[INTERVIEW]
Ronda Nelson: Have you ever wondered why your patient is not getting better despite doing all the right things — they’re eating the right foods, they’re taking the right supplements, they’re doing all the things they’re supposed to, and yet somehow the needle is barely moving? Well, what if the issue isn’t what you’re giving them, or a lack of digestive or absorptive capacity, but it has more to do with those nutrients not being able to get to the tissue? Today we’re gonna talk about microcirculation and why this critical detail gets overlooked more than it should. Let’s go.
Welcome back to the podcast, my friends. This is Ronda, and today — as you probably know if you’re a regular listener — today is the last day that we will be streaming on podcast platforms. Meaning today’s the last day you’ll find us on Apple, on Spotify, on iHeartRadio, or wherever else you’re listening. We are going to be moving fully over to YouTube, so nothing’s gonna change. You’ll still get an email from me that’ll say, hey, here’s the link. Or you can just go find and follow me over at Ronda Nelson — just that, Ronda with no H, Ronda Nelson. I think there’s a heavyweight boxer or a featherweight boxer — there’s some boxer with my same name. I’m not the boxer. So if you follow her, you’re gonna get different information than you’re gonna get if you follow me. Head on over to YouTube and subscribe so you get the notifications. That’s how you do that.
So. You ready? We’re gonna talk about microcirculation today. I was actually in the middle of re-recording — I had an older recording, just super brief, like one little lesson, one little video in Clinical Academy about microcirculation. And I thought, this deserves more attention. I need to develop this concept out a little bit more for the Clinical Academy members. So I was working on it, developing it out over the course of like four videos. And as I’m doing it and I’m digging deeper and I’m digging deeper — thinking about cardiovascular, thinking about retinopathy — all of a sudden I just sort of had this little aha moment.
You know how something just hits you funny? You’re cruising along fine and then all of a sudden you think, oh, wait a second. It was kind of like that. I kind of stopped as I was doing the research, looking at articles and all the things, and I thought, hmm. When was — and this was a really honest question I just asked myself — when was the last time I asked myself, when working with a patient, could they have poor microcirculation? Like, I don’t think I’ve ever — I may probably have, but in the recent past, I don’t know that those words have crossed my mind. I might think, poor circulation, maybe we need to give some zinc, ginkgo, or cayenne or something like that. I think about nutrient delivery being through the gut, right? We start with upper digestion, we work on the gut — those are always the low-hanging fruit for me. But I realize that I don’t think about microcirculation very often. And I think that has to change, and I’m gonna make my case today.
So I think, as I said in the opening, that the patient who’s doing all the things right — everything just looks perfect, everything’s going just like it should be, but they’re not getting better — they’re not crashing and burning, they’re still fine, but you see the signs. Maybe they have diabetes. Well, right there, you know that diabetes impairs microcirculation. Hypertension impairs microcirculation. We’re gonna talk more about that. But they’ve got like all these red flags — ding, ding, ding, ding, ding — sirens going off, microcirculation screaming. But it doesn’t cross my mind. And what if that is the key to the patient getting better, rather than us just keep changing supplements? We just say, well, let’s just try this. We all do it. Well, let’s just try that instead.
I am gonna argue today that if you have a patient who you know has a primary risk factor for having altered microcirculation — and we’re gonna talk about that — then this ought to be your first line, or at least something you’re gonna do very first with them. Because if you don’t, the next logical simple extrapolation is: how are you gonna get those nutrients to the tissue? How is that gonna happen? How are we going to deliver nutrients to the tissue if the microcirculatory vessels are not working? You can give them the best diet in the world and the best supplements in the world. But if they can’t get it from the bloodstream — effectively through those capillaries and make contact with the cell — then how is it that we’re gonna make that happen? I’m just asking the question. And I think we need to ask it more often than we do.
So before I go further, let’s define microcirculation — just so we’re all on the same page. Microcirculation is really just simply the very tiny little vessels — the arterioles, the capillaries, the venules — where the oxygen and the nutrients are delivered into the tissue and the waste products are carried away. So the arteries bring the nutrients and the oxygen into the capillaries, they diffuse out into the tissue, and then pick up the waste and bring it back into the bloodstream and into the vein. Those little capillaries have an inflow and an outflow — we could get all technical about that, but I’m not gonna do that today. It’s where the exchange happens. It’s where the bloodstream meets the cell.
Maybe think about the large blood vessels as the highways, and the microcirculation as all the little neighborhood streets. And if the street is blocked, how are we gonna get in the house? We’re not. The freeway’s fine, but maybe the little streets right around the neighborhood are blocked and I can’t get in — or there’s a raid down the street and the police have the road blocked off. Something’s blocking me from getting to where I need to go. Same thing. That’s a good analogy for microcirculation.
So if the contents of the blood are not getting to where they need to go, then we are gonna have a problem getting the patient better because we can’t deliver what’s needed. We’re not going to be healing the local tissue. And I want you to think about what that local tissue could be — it could be the kidneys, the lungs, the brain, the heart, the muscles. Any tissue, any specialized tissue in the body. The endocrine glands. Anything. So if we don’t have good microcirculation, we’re gonna have a problem.
I think sometimes — and I do this, so listen, this is the pot calling the kettle black over here — I think we’re all kind of in the same boat. What we do is look at things through the lens of: okay, what could this be? And I tend to, although I know better, want to pin a diagnosis. It’s like pin the tail on the donkey. I want to say, oh, that’s X, or that’s this. I want to wrap it up in a clean bow so I know exactly what I’m dealing with. The problem is that microcirculatory dysfunctions do not scream at you like a symptom would scream at you. They’re quiet. They whisper. They’re silent. And as that damage is happening — think about someone who has high glucose, you’ve got somebody who has diabetes — right there, stop. Get out of your car. Put the flashers on. Doesn’t matter if you’re in the middle of the freeway, you get out and we are gonna deal with the microcirculation right there. Because if they have diabetes, guaranteed they’ve got damage to those delicate little capillaries somewhere in the body. That’s why we see it in the eyes. That’s why we see it in the feet. We see it in the kidneys — high sugar affects kidney function because it messes with those little tiny vessels.
So I don’t think about that. I just don’t. I’m just admitting it. I just think, oh well, I have to support their blood sugars. And yes, some of the products we’re using may have an indirect effect, but how about adding some intentionality behind helping this silent thing that’s happening — that can be happening for a really long time. Let’s say you’ve got somebody hanging around at a 92 or 95 glucose, and maybe their A1C is 5.6. Okay — nothing to go screaming into the “you have diabetes or insulin resistance” world, but is that optimal? No. We want that lower. So are they already dealing with damage to these capillary beds? I would argue that they probably are.
So how does it show up? It would show up with cold hands and feet — the fingertips and the feet are really vulnerable, that’s where all the tiny little capillaries are. Cold hands and feet, or burning feet. Could be heavy legs — we’re not getting good return. Could be changes in their vision. Might be edema — that’s another one. Or fatigue on exertion, because those capillaries cannot get the oxygen out of the blood flow that comes in, and it’s not getting pushed back out where it needs to go. And then of course, as I mentioned, the patients who are just not getting better.
The problem is that the symptoms start to scatter, right? The patient doesn’t come in with just one problem — there’s always five or more. And so we’re trying to put the puzzle together, which is what we love to do. I love to do it too. But what if this is a key piece that we’re missing? As I was doing all this research, all of a sudden I thought of one patient — and you might be doing the same thing right now, thinking, oh my gosh, that’s so-and-so, that’s so-and-so. I have on my notepad a list of like four or five patients that I’m thinking, I need to go back and address this. I’m gonna tell you how to do that real easy in a minute. This little expedition I went on to create new content for Clinical Academy — I thought I was teaching, and instead I learned something, or remembered something I should not have forgotten.
One of the things I found interesting was a study they did on women with chest pain — intermittent chest pain. They went in and did all the imaging, all the things, and it said, your heart’s fine. Completely fine. But surprisingly, 50% of these women had no major obstructive coronary disease on an angiogram — none — but their symptoms were still present. And what they found was they had coronary microvascular dysfunction. They basically had a microcirculation problem in the coronary arteries, and that was what was causing the chest pain. Everything else looked good. You can’t test for it — it’s too tiny, you can’t see it. That’s kind of significant, because it means that the patient can be struggling with symptoms and we are not looking in the right place.
And I said earlier that by default, we may give supplements or herbs that will affect microcirculation — but do you know why? Like hawthorn, for instance — hawthorn is a heart herb and I love hawthorn. And actually one of its benefits, besides feeding the heart and supporting the muscle itself, is improving microcirculation and protecting the endothelial health and glycocalyx. So by default, if I gave hawthorn, I’m going to be impacting the microcirculation — but not because I thought about it. I have to admit, I didn’t really think about it. So looking at just the big vessels — the arteries or the veins — that’s not telling us the whole story. And as I mentioned earlier, all types of metabolic dysfunction are always going to have vascular or microvascular problems. This starts way earlier than we realize.
So when the patient comes in and you know they have some of those key tip-you-off markers — if they have hypertension, or elevation in blood sugar, or they’ve had high stress — those are all things that can damage the microcirculation. Now I can hear you, because I think the same thing: oh my gosh, I have to give them a whole bunch more supplements. No. We don’t need to do that, because we can do it with food. We can do it really, really well with food. The patient has to be good about it, but it’s like — either eat it or take it. Someone said years ago — maybe it was Dave Hogshead, maybe somebody else — but the idea is: you’re gonna eat it or you’re gonna take it. Your choice. I am not the boss. You either eat these things or you take these things. That’s all.
So I think the key takeaway here is: how many patients, if you look back, could you have gotten better faster if you had addressed the microcirculation earlier? There’s no way to really know, but it’s a question worth asking. How many of them would have spent less on supplements if we had done this first? I think it needs to be a foundational part of what we talk about.
So as I was developing this content for those four lessons in Clinical Academy, I was obviously going to include what Kerry Bone taught us. We all learned this a long time ago in the Standard Process world — it’s his five-point microcirculation protocol. You might wanna write this down. It’s super simple, and I’ve used it and talked about it over the years. But until I started digging into this topic deeper in order to teach it — because I have to really understand it in order to simplify it and give it to you in a way where you don’t have to go do all the biochemistry — it got me thinking about it in a different way.
Here’s the protocol. It just has five things. Number one: beets. Beets are the richest source of nitrate, which supports nitric oxide production — and nitric oxide relaxes the blood vessels, thereby helping to regulate hypertension. High, high, high in nitric oxide. Number two is berries — especially the darker ones, like blueberries and blackberries. They have those proanthocyanidins in them. Anything that’s dark blue. So berries every day. The patient might complain — this is the food version of what I was telling you about. We’re changing their diet anyway, we might as well have them include these foods.
Number three is cocoa or chocolate. Nobody’s ever gonna say no to that, unless they truly hate chocolate. However, there is a catch: it has to be 85 to 90% dark chocolate. None of this Hershey’s. That’s only going to spike the glucose. So 85 to 90% or greater cocoa — and you only need about 20 grams. That’s it. Just a little bit of very dark chocolate every day. Number four is raw garlic. This is where people get stuck, because how do you get it in? You’ve gotta eat it. You either have to chew it — which, I don’t even know how you would do that, it makes my eyes water just thinking about it — but you really do need to kind of chew it because we want the saliva to mix with it. We need one to two cloves of raw, fresh garlic per day. The garlic helps to thin the blood, it improves the glycocalyx, it relaxes the blood vessels — it has so many benefits for microcirculation. And then the last one is the easiest of all, and that is green tea. Three to four cups of green tea per day. I probably get that maybe three days a week, but I love green tea. I sweeten it with a tiny bit of raw honey — I make it hot and just put a little in. That cuts that tannin taste a little bit for me.
Now, I’m not saying that if you do these five foods every little symptom they have is gonna disappear. But what this does do is give you leverage. You’re changing their diet anyway — might as well have them include these foods. And here’s my practical side kicking in: the chances of me getting all five of those in every day is probably slim to none. Because if you’ve noticed, taking care of yourself is like a full-time job. By the time you meditate and you exercise and you journal and you go for a walk and you have to go to the store and cook and meal prep — and then I’ve got these five things — it’s a lot. Mad respect for people who are super disciplined and can do it. It’s just not me. The garlic is gonna be the toughest for me — I’ve tried it before, like putting it in a spoonful of olive oil. Tried that. Came right back up. Not gonna try that one again. I love garlic, but I always cook with it. Raw is different.
But if the patient only got three or four of those in a day — would it be a loss? Absolutely not. It’s a win. Don’t tell them that, but you lay out the expectation: this is what we need to do every day, these five things. Nobody’s gonna complain about eating berries. No one’s gonna complain about putting beet powder in a smoothie. The only thing they might complain about is the garlic, and maybe the dark chocolate. But you do get used to it — just start slow.
So if the foods we give them are going to improve that microcirculatory environment, what are the odds that the nutrients we’re already giving them — in the form of supplements and food — are going to be able to actually affect change? In other words, I’m back in my driveway. I can walk in my house. I can get through the cell membrane, get in and take the trash out, and know that the trash collector — the capillary — is gonna pick it up and haul it away. What are the chances that’s going to happen more effectively? Very high. It’s likely to be much more efficient. So the magnesium can get where it needs to go. The B vitamins can feed the heart. The herbs and the fatty acids — and even the health of the cell membrane — that’s going to improve as well.
I don’t think we need to add a bunch more supplements. There are supplements we could use — Gotu Kola is my favorite. Bilberry for the eyes. Gotu Kola is just good for everything as it has to do with microcirculation. I’ll tell you, as a side note — I just had a patient this last week who was really, really concerned about her eyes. Her ophthalmologist diagnosed her with the beginnings of macular degeneration and she hit the panic button. She already has super high anxiety — so much better than it was, because she’s done a lot of work on herself, but still high. And she has some endothelial dysfunction. So when she told me about the macular degeneration, I said, let’s do a supplement from Doctors Research — there’s one called Complete Eye Health. Let’s do that. It has all the nutrients your eye needs to heal and repair. And then I said, let’s add some Gotu Kola.
Now I just retested her labs, and her eGFR — she’s in her early seventies. Her eGFR was, I want to say, 65. Which, in your seventies, I’m not unhappy about that. But it went up to 90. Who has kidneys that go in the opposite direction in their seventies? I am 99% sure that was because of the Gotu Kola, because it’s improving those little tiny capillaries, improving the microcirculation. And what are the kidneys? They’re just a bunch of teeny tiny little capillaries filtering out everything in the body. We actually got her eGFR to go the other way. Now, I don’t have any way to prove that that was it — but nothing else changed. That was it. She stayed on everything exactly the same. So I do know we can make this better.
Here are the five foods again so you have them. Beets are a good source of nitrate, which supports nitric oxide production and helps the vessels relax and respond to changes in blood pressure. Berries have those polyphenols, which have been studied for support of endothelial function and vascular resilience — helping the vessels bounce back as they expand and contract. Roughly one cup of dark berries a day. Cocoa or chocolate, 85 to 90%, 20 grams a day — these have the flavonols that support the response of the endothelial lining. Garlic — garlic is like a superhero when it comes to blood viscosity, endothelial healing — one to two raw, fresh cloves a day. And last but not least, green tea, which has the catechins that support vascular health, three to four cups a day.
It’s really simple. It’s not like we had to give them a whole long supplement list. Just do that and watch what happens. Watch what changes on their blood tests. Watch and see over the next month or two if your protocol starts working better.
So I wrote down a few things you can watch for. Cold hands and feet — I mentioned that. Slow wound healing is another one where microcirculation could be compromised. Easy bruising. Even edema at the end of the day — things get swollen at the end of the day, or their legs feel heavy. Also, someone who sits a lot and is very sedentary — that is actually very damaging to those vascular beds, because we need the blood moving through them, and we get that by moving the body. If you see visual changes — where they’re starting to see things go wrong, glasses prescription needing to be updated every six months or so — that’s a microcirculation issue. Huge with vascular integrity. Coleus and Tribulus usually will help that problem — ginkgo to improve the circulation, and Tribulus to make sure there’s enough testosterone. But that’s a vascular endothelial problem right there. And then fatigue on exertion — they can’t exercise, or they don’t recover well after exercise. I think back about the number of patients I’ve had over the years who told me that, and honestly, between us, I don’t think I ever even considered that it could have been microvascular. I was just like, huh, that’s weird, let’s give you something for cardio. I don’t think I ever really considered it.
So here are the questions to look for on your intake forms, or just ask them: Do your hands or feet tend to be cold? If you get cut, does it take longer to heal than it should? Are your legs or hands swollen by the end of the day? Do your legs feel heavy when you sit? If you sit too long, is there any burning, numbness, or tingling in the feet? Now, that could be for other reasons, but certainly worth asking about. Also, smoking — smoking is a huge risk factor. There are studies showing that even secondhand smoke is a big risk factor for microcirculatory dysfunction. So: have you ever been exposed to firsthand or secondhand smoke? And even as a child, that could have caused damage. All we need to do is just go in, give them the five-point protocol — Kerry Bone’s five-point protocol — and see if we can get those capillaries to start working again.
Ask about sedentary behavior — how many hours do they spend sitting versus moving around? And fatigue induced by exertion, as I mentioned. Those are just some questions you can ask. Pretty basic. And I go into this in a ton more detail in Clinical Academy — it’s deep in there. So if you wanna join, it’s just $99 a month. All you have to do is go to rondanelson.com/clinicalacademy — click the button, join, go check it out. You’ll be happy. It’s my brain in an online platform. It is worth hundreds of dollars and it’s so inexpensive, so you really should go do it.
Alright, so to wrap it up — I think we have to make microcirculation part of our clinical vocabulary with every single patient. Just like we think about adrenals. Just like we think about upper digestion. Just like we think about the liver, making sure the liver’s working, making sure blood sugar is stable. Those are foundational aspects for me. I’ve got my five clinical foundations, and as I was preparing this podcast, I thought, I don’t know — I might have to add a sixth. Microcirculation might be number six, because I think we just have to think about it. We have to start thinking about nutrient delivery, tissue perfusion, endothelial health, vascular tone, capillary health. We have to start thinking about that earlier.
That doesn’t mean every single patient has a microcirculatory dysfunction, and it doesn’t mean you have to explain it all to them. But what if — just for fun — what if you just made it a rule that with every single patient, you told them: these are five foods that we need to get in your diet every day? Is there ever going to be anything wrong with them having those five foods? Never. Even if they don’t have a microcirculatory problem, are there enough health benefits to those foods? Of course there are. So why would we not do that? It’s a no-brainer to me. It’s not flashy. It’s not a supplement. But you can help the patient get better by just making it simple. And I think there’s something very freeing about that.
There are some specific herbs you can use — Bilberry is great for the eyes, and Gotu Kola. If you don’t know what to do, just do Gotu Kola. You’re never gonna be wrong. Cyruta is great from Standard Process for the arteries. Cyruta Plus — there are lots of options across lots of supplement companies. Find what it is that you wanna use. But I just think we would not be wrong to use these foods with every single patient. Why would you not?
[CLOSING]
Ronda Nelson: Anyway, that’s what I got for you this week. Don’t forget — I’m gonna take a moment to celebrate. This is episode number 303. Three hundred and three episodes. I have not missed a week in — how long is that? Six years-ish. Just under six years I’ve been doing this podcast, and I have not missed a week. It’s a lot of episodes.
But we’re moving — and it’s the same thing, same content, same Ronda, same everything. Now moving forward, when you click the link in the email I’ll send you, head over to YouTube. Do it now — go to YouTube, search Ronda Nelson. Not the boxer. Just come find me. You’ll see my face on there and you’ll know. Just subscribe and turn on the notifications, and it’ll ding you when I’ve got a new episode. I’ve got a lot more flexibility to put things out there that you guys can listen to — I can create lots of different kinds of content and I’m not as handcuffed as I am with a podcast.
All of these episodes, by the way, they’re all still gonna be here. They’re not going anywhere. So if you wanna go back and listen to an old one, you can. They’ll be here. We’ll also have them on YouTube. Thanks for hanging out with me. I’m just celebrating the end of an era and the beginning of a new one.
I will see you next week over on YouTube. Take care, friends.
[END]