Studies of thousands of elderly patients have found the blood pressure associated with the longest life is about 129-130, a number many guidelines classify as stage 1 hypertension.

Paul and Alison work through your comments from episode 1 and on Pauls' nutrition masterclass delivered to doctors.

::: spoiler Summary

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1. Introduction

   • The Dr. Paul Mason Show, episode two.
   • Hosts: Allison and Dr. Paul Mason.
   • Headphones are worn to improve audio quality after feedback on the pilot episode.
   • Allison explains she is helping Paul share information after 25 years of friendship.

2. Nutrition Masterclass for Doctors

   • Paul gave an online tutorial to sports and exercise medicine trainees.
   • The session lasted two hours.
   • It focused on distilling science and addressing falsehoods in mainstream medical education.
   • The goal was to help doctors provide evidence-based care.

3. Comment on Apples and Potatoes Diet

   • A viewer suggested eating only apples and potatoes would produce the same results as low-carb diets if weight is lost.
   • Paul disagrees.
   • Complex carbohydrates are chains of glucose molecules.
   • Potatoes contain starch, which is a complex carbohydrate.
   • Apples contain fructose, which Paul calls more deleterious.
   • Digestion releases glucose into the bloodstream, raising blood sugar and insulin.
   • High glucose and insulin drive production of palmitic acid, a saturated fat in blood.
   • Glycemic instability affects brain function and weight gain.
   • Low-carb diets stabilize blood sugar and reduce hunger.
   • Ad libitum trials show spontaneous calorie intake drops when sugar and insulin are controlled.
   • Apples and potatoes do not address satiety.
   • Vegan and vegetarian diets lack substantive nutrition.
   • Missing nutrients include B12, heme iron, retinol, K2, omega-3 fatty acids, and complete proteins rich in leucine and methionine.
   • Short-term metabolic improvements may occur from calorie restriction, but long-term nutrient deficiencies will cause harm.

4. Vitamin B12

   • B12 absorption requires an acidic stomach environment and intrinsic factor.
   • Absorption occurs in the ileum.
   • Pernicious anemia is a failure of B12 absorption.
   • Before injectable B12, pernicious anemia was universally fatal.
   • Animal foods are the only source of B12.
   • Paul questions how a diet requiring supplements to avoid death can be called the most healthful.
   • Reference ranges for B12 are often 95% confidence intervals based on the general population, not optimal levels.
   • One laboratory considers 135 to 650 adequate, but literature suggests levels below 400 are suspicious.
   • The elderly are at higher risk due to reduced stomach acid and proton pump inhibitor use.
   • B12 deficiency is linked to dementia, anemia, and impaired neurotransmitter synthesis.
   • Some patients diagnosed with dementia no longer met criteria after B12 supplementation.
   • Low B12 can cause depression and high cholesterol through molecular mechanisms.
   • Paul recommends annual B12 testing at minimum.
   • Supplements often do not require stomach acid for absorption.
   • Intrinsic factor deficiency may require injections.
   • Methylated B12 is preferred.
   • Hydroxocobalamin injections are acceptable.
   • Cyanocobalamin is considered less optimal.
   • Carnivore dieters often have B12 levels of 800 to 1000, which Paul says is healthy.

5. Weight Loss and Blood Pressure Medication

   • A viewer reported losing 35 lbs, stopping blood pressure medication, and ending indigestion and sciatica.
   • Paul quotes JH from 1931: "The greatest danger to a man with high blood pressure lies in its discovery because then some fool is certain to try and reduce it."
   • The caveat is that 1931 treatments included bromides and mercury.
   • Modern blood pressure targets encourage prescribing anti-hypertensives.
   • A 2018 British Medical Journal prospective cohort study examined over 4,500 elderly Chinese people with a mean age of 92, including 825 centenarians.
   • The optimal systolic blood pressure was about 129 mmHg.
   • Lower and higher pressures increased risk.
   • Diastolic blood pressure was nearly meaningless as a risk factor for all-cause mortality in that study.
   • A UK study of females over 80 found lowest death risk with blood pressure between 120 and 139.
   • A Korean study of over 68,000 adults found optimal range between 130 and 139.
   • The American Heart Association would classify 129 as just below stage 1 hypertension.
   • Paul views 130 as fine and desirable for most people.
   • Very low systolic pressure increases death risk.
   • In the last three months of life, blood pressure under 120 is common; under 110 carries the highest risk.
   • The theory that lifelong elevated blood pressure is harmful lacks convincing data.
   • Evidence for blood pressure medication improving mortality in younger people is weak, even up to 160 mmHg.

6. Deprescribing

   • A viewer commented that doctors are not interested in deprescribing.
   • Paul says deprescribing is hard and not taught in mainstream medical education.
   • Example: a diabetic on insulin who starts low-carb must have insulin reduced to avoid hypoglycemia.
   • Blood pressure medication must be reduced as blood pressure improves to avoid dizziness and falls.
   • Low blood pressure is more dangerous in the short term than moderately high blood pressure.
   • Doctors receive guidelines on starting drugs but not on stopping them.

7. Proton Pump Inhibitors

   • PPIs reduce stomach acid and impair B12 absorption.
   • Rebound acid hypersecretion occurs after stopping PPIs.
   • The body upregulates acid production to compensate for PPI suppression.
   • Stopping PPIs suddenly causes acid secretion to spike.
   • 40% of healthy adults develop reflux symptoms after abrupt PPI cessation.
   • Doctors often misinterpret withdrawal as persistent disease and restart the drug.
   • Paul was taught PPIs were safe for indefinite use, but guidelines recommend short-term use.
   • Long-term PPI use is linked to dementia, osteoporosis, and pneumonia.
   • Deprescribing requires gradual tapering to reset acid secretion.

8. Antidepressants and Deprescribing

   • Antidepressants are technically not addictive because tolerance does not require escalating doses.
   • Many patients experience withdrawal and cannot stop.
   • Dr. Mark Horowitz developed the Maudsley deprescribing protocol.
   • Antidepressant receptor occupancy follows a logarithmic curve.
   • Small doses at the end do disproportionate work.
   • Tapering should follow a logarithmic reduction, not a fixed percentage.
   • Tablets often do not come in small enough doses.
   • Compounding pharmacists can provide liquid formulations.
   • The process can take 12 months or longer.
   • Paul does not prescribe antidepressants.

9. Informed Consent and Eminence-Based Medicine

   • A dentist commented that patients ignore lifestyle advice because other doctors contradict it.
   • Paul calls this eminence-based medicine, defined in a 1999 British Medical Journal article.
   • Medical decisions are justified by the seniority of the advisor rather than evidence.
   • Patients should ask doctors for the evidence behind recommendations.
   • Informed consent requires full and accurate information on risks and benefits.
   • Doctors often confuse absolute risk reduction with relative risk reduction.
   • Example: a risk dropping from 0.1% to 0.05% is a 50% relative reduction but only 0.05% absolute reduction.
   • Patients should ask for the actual paper or data, not just guidelines.
   • Number needed to treat and realistic benefits should be disclosed.
   • Some treatments, such as certain peptides, rely on preclinical animal or cell-culture research.

10. Biofilms and H. pylori

    • A viewer compared microbial biofilms eating holes in stainless steel pipes to human abscesses.
    • Paul agrees.
    • Abscesses are acidic and have poor blood supply.
    • Antibiotics and local anesthetics often fail in abscesses due to acidity.
    • H. pylori was discovered by Barry Marshall and Robin Warren, who won the 2005 Nobel Prize.
    • Marshall infected himself, developed ulcers, and cured them with antibiotics.
    • Standard H. pylori therapy combines two antibiotics and a PPI, with a 70% to 80% success rate.
    • H. pylori may live inside Candida albicans, which shields it from immune cells and drugs.
    • Biofilm disruptors such as vitamin C and certain probiotics may improve treatment success.
    • Paul tests patients with reflux, bad breath, or epigastric tenderness.
    • Tests include urea breath test, fecal test, blood test, or biopsy.
    • Urea breath test results can be nuanced; borderline readings may indicate low-level H. pylori or other urease-producing microbes.
    • Second-line treatments include bismuth and fluoroquinolones, which have toxicities.
    • Antifungals such as amphotericin B lozenges or nystatin may help in resistant cases.

11. LDL Cholesterol Causes

    • A viewer asked what else raises LDL besides underactive thyroid.
    • Paul treats high cholesterol as a symptom with root causes.
    • B12, folate, betaine, and choline are methyl donors.
    • Undermethylation of genes regulating cholesterol production raises cholesterol.
    • Underactive thyroid is associated with undermethylation.
    • H. pylori can cause nutrient malabsorption and low B12.
    • LDL is part of the innate immune response and binds bacterial toxins.
    • Chronic infection is the most overlooked contributor to elevated LDL.

12. Water, Electrolytes, and Heart Palpitations

    • A 57-year-old viewer reported drinking 2 liters of water daily and having nighttime heart palpitations after starting carnivore.
    • Paul advises seeing a doctor for cardiac symptoms.
    • Drinking plain water can deplete electrolytes.
    • Low-carb and carnivore diets lower insulin, causing kidneys to excrete more sodium.
    • Reduced sodium lowers blood volume, which can reduce stroke volume and raise heart rate.
    • This is called keto flu or Atkins flu.
    • Paul recommends supplementing electrolytes, including sodium, when starting strict low-carb diets.
    • Magnesium loss can contribute to palpitations and arrhythmias.
    • Most magnesium is inside cells, so blood levels may not reflect total body status.
    • Beverage hydration index: adding electrolytes increases fluid retention.
    • Commercial electrolyte supplements often lack phosphate, calcium, and individualized ratios.
    • Iodized salt is good for iodine intake.
    • Paul prefers mined salt over sea salt due to concerns about microplastics and impurities.
    • Excessive iodine can cause the Wolff-Chaikoff effect and hypothyroidism.
    • Too much sodium increases urinary calcium loss.
    • Paul uses reverse osmosis filtered water to reduce microplastics, forever chemicals, and fluoride.

13. Diet While Traveling

    • A viewer found it challenging to maintain diet during a month in Japan and gave up.
    • Paul says do not let perfect be the enemy of good.
    • He uses a hierarchy: some foods are non-negotiable, others are flexible.
    • In Korea, he avoided seed oils but ate some sweet potato.
    • Travel requires more planning, supermarket visits, and food preparation.
    • Example: roasting a chicken in the morning and packing it in a cooler for theme parks.

14. Sugar Cravings and Dopamine

    • A viewer reported going full carnivore, losing cravings, and walking past bakery aisles without temptation.
    • Paul describes his own past sugar addiction, including Froot Loops, soft drinks, and up to six sugars in coffee.
    • Stabilizing blood sugar reduces hunger and hangry episodes.
    • Dopamine synthesis requires B12, iron, zinc, and low inflammation.
    • Improved nutrient status raises baseline dopamine and reduces cravings.
    • Ketones provide alternative brain fuel and improve energy.
    • Better sleep and stable glucose reduce comfort eating.
    • Leptin sensitivity improves when insulin is fixed.
    • Paul does not fast because he believes benefits mainly help those on poor diets.
    • He notes therapeutic fasting research by Dr. Matt Phillips for cancer.
    • Intense exercise may boost autophagy more effectively than fasting.

15. MCT Oil

    • MCT oil can boost ketones therapeutically.
    • It may help conditions such as dementia by raising ketone levels.
    • Paul cautions against coconut oil due to phytosterols.
    • C8 or C10 MCT oil is preferred.

16. Carbohydrates and Body Composition

    • A viewer asked whether 30 to 50 grams of carbs would slow muscle gain or fat loss on a high-meat diet.
    • Excess carbohydrates are converted to saturated fat via de novo lipogenesis.
    • The body stores about 400 grams of glycogen in muscles and 100 grams in the liver.
    • Glycogen stores deplete after 12 to 24 hours of fasting.
    • Exercise depletes glycogen faster.
    • Carbs consumed around training may refill glycogen without raising triglycerides.
    • Paul recommends continuous glucose monitors to observe individual responses.
    • A glucose spike that looks like something you would not want to sit on is probably excessive.
    • Bodybuilders with more muscle can tolerate more carbs than sedentary elderly people.

17. Phytonutrients and Herbal Medicine

    • A viewer reported craving phytonutrients after going keto.
    • Paul states phytonutrients have no known role in mammalian physiology.
    • There is no recommended daily intake or deficiency syndrome for phytonutrients.
    • Some plant chemicals may have pharmacological effects, which makes them drugs rather than nutrients.
    • Polyphenols such as resveratrol show benefits in lab studies but not in humans.
    • Herbal medicine can have utility as pharmacological agents.
    • Examples: aspirin from willow bark, digoxin from foxglove, artemisinin, morphine from poppies.
    • Oregano oil has antimicrobial properties.
    • Berberine may lower cholesterol through antimicrobial effects.
    • Nattokinase may act as a biofilm disruptor.
    • Plant substances used as drugs require awareness of dosing and side effects.

18. Boron Deficiency

    • A viewer raised boron deficiency as an important issue.
    • Boron is not classified as an essential nutrient, but Paul believes it should be.
    • Benefits include bone metabolism, reduced arthritis pain, parathyroid hormone regulation, vitamin D metabolism, and steroid hormone health.
    • Veterinarians and farmers recognize boron deficiency, such as hip problems in pigs.
    • Boron is the second most common deficiency Paul identifies in his patients.
    • High-rainfall areas leach boron from soil, affecting crops and animals raised there.
    • Testing is not covered by Medicare and is rarely done.
    • Common use cases for supplementation include low testosterone, osteoporosis, and osteoarthritis pain.
    • Dosing should be precise rather than a pinch.

19. Protein and Kidney Health

    • A viewer claimed eating too much animal protein destroys kidneys.
    • Paul says this common belief is unproven and likely false for healthy kidneys.
    • High protein intake does not damage healthy kidneys.
    • A landmark study restricting protein in kidney disease patients found no benefit.
    • Higher protein intake is associated with lower risk of chronic kidney disease in observational studies.
    • Advising protein restriction causes sarcopenia and malnutrition.
    • Meat provides protein and most micronutrients.
    • The myth arose from animal models showing hyperfiltration after high-protein meals, but this is an adaptation, not damage.
    • Damaged kidneys leak protein into urine.
    • Restricting protein reduces urinary protein simply by lowering circulating protein, but it does not improve kidney health.
    • Paul does not restrict protein in kidney disease.

20. Conclusion

    • Allison and Paul end episode two.
    • They encourage viewers to ask doctors for evidence and to seek informed consent. :::