“All health professionals are advised by the medical community to actively promote lifestyle strategies first and foremost as the basis for controlling blood pressure and preventing CVD.” – PhD, R.D., Janet Bond Brill, author of the book “Blood Pressure Down”.
Hypertension – No. 1 Killer in the world!
High blood pressure contributes to more deaths than any other preventable factor. It is estimated that over a billion people have high blood pressure globally. The International Society of Hypertension causes 76 lakhs of premature deaths each year. WHO reports that high BP is the most prevalent risk factor for heart attacks and stroke with high BP affecting 20-25% of the entire global adult population.
It’s not only a killer disease, but it’s also among the most expensive diseases in the world. And the worst part of the disease is that it’s largely a symptomless disease. So many people are not even aware of the problem and don’t take treatment, leading to sudden deaths.
3 Stages of Hypertension
There are three stages of hypertension:
|Systolic BP (top number) – mm HG
|Diastolic BP (bottom number) – mm HG
|Stage 1 Hypertension
|Stage 2 Hypertension
Even prehypertension is not worth taking lightly as it increases the risk of stroke by 55%.
Why is it Important to Normalise Blood Pressure?
Hypertension, if left uncontrolled, can be a major cause of other health problems including stroke, heart attack and heart failure. Lowering your high blood pressure will:
1. Reduce your risks of heart attack by 20-25%
2. Reduce your risks of heart failure by 50%
3. Reduce your risks of stroke by 35-40%
Is it Possible to Normalise Blood Pressure Naturally?
If you ask a conventional doctor, the answer would be a “BIG NO”. If you are diagnosed with high blood pressure, you will be put on medications and you are expected to take those medications all your life. But these medicines have multiple side effects such as erectile dysfunction from beta blockers, leg swelling from certain calcium-channel blockers, and cough from ACE inhibitors. The medication-alone approach is never a good solution for chronic diseases. Lifestyle plays a much bigger role than medicines and it should be the first line of treatment.
What are the Root Causes of Hypertension?
Conventional medicine does not believe in attacking the root causes of chronic disease. It gives medicines to manage symptoms, hence you need to be on medications all your life and live with all the side effects.
Whereas Functional Medicine believes in tackling the root cause of the disease. Hence, reversal becomes possible.
There are multiple reasons why hypertension may happen. The most prominent ones are:
1. Overweight or Obesity
“Obese people are 5 times more likely to have high BP. Researchers have found that extra body fat activates two of the factors underlying elevated pressure: an overactive sympathetic nervous system and an underactive renin system. Lose body fat and your blood pressure will go down.” – PhD, R.D., Janet Bond Brill, author of the book “Blood Pressure Down”.
A 2020 review in Pubmed estimates that obesity accounts for 65 to 78% of hypertension cases.
It’s not that a person with normal weight can’t have hypertension, but the chances are much lower.
|Gyaan Time: Why does obesity lead to hypertension?
Obesity can induce hypertension in a variety of ways. Some of them are:
2. Insulin Resistance
Insulin resistance is infamous for Type 2 Diabetes. But it also causes many other diseases including hypertension and heart attacks. Insulin resistance is probably more important than excessive sodium for hypertension. (We will talk about sodium in a while).
Gerald Reaven, a Stanford University medical professor, observed in 1988 that insulin resistance was at the centre of many diseases: high BP, obesity, and high triglycerides. His studies show that if a person suffers from insulin resistance, then he or she has a 40X increase in his risk for heart disease.
What is insulin resistance?
Insulin resistance is when cells in your body don’t respond well to insulin and can’t easily absorb glucose from your blood. As a result, your pancreas has to make more insulin to help glucose enter your cells.
How to measure insulin resistance?
There is a very simple blood test for it: HOMA-IR. HOMA stands for the Homeostatic model of insulin resistance. Just with the help of your fasting blood sugar levels and fasting insulin levels, this parameter is calculated. If your value is between 0.5-1.4, then you are healthy. And if it’s higher than 1.9, then you have insulin resistance. A value above 2.9 should ring alarm bells in your head and you need to take action immediately.
If you are obese or you have some chronic disease, chances are very high that you are insulin resistant. I would highly recommend you check your insulin resistance as soon as possible.
The medical system is managing symptoms, not curing this root cause.
How many times have you heard doctors talking about insulin resistance? Everyone talks about HbA1c, cholesterol levels, BP, and TSH levels, but how many times have you heard of HOMA-IR? HOMA-IR is far more important than managing just the symptoms. In diabetes, blood sugar is not the problem. It’s only a symptom. The problem is insulin resistance. Most of the time, the medical system is not solving the root cause, but only managing the symptoms. Just because your blood sugar is under control, you feel relaxed that your disease is under control. But it’s not. You are measuring the wrong parameter. You need to see if your insulin levels are getting better or not. Unfortunately, that’s not the current protocol. But if you are serious about your long-term health, then you need to cure this root cause, so that you don’t have to depend on medications (to manage your symptoms) lifelong.
3. Internal Inflammation
Internal inflammation is another major factor for hypertension. It is neither painful nor visible, but it’s extremely deadly. It is a fire that is kept hidden by the body‘s immune system as it combats food allergens, toxins, stress, and bad food. It’s such an important topic, that I have written a complete blog on it. Check it out here – Internal Inflammation: One of the Most Important Blood Markers for Disease Risk
Stress increases blood pressure. Period. Everyone knows about it. But simply knowing is not enough. We must act. If you have high levels of stress, you need to take corrective measures. Meditation, physical exercise, socialising, engaging in hobbies, and going on vacations can help you relax and reduce stress. Also, it’s good to maintain a gratitude journal. We tend to only focus on things which we are missing in our lives, but hardly notice the many gifts we have got. It’s important to be grateful and if you are grateful, there is not much room for stress.
In terms of herbs, ashwagandha is beneficial for stress management. But if your stress levels are extremely high, you should visit a doctor.
5. Sedentary Lifestyle
Again, everyone knows that a sedentary lifestyle is a cause of multiple disorders including hypertension. It’s recommended to have some activity for 30 minutes for 5 days a week. And ideally, it should include both strength training and cardio.
I know you are busy but there are many ways to stay active even in the busiest lifestyle e.g. walking while talking, taking stairs instead of lifts, and if you are in a desk job, then standing and working for an hour.
6. Alcohol and Smoking
No new information, but still very important for normalising blood pressure. If you must drink, then red wine is the best choice because of its high resveratrol, a very potent antioxidant. Restrict it to 1-2 glasses and for a couple of days a week.
What are the Most Important Nutrients?
1. Sodium: The Usual Suspect
Salt is an important nutrient and wars have been fought over it in history. It was once a form of legal tender and Roman soldiers were once paid in salt. In fact, the word salary has come from the Latin word for salt. As a food preservative, it also spurred agricultural growth much before refrigerators were invented.
But too much of anything is bad. And that’s the problem with salt.
Everyone knows that too much salt is bad for health, especially for hypertension patients. Salt is bad because of its high sodium content. Each gm of salt contains 400 mg of sodium.
The typical standard recommendation for sodium is 2400 mg/day (1 teaspoon of salt). American Heart Association (AHA) recommends not having more than 1500 mg of sodium in your diet daily, especially for hypertension patients. Most of us eat a lot more than that. It is estimated that an average person is eating anywhere between 4000-6000 mg of sodium per day.
|Gyaan Time: Why is sodium toxic?
Sodium is a charged particle and the electrical charge attracts water. So, it tends to pull fluid from the tissues into the arteries and thus raises blood volume. With a higher volume of blood, the heart has to work harder to circulate it, and the pressure against the blood vessel walls increases. It also leads to the narrowing of blood vessels in the long term.
Hence, the first drug of choice for hypertension is a diuretic which reduces the amount of water in the body.
What does research tell us about sodium?
It is observed that for people who eat over 4000 mg of sodium daily, systolic BP rises with age by an average of 7 mm Hg per decade after age thirty. It may not look much, but within a couple of decades, a normal person becomes hypertensive.
The good news is that cutting salt leads to a lowering of BP. And that too in just 4 weeks. A meta-analysis of 28 clinical trials involving nearly 3000 people found that cutting salt intake to 5 gms/day lowered BP by an average of 5/3 mmHg in hypertensive patients.
A study published in the New England Journal of Medicine found that if all of us could cut our salt intake by up to 3 gm/day (1200 mg of sodium), there would be close to 100,000 less deaths from cardiovascular diseases every year.
Another study found that if Americans cut their salt intake by 10%, it would save an astronomical $32 billion a year in health care costs.
Do you need any more reasons to cut down on salt intake?
|Salt is the new Sugar!
Sugar is mostly considered a dietary villain and salt is generally ignored. Most food labels do not even disclose how much salt is there in the food. But salt is equally bad. And one needs to be conscious of overall salt content.
And it’s not just salty food. You will be surprised to know that a large McDonalds’ shake has almost 2 times more salt than a large french fries.
What are good salt substitutes?
Use herbs and spices to flavour food. Herbs such as rosemary, parsley, cilantro, and basil; spices such as cinnamon, cumin, and nutmeg; seasonings such as lemon, lime juice, pepper, vinegar, and wasabi paste.
Also, you could use potassium chloride instead of salt. It’s not as tasty, but it may be used to replace 25% of overall salt. But care has to be taken if you have kidney problems or are taking medicines that cause potassium retention.
2. Potassium: Mother Nature’s Best Hypertension Medicines
Though most people focus only on cutting sodium in their diet, there is another nutrient which is almost equally important: Potassium. The American Heart Association (AHA) recommends having a sufficient potassium intake both as a preventative measure and a treatment option for patients with hypertension.
Potassium is sodium’s enemy!
Potassium has the opposite effect on blood pressure as sodium. Also, they fight each other. When sodium is high, kidneys eliminate more potassium. And when potassium is high, kidneys excrete sodium.
Cardiovascular specialist Raghavendra Makam, MD, MPH says, “Potassium helps the kidneys excrete excess sodium instead of retaining it. Potassium also helps improve your body’s overall vascular health, he adds. Potassium eases tension in the walls of blood vessels and that, in turn, can have other benefits on your heart health.”
Potassium acts as a natural diuretic: it helps in eliminating excess water and sodium in the urine.
How much potassium to consume?
The recommended daily requirement of potassium is 4700 mg. Most of us consume a lot less; almost half. The ideal ratio between potassium/sodium is 3:1 but not many people eat in that ratio.
One of the best sources of potassium is banana, but 1 medium size banana has less than 500mg so if you rely only on bananas for potassium, then you will need 10 bananas which is impractical. So, include other good sources like kiwi, spinach, carrots, orange, white beans, pistachios, baked potato, sweet potato, figs, broccoli, tomato, cucumber, raisins, carrots, dates, cauliflower, lentils, mushrooms, and avocados.
Norwegian researchers conducted a kiwifruit experiment where a group of hypertensive patients consumed 3 kiwis a day for a period of 8 weeks. And the results were nothing short of miraculous: a drop in BP by 10/9 mm Hg; a 15% decline in blood clotting and an 11% reduction in ACE.
If your diet is largely plant-based (vegetables and fruits), then you don’t have to worry about potassium. If it is not, you need to increase your consumption of fruits and vegetables and cut down consumption of junk food.
The largest meta-study (over 250,000 people) on potassium was published in the Journal of the American College of Cardiology. It found that by adding potassium-rich foods and by cutting down sodium intake, we could prevent as many as 11,55,000 worldwide stroke deaths every year.
But if you have a medical condition that impairs kidney function, then you must restrict your intake of potassium.
3. Magnesium: The Yoga Master for Arteries
“Magnesium helps regulate hundreds of body systems, including blood pressure, blood sugar, and muscle and nerve function. We need magnesium to help blood vessels relax, energy production, and bone development. Just like potassium, too much magnesium can be lost in urine due to diuretic use, leading to low magnesium levels.” –Harvard Health.
Magnesium is also called Potassium’s “Twin” as both of them are very tightly bound metabolically. If you don’t get enough magnesium, it is difficult to maintain adequate levels of potassium in your cells.
Magnesium soothes the muscles in your blood vessels. It is like yoga or a massage for your vessels. It is also anti-inflammatory and is associated with lower amounts of inflammatory markers in the blood. As a result, it also helps in endothelial dysfunction, one of the reasons for hypertension.
Magnesium is also Nature’s calcium channel blocker. It acts very similarly to synthetic calcium blocker medicines. If your body does not get enough magnesium, too much calcium enters the muscle cells and causes the arteries to squeeze, and increases blood pressure.
Magnesium deficiency may also cause fatigue, weakness, osteoporosis, and irregular heartbeat, amongst others.
How much magnesium to consume?
The RDA of magnesium is 420 milligrams (mg) per day for men aged 50 and older; 320 mg/day for women aged 50 and older.
Good sources of dietary magnesium are dark, leafy green vegetables, spinach, cocoa powder, brazil nuts, chickpeas, coffee, unrefined grains, buckwheat, and legumes.
|Magnesium cuts the risk of death from a Heart Attack by half!!
59000 Japanese people were observed for 15 years in a very large-scale observational study. It was found that people who had the highest dietary intake of magnesium had a 50% reduction in risk of death from cardiovascular disease.
4. Antioxidants: The Scavengers
Oxidative stress is one of the major problems wherein free radicals (highly destructive molecules) attack the fragile endothelium (the inner cellular lining of the blood vessels), impairing the blood vessels’ ability to relax and dilate. What is oxidative stress? A simple example to understand is what happens to an apple when you cut it and keep it. It turns brown because of oxidative stress.
But the body has a solution for every problem. And the solution for free radicals is antioxidants, also known as free radical scavengers. Antioxidants’ main job is to protect the body from free radicals. It not only helps in preventing cancer but also in managing blood pressure. Antioxidants are abundantly available in fruits and vegetables. So, one more reason for you have to have more servings of them, especially vegetables.
There is a particular antioxidant that is probably more important than other antioxidants for good heart health: CoQ10.
“CoQ10 is a potent chain-breaking antioxidant with the proven ability to counteract the constriction of the arteries by free radicals, thus fighting off oxidative stress and lowering blood pressure.”
An Australian meta-analysis of 12 clinical trials showed that CoQ10 supplements significantly lowered BP by 17/8 mmHg without any side effects. Though not all studies are similarly optimistic.
Statin medicine inhibits CoQ10 production, hence if you are taking a statin, it’s even more important to take this supplement. The recommended dose for CoQ10 is 100-300 mg/day.
Some natural sources of CoQ10 include organ meats, soya, fatty fish, vegetables, seeds, and nuts.
5. Essential Omega 3 Fatty Acids: The Ultimate Wellness Molecule
Omega 3 is a type of essential fat, which means our body cannot manufacture it and they are essential for our survival. It has to come from dietary sources. Experts call it “The Ultimate Wellness Molecule ” for the immense benefits it possesses.
As per WebMD, “They’re key to the structure of every cell wall you have. They’re also an energy source and help keep your heart, lungs, blood vessels, and immune system working the way they should.”
Omega 3 is your heart’s best friend. It can improve risk factors for heart disease.
- It can lower triglyceride levels
- It can reduce BP for people with high BP
- It can reduce inflammation
- It can increase HDL
The American Heart Association (AHA) recommends that people with no history of heart disease should eat at least 2 servings of fish each week (a total of 200gms). The best sources of Omega 3 fish are salmon, tuna, swordfish, anchovy, mackerel and sardines.
If you have a history of heart disease or are a vegetarian, then taking a supplement is advisable. It should be a minimum of 1 gm capsule daily. Ideally, 2gms of fish oil.
For detailed information on Omega 3, read here – Why Should You be Taking an OMEGA 3 Supplement?
6. Other Nutrients
Many other minerals and vitamins play an important role in managing your blood pressure e.g. biotin, vitamin D, vitamin C, and B1.
What’s the Ideal Diet to Normalise Hypertension?
- If you have belly fat or visceral fat, then that’s the No. 1 thing that you need to do is lose fat and get back to normal shape. That will have the biggest impact on insulin resistance.
- Reduce dependence on wheat and rice. The Indian diet is largely formed of these two grains. Include more grains, millets in your diet. Replace white rice with brown rice. Have rotis made of different grains, not just wheat. Try to go gluten-free for a few days.
- Avoid refined and simple carbohydrates completely. No maida. No sugar. No white rice.
- Replace sugar with some natural sweeteners like stevia and erythritol. Gur, honey and brown sugar are healthier than white sugar, but they are still sugar and can spike your insulin levels.
- Restrict consumption of fruit to 1 per day. Fruits are also high in sugar and too much of a good thing is also not good.
- Increase protein sources in your diet. E.g. have sprouts, and eggs. Have 2 bowls of dal, rajma, chole instead of 1. Have chila, dhokla and other protein-rich breakfast items. Take a protein shake.
- Include good sources of fat. Have soaked seeds and nuts every day. Good fat is extremely beneficial for insulin resistance. You can have a handful of seeds and nuts every day. But it’s important to increase your fat consumption while reducing your carb. Too much food is not recommended.
- Sleep for 7-8 hours. Take less stress. Lack of sleep and too much stress releases cortisol, which is not good for insulin resistance.
- Be active. It’s not necessary to go to a gym (if you can go, very well). Play some sports. Or do simple brisk walking. A 10-15 minute walk after meals, especially after dinner is very important.
- Though the common belief is that saturated fat is bad for the heart, it’s a big lie. Read my other blog on the topic here: “Is saturated fat bad for cholesterol and heart health? What do studies indicate?”
What Supplements are Required?
- A good multivitamin: A good multivitamin takes more of many nutrients in 1 capsule. So, it is highly recommended.
- Omega 3 fish oil or veg omega 3: Almost all of us are deficient in essential omega 3. Supplementation is a good way to avoid omega 3 deficiency.
- CoQ10: “A CoQ10 deficiency affects your heart as profoundly as calcium deficiency would affect your bones. We create less of it as we age, making it all the more important to supplement with CoQ10, as we grow older… CoQ10 reduces Lp(a), improves endothelial function, decreases cholesterol/triglyceride levels, increases HDL, decreases fasting blood sugar”: Dr. Jonny Bowden and Dr. Stephen Sintara write in their bestseller book “The Great Cholesterol Myth”
- Magnesium: Get yourself tested for magnesium deficiency. And if you are deficient, then you should consider 400-1000mg of magnesium supplement. Studies have shown a high dietary intake of magnesium resulted in reduced BP. Also, it helps with insulin resistance which is a big factor in causing heart disease. Also, it helps in relaxing heart muscles, dilates the arteries, and makes it easier for the heart to pump blood.
Research scientist Andrea Rosanoff, PhD. looked at multiple studies dating back to 1937 to conclude that low magnesium levels have been found to be the best predictor of heart disease, contrary to the traditional belief that cholesterol or saturated fat play the biggest roles.
Magnesium supplements should not be taken if you suffer from kidney disease.
- Avoid calcium supplementation unless strongly recommended by a good practitioner. Calcium in arteries is not good. Research has shown that a faster progression of coronary artery calcium increases the risk of heart attack by 17 times.
- Cover up for your deficiencies based on your lab reports. The most important ones to check are vitamin d, vitamin B12, zinc, iron, and chromium.
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**Disclaimer: The testimonials mentioned above are based on each individual’s experience and results may vary for different individuals.