Nutritional deficiencies can cause high blood pressure
This is another article in a series designed to increase our knowledge of the aging process and to understand how we can hopefully slow the process and improve the quality of our lives and our longevity.
High blood pressure is a chronic illness that can have significant negative effects on the heart, kidneys, lining of the arteries (endothelium) and essentially all organs of the body. All cells in the body require macro and micronutrients to remain healthy. Deficiencies in macronutrients (proteins, carbohydrates and fats) and micronutrients (vitamins, minerals and anti-oxidants) are common in the general population. It might be even more common in individuals with high blood pressure and cardiovascular disease.
A recent study done at the Hypertension Institute in Nashville revealed significant differences in numerous intracellular nutrients when comparing normotensive individuals (those with normal blood pressure) and those with hypertension. In order to avoid the many complications of high blood pressure, it is most important to develop a treatment plan that gets the blood pressure into a normal range.
Replacement of nutrient deficiencies helps get the pressure into the goal range; and when done in combination with exercise and weight management, many individuals with hypertension are actually able to discontinue medications. Repletion of deficient nutrients has enormous positive health benefits and helps to improve overall cardiovascular health and to decrease the risk of heart attacks, strokes and kidney failure.
I recently authored an article that ran in The News-Press about the condition called "endothelial dysfunction" (ED). By improving the nutrient status of individuals with hypertension, the blood pressure is reduced, vascular health is improved and the overall complication rate is reduced. When the cells lining the arteries are not healthy (because of malnutrition), the endothelium (the lining of the arteries) becomes inflamed and injured which results in poor function of the arteries and a higher than normal blood pressure. This places a strain on the heart, the kidneys and all other vital organs.
Blood pressure control is attained by a combination of optimal nutrition, vitamins, minerals, anti-oxidants, weight loss, smoking cessation, exercise and moderate alcohol intake. As such, lifestyle modification prevents and treats high blood pressure. When an individual has high blood pressure, the evaluation should include an assessment of all cardiovascular risk factors; a determination of the function (or dysfunction) of the vascular endothelium (the lining of the arteries); examination to identify the presence of any end organ damage; and an overall assessment of the health of the individual. Cardiovascular risk factors include poor nutrition, a sedentary lifestyle, cigarette smoking, diabetes, high cholesterol, obesity, male gender and a family history of premature cardiovascular disease.
Once an assessment of the above is complete, the individual works with the physician or health care provider to develop an action plan which includes getting all the macro and micro nutrient levels up to normal; starting the individual on a physical activity program; making sure that he or she stops using any form of tobacco; limiting alcohol; getting the weight to an optimal level; correcting high cholesterol and making sure diabetes management is comprehensive and gets the individual to the goal glucose levels; and corrects for any other risk factors.
When we look at the nutritional part of this program and consider replacement, we first have to measure the levels of all the macro and micronutrients before deciding on which vitamins, minerals and anti-oxidants to prescribe. In many of my public presentations I ask the audience if they use vitamins and supplements and almost always the majority of the room will raise their hands. Next I ask how they know what specific vitamins, minerals and anti-oxidants to use and most individuals are not sure. They will usually tell me that they take a multivitamin as recommended by their physician or health care provider but the majority of these individuals have not had any blood tests done to specifically determine which they are deficient in. I will then go on to explain that being academic in the approach makes the most sense to me and I let the audience know that there are specific blood tests that can be done to measure these levels appropriately.
Nutrient deficiencies can be easily explained by understanding the transition from a previous Paleolithic diet to our current standard American diet. The Paleolithic diet was essentially a plant-based diet with some fruits and occasionally grass-fed, wild game meats. This diet was low in calories from fat and loaded with plant sources of protein, vitamins and minerals. Plant foods contain hundreds, if not thousands, of health promoting chemicals. As we know, the vast majority of Americans do not eat the recommended number of servings of vegetables and fruits thus contributing to and essentially causing high blood pressure and many of the chronic cardiovascular complications. Without the protection of all the essential vitamins, minerals and antioxidants an individual is at risk for not only high blood pressure but also for hardening of the arteries, heart attacks, strokes, kidney failure, diabetes, metabolic syndrome and weight related problems. With the proper lifestyle modifications most of these complications can be avoided.
It is important to integrate nutrition with nutraceutical science and traditional drug therapy to get blood pressure into the normal range and to avoid target end-organ damage. This comprehensive approach is what allows an individual to become and stay healthy. In addition to replacing deficient essential nutrients, we have to also be sure that the body has a proper ratio of minerals including sodium, potassium, calcium, magnesium, phosphorus and others. We also need proper levels of what are called Omega 3 and Omega 6 fatty acids which help to keep all cells healthy; and help to lower the risk of all cardiovascular diseases. It is important to eat foods higher in polyunsaturated and mono unsaturated fats; and limit the intake of saturated fats and to avoid trans fats which are directly related to cardiovascular disease.
When we look at the standard American diet, we see that the average sodium intake is about 5,000 mg per day and we know that the proper amount should be around 1,500 mg. The standard American diet provides an abundance of sodium and is essentially deficient in potassium and other healthy minerals. Clinical evidence makes it clear that reducing the dietary salt intake decreases the incidence of target end organ damage involving the brain, heart, kidneys and vasculature.
When we look at the average US dietary intake of potassium, we find that it is about 45 mEq/L (milliequivalent per liter) when it should be around 650. It is important to make sure that there is an adequate amount of potassium in the diet because this results in not only a decrease in blood pressure but also a reduced incidence of cardiovascular and cerebrovascular disease. This means that there would be a lower risk of heart attacks and strokes. When we are measuring the levels of electrolytes such as sodium and potassium, we also get measurements of magnesium, calcium, phosphorus and zinc which are all essential to good health and participate in blood pressure control.
These blood tests also allow for the measurement of the particular fatty acids as described above; and the dietary history helps the physician or health care provider understand the individual's sources of protein. When we are looking at the recommended daily requirement for protein, this is generally about 70-105 grams per day depending on the gender, activity level and the health of the kidneys.
Scientific studies have also shown that garlic is beneficial for blood pressure as is green and black tea. Vitamin C is a helpful anti-oxidant that is known to improve endothelial dysfunction because it produces diuresis (enhanced urine flow) which also helps to lower blood pressure.
In summary, the first step that should be undertaken to manage an individual with high blood pressure is to get a proper and accurate evaluation of the nutritional status; and then develop a plan to replace what is deficient. In addition a comprehensive lifestyle management plan should be developed to decrease other health risks and improve overall health and longevity. It's all about adding life to your years in addition to adding years to your life. The goal is to grow old gracefully and fitfully so that you have the health, energy and vitality to do all the wonderful things you can do to make the world a better place.
Stay well my friends and as always please send comments and questions to Dr.Sal@Leememorial.org.
Dr. Salvatore Lacagnina is vice president of health and wellness for Lee Memorial Health System.