Chasing Life

Hey there, welcome to Paging Dr. Gupta. This is the place where I get to open the mailbag, listen to your health questions, and hopefully give you some answers that can improve your life. So if you've ever sort of found yourself scratching your head over a puzzling health problem, you have come to the right place. And I want to explain not just the what of things, but also the why. So Kyra's back with us. Who do we have first?

All right, hey Sanjay. So first up today, we have a question about a certain name brand water bottle that has been everywhere the last few years and I'm actually drinking out of mine right now. So I definitely need to know the answer to this. Here is the listener's question.

Hi, this is Stephanie. I am 50 years old and I was wondering about the straws on the Stanleys, thinking don't the microplastics still get into your system from the straw? I was just curious if I'm supposed to just lift off the top and drink out of the Stanley without the straw. Anyway, I'd love to know the answer for that or how I could find out. Thank you.

Okay, well this is something that I have thought about a lot as well, Stephanie. So tell you what, go pour yourself a big tall glass of water, pay close attention to the material of the cup or the bottle or even the straw, and let's meet back here with an answer. So Stephanie is asking about the plastic straws on water bottles like the popular Stanley cups. The question being, can they lead to ingestion of microplastics into your system? It is a really good question and those water bottles are trendy right now. I think my daughters all have one. They are made with a variety of materials. And I appreciate the idea that you're thinking about plastics because this is a topic I think about all the time. Plastic items contribute to pollution when they are discarded. Why? Because they take a really long time to break down in the environment, and then when they do deteriorate over time, they shed tiny particles, known as microplastics. Now, microplastics are bad on their own because they can get into the food and water supply and make their way into your body. But in addition to that, they often have other chemicals that are piggybacking on top of them. Chemicals that may have been added to the plastic to make it stronger or softer or more waterproof. Now, if you've paid attention to this podcast, you know that microplastics and even smaller pieces known as nanoplastics, they make their way into your body, your nose, your brain, your arteries. A recent study of about 257 people found microplastic or nanoplastic in carotid artery tissue. Those are the arteries that take blood to your brain. If you had micro or nanoplastics there, you were twice as likely to have a stroke or a heart attack or die from any other cause. Over the next three years, as compared to people who didn't have microplastics there. Again, plastics are a double whammy. They're the actual particles, the microplastic particles, and then the chemical additives, and both of those can potentially be problematic. I've talked about this quite a bit in the past, including on a past Chasing Life episode.

Plastic begins with fossil fuels. So ethane is turned into ethylene, or propane is turn into propylene, either from oil or gas. And then what happens is a big old chemistry reaction where these monomers are then made into chains. And then, what has to happen from there are their additives that are intentionally added. So we think of the crinkly polyvinyl chloride plastic that we're so used to in food packaging. Coming that way just on its own, but phthalates are added to polyvinyl chloride to make it softer.

'That's Dr. Leonardo Trasande. He is the Director of Environmental Pediatrics and the Vice Chair for Pediatric Research at the New York University School of Medicine. For the last two decades, he's been studying how environmental exposures to microplastics can impact our health and our wellbeing. And he's gonna come in handy today with our answer. But let me start with this. Here's what we know about the Stanley straw. If you just take a look at the website, it is actually difficult to determine the precise material the straw is made of. It only says the straw quote "is BPA-free and reusable." And that's actually a pretty good start. BPA stands for Bisphenol A, a chemical that has been used to manufacture certain plastics going way back, the 1950s. BPA can leach out due to elevated temperatures or acidic conditions. And then you can be exposed to it through ingestion, skin absorption, inhalation, and through IV catheters. Now, in light of health concerns and a lot of public pressure, many food companies have already been moving away from BPA. In terms of what we more definitively know, there are studies that show BPA can harm human health due to its properties as what's known as an endocrine disrupter, which basically means it alters how the hormone systems function in your body and can affect mammary gland development, cognitive function, and metabolism. It can also damage your reproductive system, impacting functions such as fertility, pregnancy, and human fetal development. There's even been more recent studies where BPA has been suspected to play a role in cardiovascular disease, serious eye damage, allergic skin reactions, and respiratory irritation. So with the Stanley straws, at least we know they are BPA-free. Now we circle back with Dr. Trasande, and he said generally for any plastic, just because it doesn't have BPA doesn't mean it is necessarily safe from leaching other potentially toxic chemicals such as bisphenol S. Bisphenol is one chemical that has come into wider use as industry moves from BPA. They started replacing it with BPS, bisphenols S. It's a close analog of BPA meaning that shares a similar chemical structure. And Dr. Trasande told us BPS, for example, is as estrogenic, toxic to embryos, and persistent in the environment as BPA. Now, the bottom line, as Dr. Trasande puts it, straws are perhaps not the biggest component of dietary plastic exposure. Other food packaging is likely a much more substantial contributor. But here's what you can do to reduce your exposure. When it comes to your water bottle specifically, You may want to consider switching out the plastic straw for one that is made from stainless steel or glass. We've started buying stainless steel ones in our home. You can help avoid those chemical additives. You can avoid the micro plastic particles. Or if you don't want to bother with a new straw, just pop the lid off and drink directly from the tumbler, obviously. Other ways to reduce your plastic exposure: don't use plastic to reheat food in the microwave. Don't put plastic in the dishwasher. Throw away those roughed-up plastic items like cutting boards with too many cuts and storage containers and lids that have seen better days. Avoid single-use plastics. Keep in mind, you don't need multiple reusable tumblers. No matter how badly you or your child want one in every color, playing into trends, buying more stainless steel than we need, that is not great either. That may be negating the environmental impact of avoiding single-use plastics. And stay hydrated! I'm not saying don't drink. It's great that you have these water bottles. Carry them around with you. You need water no matter what. Be mindful of the plastics, but stay hydrated. Coming up after the break, when to take high blood pressure in young adults seriously. Okay, we know what that sound means. Another question has landed. Kyra, who do we have next?

Okay, next up, we've got a listener calling in from Minneapolis with a really powerful story and a question about high blood pressure. Take a listen.

Hi, Doctor, I am reaching out from Minneapolis, Minnesota. I am 41 years old. I'm calling after listening to your recent episode regarding the updated recommendations for hypertension in the United States. And this is an issue that is quite of importance to me. My husband passed away in February of this year of a heart attack at the age of 40. He was first diagnosed with hypertension when he was 16 years old. His age, being a factor, led to why he was not put on medication for many more years after that, and I feel that it played a role in a lot of, I don't wanna say negligence, but more of dismissal from doctors. My question really is: Half of the people in the United States have hypertension and I have to imagine that a lot of those are people that are becoming younger and younger. And so at what age do doctors start to take this serious and are they taking it serious at a young enough age at this point? Thank you very much.

'Well, first of all, I'm so sorry to hear that your husband passing away at age 40, what a shock. I am really sorry. I appreciate you calling in, asking about this. So let's start with the basics. High blood pressure is also hypertension. That's the same thing. And it basically means the pressure inside your blood vessels is too high. You know that. But let's get more specific. Blood pressure is written as two numbers. The first number, which is the top number, systolic, that represents the pressure in your blood vessels when the heart is contracting, when it's beating. The second number, the diastolic, which is lower number, that represents the pressure on the vessels when the hear is resting in between beats. So, to your point, blood pressure is classified by the following framework. Normal blood pressure is less than 120 over less than 80. Elevated blood pressure, 120 to 129. Under 80. Stage one hypertension, stage one high blood pressure, 130 to 139, the upper number 80 to 89, the lower number. And stage two is when that upper number is over 140 and that lower number is 90. Hypertension is common. I mean, it's really common, and a lot of people don't know they have it and it can be very serious if not treated. In fact, hypertension is a major cause of premature death worldwide, not just in the United States. Some say it is the most prevalent and modifiable risk factor for the development of heart disease including coronary artery disease, heart failure, atrial fibrillation, but also stroke and things like dementia. But again, due to its lack of severe symptoms, Hypertension is known in the medical world as a silent killer. A lot of people don't know they have it. You're right. It is a big problem in the United States and globally. According to the World Health Organization, an estimated 1.4 billion adults ages 30 to 79 had hypertension in 2024. It's 33% of the population in this age group. In the United states, according to a 2024 governmental report, the prevalence of adult hypertension was estimated to be 47.7%. Higher in men, 50.8%, little lower in women, 44.6%. But again, think about that. Half the people that are adults in this country have high blood pressure. The prevalence does increase with age, so about a quarter of people between the ages of 18 to 39, 52% of people between 40 and 59, and 71% of the people who are 60 and older. But here is the critical point. In the United States, among adults with hypertension, 59% were aware of their hypertension, which means around 40% don't know they have it. More than half the adults with the hypertension are currently taking medications to lower blood pressure, but only about one fifth of adults with hyper tension had their blood pressure controlled to less than 130 over 80. This is something that's very addressable. You can measure the high blood pressure. You can treat it. And yet so many people don't even have a diagnosis. Now the new guidelines from the American Heart Association and the American College of Cardiology came out in August and they are a bit more aggressive than the 2017 guidelines. And a lot of people ask, so what changed? I mean, we're all humans. We have these standards of blood pressure. Why did those standards change? Well, the overarching blood pressure goal is less than 130 over 80 for all adults with additional consideration for special groups, including pregnant women. That means if your systolic blood pressure is in the 130 to 139 range, your medical provider should encourage you to adopt healthy lifestyle changes first, increasing exercise, reducing sodium, losing weight. But importantly, after three to six months, if the lifestyle changes alone, don't lower your blood pressure into the goal range, then medication is recommended. Lifestyle changes first. Then medication. And there was also mention of the role of alcohol. New guidelines say skip. Those night caps, because the evidence is pretty clear now that alcohol negatively impacts blood pressure. Now I do want to point out, you know, you may never know for sure why your husband's doctors did not treat your husband more aggressively for high blood pressure, hard to really say for sure what happened there, but to your question about younger people overall, it does state that hypertension among young people is common. So, what does cause high blood pressure in younger people? A new article from the journal Hypertension, which came out in 2019, said some factors may go back to the womb as well as other environmental and genetic influences. In some situations, there may be a secondary cause, meaning some sort of underlying condition. So it's important to investigate that as well. What we do know is that blood pressure tracks strongly within individuals from adolescence through to later life, meaning that individuals with elevated blood pressure in youth, they are likely to have elevated blood pressure in later life, usually stays with you. Higher blood pressure at a younger age is often associated with abnormalities on heart and brain imaging and increased likelihood of cardiovascular events by middle age. But as low as the diagnosis rates are overall for hypertension, they're even lower in younger people. And treatment, as a result, is often delayed in younger people as well. Now to be fair, it is hard sometimes to draw a cause-and-effect relationship, as I mentioned with your husband. That's because there's not great high-quality evidence demonstrating that lowering blood pressure in young adults definitively improves cardiovascular outcomes later in life. Most doctors believe it does, but they also concede that more studies are needed. So I know that's not a super satisfying answer, but I hope by understanding the national behind treatment decisions in general. You might reflect on what happened with your husband, stemming less from negligence or dismissal and more from a place of uncertainty. I hope that helps. And again, sorry for your loss. That wraps up our show for today. I wanna thank everyone who sent in questions. We're getting so many questions. I love hearing your voices. It really brings this show to life. So keep them coming. Send your questions to us via a voice memo and email it to asksanjay@cnn.com, or give us a call at 470-396-0832 and leave a message. Who knows, we might answer your question on the next show. Thanks for listening. I'll be back next Tuesday.