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Holistic Hypertension

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Episode 77

High blood pressure has become so common that the diagnosis does not even shock or surprise people. However, high blood pressure is a sign of systemic dysfunction at the hand of one of the seven root causes of chronic disease. If we do not address the root cause, we will continue to suffer from dysregulated blood pressure. In holistic medicine, we look at high blood pressure as a symptom of an underlying disease; and this episode of the podcast outlines how we holistically approach hypertension with nutrition, stress management, supplementation, and more.

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Introduction

Hypertension (high blood pressure) is extremely common.  Hypertension is defined as a systolic (the top number) ≥ 130 mmHg or a diastolic blood pressure (the bottom number) ≥ 80 mmHg.[1]  Data from the CDC indicate that 45% of the adult population has high blood pressure, which is predicted to increase.  In 2018, high blood pressure was the primary or contributing cause of death for almost 500,000 Americans.[2] Only 24% of those with high blood pressure have their blood pressure controlled.  High blood pressure is more common in the black and Hispanic communities.  The average yearly cost of high blood pressure from 2003 to 2014 was $131 billion each year.[3]

In fact, data shows that even a blood pressure in the range of 120-129/80-84 increases the risk of death from cardiovascular disease by 46%.  This effect was higher in men, a staggering 80% increase in the risk of death from cardiovascular disease.[4]

Studies showing benefit for blood pressure medications reducing mortality (deaths) have been mixed.  A recent meta-analysis (a type of study that pools together information from many different studies) concluded that each 5 mmHg reduction in blood pressure decreased the risk of major cardiovascular events (stroke, heart attack, cardiovascular death) by about 10% in patients with and without a prior history of cardiovascular disease.[5]

In holistic medicine, we try to address the root cause of an illness through a combination of lifestyle medicine (our daily behaviors), mindset modification, and targeted supplementation.

High blood pressure is typically caused by a mismatch between our genes and modern lifestyle, and nutrition.  There is a genetic component, but data from hunter-gatherer populations following a traditional lifestyle reveal a 1% rate of high blood pressure.  This increases as these cultures adopt a western style of nutrition and behaviors, including increased intake of processed foods, sedentary behavior, chronic stress and sleep deprivation, chronic sleep deprivation, lack of sun exposure, and ingestion or inhalation of toxins such as alcohol and tobacco.[6]  What follows is a set of recommendations to holistically address hypertension by addressing several of its root causes.

Nutrition

Increase potassium intake

The RDA (recommend daily intake) for potassium is 4,700 mg per day; however, most Americans only consume about 2,800 mg per day.  Potassium has a relaxing effect on your blood vessels and also helps our bodies remove sodium.  Adequate intake of potassium through nutrition is associated with lower blood pressure.[7]  One of our favorite apps is Cronometer.  Cronometer allows you to track the nutrient content of your food and ensure you are getting enough potassium daily.  Food sources of potassium include avocados, sweet potatoes, spinach, edamame, coconut water, white & black beans, watermelon, beets, and apricots.

Increase magnesium intake

Magnesium is the fourth most abundant mineral in our bodies.  It is involved in over 600 different processes that are necessary for our cells to function!  These range from energy creation, protein formation, activating vitamin D, and muscle movement to regulating our heartbeats and brain chemicals. Most of the magnesium in our bodies is in our bones (60%), and only 1% is present in the blood.  For this reason, blood magnesium testing alone is a poor proxy for the 99.2% of magnesium present in other tissues.  The RDA is 420 mg daily for men and 320 mg for women; however, 60% of the population does not meet this, and 45% are magnesium deficient.[8] Magnesium deficiency is associated with diabetes, heart disease, osteoporosis, soda intake, processed food intake, diuretics, antacids, and metabolic syndrome (elevated waist circumference, elevated triglycerides, reduced HDL, elevated fasting blood sugar, and increased blood pressure).  Magnesium is found in almonds, pumpkin seeds, dark chocolate, flaxseeds, cocoa, avocadoes, cashews, black beans, salmon, mackerel, and halibut.  Magnesium intake is associated with reductions in blood pressure.[9]

Reduce sugar intake

The AHA recommends 6 teaspoons (25 grams, roughly 100 calories) of added sugar per day for women and 9 teaspoons (38 grams, approximately 150 calories) per day for men.  However, we consume upward of 18 teaspoons (77 grams) of added sugar per day. Overall, this amounts to around 60 pounds of added sugar consumed every single year.  Snacks and sweets account for 31% of the added sugar, soft drinks 25%, fruit drinks 11%, coffee/tea 7%, and sports drinks/energy 3%.[10]  Reducing intake of added sugar has been shown to lower blood pressure.[11]

Reducing sugar intake also has a positive effect on insulin sensitivity.  Insulin is the hormone associated with moving sugar into our cells.  Insulin resistance occurs after prolonged periods of excess sugar intake combined with excess calorie intake.  The body begins to become deaf to insulin; insulin cannot do its job of getting sugar inside our cells, and that sugar starts to damage proteins and blood vessels.  Insulin resistance also decreases the clearance of sodium from the body.  By lowering sugar intake, you help ensure insulin is working correctly, which will help normalize blood pressure.  High blood pressure can make insulin resistance worse by decreasing insulin and sugar levels delivered to the muscles.  This creates a vicious cycle causing damage and inflammation to the body![12]

Reduce processed food intake

Most people associate salt with hypertension.  However, there is no substantial evidence that limiting salt (sodium chloride) intake below 3,600 mg (one and a half teaspoons) per day is helpful. This is the amount that the average American consumes. In fact, salt may be a red herring when it comes to high blood pressure.  Now, everything in medicine isn’t black and white, and some people are genetically susceptible to increases in blood pressure because of sodium.  Sodium tends to cause water to follow it, and if more water comes into our blood vessels, it will increase our blood pressure.

Salt is absolutely essential to our overall health and is involved with balancing body water, electrolytes, the transmission of signals in our nervous systems, the secretion of stomach acid to digest food, and the absorption of nutrients in our intestines. In fact, low sodium release by the kidneys is associated with stroke, heart attack, and an increased overall chance of death.[13]  Another study found that people with low salt intake had higher renin levels (a hormone involved in regulating blood pressure, increased levels are associated with higher blood pressure and increased risk of cardiovascular disease and death[14]), cholesterol, and triglycerides. Renin levels increase as sodium intake falls below 1.5 teaspoons per day.[15] Low sodium intake is also associated with worse outcomes in Type 2 diabetes and has been shown to increase insulin resistance in healthy individuals.[16][17]

The call to limit salt intake came from studies in the 1970s by Dahl where he fed rats a high sodium load equivalent to 50 times higher than the average intake in western cultures.  Since then, we have been on a crusade to limit salt intake despite mounting evidence that doing so is actually harmful.  What if it wasn’t the salt, to begin with?

Processed foods are a significant contributor to the overall sodium intake.  One study of individuals in Brazil showed that 33% of the 1970 mg of salt intake for women and 2642 mg for men was from processed foods.[18]  Data from the CDC indicates that over 40% of the daily sodium intake comes from ultra-processed foods (UPF) such as bread, processed meats, pizza, and snacks.[19]  Data indicates that UPF accounts for 60% of the daily caloric intake in the USA.[20]  High consumption of UPF correlates with an increased risk of death, cardiovascular disease, hypertension, metabolic syndrome, obesity, depression, irritable bowel syndrome, breast cancer, asthma, and frailty.  These foods have dense with calories but low in vital nutrients.  Decreasing UPF and increasing the intake of whole foods can have a tremendous impact on our health.[21]   I highly recommend a book called The Salt Fix by Dr. James DiNicolatonio for a deep dive into salt intake and health implications.  We aren’t saying go wild with salt intake; instead, salt your whole food to taste and do not add salt to processed foods!

Here are 5 simple tips that can help improve your overall nutritional quality.

1.) Get 90% of your calories from single-ingredient whole foods such as cruciferous veggies, nuts, seeds, legumes, fish, fruits, and other meats.  I like to tell my clients it’s better to eat foods that do not have labels, but if they do have labels, make sure you can clearly identify every ingredient on the label as a whole food.

2.) Avoid seed oils like canola oil because of the high omega 6 content.  A high Omega 6 to Omega 3 ratio is associated with cardiovascular disease, inflammation, and insulin resistance.[22]  Use extra virgin olive oil, coconut oil, avocado oil, butter, or ghee instead.

3.) Eat your calories do not drink your calories.  We can overconsume calories when we drink them (especially in the forms of juice), and we also lose some of the natural signals our bodies send when we are full.  Overall, this can make it harder to regulate our calorie intake and expose us to excess sugar.

4.)  Eat the rainbow.  The different colors in fruits and vegetables mean there are different nutrients present in the foods.  By eating various colored foods, we decrease our chances of missing out on crucial nutrients our bodies need to function.

5.) Don’t fear fat.  There are things called essential fats; these are fats our bodies cannot produce that must be taken in by our nutrition plans.  Saturated fats raise cholesterol levels, but they also raise HDL and lowers the number of LDL particles associated with a lower risk of heart disease.[23],[24] Recent evidence has called into question the association with saturated fat and heart disease, with two meta-analyses showing no association of saturated fat intake with cardiovascular disease.[25],[26]  Healthy fats include whole foods like olive oil, nuts, fatty fish, cheese (real cheese), whole eggs, coconuts, full-fat yogurt (without added sugar), chia seeds, dark chocolate, and avocados.

Increase intake of Omega 3 Fatty acids (fish oil)

EPA and DHA have numerous health benefits, including reducing inflammation and lowering triglycerides.  DHA is very effective in lowering blood pressure.[27]  3 servings of fatty cold-water fish (salmon, halibut, mackerel, sardines, herring, tuna) weekly are just as effective as taking fish oil supplements to reduce blood pressure.  Other sources of Omega 3 Fatty acids include flax seeds, chia seeds, and walnuts.

Lifestyle Modifications To Reduce Blood Pressure

Sunlight

Nitric oxide is the primary signal in our body that regulates blood pressure and blood flow. Nitric oxide is a potent relaxer of our blood vessels and can help lower blood pressure. Exposure to UV light increases the production of nitric oxide.[28]  Avoid using mouthwash as this can significantly lower our nitric oxide levels and is associated with elevated blood pressure.[29] Mouthwash kills the normal and helpful nitric oxide-producing bacteria in our mouths.

Sun exposure (our main source of UV light exposure) also increases serotonin (our happy brain chemical) production, which can help lower stress.[30]  Sun exposure also increases our vitamin D levels, and higher vitamin D levels are associated with lower blood pressure.  Vitamin D supplementation, however, has shown mixed results for lowering blood pressure in studies.[31]  This is likely because other vitamins and minerals are needed for vitamin D to work correctly, and none of the studies, to my knowledge, look at those other factors.  Aim for 20 minutes to one hour of sun exposure per day, depending on your own tolerance and skin pigmentation.  Staying in the sun to the point of burning is overdoing it.

Improve your lean muscle/fat ratio

Excess body fat increases the stiffness of blood vessels, increasing blood pressure.  Extra body fat is also associated with higher levels of inflammation.[32] 5 extra pounds can make a difference when it comes to the health of our blood vessels; therefore, even small changes in body composition can make a big difference.  Evidence shows that every 1 kg (2.2 lb.) weight loss is associated with a reduction in blood pressure by 1 mmHg.[33] 

Exercise is associated with a reduction in blood pressure through several mechanisms.  If you have excess body fat, losing body fat can lower blood pressure.  Exercise also improves the function of our blood vessels by decreasing their stiffness.[34]  Exercise also enhances our self-image and releases endorphins.[35][36],[37]  This effect can directly lower our blood pressure and can help lower blood pressure by reducing stress.

Positive body composition changes are best accomplished using exercise (aerobic and strength training) with a slight calorie deficit.  We highly recommend Joseph Murci as an online personal trainer who has an extraordinary, evidence-based online program for body composition change.

Quality Sleep

Poor sleep quality and short sleep duration are associated with an increased risk of high blood pressure.[38]  We highly recommend sleep hygiene to our clients as the first line to improve sleep duration and sleep quality.  Some fundamental principles of sleep hygiene include:

  • Budgeting 30-60 minutes to wind down at night before bed
  • Unplug from electronics 30-60 minutes before bed
  • Avoid blue light as this sends signals to wake up
  • Have a fixed wake-up time
  • Aromatherapy with lavender can be useful
  • Meditation or breathing exercises before bed
  • Get sunlight during the day
  • Alcohol actually disrupts sleep rhythms impairing sleep quality
  • Avoid eating big or spicy meals 2-4 hours before bed
  • Restrict the use of your bed to sleeping or sexual intercourse
  • Do your exercise in the morning.

Mindfulness

Chronic stress is a risk for numerous chronic diseases and is associated with elevated blood pressure.[39]  Mindfulness-based techniques like meditation and breathing exercises have been associated with a reduction in blood pressure.[40] Aim for slowly increasing your mindfulness/breathing sessions to three to four 15-minute sessions a week.  There is no limit to how much you can meditate to lower your stress levels.  We highly recommend apps like Calm or Headspace as a way to introduce yourself to meditation and mindfulness.  Breathing techniques like alternate nostril breathing, diaphragmatic breathing, body scanning, and 4-7-8 breathing are remarkable breathwork techniques to induce relaxation and lower blood pressure.

Supplements *disclaimer* before starting any supplements, discuss them with your physician or pharmacist

L-Arginine

L-arginine is an amino acid (protein building block) that is a precursor to nitric oxide. L-arginine supplementation has been associated with a reduction in blood pressure.[41]

Garlic

Delicious and nutritious garlic has many beneficial health properties. The main compound associated with lower blood pressure in garlic is allicin.  Allicin via supplementation has been shown to reduce systolic blood pressure by 16 mmHg and diastolic blood pressure by 9 mmHg.[42]  10,000 units of allicin are needed for this effect which is equivalent to four cloves of garlic. The dose in the meta-analysis of garlic ranged from 12.3 mg to 900 mg daily.  Supplementation may be used as part of a treatment plan for high blood pressure, but don’t forget to get some garlic (don’t try to eat 4 cloves a day) with your food regularly. It’s a beautiful additive for flavor.

CoQ10

CoQ10 is a powerful antioxidant that also plays a role in energy generation.  We store about 2000 mg of CoQ10 in our bodies, and only about 5 mg of that is obtained from food; therefore we make the majority of the CoQ10 our bodies use.  CoQ10 levels decline as we age, and at the age of 65, our production of CoQ10 is 50% of what it was at age 25.[43]  CoQ10 in doses of 100-225 mg daily has been associated with reduced systolic blood pressure by 15 mmHg and diastolic blood pressure by 10 mmHg.[44]  CoQ10 is fat-soluble, and supplements are best taken with a meal containing good fats.

Supplemental Material

We have several podcasts that outline several of the fundamental principles mentioned in this holistic guide.  Here are a few that may help you on your journey to a healthy blood pressure: stress, insulin resistance, anxiety, cholesterol, nitric oxide, mindset, and metabolism.

Thank you, and God bless!

-Dr. Richard Harris

References

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