Take the pressure down, Pt. 2

Courtesy Walking Melbourne.

In my previous blood pressure post, I put forward what I believe to be the best way of addressing the problem through diet, and a link to an inspiring talk by Dr Dean Ornish. The main reasons why high blood pressure is a concern are the dramatically increased risk of stroke, heart attack and kidney failure. So, what causes high blood pressure (hypertension)?

1. atherosclerosis - the build-up of fatty deposits on the walls of your arteries; the major dietary causes are ingestion of animal protein, saturated fat and cholesterol (in that order), although there is also a role played by over-consumption of refined sugars
2. high sodium intake - sodium is actually essential, but is readily obtained in sufficient quantities in just about any natural food, however the kidneys struggle to deal with the quantity of sodium typical in Western diets, so it is retained, and along with it, water is also retained. The excess water increases blood volume, which thereby increases blood pressure.
3. low potassium intake - the ratio of sodium to potassium is important, but since potassium isn't present in your normal everyday table salt, most people get much less than is ideal, so increasing potassium intake can have beneficial effects. Potassium rich foods include many fruits, but especially bananas, citrus, avocados and melons; vegetables and nuts, such as almonds, walnuts and pistachios (unsalted!)
4. alcohol - beyond a moderate amount (1-2 standard drinks per day), alcohol causes increased blood pressure and the effect can be persistent; caffeine can also significantly increase blood pressure, although the effect is generally short-lived

You won't be surprised to hear me say that a low-fat, whole-foods vegan diet is the best way to address all of the above! If you can't quite make that big a change right now, you could try some of these changes:

• eat porridge topped with fruit for breakfast - oats have a powerful cholesterol-lowering capacity mostly due to soluble fibre in the form of beta glucan; the fruits help with potassium, fibre and all sorts of other goodness; the fibre and low glycemic index keep you full longer; and, most likely porridge displaces something less healthy from your diet
• eat an all-fruit brekky - if you truly can't stomach porridge, or it's summer and you don't want something hot; if you get hungry again mid-morning, eat some more fruit! Perhaps you can make every AM a "fruit-zone"
• eat as much salad as you can - try it with just balsamic vinegar; eat a big portion of salad first, before moving on to other things
• replace your worst snack, eg. potato chips, chocolate bar, with raw unsalted nuts (any, but walnuts are particularly good) and/or fruit
• do a week-long cleanse - no animal products, salt, refined sugar/flour, oil; it's only 1 week! Make sure you check your blood pressure at the end of the week. It would be great if you kept eating this way: your blood pressure will continue to improve, but even if you go back to your old ways, your taste buds will be partially reset - you will find you need much less salt and oil than before
• if you drink every night, try alternating with alcohol-free nights

The ironic thing is that as diet improves, so do energy levels, so getting more exercise also becomes easier. Blood pressure, heart disease, atherosclerosis are all intertwined in terms of causes and outcomes. My next post will link to an amazing talk by a world-leader in heart disease treatment through dietary measures - Dr Caldwell B. Esselstyn. What he says about heart disease and atherosclerosis applies equally to hypertension - his message is that you can make yourself "heart attack proof" through diet.

Unfortunately, many GPs, in trying to focus only on the very highest risk patients, normally give the wrong impression of what is a normal blood pressure reading. We should set our sights higher than this - heart attacks and strokes are almost entirely preventable! I'll finish with an excerpt from Eat to Live by Dr Joel Fuhrman:

Your Doctor Lied: You Do Have High Blood Pressure and High Cholesterol

I know you were told that if your blood pressure is below 140/90, it is normal. Unfortunately, this is not true, either. It is average - not normal. This number is used because it is the midpoint of adult Americans older than sixty. The risk for strokes and heart attacks starts climbing at 115/70. 

In societies where we do not see high rates of heart disease and strokes, we do not see blood pressure increase with age. In rural China the healthy elderly had the same low blood pressure readings as they did when they were kids. Almost all Americans have blood pressure that is unhealthfully high. At a minimum, we should consider blood pressure higher than 125/80 abnormal.

Numerous scientific investigations have shown that the following interventions have some degree of effectiveness in lowering blood pressure:

• Weight loss
• Sodium restriction
• Increased potassium intake
• Increased calcium and magnesium intake
• Alcohol restriction
• Caffeine restriction
• Increased fibre intake
• Increased consumption of fruits and vegetables
• Increased physical activity or exercise

Studies have shown controlling sodium intake and weight loss to be effective in reducing blood pressure, even in the elderly. How can you implement these interventions into your lifestyle? It's simple. Eat many more fruits, vegetables, and legumes; eat less of everything else; and engage in a moderate amount of exercise. High blood pressure is relatively simple to control.
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I encourage my patients to do whatever it takes to normalize their blood pressure so they do not require medication. Prescribing medications for high blood pressure has the effect of a permission slip. Medication has a minimal effect in reducing heart attack occurrence in patients with high blood pressure because it does not remove the underlying problem (atherosclerosis), it just treats the symptom. Patients given medication now falsely believe they are protected, and they continue the same disease-causing lifestyle that caused the problem to begin with, until the inevitable occurs - their first heart attack or stroke. Maybe, if high blood pressure medications were never invented, doctors would have been forced to teach healthful living and nutritional disease causation to their patients. It is possible that many more lives could have been saved.