Hypertension is also categorized as either primary or secondary hypertension. The former applies to about 90-95 percent of those with high blood pressure, and while the conventional medical establishment claim the cause is idiopathic or unknown, primary hypertension (aka essential hypertension) is more than likely linked to insulin/leptin resistance.
Secondary hypertension applies to the remaining five to 10 percent whose high blood pressure is caused by chronic liver disease. The revised blood pressure guidelines issued late last year emphasize when and how doctors should treat high blood pressure. Pre-hypertensive patients should not be treated with blood pressure lowering drugs; rather, they should be encouraged to make appropriate lifestyle changes to address their condition.
If you’re between the ages of 18-59 without major health conditions, or if you’re 60 or older with diabetes and/or chronic kidney disease, conventional medicine believes drug treatment is advised to begin if your blood pressure is at or above 140/90. In those over 60 who do not have diabetes or chronic kidney disease, the panel suggests delaying drug treatment until you’re above 150/90. According to the JNC panel members:10
“For all persons with hypertension, the potential benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized. These lifestyle treatments have the potential to improve BP control and even reduce medication needs. Although the authors of this hypertension guideline did not conduct an evidence review of lifestyle treatments in patients taking and not taking antihypertensive medication, we support the recommendations of the 2013 Lifestyle Work Group.”11
What’s Your Fasting Insulin Level?
This is a step in the right direction, even if the panel didn’t take it all the way. Personally, I believe even stage 1 and 2 hypertension can be successfully treated to where drugs become unnecessary, provided you’re aggressive enough in your diet and lifestyle modifications. And there are plenty of clinical success stories that vouch for this stance.12 However, if you have seriously elevated pressures it would certainly be wise to be on medication to prevent a stroke while you are in the process of implementing the recommendations.
In addition to checking your blood pressure, I highly recommend getting a fasting insulin level test done. Remember, high blood pressure and insulin resistance tend to go hand-in-hand, and if your hypertension is the result of elevated insulin levels, you’ll know how to nip it in the bud by the end of this article.
The fasting insulin level you want to strive for is about 2 or 3 microU per mL. If it’s 5 or above, you definitely need to lower your insulin level to reduce your risk of high blood pressure and other cardiovascular health hazards. Keep in mind that the so-called “normal” fasting insulin level is anywhere from 5-25 microU per mL. Please do NOT make the mistake of thinking that this “normal” insulin range equates to optimal.
How to Avoid a False Hypertension Diagnosis
To avoid a false hypertension diagnosis, keep in mind that your blood pressure reading can vary significantly from day to day, and even from one hour to the next, so don’t overreact if you get one high reading here or there. It’s when your blood pressure remains consistently or chronically elevated that significant health problems can occur. The following variables can also affect the validity of your blood pressure reading:
- Incorrect blood pressure cuff size: If you’re overweight, taking your reading with a size “average” blood pressure cuff can lead to a falsely elevated blood pressure reading, so make sure your doctor or health care professional is using the right size cuff for your arm.
- Incorrect arm position: If your blood pressure is taken while your arm is parallel to your body, your reading can be up to 10 percent higher than it really is. Blood pressure readings should always be taken with your arm at a right angle to your body.
- Nervousness: “White coat hypertension” is a term used for when a high blood pressure reading is caused by the stress or fear associated with a doctor or hospital visit. This can be a transient yet serious concern. If this applies to you, stress reduction is key. Below, I will address stress reduction, and provide a technique that can help you control stress that may be contributing to high blood pressure.
Also, to decrease your risk of being falsely diagnosed with hypertension in this situation, take a moment to calm down (be sure to arrive for your appointment ahead of time so you can unwind), then breathe deeply and relax when you’re getting your blood pressure taken.
Using Waist-to-Hip Ratio to Assess Your Hypertension Risk
Research suggests your waist size may be an effective measure for assessing obesity-related hypertension risk.13 If you have a high waist-to-hip ratio, i.e. you carry more fat around your waist than on your hips, you may be at an increased risk for obesity-related hypertension.
Certain body compositions do tend to increase your risk of chronic disease, and carrying extra inches around your midsection has been repeatedly shown to increase cardiovascular health risks. Your waist size is also a powerful indicator of insulin sensitivity, as studies clearly show that measuring your waist size is one of the most powerful ways to predict your risk for diabetes.
To calculate your waist-to-hip ratio, measure the circumference of your hips at the widest part, across your buttocks, and your waist at the smallest circumference of your natural waist, just above your belly button. Then divide your waist measurement by your hip measurement to get the ratio. (The University of Maryland offers an online waist-to-hip ratio calculator14 you can use.) The Mayo Clinic uses the following waist-to-hip ratio designations to evaluate your health risk:
High Blood Pressure Drugs Can Increase Risk of Serious Fall-Related Injuries in the Elderly
Before I review lifestyle modifications that can help you normalize your blood pressure, I want to address the issue of medications. It’s important to realize that while blood pressure medications are very effective at lowering blood pressure, they do NOT in any ways shape or form address the underlying cause. Moreover, statistics show that about half of those taking such medications are still unable to manage their condition, so clearly these drugs don’t work as advertised for a lot of people. There are also side effects to contend with, some of them quite harmful and/or debilitating.
For example, a recent study published in JAMA15, 16 found that hypertensive patients over the age of 70 who were taking blood pressure medication increased their risk of serious falls requiring hospitalization due to fractures, brain injuries, hip dislocation, or dislocation to the knee, shoulder, or jaw. Risk of falling can increase if your blood pressure drops too low too suddenly upon standing. According to the authors:
“Antihypertensive medications were associated with an increased risk of serious fall injuries, particularly among those with previous fall injuries. The potential harms vs benefits of antihypertensive medications should be weighed in deciding to continue treatment with antihypertensive medications in older adults with multiple chronic conditions.”
Some Blood Pressure Drugs Raise Risk of Blindness
Another major population study discovered that some type of hypertension drugs called vasodilators actually increase your risk of early onset of age-related macular degeneration (AMD), which is the most common cause of blindness among American seniors. As noted in a press release:17
“…[R]esearchers… conducted a long-term population-based cohort study from 1988 to 2013 of nearly 5,000 residents of Beaver Dam, Wis., aged 43 to 86 years… The researchers found that, after adjusting for age, sex and other factors, using any vasodilator such as Apresoline and Loniten, which open (dilate) the blood vessels—was associated with a 72 percent greater risk of developing early-stage AMD. Among people who were not taking vasodilators, an estimated 8.2 percent developed signs of early AMD. In comparison, among those taking a vasodilator medication, 19.1 percent developed the disease.
The researchers also found that taking oral beta blockers such as Tenormin and Lopressor was associated with a 71 percent increase in the risk of neovascular AMD, a more advanced and vision-threatening form of the disease. Among those who were not taking oral beta blockers an estimated 0.5 percent developed signs of neovascular AMD. In comparison among those taking oral beta blockers, 1.2 percent developed neovascular AMD.”
Arterial Stiffness Linked to High Blood Pressure and Vitamin D Deficiency
According to Norwegian researchers, arterial stiffness (atherosclerosis) is a driving factor for high blood pressure,18,19, 20 and represents “a major therapeutic target” for treatment. They discovered that as your blood travels from your heart, cells in the wall of your aorta, called baroreceptors, sense the pressure load, and signal your nervous system to either raise or lower the pressure. However, the stiffer your arteries are, the more insensitive your baroreceptors become, and the less efficient they become at sending the appropriate signals.
As a result, your body doesn’t get the signal to lower the blood pressure coursing through your arteries. “‘This is contrary to existing models, which typically explain high blood pressure in terms of defective kidney function,’ said Klas Pettersen, a researcher at the Norwegian University of Life Sciences and first author of the study.”21
Take Vitamin D to Relax Your Arteries and Improve Blood Pressure
Vitamin D deficiency and trans fat consumption can lead to stiff arteries. Vitamin D deficiency appears to be associated with both arterial stiffness and hypertension.22 Each cell in your body has a DNA library that contains information needed to address virtually every kind of stimulus it may encounter, and the master key to enter this library is activated vitamin D. This is why vitamin D functions in so many different tissues, and affects such a large number of different diseases and health conditions, one of which is heart disease.
According to researchers from the Emory/Georgia Tech Predictive Health Institute,23 even if you’re considered generally “healthy,” if you’re deficient in vitamin D, your arteries are likely stiffer than they should be, and your blood pressure may run high due to your blood vessels being unable to relax. In their study, having less than 20 nanograms per milliliter (ng/ml) was considered a deficiency state that raises your hypertension risk. Less than 30 ng/ml was deemed insufficient.
According to the researchers: “We found that people with vitamin D deficiency had vascular dysfunction comparable to those with diabetes or hypertension.” Previous research24 has also shown that the farther you live from the equator, the higher your risk of developing high blood pressure. (Blood pressure also tends to be higher in winter months than during the summer.) Exposing your bare skin to sunlight affects your blood pressure through a variety of different mechanisms, including the following:
- Sun exposure causes your body to produce vitamin D. Lack of sunlight reduces your vitamin D stores and increases parathyroid hormone production, which increases blood pressure.
- Vitamin D deficiency has also been linked to insulin resistance and metabolic syndrome, a group of health problems that can include insulin resistance, elevated cholesterol and triglyceride levels, obesity, and high blood pressure.
- Recent research25 shows that sun exposure increases the level of nitric oxide in your skin. This dilates your blood vessels, thereby reducing your blood pressure. (For comparison, and to show how various factors tie together, uric acid, produced when you eat sugar/fructose,raises your blood pressure byinhibiting the nitric oxide in your blood vessels—the opposite effect of sun exposure. This will be discussed further in a later section).
- Vitamin D is also a negative inhibitor of your body’s renin-angiotensin system (RAS), which regulates blood pressure.26 If you’re vitamin D deficient, it can cause inappropriate activation of your RAS, which may lead to hypertension.
- Additionally, exposure to UV rays is thought to cause the release ofendorphins, chemicals in your brain that produce feelings of euphoria and relief from pain. Endorphins naturally relieve stress, and stress management is an important factor in resolving hypertension.
Guidelines for Optimizing Your Vitamin D Level
Ideally, you’ll want to get your vitamin D through sun exposure on your bare skin, or by using a safe tanning bed. If you opt for an oral vitamin D supplement, make sure you use vitamin D3, not D2, which is typically prescribed by doctors but has been linked to poorer health outcomes. As a general guideline, research by GrassrootsHealth suggests that adults need about 8,000 IUs per day to achieve a serum level of 40 ng/ml. Keep in mind that if you decide to supplement with oral vitamin D3, you also need to boost your vitamin K2intake, as these two nutrients work in tandem. Together, they produce and activate Matrix GLA Protein (MGP), which congregates around the elastic fibers of your arterial lining, guarding them against calcium crystal formation.
Vitamin K2 also activates a protein hormone called osteocalcin, produced by osteoblasts, which is needed to bind calcium into the matrix of your bone. Osteocalcin also appears to help prevent calcium from depositing into your arteries. In other words, without the help of vitamin K2, the calcium that your vitamin D so effectively lets in might be working against you — by building up inside your arteries rather than your bones… Ideally, you’ll want to test your vitamin D level at regular intervals to make sure you maintain clinically relevant levels year-round (see table below).
To learn more about the value of vitamin D testing, please see my previous article, “How Vitamin D Performance Testing Can Help You Optimize Your Health.”
Five Key Lifestyle Strategies for Lowering Your Blood Pressure
Alright, time to get down to the nitty gritty of normalizing your blood pressure. As mentioned earlier, high blood pressure is typically associated with insulin resistance, which results from eating a diet too high in sugar. As your insulin level elevates, so does your blood pressure. As explained by Dr. Rosedale,insulin stores magnesium, but if your insulin receptors are blunted and your cells grow resistant to insulin, you can’t store magnesium so it passes out of your body through urination. Magnesium stored in your cells relaxes muscles. If your magnesium level is too low, your blood vessels will constrict rather than relax, and this constriction raises your blood pressure.
Trans fat consumption is another dietary factor. It’s now known to cause atherosclerosis (hardening of your arteries), which researchers now have pin-pointed as yet another treatment focus for hypertension. So make sure you avoid all trans fats or hydrogenated fats that have been modified in such a way to extend their shelf-life. This includes margarine, vegetable oils, and various butter-like spreads.
I recently interviewed Dr. Fred Kummerow who is nearly 100 years old and was the first scientist to document the dangers of trans fats. In the interview, he explains that trans fats prevent the formation of prostacyclin, which acts as natural blood thinning agent. By diligently avoiding trans fats, your body will make prostacyclin that keep your blood thin, which will reduce your risk of heart attack and stroke.
Now, if you think about these two factors alone—insulin resistance and atherosclerosis—what kind of dietis bound to produce high blood pressure? The answer, of course, is a processed food diet, loaded with carbohydrates (sugar/fructose/grains) and trans fat. Knowing that, the answer to correcting high blood pressure becomes rather self-evident. If your blood pressure is running high, you need to restore your insulin and leptin sensitivity, and the following five strategies are among the most effective for doing so:
- Avoiding processed foods (due to their being high in sugar/fructose,grains, trans fat, and other damaged fats)
- Intermittent fasting is one of the most effective ways I’ve found to normalize your insulin/leptin sensitivity. It’s not a diet in conventional terms, but rather a way of scheduling your eating in such a way as to promote efficient energy use. Essentially, intermittent fasting means eating your calories during a specific window of the day, and choosing not to eat food during the rest. When you eat, your body reacts by elevating insulin and leptin.
Non-starchy carbs cause a far greater insulin elevation than protein while fat requires no insulin for digestion. If you’re constantly snacking (or drinking) on sugary fare, your insulin/leptin levels will remain chronically elevated, which tends to promote high blood pressure. The more sensitive your body is to insulin/leptin, the more likely you’ll be to use the food you consume efficiently, which will help improve insulin resistance, and promote weight loss and the creation of muscle. Your body is most sensitive to insulin/leptin following a period of fasting. (Fasting also boosts growth hormone secretion—another important key to weight loss and muscle growth.)
- Making whole, ideally organic foods the focus of your diet
- Swapping carbs for healthy fat. Sources of healthy fats to add to your diet include:
|Avocados||Butter made from raw, grass-fed organic milk||Raw dairy||Organic pastured egg yolks|
|Coconuts and coconut oil (coconut oil actually shows promise as an effective Alzheimer’s treatment in and of itself)||Unheated organic nut oils||Raw nuts, such as pecans and macadamia, which are low in protein and high in healthy fats||Grass-fed meats or pasture raised poultry|
- Exercising regularly. On a side note, I recommend training yourself to breathe through your nose when exercising, as mouth breathing during exercise can raise your heart rate and blood pressure, sometimes resulting in fatigue and dizziness. To learn more about this, please refer to my previous article on theButeyko breathing method.
My optimized nutrition and exercise plan can help guide you step-by-step toward normalizing your insulin and leptin levels, which in turn will help normalize your blood pressure and help you shed excess weight. It’s a free resource that can help you improve your health, or take it to the next level if you’ve already started making some changes. My plan addresses all five of these key strategies in a systematic fashion, but below I will discuss why you really want to take these recommendations to heart if you’re struggling with high blood pressure.
Fructose Causes Blood Pressure to Skyrocket
If you are seeking to control high blood pressure without drugs, my strong recommendation for your first step is to remove all grains and sugars, particularly fructose, from your diet until both your weight and your blood pressure have normalized. If you have high blood pressure, eating sugars and grains — including any type of bread, pasta, corn, potatoes, or rice — will cause your insulin and leptin levels, and your blood pressure, to remain elevated.
One 2010 study27 discovered that those who consumed 74 grams or more per day of fructose (the equivalent of about 2.5 sugary drinks) had a 77 percent greater risk of having blood pressure levels of 160/100 mmHg (stage 2 hypertension). Consuming 74 grams or more of fructose per day also increased the risk of a 135/85 blood pressure reading by 26 percent, and a reading of 140/90 by 30 percent.
A more recent analysis of the available research,28 reported by Time Magazineunder the telling headline, “Sugar Goes Straight to Your Blood Pressure,”29 concluded that the sweet stuff makes your blood pressure soar regardless of your weight, although eating too much sugar will typically cause weight gain that also contributes to hypertension (as discussed above).
Fructose also elevates uric acid, which drives up your blood pressure by inhibiting the nitric oxide in your blood vessels. (Uric acid is a byproduct offructose metabolism. In fact, fructose typically generates uric acid within minutes of ingestion.) Nitric oxide helps your vessels maintain their elasticity, so nitric oxide suppression leads to increases in blood pressure. High levels of uric acids have long been associated with gout, but recent studies reveal its association with many more serious health problems, including hypertension, cardiovascular disease, type 2 diabetes, fatty liver disease, and kidney disease. For more information on the connection between fructose/uric acid/hypertension, please see my previous article, “Fructose: The Hidden and Pervasive Cause of High Blood Pressure.”
As a standard recommendation, I recommend keeping your total fructose consumption below 25 grams per day. If you’re insulin resistant (about 80 percent of Americans are), have high blood pressure, diabetes, heart disease, or other chronic disease, you’d be wise to limit your fructose to 15 grams or less per day, until your condition has normalized. In his book, The Sugar Fix, Dr. Johnson includes detailed tables showing the content of fructose in different foods, but for a sampling of the fructose content of several common fruits, please see this link.
The Pros and Cons of a Vegetarian Diet to Control Your Blood Pressure
A recent meta analysis30, 31, 32 suggests that a vegetarian diet can help resolve high blood pressure. A vegetarian either excludes or severely limits meat, but typically includes dairy products, eggs, and fish. (Vegan diets, which are even stricter, typically exclude fish, eggs, and sometimes dairy as well.) According to this analysis, removing meat from the diet led to blood pressure reductions similar to losing five kilos of body weight. Compared to blood pressure drugs, a vegetarian diet was found to be about 50 percent as effective for lowering blood pressure.
Most people do not eat enough vegetables, let alone high-quality organic ones, so it makes sense that individuals who consume more vegetables are likely to be healthier. But I still do not believe excluding all meats makes for an ideal diet in the long run. There’s ample evidence that abstaining from animal protein altogether can lead to health complications, such as:
- Vitamin B12 deficiency, which can lead to anemia
- Sulfur amino acid deficiency
- Nervous and digestive system damage
Both vitamin B12 and sulfur amino acid deficiency increases your risk of heart disease. Claims that B12 is present in certain algae, tempeh, and brewer’s yeast fail to take into account that the B12 analogues present in these foods are not bioavailable. The only reliable and absorbable sources of vitamin B12 are animal products, especially pastured eggs.