Seventy-five million American adults, almost one in three, have high blood pressure. Another one in three have prehypertension. The majority of hypertensive patients are treated with blood pressure-lowering medications, but is a prescription the best course of action? Read on to discover which nutrients, as part of a healthy Paleo diet, can help lower blood pressure naturally and what options are available for patients who don’t respond well.
Hypertension is the leading cause of cardiovascular mortality in the United States. In 2014, high blood pressure was the primary or contributing cause of 410,000 deaths. (1) In the developed world, blood pressure tends to increase with age, and it’s killing us. Treating hypertensive patients is critical to their overall health outlook, but are blood pressure-lowering drugs always necessary?
Should you prescribe drugs?
When blood pressure meds first hit the market, only truly hypertensive patients (above 160 mmHg/100 mmHg) were recommended for treatment. Today, clinicians often prescribe drugs to any patient whose blood pressure exceeds 140 mmHg/90 mmHg, despite research showing that treating mild hypertension with drugs does not reduce cardiovascular disease. (2) A Cochrane Database review agreed that there’s little support for prescribing drugs to those with low cardiovascular risk. (3)
Blood pressure-lowering drugs are not without risk. Reported side effects range from depression and dizziness to erectile dysfunction and muscle fatigue. Luckily, drugs aren’t the only option. This article will focus on key nutrients that can lower blood pressure and that can be obtained in the context of a Paleo diet.
Nutritional strategies to lower blood pressure
Excess sugar is related to increased blood pressure, and reducing it lowers blood pressure. (5, 6, 7) Although many studies focus on sugar-sweetened beverages, the results apply to any large excess of sugar; these beverages are just one of the easiest ways to consume a ton of hidden sugar.
The mechanisms by which sugar increases blood pressure are not entirely known. Sugars may increase insulin and reduce sodium excretion, which in turn would increase blood volume and therefore blood pressure. Added sugars can also lead to obesity, which is usually accompanied by increased blood pressure. (8)
It is well accepted that higher potassium intake is associated with lower blood pressure. (9, 10, 11) For every 600mg increased daily potassium intake, systolic blood pressure could be reduced by 1 mmHg and diastolic blood pressure could be reduced by 0.52 mmHg. (12) The average American only consumes 2,800 mg/day, well below the adult RDA of 4,700 mg/day, while Paleo dieters on average consume 10,500 mg/day. (13)
Bananas are a well known source of potassium, but avocados, sweet potatoes, white potatoes, halibut, beet greens, and spinach are other rich sources. In contrast, grains have very little, which is just another reason to choose quality carbohydrates and replace grains with root vegetables. Potassium-rich foods can be relatively high in carbohydrates. If you have patients who are extra-sensitive to weight gain on a moderate-carbohydrate diet, a low-carb Paleo diet might be best.
Many prospective studies show that consumption of fish, rich in EPA and DHA, is related to lower blood pressure. Dietary analyses from Cyprus, China, and Iran found lower blood pressure in those who consumed the most fish. (14, 15, 16) Serum measurements of DHA/EPA, another measure of fish intake, demonstrated a similar trend. (17, 18, 19)
Controlled trials ranging from two to 12 weeks have shown that increasing fish intake reduced blood pressure. (20, 21, 22, 23) Fish oil supplementation has also been proven to lower blood pressure, but the large doses required (3–4g/day) are not easily obtained through normal diet. (24, 25)
Recent in vitro and animal work suggests that the proteins and peptides from fish may also boast some of fish’s blood pressure-lowering effects, (26) and so I first recommend up to one pound of cold-water fatty fish or shellfish per week instead of a supplement if possible.
Most Americans are deficient in magnesium, a nutrient required for billions of reactions within our cells each day. Increased dietary magnesium is correlated with lower blood pressure. (27, 28, 29, 30, 31, 32) For every 10 mmol/day increase, blood pressure could be lowered 4.3 mmHg / 2.3 mmHg. (33) Increasing both magnesium and potassium while moderating salt could lower blood pressure as much as a single medication. (34)
Nuts, seeds, spinach, beet greens, and chocolate are good sources of magnesium. Mechanistically, magnesium stimulates the production of vasodilators to reduce blood pressure. (35) It also may inhibit free radical formation by blood vessels and prevent arterial thrombosis. (36)
Patients usually love when I recommend chocolate therapy, but I am specifically referring to the super-dark varieties, at 80 percent cocoa and above. Cocoa is generally recognized as blood pressure-lowering from controlled trials and meta-analyses, and the effects are most pronounced in hypertensive patients. (37, 38, 39, 40, 41)
The polyphenols and flavanols abundant in cocoa increase the production of nitric oxide, which relaxes blood vessels and reduces blood pressure. (42) Chocolate is also believed to improve overall endothelial function in blood vessels. (43, 44)
This delicious tea boasts several studies demonstrating its ability to lower blood pressure. (45) Three cups a day was effective in lowering systolic blood pressure in hypertensive individuals, (46) and two cups per day lowered systolic blood pressure in hypertensive patients who had type 2 diabetes. (47) Many enjoy this tea either hot or iced.
The American Heart Association recommends under 2,300 mg of salt per day, and under 1,500 mg per day for those over age fifty with hypertension. In 2013, the Institute of Medicine said that there was very little evidence to reduce salt that drastically. (48) Most patients associate increased salt intake with hypertension, but as I covered before, that isn’t the whole story.
Decreasing salt can lower blood pressure, but it might be more due to the foods it is in (overly salty, fried, take-out, etc.) than the salt itself. (52) Another hypothesis puts salt and sugar hand in hand. Salty foods increase thirst, and so people consume more beverages that are often sugar-sweetened, which leads to weight gain and increased blood pressure. (53)
Overall, it appears that only a subset of people that suffer from hypertension are “salt-sensitive” and would thus benefit from sodium reduction.
Vitamin D deficiency is a risk factor for hypertension. (54) In prospective studies, vitamin D intake is inversely related to hypertension. (55, 56) In vitamin D-deficient patients, large doses (50,000 IU per week) for eight weeks lowered both systolic and diastolic blood pressure. (57) To increase vitamin D, I recommend that patients go outside daily for about half the time it takes for their skin to turn pink.
In my recent article about vitamin K2, I explained that its main job is to make sure calcium goes where it should, such as bones, and doesn’t end up where it shouldn’t, like blood vessels. Therefore, vitamin K2 is important for preventing vascular stiffness and calcification, which can lead to hypertension and heart disease. (58)
From an analysis of 168 countries, deaths from cardiovascular disease are higher in people who consume less vitamin K2. (59) Peripheral arterial disease is also more common in hypertensive patients with lower vitamin K2 intake. (60)
Vitamin K2 can be difficult for some to obtain through diet, but the richest sources are natto (fermented soy), some cheeses, butter from grass-fed cows, goose liver, and egg yolks.
A Paleo diet itself can lower blood pressure
A Paleo diet itself has beneficial effects on blood pressure and more, probably because it naturally contains many of the beneficial nutrients discussed above in their whole-food forms, complete with complimentary vitamins, minerals, and cofactors.
A few randomized, controlled trials have compared the Paleo diet to other modern “healthy” diets, and blood pressure improvement was one benefit of going Paleo. (66, 67) Small pilot studies have shown blood pressure improvements among other positive health outcomes for patients who adopted a Paleo diet. (68, 69) For some, adhering to a Paleo diet can improve blood pressure without necessarily focusing on particular nutrients.
Supplements to try before prescriptions
Before resorting to prescriptions, the supplements I often try with patients are:
- CoQ10 (100–225 mg/day)
- Garlic (10,000 units allicin/day)
- Vitamin C (250 mg twice daily)
- Potassium (2,000–3,000 mg/day)
- Magnesium (500–1000 mg/day
- Cod liver oil (1g/day)
Some patients may not respond adequately to diet changes or even supplements. Because elevated blood pressure is a huge risk factor for cardiovascular disease and death, these patients may in fact be candidates for traditional blood pressure-lowering drugs.
Although not the focus of this article, lifestyle matters too! Regular exercise, avoiding tobacco products and alcohol, managing stress, acupuncture, and meditation can all improve blood pressure. (70)