Is Your Blood Pressure Too Low? Understanding Hypotension

0:00 Hello everyone. I'm Dr. Lesley Kernison, board certified geratrician and the founder of the website betterhealthaging.net and this is the better health while aging video podcast where we discuss common health problems that affect people over age 60 and the best ways to prevent and manage those problems. This episode is part of a series that I'm doing on blood pressure in aging adults. Now, in a previous episode, I covered what is normal blood pressure versus high blood pressure and how high is too high in older adults. And then I have another episode about how to treat high blood pressure, also called hypertension, in which I cover common medications used to lower blood pressure and also non-drug approaches to lowering blood pressure. So today in this episode, I'm actually going to cover the other side of the blood

0:46 pressure spectrum, which is low blood pressure. And I want to talk about what to know about low blood pressure. This is an issue that actually comes up quite often for older adults. So we geriatricians are often checking blood pressure and looking not only to see is the blood pressure too high but is it maybe a little too low. So I think this is worth understanding if you are somebody who is on medications for blood pressure or if you have ever had concerns about blood pressure being too low. And specifically, here is what I'm going to be talking about in this episode. So, I'm going to start off by talking about what counts as low blood pressure. It's also sometimes called hypotension. I'm going to review common causes of low blood pressure in older adults. I'm going to talk about the

1:32 signs and symptoms of low blood pressure. I'm also going to talk about a particular kind of low blood pressure that is called orthostatic hypotension. Really common issue in older adults. And I'm going to explain that. Uh and then I'm going to share with you, you know, my geriatrician's approach to uh low blood pressure and I'm going to finish with some suggestions on what you can do if you're concerned. So, we're going to get started with that. But before I get into that, I do have a very quick request, which is if you're here and you're finding this topic interesting or if you've been finding my video podcast interesting, if you haven't yet subscribed, could you please go ahead and subscribe right now? It would really mean a lot to me. It does help me out. It helps other people find the channel when you subscribe and it helps support the work that I'm doing. Okay, moving on. Let's talk now about normal versus

2:20 low blood pressure. So, as I explained in my first video about blood pressure, normal/optimal blood pressure is currently defined as being less than 120 over 80 mm of mercury. And so, the first number in a blood pressure reading is what we call the systolic blood pressure. the pressure when your heart squeezes and pushes a big um you know a load of blood out of out of the heart into uh your um your aorta that big blood vessel and then the second number is the diastolic blood pressure um the blood pressure um when your heart is relaxed. So that would be normal or optimal blood pressure. Now it turns out that hypotension is not officially defined by the current blood pressure

3:06 guidelines but it is generally accepted as being a blood pressure that is less than 90 over 60 mm of mercury. So then there's also um a systolic blood pressure of 90 over 110. Now when they define optimal blood pressure they say less than 120 but they don't say how low under a systolic of 120 is still considered optimal. So what I would say is that a systolic of uh I would say 90 to 110 is often described as being low blood pressure. Now this can be asymptomatic and not an issue. I myself actually have a blood pressure that often measures uh when I go see a doctor with a systolic of 105. So especially in younger people

3:52 uh in people who aren't on medication, there are some older adults who also chronically run a lowish blood pressure like that and otherwise seem fine. That's you know that can happen. So uh whether a blood pressure in that range is concerning does depend on the context uh and whether it's causing symptoms. And when I say context, I mean what is this person's blood pressure usually? Are they on medications? What are their other health conditions? uh that they have. That's some of what we have to consider. Uh so people sometimes tell me well so and so has a blood pressure uh systolic blood pressure of 100. Um is that too low? And you know um they haven't defined the bottom edge of optimal. It's a little on the low side

4:38 but at the same time is the person feeling okay? How old are they? What are their circumstances? Those would be the things that we'd be thinking of. Now you might be wondering well what about the diastolic in all this? How low of a diastolic is too low? The truth is from a practical perspective, we often don't think all that much about a low diastolic uh unless a person is having symptoms. And most of the time when people are having symptoms, it is both the systolic and the diastolic that is low. Uh it's actually fairly common as people get older. uh and I explained I touched on this briefly in one of my previous videos that they develop um a high systolic uh number but still have a quite low diastolic that's called isolated systolic hypertension fairly common in older adults and most of the

5:25 time we focus on the top number the systolic so often you're going to hear me refer mainly to that when I'm talking about low blood pressure and when to be concerned so let me now talk about causes so when blood pressure is very low, we do want to think what might be causing this because there are some causes that are very important for us to consider. So blood pressure that is very low is definitely a flag and should be investigated. Uh in particular the sudden onset of very low blood pressure um meaning less than 90 over 60 especially if the systolic is under 80. Sudden onset meaning it has come on you know over minutes, hours, you know even over like a day or two. that's you know fairly sudden. Um that can be a medical

6:13 emergency because some of the potential causes include um first of all something that medically we call hypoalmia which means low blood volume. This can be caused by bleeding. So we do see this after people have had you know accidents. So typically in the emergency room uh you know certainly if somebody has has had a bad injury and is bleeding uh very obviously or god forbid you know a gunshot wound or maybe uh a car accident that can cause significant bleeding. Sometimes people have something happen in their bowel or they get you know a a blood vessel bursts and uh and starts bleeding. So that can be a form of hypoalmia um and that leads to something that is called hypoalmic shock. Occasionally very severe dehydration can also cause

6:59 quite low blood pressure like that. Another condition that can cause very low blood pressure and is very serious is sepsis. So sepsis means an infection that has spread to the bloodstream and is starting to affect the whole body. And when this happens the body does have this response where blood pressure gets too low. the body actually becomes unable or starts having a lot of difficulty of maintaining the blood pressure correctly and that can cause organ failure because your body's main organs do need enough blood flow. So that is called septic shock. Also some other potential causes of sudden uh relatively sudden very low blood pressure anaphilaxis a type of very severe allergic reaction uh can cause it um heart attacks. you know, if your if

7:44 your heart has an attack and can't pump the blood uh the way it should, then your blood pressure can collapse. A little less common, actually a lot less common, I would say, is a crisis related to your adrenal glands. So, those are some of the potential causes. Um the takeaway is that blood pressure that is very low or suddenly much lower than usual does warrant urgent evaluation. You know, do not delay to get it checked out because it could be something very, very serious. And we especially want to check on it if the person has had recently a fall or an injury or you know sudden pain or symptoms. Now let me briefly speak to uh an interesting form of very low blood pressure which is actually a temporary form of very low blood pressure and that is called the vasovagal response. This

8:30 is a neural reflex that happens within the body that briefly causes the blood pressure to drop quite a lot. And the reflex itself is not the sign of anything dangerous or bad in the body. Uh what's dangerous about having this happen is that during that moment of sudden very low blood pressure. People can pass out and fall and hit their heads. So this is sometimes preceded by symptoms like lightadedness, nausea, sweating, getting pale. It can be confused with a heart attack. Uh and interestingly, it is sometimes triggered by certain activities including urinating, peeing or defecation, uh passing a bowel movement. And this actually is a quite common cause of passing out and it does affect older adults. So now normally by the time they

9:16 are found on the ground, their blood pressure is no longer dangerously low. Uh and especially if an older person has hit their head, they probably should go to the emergency room and uh get checked out. So that's a sort of interesting um temporary form of low blood pressure that uh does affect people. Let me now talk about common causes of blood pressure that is not very low but is low. So again in the range of a systolic blood pressure of 90 to 110 especially in older adults. So um probably the most common cause is medication. High blood pressure is the most common chronic condition among older adults and so lots of older people are also taking medications. uh for blood pressure and so sometimes being on those medications their blood pressure can end up in this

10:01 range that is that is pretty low and as I'm going to explain you know might be a little lower than it needs to be so uh especially blood pressure medications however there are other medications that are not prescribed for blood pressure that also affect blood pressure so an example would be tsyosin the brand name is phmax it's often prescribed uh it's a vasoddilator type of medication so it expands not only your blood vessels but your urethra and it's prescribed for uh an enlarged prostate, benign prostatic hypertrophy to help men urinate. Another potential cause of lowish blood pressure in older adults would be dehydration. You know, mild to moderate dehydration could do this as well. Another cause to consider is something that is called autonomic insufficiency. So, your autonomic nervous system is a system of

10:48 um nerves, sensors and nerves that change muscles in your body that is not under your voluntary control. It actually affects the nerves uh excuse me the muscles in your blood vessels that makes them expand or tighten. It also um is involved in your flight or fight response, your rest and digest response. So that is the autonomic nervous system. And in some people it starts to malfunction either because the sensors aren't working well or because the signals that tell parts of your body including your blood vessels to squeeze or relax stop working uh as well. And so that can also cause chronically low blood pressure. So this kind of malfunction is associated with conditions such as Parkinson's, Louisibody disease and a few other neurodeenerative conditions. It can also

11:34 be associated with diabetes because when people have diabetes for many many years, it starts to damage nerves in the body and not only the sort of nerves that you know cause feeling in your toes or maybe your hands but also the nerves that are involved in this autonomic nervous system that is regulating many of your unconscious bodily functions. Autonomic insufficiency can also cause something that is called postprandial hypotension. So postprandial means after eating and this is a having a drop a pretty significant drop in blood pressure that happens one to two hours after eating and that is also associated with disregulation of the autonomic uh system and how it manages blood pressure. So those are some common causes and then you know some other things that can certainly affect uh

12:20 blood pressure and cause lowish blood pressure in an older person uh blood loss. So you know before I mentioned severe blood loss after you know an accident or a major injury but older adults sometimes have just slow and steady blood loss. It can be uh an oozing ulcer in their their bowel uh somewhere or you know sometimes from a tumor in uh in the bowel or it can be from somewhere else in the body. Another potential cause would be heart failure especially when it's severe. If the heart isn't pumping strongly, uh blood pressure can end up being chronically low. Another potential cause would be advanced liver disease, liver cerosis. And then also, uh problems with your hormones with what we call your endocrine system like problems with the adrenals or certain other hormonal

13:06 problems can also lead to lowish blood pressure that is a chronic condition. So those are some of the common causes of lowish blood pressure in older adults. Now let me talk a little bit about orthostatic hypotension. What is orthostatic hypotension? It's something that geriatricians pay a lot of attention to because it affects a lot of older adults. So this basically uh is a condition where people experience a drop in blood pressure when they stand or change their body's position. So this is partly related to uh in a normal healthy functioning human body you have a system of sensors to detect the position of your body and um relax or squeeze your blood vessels as needed to keep a relatively constant blood pressure because otherwise when you go from

13:52 sitting to standing a lot of blood will fall into your legs because of gravity. So the body is kind of designed to tighten things up a little bit so that it doesn't drop too much because otherwise if all the blood goes down to the ground you do not have enough blood flow to your head and that would make you laded and uh and dizzy. So that's how the body is supposed to work and as we get older that whole system tends to work less well. Um so defining orthostatic hypotension it is technically a drop in your systolic blood pressure of 20 millm of mercury or more or a drop in your diastolic blood pressure of 10 millm of mercury or more. And these orthosis drops in blood pressure become very common as we age. It's estimated that this affects uh about 25% of older adults and an even

14:38 higher proportion of the ones who are in the hospital or are in nursing homes. So um it's of a special interest to us in geriatrics because that moment of lightadedness when people first stand up or uh change position and this lightheadedness can last for a few minutes uh can cause falls and near falls. So it's an important condition to uh know about when it comes to older adults and I also want to mention that it is uh because it's associated with this change in posture it is also sometimes referred to as postural hypotension. So what causes this? So, as I said, you know, aging in of itself uh does cause it, but often in older adults, there are multiple causes at the same time that are kind of adding up together. That's very common in geriatrics. Many problems are what we call multiffactorial. So, causes might

15:25 include being on medications. Uh many medications not only lower blood pressure in general, but slow that reflex that the body has to make adjustments when we change position. uh dehydration or another form of low uh blood volume can also cause or worsen uh an orthostatic response when we stand up. Uh autonomic insufficiency, a vaso veagal component. So essentially the things that can cause lowish blood pressure in general might also cause somebody to uh perhaps they don't have such lowish blood pressure when they are sitting but when they stand up they experience this uh this drop. And again also just as we age that causes a slowing of that whole system of reflexes and responses that is supposed to keep our blood pressure steady as we change

16:10 position. So how do we check for orthostatic hypotension? So ideally what we are supposed to do is have an older person lie down for 5 minutes check their blood pressure and then have them stand up and then check their blood pressure after 1 to three minutes. And when I say blood pressure, for any of these, you want to be writing down the blood pressure and also the pulse because in medicine we always think about blood pressure and heart rate together. And you you kind of um you need the heart rate to thoroughly uh interpret blood pressure generally. So that's how we would do it ideally. Now in common practice, what we often will especially focus on is the change when they go from sitting to uh standing. Uh so often we already have a sitting blood pressure when somebody has come to the

16:56 clinic. Hopefully it has been done with good technique and so then we might have them stand up and check again within 1 to two minutes. Do you have to wait a minute before you check again? Not necessarily. I mean if it's less than a minute I think it's okay. And we want to be asking also as we do it when they stand up are they actually experiencing uh any symptoms? Are they feeling lightadedness, dizzy like they might be about to fall? That's relevant as well. So that's how we would check for orthostatic hypotension. Let me now talk um speak a little bit about the signs and symptoms of low blood pressure. Uh so whether a person has symptoms and what they are is going to depend on a couple things. One is how low is the blood pressure? How low is it in absolute terms? How much lower is it than their usual blood pressure? And what is the underlying cause of their

17:42 low blood pressure? very low systolic blood pressure such as a systolic blood pressure uh under 80 often causes passing out or collapse and as I said is often a medical emergency. Lowish blood pressure may or may not cause symptoms but some of the symptoms that we might um that a person might experience include uh fatigue just feeling tired especially when they're standing up and moving around. uh lightadedness uh again especially when they're standing up falls and near falls and then uh I was mentioning that we want to think about you know heart rate along with blood pressure. So low blood pressure often causes a fast heart rate. That's because a normal body if it realizes that blood pressure is low a normal heart will

18:30 speed up to try to compensate and help increase blood pressure. And basically the body knows we got to get blood to all the organs. So if blood pressure is low, the heart is like, "Oh, I got to work a little like faster to keep things moving around and keep the organs getting the blood flow they need." So um that's what it's supposed to do. That said, uh this response assumes that the heart is able to respond appropriately. But often as we get older, there are reasons why we might not have this heart rate response. Uh some older people are on medications that slow their heart rate. uh for instance if they have atrial fibrillation there are various uh diseases and chronic conditions that can also lead to slow heart rate and actually if you would like to learn more about slow heart rate uh I have a video about that um about brada cardia and slow heart rate uh and when to consider

19:17 a pacemaker uh and also you know to a certain extent normal aging can um slow the heart rate response as well. Uh so especially when it comes to low blood pressure, we often want to know, well, is the heart rate also low or is it sped up? You know, is it faster? And that's why you always want to report heart rate along with blood pressure. Just record them in in your journal. And if you are relaying them to a health provider, you want to relay both. So those would be some signs and symptoms of low blood pressure. But again, you know, sometimes it causes no symptoms at all. So given that how should we approach low blood pressure in older adults? So let me speak right now to the approach that I use and that I think a lot of geriatricians use. So generally in geriatrics we're going to be dealing with lowish blood pressure where most of

20:04 us are not in the emergency room dealing with very low blood pressure. Somebody comes to clinic and has very low blood pressure like that. We're going to treat it you know more as a sort of emergency. But for lowish blood pressure uh I would say we do two things. So one is that we're proactive. we're proactive about noticing it. So if systolic blood pressure is less than 120 mm of mercury, it's optimal. Yay. But before I think, yay, I usually take a closer look at it and I initiate some additional uh checks. So first of all, I ask, has the person been feeling okay? And I'm especially interested, do they ever experience lightadedness or unsteadiness after they are standing? I might actually check them for an orthostatic drop, have them stand up and um see what

20:50 their their blood pressure is. I should say actually when you know if there's a low reading, whenever there's a reading of anything that surprises you, the first thing to do is to check it again, see if it's real. But uh if it is, I'm asking about symptoms, checking for an orthostatic drop in blood pressure, reviewing medications, considering the possibility, could they be dehydrated? And I would consider reducing medications that affect blood pressure or falls. I mean, I would think of it as huh, especially if the person is on medication for blood pressure. Maybe they're on a little bit more than they need. Now, it depends, of course, you know, what is the blood pressure reading? If if their systolic blood pressure is 118, they're feeling totally fine, that's okay. uh if it's 105 when they're sitting down, even if they're feeling totally fine, if they are on

21:37 medication or anything that's lowering their blood pressure, I might think, well, do we really need you to be so uh so low because it does seem awfully low to me. And as we consider this, we do want to consider their past blood pressure readings, including the heart rate. We want to know what is this person's uh what has this person's trend in blood pressure been? And so um uh this is one of many reasons why I think it's great to have a home blood pressure monitor actually um so you can have a few additional data points and that's really useful for your health provider as they consider your blood pressure. Uh so that's the proactive approach. Um, and then there's the way we react. And specifically, if an older person comes in with symptoms that could potentially be related to low blood pressure, we think of low blood pressure or orthostatic hypotension and we check on

22:25 that and consider whether we want to make an intervention. So, if they're having symptoms such as falls, near falls, fear of falling, fatigue, dizziness, unsteadiness, or reduced mobility or physical activity. As geriatricians, we often think, huh, could low blood pressure be playing a role in this? Now, the thing about these symptoms is um a couple things. So, first of all, these symptoms are very common in older adults and they are non-specific, meaning there are all kinds of things that could cause these problems. Now, being geriatricians, some health providers when an older person has these symptoms are like, "Oh, it's aging. What do you expect?" We don't treat these symptoms uh that way. These are common symptoms in older adults, but we do not wave them off to normal aging.

23:11 We look into it and see uh what are underlying causes and contributors. What can we do or adjust because these are important symptoms that affect older people's quality of lives and ability to participate in their lives. But I will say these are non-specific symptoms that often have multiple underlying causes or can have several underlying causes. And so we also don't want to just assume, oh, this is just low blood pressure. There can be so many things that cause fatigue. Um low red blood cell counts which actually anemia uh which actually if it gets really bad can also cause lowest blood pressure come to think of it. But um yes you know I think what we bring as geriatricians is that uh if an older person has this kind of symptom uh we might take another look what was their blood pressure when they came in we might double check it. If it's lowish

23:57 we might think well let's see if we can get your blood pressure a little higher and maybe some of these symptoms will get better. So yeah, so for these symptoms, we think blood pressure, but we also want to do our our work well and look into other possibilities to correctly evaluate and manage these kinds of symptoms. So I've mentioned checking medications a few times because that is again one of the most common causes of an older person having lowish blood pressure which may or may not be causing uh symptoms. Um so I just want to speak for a little bit about the kinds of medications we especially look for in this situation. So first of all, uh any medication prescribed for high blood pressure, right? By definition, it's meant to lower your blood pressure. So uh in particular, um as I explained in one of my previous videos, the ones um that are

24:44 first line for treating high blood pressure uh in older adults and in any uh adults really are calcium channel blockers, thyide diuretics, ACE inhibitors, uh ARBs, angotensin receptor blockers. We also want to consider other medications prescribed for heart conditions. There are medications that are prescribed for heart conditions not specifically uh necessarily for high blood pressure but other types of heart conditions such as beta blockers such as uh nitroglycerin. There are other vasoddilating medications that are meant to uh again either relax your blood vessels or relax other parts of uh the body specifically such as the urethra for men who have an enlarged prostate. So tamillosin, terrazisonin, these are medications that are prescribed for an

25:30 enlarged prostate. They also relax your blood vessels. Drugs for erectile dysfunction such as selenaphil, Viagra, also vasoddilates and can contribute to low blood pressure. Uh other diuretics, um medications designed to make you pee more and release fluid from the body. These are often prescribed for conditions such as kidney disease or heart failure. And then there are certain diabetes drugs uh that also work by causing the body to urinate a little bit uh more um and so those two can you know affect blood pressure. Lastly anti-depressants including SSRI type anti-depressants have been associated in some studies with orthostatic

26:16 hypotension. So uh that's another type of medication to potentially consider. They also have actually been associated with a a bit of an increase in falls uh as well although not as much as certain other medications. So given that what should you do if you are concerned about blood pressure? Um so I would say that um my first question would be well are we are you experiencing symptoms that could potentially be related to low blood pressure or not? So, if you or a person you're concerned about are experiencing symptoms, uh I would definitely let your health provider know you're concerned um about the symptoms and wondering if it could be related to blood pressure. And the um you should ask about coming in for an evaluation. And what is going to be really really helpful if you have this

27:02 concern is if you can use a good home blood pressure monitor to check your blood pressure. Don't forget to write down your pulse when you notice symptoms. And also log your symptoms and when you get them, right? Like how many times a day? What are you doing when they come on? What are the symptoms? Uh if there's any possibility of dehydration, you can try increasing your fluid intake to help with that. And then what's going to be very helpful along with your blood pressure at the time when you're feeling the symptoms is if you bring in other blood pressure readings, ideally at a time maybe when you're not feeling symptoms. So, um you know, checking your blood pressure every day at the same time for several days in a row is going to provide a nice kind of background uh blood pressure um for your health providers to work with and it will help them interpret what your blood

27:48 pressure is when you are having these symptoms and that'll help them sort out whether your symptoms are due to low blood pressure or not. And then when you come to see your health provider, bring all your medications, not just your blood pressure medications, everything. just bring everything in in a bag so that it can be looked at and so that your health providers can identify whether your medications might be contributing to this issue. Now, what if you have no symptoms? What if you've just noticed that your blood pressure is sometimes kind of low when you check it yourself uh with your home monitor or at the doctor's office? So, if it's low systolic blood pressure, you know, less than 110 but no symptoms. So, first of all, I would say get more data points. Check your blood pressure daily at the same time for several days uh to see is this a sort of temporary blip? Is this

28:34 something that happens to you a lot because uh you'll want to confirm that your blood pressure is often low. If you're on medication for high blood pressure, uh especially if you're older, getting, you know, above age 75, uh certainly above age 80, um you might be on more blood pressure uh medication than you need. So I would suggest uh asking your health provider to have a visit where you can discuss your blood pressure treatment including what your blood pressure goal should be and talk about you know whether it might make sense to try dialing back the medication a little bit and following up on your blood pressure. So for that appointment also I recommend bringing all your medications when you come to that appointment. You can also ask your provider when you're there uh if you've noticed lowest blood pressure if they can check for orthostatic blood pressure

29:21 changes if they can check for that drop when you stand up during the visit as well. So uh let me now recap that's that's pretty much everything I have to share about low blood pressure. So let me recap my key points for you. Uh so again normal optimal blood pressure is less than 120 over 80. Uh and hypotension is generally defined as blood pressure less than 90 over 60. And then I consider systolic blood pressure of 90 to 110 as low especially in older adults. Um this can cause no symptoms and be not an issue especially when it comes to younger people who aren't on medication but it's more likely to be concerning in older adults who first of all are often on medications that affect their blood pressure and are much more likely to be experiencing symptoms including uh falls, near falls,

30:08 dizziness, unsteadiness when they stand up. Any new very low blood pressure usually causes symptoms and is often a medical emergency. That vaso veagal response that neural reflex that temporarily drops your blood pressure uh is common can cause a temporary significant blood pressure drop. It is a common cause of passing out. But also orthostatic hypotension is common in older adults and again that's that drop of 20 millm of mercury uh systolic withstanding or 10 millimeters of mercury diastolic. uh and it can cause symptoms such as falls and lightheadedness. And so if we notice it in our older patients in geriatrics, that often leads us to try to uh review medications, dial something back if possible, or see if there's any way that we can reduce that phenomenon and help

30:54 the person feel more comfortable. Another strategy is also to just be a little bit more slower and methodical as you stand up. It's my opinion that low blood pressure a systolic of 90 to 110 should be investigated in older adults and not just waved off as great they're under 120 you know we're at a um consider the role of medications dehydration autonomic insufficiency plus other causes. Uh so my own approach is uh if somebody one you know who sees me has a systolic blood pressure less than 120 I notice I investigate I ask uh some more questions are they experiencing symptoms uh should we check for an orthostatic drop you know looking at the medications should we dial back any high blood pressure treatment could there be

31:41 a possibility of dehydration I think about things like that uh and then I do consider the role of low blood pressure if a person an older adult is experiencing symptoms that could be caused by low blood pressure such as falls, fatigue, lightadedness, unsteadiness, and reduced mobility. So, if you're concerned, I highly recommend letting your health provider know. I recommend having a home blood pressure monitor to check your blood pressure when you feel symptoms and also to gather a few more data points that you can provide to your health providers. Don't forget to jot down the heart rate along with the blood pressure when you are logging things in your blood pressure log. And that's what I have for low blood pressure today. So with that, thank you so much for watching. And if you found this video podcast helpful, if you're here on YouTube, please go ahead and subscribe. It does help more people

32:27 find the channel. If you've been listening to the audio version on the podcast feed, come and take a look at the video if you get a chance. You'll see my key points being displayed on the screen. So, thank you once again, and I look forward to seeing you all again on a future episode of the Better Health While Aging video podcast.