Talking Health with Dr. Carter By Dr. Lester Carter
Owner, Carter Drug Store
Heart disease, cardiovascular disease (CVD), is the leading cause of death for all Americans age 35 and older. This means men and women among all racial and ethnic groups. According the Centers for Disease Control, over 600,000 people died of heart disease in 2008, 25 percent of all deaths. In other words, one in four Americans died of heart disease in 2008.
Among those with heart disease, 32 percent are known to have high blood pressure (HBP) or hypertension. HBP damages the blood vessels, weakening them and robbing them of their inherent flexibility. This can result in heart attack, congestive heart failure, stroke, blindness, and kidney failure. Called “the silent killer” because symptoms are so subtle, even moderately elevated blood pressure is associated with a shortened life expectancy.
High blood pressure is a major health problem in the U.S. The CDC estimates that 1 in 3 U.S. adults – about 68 million – has high blood pressure. In 2008, HBP was listed as a primary or contributing cause of death for more than 347,000
Americans. African-Americans are especially susceptible, and are one of the most likely ethnic groups in the world to receive the diagnosis. HBP has also been diagnosed in two-thirds of Americans over 65 and in a growing number of young adults and children.
The LowDown On High Blood Pressure
lood pressure is the force of the blood against the walls of the arteries, similar to the pushing of water against the sides of a garden hose. Exact pressure is determined by two factors: the strength of the heartbeat and the resistance of the arteries and capillaries. Interestingly, the tiny arteries leading into the capillary network (arterioles) are the primary regulators of blood pressure. Lined with muscle tissue, they contract or relax in rhythm with the heartbeat.
There are two main categories of hypertension: essential and secondary. Secondary hypertension is a symptom of an underlying disease, and normalizes when health is restored. Over 85 percent of patients are diagnosed with “essential” hypertension, or ordinary high blood pressure, the type we discuss here.
A blood pressure measurement consists of two numbers. For example, a healthy blood pressure reading is 115/75, which reads “one fifteen over seventy-five”. The first number (115) is called systolic pressure and the second (75), diastolic. Systolic is the high point of pressure as the heart beats. The low point occurs in between beats and is called diastolic pressure.
Diastolic pressure is the more important measure. When high, it reveals that the arteries are under excessive pressure even though the heart is relaxed. We suggest a healthy diastolic of 75. In
well-conditioned athletes, it’s not unusual to find diastolics in
the low 60s.
The currently recommended blood pressure measure is 120/80. It is based on normal measures. Normal does not mean healthy. In 2006, researchers found that levels from 120-129 over 80-84 were associated with an 81 percent higher risk of heart disease compared to levels of less than 120/80. (Kshirsagar 2006) Maintaining the recommended pressure of 115/75 can reduce risk of death from heart disease by 30 percent and death from stroke by 40 percent.1
Sometimes a false high reading occurs at the doctor’s office. This fluke is called “white coat hypertension”. Three elevated readings have to occur with systolics above 140 and diastolics above 90 before a formal diagnosis is made.2
If you are under fifty and have healthy blood pressure, measure it again within two years. Over 50, check your numbers annually. Do likewise if the following factors exist: family history, obesity, diabetes, elevated blood cholesterol, and/or African ancestry. Remember, there is no persistent difference in the prevalence of diastolic hypertension between men and women.
Is low blood pressure anything to worry about? Only a very small number of people need to take medication for low blood pressure. Generally, it is only dangerous when diabetes is a complication. Lightheadedness which occurs after sitting or lying down for a while is a temporary form of low pressure.
lthough considered incurable, at its base, HBP is the result of unhealthy lifestyle choices. Overweight, diets high in salt, fat, and alcohol, smoking, chronic stress, persistent exposure to toxins, and sedentary habits are all contributing factors. Correct any of these and the result is healthier blood pressure readings. Correct all of them and improve health exponentially. Of course, the changes must be maintained or the numbers will go back up.
“While some people need drugs to lower their blood pressure, millions can do it through diet,” says Norman Kaplan, MD, the nationally known blood pressure expert.3 Eating an ideal diet not only lowers blood pressure but restores damaged blood vessels, kidneys, hearts, eyes, and brains. Kaplan agrees that whole, fresh, and lively foods are the basis of a healthy diet.
Eat lots of fresh fruits and vegetables, especially leafy greens; grains and legumes; nuts and seeds; low fat or no fat dairy foods; lighten up on meat and put deep water fish on the menu at least once a week. This diet ensures high fiber intake, increased beneficial fat and decreased saturated fat, and a beneficial mineral balance. For many, weight loss comes automatically.
Consistently recommended by Nutrition News, these foods mirror the original DASH diet, developed for the NIH by a world class team of doctors and nutritionists.4 The first DASH study involved 459 individuals (8,800 applied), sixty percent of whom were African-Americans. In the amazing results of the 12 week study, reductions in blood pressure occurred in the first week, stabilized within two weeks, and remained low during the remaining weeks.
Losing weight is another positive effect of a fresh food diet. This is sometimes the only thing people need to do to bring blood pressure levels to normal. Even a loss of ten pounds can make an improvement. Although HBP does not necessarily follow a weight problem, overweight people are three times more likely to have it than normal weight individuals. In fact, obesity is a key factor in 60 percent of all cases of HBP. In the US, weight increases with age. By age 74, half of us have high blood pressure. In societies where weight does not increase with age, neither does blood pressure.
A natural diet also implies greater fiber intake and the use of vegetable-based (rather than animal-based) fat sources. Diets with high fiber and low fat have been shown to have benefits in reducing blood pressure. In addition, studies show high fiber diets to be effective in preventing and treating many forms of heart disease. Further, the presence of soluble fibers in the body clears the blood of toxins such as lead and cadmium, both higher than normal in persons with HBP.
A wholesome diet is also low in sodium (section “Too Salty?”)
and provides sufficient potassium, magnesium, and calcium (section “Magic Minerals”). Denatured foods like sugar, hydrogenated fats, caffeine, and white flour are avoided. These substances activate the stress response, using up nutrients and weakening the body’s ability to recover from common stressors.5
Beyond diet, other lifestyle changes can improve the result. Of course, smoking is out. Not only is it a major heart disease risk factor, nicotine actually constricts the small blood vessels and thickens the blood, directly affecting blood pressure levels. Additional helpful behaviors are learning relaxation techniques, exercising regularly, and taking nutrient supplements.
hile there is nearly universal agreement about the importance of limiting sodium intake for people with HBP, it is equally important to increase your intake of both potassium and magnesium.
Potassium works with sodium to help regulate fluids in the cells, and to equalize the acid-alkaline balance in the blood. To function correctly, these minerals need to be in a ratio of 5:1, potassium to sodium. Presently, the typical American diet includes twice as much sodium as potassium. This results in water retention and the loss of potassium through the urine. Researchers from the University of Mississippi report that too little potassium and too much sodium may be a major contributing factor in the development of HBP.
To study the effects of potassium, researchers at Duke University ran double-blind studies using potassium supplements. Participants receiving the supplements had a significant reduction in blood pressure. African-Americans showed the biggest drop. Blood pressure went down almost 20 points, causing the speculation that this sub-group might be particularly sensitive to the blood pressure lowering effects of potassium. Also, animal studies have shown potassium to be protective against both kidney damage and stroke. Both of these major health problems can occur because of ongoing high blood pressure.
Magnesium also plays a part. The body cannot store potassium without magnesium. Adequate amounts of the two insure that potassium functions more efficiently, eliminating excess sodium and excess fluids. Surprisingly, magnesium alone can reduce HBP at doses of only 370 mg/d. This was discovered by Lindsey Kass in her meta-analysis of 22 clinical trials (over 1100 patients). The study was reported in the European Journal of Clinical Nutrition.
Dietary sources of potassium include sea veggies (highest), legumes (particularly soybeans), apple juice, apricots, avocados, bananas, beets, cantaloupes, carrots, oranges, pears, white and sweet potatoes, raisins, salmon, sardines, watermelon, and winter squash. The RDA is 1.9-5.6 grams per day.
Magnesium is highest in kelp, wheat germ and bran, almonds and other nuts, and soy and other legumes. Small amounts (under 100 mg) occur in many fruits and vegetables. The recommended intake ranges from 300-500 mg.
Regarding calcium, Kaplan reports a “major controversy” surrounding its usefulness in lowering blood pressure. However, he notes that up to 30 percent of people with HBP also excrete calcium in their urine, adding that such persons might find more calcium useful. Resnick reports the that calcium supplements
(2 g/d) have lowered blood pressure in people who are salt sensitive. The authors of a 1985 study in JAMA report finding that African-American men have lower calcium levels partly as a result of being lactose intolerant.
Calcium is found in yogurt and other milk products, soybeans, sardines, salmon, peanuts, sunflower seeds, and leafy greens. The RDA is 800-1500 mg. The DASH Diet supplies 1200 mg of calcium daily.
able salt (sodium chloride) is the culprit. In cultures where salt is used, people tend to have higher blood pressure than those in cultures where no salt is used. Further, in salt-using cultures, blood pressure levels escalate with age. Although sodium occurs naturally in food, that source accounts for only about 10 percent of total sodium intake.
For health, our bodies need less than a 1/4 tsp of salt daily. Unfortunately. the average American consumes 10-50 times that amount. People who are salt resistant can eat large amounts all their lives without bad effects. However, as many as 40 percent of people with high blood pressure are “salt sensitive.” Their blood pressure falls with a low salt diet. This sensitivity is higher among African-Americans, the elderly (the kidneys slow down with age and so don’t excrete excess sodium as easily), people who are overweight, and those who have a family history of high blood pressure.
Since there is no easy way to detect salt sensitivity, the general advice to people with HBP is to assume sensitivity and reduce salt intake. The British Medical Journal reported that a modest reduction of sodium (from 8 g to 5 g per day, 1 1/4 tsp) will reduce stroke risk by 22 percent and heart disease by
Healthy women may also want to cut back on salt. The more salt, the more water retention and weight gain experienced premenstrually. Also, salt causes bloating when combined with The Pill or estrogen therapy. And, it is suspected to increase the risk of premature osteoporosis. (The more salt in the diet, the more calcium is excreted.) Moderate salt intake is no more than 6 g/d (1 ½ tsp).
FYI: As much as 75 percent of the salt in the average diet comes from processed foods. We add only 15 percent of our total salt intake to food at the table.
Supplement Your Health
n addition to dietary changes, taking supplements can help to lower HBP and to maintain already healthy blood pressure. If your readings are over 115/75 and you are not currently on medication for HBP, give this program a 30-day trial. Many nutrients affect blood pressure similarly to medications. Thus, if you’re on medication/s, consult your physician. Unhappily, many older people will also need medication to lower their blood pressure.
In addition to my own work, the information below relies heavily on that of researchers at the Life Extension Foundation.
1. Control Heartbeat Strength
Magnesium: 350 – 1,500 mg daily
Hawthorn Berry extract: 3 – 5 caps daily, or drops per label
2. Regulate Blood Volume
Potassium: Only available at 99 mg tablets. Eat potassium rich foods.
Calcium: 1,000 – 1,200 mg daily (See section “Magic Minerals”)
3. Antioxidants (Support blood vessel integrity.)
CoQ10: 100 – 300 mg daily (of the ubiquinol form of coenzyme Q10)
Lycopene: 15 – 30 mg daily
Vitamin C: 1,000 – 2,000 mg daily
4. Vasodilators (Blood vessel dilation helps reduce blood pressure.)
Grape seed extract: 150 mg daily
L-Arginine: 1,600 mg three times daily between meals*
Soy isoflavones: 135 – 270 mg daily
*If you have diabetes and/or significant heart, kidney or liver disease, talk with your healthcare professional before using arginine.
5. Other Helpful Nutrients
Vitamin D: 5,000 – 8,000 IU daily, depending on blood test results
Vitamin K2: 100 mcg
Garlic: standardized extract: 1,500 – 6,000 mg daily
Fish oil: 2,000 – 4,000 mg daily
Information on “Other Helpful Nutrients”: Vitamin D receptors are located within the blood vessels. Studies comparing higher and lower amounts of serum vitamin D reveal an increased risk for HBP among those with lower amounts. NHANES reports that nearly 75 percent of light-skinned and up
to 90 percent of dark-skinned Americans get insufficient vitamin D.
For several years, we have harped on the importance of vitamin K2. This is because K2 makes sure calcium goes to the bones and doesn’t lay down in the arteries and form plaque. Animal studies indicate that K2 supplements can reverse calcified arteries. (Schurgers 2007) Garlic has long been recognized for its effects on HBP. Besides supporting heart health, fish oil studies have shown reductions in blood pressure. Studies show that these foods taken daily display blood pressure
lowering properties: whey protein (1 srvg), celery (1/2 c. cooked), and pomegranate juice (1/4 c.).
Siri Says: HBP is dangerous. Be sure you know what your measurements are and remember, you’re not safe unless your readings are 115/75 or lower. Meanwhile – Eat right. Love a lot. Heal your heart. And, get out from under the pressure.
1 For a 20 page report on blood pressure management, go to the Life Extension Foundation website at www.lef.org.
2 If you have a reading this high at your doctor’s office, I recommend you immediately either buy your own blood pressure meter or make a couple of trips to the drugstore when you’re feeling calm and take your own additional measures. Ed.
3 Kaplan has literally written “the book” on hypertension. A clinical professor of internal medicine at the University of Texas, Dallas, his textbook, Kaplan’s Clinical Hypertension, is in its ninth edition.
4 The acronym stands for Dietary Approaches to Stop Hypertension. This diet was not salt free and still got results. Today’s DASH has salt restrictions.
5 Not just intuitively true, people who have high stress jobs do tend to have higher average blood pressure than others.
Each month, Nutrition News features three additional titles to support our main topic. This month’s selections are “Vitamin K2”, “Supplement Your Heart”, and “Fish Oils”.