So that was a big headline. And in addition to all the lifestyle changes they talk about, they also say, when you get to that period of time when you're incorporating these lifestyle changes then alcohol abstinence could make a big difference. I do want to point out something else as well, something that I pay attention to, and that is, again, the association between high blood pressure and the risk of dementia. We've long suspected this, but there was a study that came out of rural China that I think really made the case that good blood pressure control could be helpful for dementia as well. So blood pressure control below 130 over 80 lowered the risk of dementia by 15 percent. So we think about blood pressure in terms of heart disease, but we really have to think about it in terms brain health as well. And I think that's in part why these guidelines are out, why they have been changed. If you're getting into a blood pressure of 130, top number 130, then it's time to implement some of these changes. I hope that helps you understand the new guidelines. If you do want to read more about this, we have a link to CNN's reporting in our show notes. But after a break, as I mentioned, a very astute listener has a follow-up question for me, right after the break.

All right, we got time for another question. Kyra, what do we have?

'Okay, Sanjay, here's the listener with the follow-up question from a previous episode. Take a listen.

Hi, Dr. Gupta. My name is Mark. I live in New Jersey. I'm 69 years old. I know you've already pretty much exhausted the topic of sunscreen and how much sun is good for you, both in general and for your eyesight. But your podcast on the subject begged a couple of questions. You said that the ideal situation was a certain number of minutes of morning sunlight. Not every day starts off with beautiful golden rays of morning sunshine. How would your recommendation change in the following weather conditions? 1. cloudy all day. 2. Light rain or light snow all day. 3. cloudy or rain or snow in the morning and then sunlight starting at 1 p.m. 4. windy with clouds in the mornings so the sun is only out about 50% of the time. Sorry to get so granular, but just trying to be realistic in terms of actual weather conditions. Thank you!

'Wow, Mark, thank you very much. It is just gratifying for me to know that you're listening so closely that you actually have a really smart follow-up question for me. I'm impressed. Let's start with the advice that you referenced. That came from Dr. Raj Maturi. He's an ophthalmologist with 25 years of experience.

'Aim for 10 to 15 minutes of direct, unfiltered morning light. No windows, no sunglasses, as soon as practical after waking up. In fact, the best and safest time to do it is in the first 45 minutes after the sun rises. Early in the morning, the sun is coming at a pretty acute angle on the atmosphere. A lot of the bad stuff, the UVB light, the really short wavelength light that's bad for us, jumps off the atmosphere. So we don't get that, our skin doesn't get that, and therefore doesn't get red even if you're outside 10-15 minutes. That's a clear sign that it's still safe. And your sunburn risk is almost zero at that early point in the morning and it allows your vitamin D production to happen.

So let me establish a couple of things here. And I think this is clear, but first of all, skin cancer is typically caused by exposing the cells in the skin to UV radiation, ultraviolet radiation. Most of those harmful ultraviolets rays are coming down from about 10 a.m. To 4 p.m., that's six hour window. That's typically the hottest part of the day with the most sunshine. Now, that's why Dr. Maturi suggests getting those 10 to 15 minutes of direct sunlight In the morning, before most UV rays are beaming down from the sun. And again, that means taking the time without sunglasses on, and of course, being careful to avoid looking directly at the sun, but let me get to the specifics of your question. And I think it's how to achieve the benefits of that direct sunlight, even when it's a rainy day or the sun doesn't come out until the afternoon. First of all, keep in mind that even if it's cloudy, or even if there's a bit of a drizzle, there is sunlight still reaching the earth, and that means it's reaching your body and your eyes. So even if it's not a particularly bright day, that 10 to 15 minutes could still be beneficial. Now if the sun doesn't come out until 1 p.m., you should not consider this your opportunity to make up for the missed morning of sunlight. Why? It may be the first light of the day, but it's still within that higher period of UV rays. So you gotta exercise normal caution. One thing I want to point out, seasonal affective disorder, SAD, that's the acronym. That's a form of depression caused by a lack of sunlight, and about 10 million people in the United States suffer from it. I lived in the North for a long time in Michigan, and the percentage of people suffering from it was even higher up there. So you know, you got to take that into account. That's why a lot of people I think plan a vacation to somewhere warm and sunny during the winter months. And if you can't travel, you could consider getting a lightbox that's a specialized lamp that can at least approximate some of that early morning light. Now, it is important to remember that time outdoors, taking a walk, just spending time in nature, something that is referred to as forest bathing has been shown to benefit not just mood, but also your immune system. So even if it's cloudy outside, maybe even if its lightly snowing outside, consider putting on a coat, taking a walk. It can be a real boon to your eyes, to your immune system, and to your mood as well. I can almost guarantee you, you're gonna feel better. Sometimes when I'm having a tough day, just putting on my sneakers, getting outside, taking a walk, even for a few minutes, makes a huge difference! And Mark, I think it'll help you a lot as well.

'Thanks so much to everyone who sent in the questions. You know, I say this all the time, but it's true. This show would not exist without you, and I'm really glad you're a part of it. If there is anything health-related you've been wondering about, don't keep it to yourself. I've dedicated myself to this show, so share it with me. Record a voice memo, email it to asksanjay@cnn.com, or give us a call, 470-396-0832, and leave a message. Thanks for listening.