Heart Health: Hypertension and High Blood Pressure
Sample Chapter from Natural Medicine, Optimal Wellness
by Jonathan V. Wright, M.D. and Alan R. Gaby, M.D.

Dr. Wright's Case Study

"I'm always nervous when I see a doctor," Fred Keyser said. "So I brought my blood pressure records with me. I take my blood pressure at home. It's always lower than at the doctor's office, but without medication it's still too high. So Susan here ..." he gestured to his wife "... insisted that I check in at your office. She does a lot of reading about health." He handed me several sheets of paper. A quick glance showed they covered several years of blood pressure records.

"Sure I do," Susan Keyser declared. "One of us needs to. I want to make sure we both stay relatively healthy and able to take care of ourselves until we're at least 90 or so. And I especially don't want Fred to have a stroke like his grandfather did. My reading tells me a natural-medicine approach might not get Fred off drugs completely, but it could, and at the very least he'll be healthier for it. So here we are."

I looked more closely at the blood pressure records. "Let's see - 5 years ago your blood pressure was about 160 to 170 over 100 to 110 or so ..."

"That's when I absolutely insisted Fred start taking medication," Susan said. "After all, he wasn't even 50 yet, and his blood pressure was up there! I'd already cut out all the added salt, eliminated the high-salt foods, and switched us to decaffeinated coffee. We cut out all the alcohol, too, except a little beer or wine. But his blood pressure just kept going up."

"Had you eliminated the added sugar and foods with sugar in them, too?"

Susan and Fred looked at each other skeptically. "Sugar? No one ever told us that sugar causes high blood pressure."

"It doesn't for everyone, but several small studies have shown that sugar can raise blood pressure significantly for some individuals, and that sugar can cause significant excretion of calcium and magnesium. My observation has been that eliminating sugar helps control blood pressure for individuals who have diabetes or hypoglycemia in their families."

"My grandmother, mother's mother, had diabetes when she was past 60 or so," Fred observed.

"Then restricting sugar and refined carbohydrate - that's mostly white flour and other refined flour products - would be very important for you to try."

Susan pulled a notebook out of her purse, and started writing. "We'll give it a try," she said.

I looked at Fred's blood pressure records again. "You've had good blood pressure control for the past 3 years - l30 to 140 over 80 to 90. What medications have you been using?"

''A calcium-channel blocker, I think it's called ... a beta-blocker, which blocks adrenalin; and a diuretic. We tried several things to start ... you can see the blood pressure control was variable ... and this combination seems to do the best job. I have noticed it seems to tire me our more than I'd expect at my age, though."

"I've read that's common with many anti-hypertensive medications," Susan said.

"That's true," I said. "You know, the pressure within the arterial system - the blood pressure - is one of many factors in the health of the vascular system. Natural medicine can sometimes help us reduce blood pressure to normal without drugs, and sometimes it just lessens the amount of drugs necessary to achieve blood pressure control. But natural medicine usually improves the health of the entire cardiovascular system, the strength of the blood vessels so they can withstand a higher blood pressure without rupturing as easily, the ability of the heart to pump at higher pressures, and the ability of blood to flow through possibly-narrowed blood vessels. Those are just some examples."

"Sounds good," Fred said. "What vitamins and minerals should I take?"

"Before we get to those, let's make sure we've covered basic diet and a few other 'natural medicine' things like exercise, acupuncture, and psychological aspects like meditation, biofeedback, and prayer."

"Where shall we start?" Susan asked.

"You've already done quite a bit with diet, so let's just finish that. Let's see - low salt, minimum alcohol, no caffeine, and you'll try eliminating all sugar and foods with sugar as well as refined carbohydrate. That leaves vegetables and allergies."

"As far as I know I don't have any allergies," Fred said.

"And there aren't any in his family, according to his mother and aunts," Susan said. "I've checked, because I read that occasionally allergies can make the blood pressure go up."

"Allergy is only a major factor in a small minority, but I always ask about it. Now, vegetables - many studies have shown that long-time vegetarians have significantly lower blood pressure than those of us who eat meat and other animal proteins. That doesn't mean that everyone with high blood pressure should - or even can become an instant vegetarian, but gradually moving as far as comfortable in that direction is usually advisable. At the very least, substitute fish for beef and pork as much as possible. People who eat considerable fish have somewhat lower blood pressures, and definitely less heart attacks.

"What about eggs?"

"Eggs are one of very few sources - the other one is soy lecithin - of phospholipids in our diets, substances very important to nerve cell membranes. Usually I don't recommend eliminating eggs unless they're demonstrated to cause problems." I looked at my notes. "That's all about diet for now. Please check in with our clinic nutritionist 'for further details', as the saying goes.

"Now - how much exercise are you getting?"

"I think I have that one covered. I tried a lot of things, and finally settled on one of those ski track type indoor machines - this is Seattle, after all - and I use it every day while I watch the news - at least 30 minutes a day, and sometimes an hour if there's something interesting on after the news.

"About those other things: I tried biofeedback, but it just didn't seem to work for me. And I just can't do meditation - I'm too restless and more action-oriented. That's why the exercise comes easy. And I haven't prayed a lot since my mom made me - so that whole area of 'psychic' or 'psychological' or whatever just isn't working for me now."

"Not everything works for everyone - maybe later. Have you tried acupuncture?"

"I thought acupuncture was for pain relief. I didn't know it helped blood pressure," Susan said.

"It's another thing that's a major help only for a minority, but I've seen a few dramatic results," I said.

"We'll try it," Susan said, and made more notes. "Now about those supplements - what are you taking now?"

"Not much - we thought we'd wait until after we came here. We do have a potassium prescription since Fred's taking a diuretic, and the doctor surprised us by recommending a multiple vitamin and vitamin E, 400 IU. She said there's enough study to convince her that vitamin E will prevent a significant proportion of heart attacks. She made sure to check that the vitamin E didn't raise Fred's blood pressure, either. Apparently it can do that?"

"Very rarely. But it can't hurt to check. And she's certainly gotten you off to a good start. What about calcium and magnesium?"

"There's a little in the multiple, but Fred's not taking extra. After all, he's taking a calcium blocker."

"Magnesium is very important for all cardiovascular problems, including hypertension. It dilates blood vessels, which helps to lower blood pressure. It helps regulate blood fats, helps prevent and correct heart rhythm disorders, prevents 'sudden cardiac death' ... very important. But supplemental calcium is important in hypertension, too. Paradoxically, it's been observed that both calcium-channel blockers and calcium supplements can help lower blood pressure."

"How does that work?"

"It's rather complicated, but it has to do with a recently discovered hormone made by the parathyroid gland that affects calcium channels and that is affected by calcium. When calcium is supplemented, often the amount of calcium channel blocker can be reduced. Please take 1,000 milligrams or a little more calcium daily, and 300 to 400 milligrams of magnesium. Look for a combination preparation."

"Two other specific supplemental items can help control blood pressure - essential fatty acids and coenzyme Q10. Please start with 2 tablespoons of cod-liver oil daily. We'll monitor your balance of fatty acids with a blood test in 3 to 4 months. Because you'll be getting about 2,800 IU of vitamin D per day in the cod-liver oil, we'll measure your serum calcium periodically, although problems are exceptionally unlikely. Coenzyme Q10 should be at least 50 milligrams, 3 times daily - more if you can afford it. Take it with the cod-liver oil - it absorbs better that way. Studies with coenzyme QlO show it doesn't start to affect blood pressure for several months, so we'll need some patience."

Susan was writing rapidly. "Let's see-calcium, magnesium, continue the potassium and vitamin E, cod-liver oil, coenzyme Q10, and the multiple vitamin-mineral. That should keep Fred busy."

"Actually, considering Fred's temperament, there's one other thing."

"My temperament? What do you mean?" "You noted that you're always a bit nervous, and your blood pressure is always higher at the doctor's. You're action-oriented - doing your exercise regularly - buy meditation and biofeedback-relaxation-type things don't fit so well. And part of your blood pressure program is a beta-blocker. Overall, an 'adrenaline-type' guy."

"You can say that again," Susan said.

"There's an Ayurvedic botanical that might help. It has many names-one is 'sarpaganda' (also called Rauwolfia serpentina), that's usually very effective in 'adrenaline-types' with hypertension. It works, among other things, by reducing the level of adrenaline at nerve endings in a natural way. Actually, decades ago, Western chemists and drug companies crystallized a single molecule from it, and sold it as a drug called creepiness. It was usually very effective, but had serious side effects for a few people, and was gradually replaced by more-recently patented drugs."

"So is the whole-plant remedy safe?"

"Much safer than the isolated, crystallized single molecule. It's been observed over and over again that whole herbal complexes of ingredients do the job and cause much less trouble. Isolated crystalline reserpine often caused depression, precisely because it was too strong, and decreased adrenaline and similar molecules too much. I've rarely had anyone tell me that sarpaganda does that, although of course you should watch for it."

Fred chose to try the diet, vitamins, and minerals for the first 10 months. He felt considerably better, and he was able to eliminate the diuretic, and cut the quantity of the beta-blocker and calcium-channel blocker by half while maintaining the same good blood-pressure control. He then started sarpaganda, and within another 6 months he was off synthetic medication entirely while maintaining normal blood pressure. Susan noted that with the use of sarpaganda, he seems a little less tense, a little more relaxed.

*Because of the potential for serious side effects, even if rare, sarpaganda should only be used under medical supervision. At Tahoma Clinic, sarpaganda has been superseded by another Ayurvedic combination containing sarpaganda as one of its ingredients.

Dr. Gaby's Commentary

A number of non-drug approaches are available that can effectively reduce blood pressure, often eliminating the need for prescription drugs. Stress reduction, meditation, relaxation techniques, weight loss, discontinuing cigarettes, and participating in a medically supervised exercise program are each effective for some people. In addition, combination therapy is often more effective than any individual treatment alone.

Dietary Considerations

Basic dietary changes are frequently helpful in reducing high blood pressure. It is well known that avoiding excessive sodium-chloride (salt) intake will lower blood pressure for many patients, although in approximately 30% of individuals with hypertension, salt intake has little or no effect on blood pressure. Studies in animals show that a high-sugar diet can also raise blood pressure, and this effect seems to occur in humans, as well. Vegetarian or high-fiber diets may lower blood pressure in some patients.

Some evidence shows that both garlic and onion can lower blood pressure. These foods have also been shown to have other beneficial effects on the cardiovascular system, such as lowering serum cholesterol and inhibiting platelet aggregation. Although not all of the studies agree, including garlic and onion in the diet seems like a good idea.

Some studies have shown that ingestion of caffeine is associated with an increase in blood pressure, but other studies have failed to confirm that finding. Although the data are conflicting, our observation is that the blood pressure of some individuals is indeed affected by caffeine intake.

Drinking alcohol can cause a significant blood pressure elevation in many people with hypertension. Therefore, even though some studies have associated moderate alcohol intake with a lower risk of heart disease, we believe that most hypertensive patients should avoid alcohol.

Food Allergy

Food allergy can contribute to hypertension and, for some patients, allergy is the primary cause of the problem. Individuals who suffer from other allergy-related symptoms, such as migraines or nasal congestion, may experience a substantial reduction in blood pressure after identifying and eliminating allergenic foods.

I once saw a robust 26-year-old man who ate well, exercised regularly, and had little stress in his life. Yet, he had a long history of significant hypertension, which required 2 prescription drugs for adequate control. Based on his history of chronic nasal congestion, I asked him to try an allergy elimination diet. He identified dairy products and eggs as the cause of his nasal congestion. By avoiding these 2 foods, he was able to discontinue both of his blood pressure medications, while maintaining a perfectly normal blood pressure (110/70 mm Hg) for the next 10 years.

Nutritional Supplements

Potassium

At least 19 studies have examined the effect of potassium supplementation on blood pressure. An analysis of the combined results (called a meta-analysis) showed that supplementing with potassium significantly reduced both systolic (the higher number) and diastolic (the lower number) blood pressure.

The best way to obtain potassium is by eating abundant amounts of fruits and vegetables. One would need to take a large handful of overcounter potassium tablets in order to supply the amount of potassium found in a high-potassium diet. While prescription-strength potassium supplements are more potent, they can be irritating to the stomach. However, in cases where dietary changes are not feasible, supplements may be desirable.

NUMEROUS studies have demonstrated that supplementing with calcium can lower the blood pressure of hypertensive individuals. However, other studies found that calcium supplements had absolutely no effect on blood pressure. This discrepancy is due to the fact that hypertension has a number of different causes. One contributing factor is an elevated level of renin, an enzyme produced by the kidney that influences salt and fluid balance. Calcium supplements have been shown to reduce blood pressure in patients with low-renin hypertension, but not in those with high-renin hypertension. These 2 types of hypertension can be distinguished by a lab test called the "renin profile," which measures plasma renin and urinary sodium excretion. On the other hand, one could also try supplementing with calcium (and magnesium) for a few months and see if the blood pressure changes.

Magnesium

There is no question that magnesium lowers blood pressure in certain clinical situations. In a double-blind study, patients taking magnesium depleting diuretics for hypertension had a significant decline in blood pressure after adding a magnesium supplement to their program. However, in another double-blind study, supplementing with magnesium had no significant effect on blood pressure.

I recommend calcium and magnesium supplements for many of my patients, including those with hypertension. The optimal ratio of calcium to magnesium is often debated, but is not known. One might speculate that a calcium/magnesium ratio of 2 to 1 is best for people with low renin levels, whereas a 1-to-1 ratio is more appropriate for those with elevated renin. However, more research is needed before we will know for sure.

Essential Fatty Acids

Essential-fatty-acid (EFA) deficiency can also contribute to hypertension. Both omega-6 fatty acids (from sources such as sunflower or safflower oil) and omega-3 fatty acids (from fish oil) have been shown to lower blood pressure. A physical sign that suggests the presence of EFA deficiency is dry, flaky skin. Avoiding margarine and fried foods may help prevent EFA deficiency. Good sources of EFA's (in addition to those listed above) include nuts, seeds, some vegetables, and oily fish (such as mackerel, salmon, tuna, halibut, and cod).

Coenzyme Q10

Supplementing with coenzyme Q10 (CoQ10) - a compound that plays a fundamental role in human biochemistry- can produce a considerable reduction in blood pressure. In one study, 26 patients with hypertension received 50 mg of COQ10 twice a day. After 10 weeks, the average systolic blood pressure decreased from 164.5 to 146.7 mm Hg, and the average diastolic pressure decreased from 98.1 to 86.1 mm Hg. Similar results have been reported in other studies.

The effect of COQ10 on blood pressure was usually not seen until 4 to 12 weeks after the start of therapy. Therefore, it is important not to give up on this treatment too early.

The Role of Thyroid Hormone

In one study, the incidence of hypertension was 14.9% among patients with hypothyroidism, compared with 5.5% in healthy people. When the proper dose of thyroid hormone was given to the hypothyroid patients, their blood pressure fell significantly. I have observed that many patients are "clinically hypothyroid," despite having normal thyroid blood tests (see chapter 4). When these patients were treated with thyroid hormone, some of them experienced an improvement in their high blood pressure.

The research I have discussed indicates that diet and nutrients play a complex but important role in the prevention and treatment of hypertension. As is often the case with natural medicine, a combination of treatments may be more effective than any single treatment alone. That is especially true for hypertension, since the effectiveness of the individual dietary changes and nutrients seems to vary from person to person. Of the patients we have seen who required prescription medications for high blood pressure, about 40% were able to wean themselves off of their medications and maintain a normal blood pressure with the help of nutritional and lifestyle changes. Others were able to reduce the dose of their medications, but could not discontinue them completely.

Because the nutritional treatment of hypertension involves so many different variables, it is important to consult a practitioner who is experienced in nutritional medicine.

Summary of Recommendations for Treating Hypertension

• Avoid refined sugar, caffeine, alcohol, fried foods, margarine, and partially hydrogenated vegetable oils.

• Consume salt (sodium chloride) in moderation.

• Emphasize fruits, vegetables, whole grains, nuts, seeds, legumes, garlic, and onions.

• Use oily fish in moderation.

• Work with food allergies, in selected cases.

• Maintain ideal body weight.

• Lifestyle interventions that may be helpful include regular exercise, meditation, relaxation and stress-reduction techniques, and biofeedback.

• Calcium, 500 to 1,000 mg per day.

• Magnesium, 300 to 500 mg per day.

• Essential fatty acids, in selected cases. Because of their vitamin A and D content, doses of cod-liver oil greater than 1 tablespoon per day should be monitored by a physician.

• Coenzyme QlO, 60 to 100 mg per day.

• Thyroid hormone, in selected cases.

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