“normal” blood pressure [Hypertension]was accepted as whatever your age was plus 100. So a twenty-year old was expected to have a BP no higher than 120/80. A forty-year old, 140/90. And if you were 60, a top number of 160 was considered perfectly acceptable. But medicine changes its mind more often than most of us change our socks.
If your blood pressure is high and you are on medications, I recommend the following:
1. Measure your blood pressure twice a week after taking deep belly breath and record the value in a book.
2. Follow the wellness IQ on this website to improve your eating and drinking habits.
3. Increase your exercise to improve your cardiovascular function by brisk walking daily.
4. If your blood pressure reading is high during your doctor visit, this is due to white coat syndrome.
5. Stay taking your medications until your blood pressure becomes stable then you can gradually reduce your medications by working with your health care provider. Taking medications indefinitely is not recommended.
According to the Centers for Disease Control and Prevention (CDC), 1 in 3 American adults (about 70 million people) have high blood pressure. About half have uncontrolled high blood pressure, which increases your risk for a number of serious health problems, including:
Cognitive decline, dementia and Alzheimer’s disease
Globally, more than 1 billion people struggle with high blood pressure, and prevalence has nearly doubled in the past four decades.
Overall, men tend to have higher blood pressure than women, and while high-income nations have seen a significant decline in hypertension, prevalence in low- and middle-income countries, such as South Asia and Africa, is spiking. According to researchers, prevalence is “completely inverse” to national income.
Worldwide, high blood pressure is thought to cause nearly 13 percent of all deaths, or about 7.5 million deaths annually.
What Causes High Blood Pressure?
According to medical physiology textbooks, as much as 95 percent of hypertension is called essential hypertension, meaning the underlying cause is unknown. From my perspective, this simply isn’t true. A number of factors have been identified as contributing to high blood pressure, including but not limited to:
Insulin and leptin resistance. As your insulin and leptin levels rise, it causes your blood pressure to increase
Elevated uric acid levels are also significantly associated with hypertension, so any program adopted to address high blood pressure needs to normalize your uric acid level as well
Poor nutrition in childhood has been shown to raise the risk of high blood pressure in adulthood
Pollution. As your insulin and leptin levels rise, it causes your blood pressure to increase
Insulin and leptin resistance. Air pollution affects blood pressure by causing inflammation while noise pollution asserts an effect via your nervous and hormonal systems.
Air pollution has been shown to increase your risk of high blood pressure to the same degree as having a body mass index (BMI) of 25 to 30.
Living in an area plagued by constant noise pollution (busy city streets with night time traffic) has been shown to increase the risk of hypertension by 6 percent, compared to living in an area where noise levels are at least 20 percent lower
The Importance of Diet and Insulin Sensitivity
As noted by the lead author Majid Ezzati, Ph.D., a professor of global environmental health at Imperial College London.
“The perception is that people are not getting enough calories, but the reality is, they’re not getting healthy calories. Making fresh, healthy food affordable and accessible for everybody should be a priority.”
One of the most important dietary changes needed to improve high blood pressure is to eliminate or dramatically reduce sugar and processed fructose from your diet. The easiest way to do that is to replace processed foods with real, whole foods. This will address not only insulin and leptin resistance but also elevated uric acid levels.
One 2010 study 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. To learn more about healthy eating, please see my optimal nutrition plan, which will guide you through the necessary changes step-by-step.
To ascertain whether insulin/leptin resistance is at play, be sure to check your fasting insulin level. If your hypertension is the result of elevated insulin levels, dietary intervention will be key.
Aim for a fasting insulin level of 2 to 3 microU per mL (mcU/mL). If it’s 5 mcU/mL or above, you definitely need to lower your insulin level to reduce your risk of high blood pressure and other cardiovascular health problems.
Keep in mind that the so-called “normal” fasting insulin level is anywhere from 5 to 25 mcU/mL, but please do not make the mistake of thinking that this “normal” insulin range equates to optimal.
The American Heart Association (AHA), the American College of Cardiology (ACC, and the Centers for Disease Control and Prevention (CDC) recommend lifestyle modification as the first-line treatment. If that doesnt work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.
Whats wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs dont treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue, and muscle cramps.
What are the recommended lifestyle changes? The AHA, ACC, and CDC recommend controlling ones weight, salt, and alcohol intake, engaging in regular exercise, and adopting a DASH eating plan.
The DASH diet has been described as a lactovegetarian diet, but its not. It emphasizes fruits, vegetables, and low-fat dairy, but only a reduction in meat consumption. Why not even more plant-based? Weve known for decades that animal products are significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.
Ive talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. They eat plant-based day-to-day, with meat only eaten on special occasions.
How do we know its the plant-based nature of their diets that was so protective, though?
Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low on average were those eating strictly plant-based diets, coming in at about 110 over 65.
So were the creators of the DASH diet just not aware of this landmark research done by Harvards Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet including enough animal products to make it palatable to the general public.
You can see what they were thinking. Just like drugs never workunless you actually take them. Diets never workunless you actually eat them. So whats the point of telling people to eat strictly plant-based if few people will do it? So by soft-peddling the truth and coming up with some kind of compromise diet, the on a population scale maybe youd do more. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe its time to start telling the American public the truth.
Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that its the added plant foodsnot the changes in oil, sweets, or dairythat appears to the critical component of the DASH diet. So why not eat a diet composed entirely of plant foods?
A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers, and even death. But completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But those eating meat-free, egg-free, and dairy-free may have 75% lower risk.
What if were already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70? Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention. Watermelon also appears to be extraordinary, but youd have to eat around 2 pounds a day. Sounds like my kind of medicine, but its hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may also help a bit.
Kiwifruits dont seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with a study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy.
Your diet is an important, if not crucial, factor for the maintenance of a healthy heart well into old age. Healthy dietary fats top the list of heart-healthy foods, of course, but aside from that, a nitrate-rich diet can go a long way toward protecting your heart.
Nitrates should not be confused with nitrites, found in bacon, hot dogs, ham and other less-than-healthy cured meats. Nitrites can convert into potentially dangerous nitrosamines, especially if heated, which is why processed meats are best avoided. In fact, after examining over 7,000 clinical studies, the World Cancer Research Fund concluded there’s no safe lower limit for processed meats.1 They should be avoided altogether.
On the other hand, many vegetables contain naturally occurring nitrates. When consumed, the bacteria in your mouth convert these nitrates to nitrites, but since vegetables are also rich in antioxidants, these nitrites do not pose a health hazard. More importantly, your body transforms the nitrates in vegetables into nitric oxide (NO),2 a soluble gas continually produced from the amino acid L-arginine inside your cells.
Nitrate-Rich Foods Boost Nitric Oxide Production
NO is a gas and free radical that is an important biological signaling molecule that supports normal endothelial function and protects the little powerhouses inside your cells, your mitochondria. Acting as a potent vasodilator, NO also helps relax and widen the diameter of your blood vessels, allowing a greater volume of blood to flow through.
Healthy blood flow helps your body function at its best, as your blood carries oxygen and nutrients to your heart, brain and other organs. It nourishes and oxygenizes your immune system and muscles, and helps keep your heart beating. It also carries away waste material and carbon dioxide.
As noted in research3 presented by Dr. Michael Greger above, a diet high in nitrate is a natural strategy recommended for the treatment of prehypertension and hypertension (high blood pressure), “and to protect individuals at risk of adverse vascular events,” i.e., heart attacks. Indeed, raw beets which are high in nitrates have been shown to lower blood pressure by an average of four to five points within a matter of hours.4
Some studies have shown a glass of beet juice can lower systolic blood pressure by more than eight points5 far more than most blood pressure medications. In conventional medicine, nitrates are used to treat angina and congestive heart failure, and research shows a glass of beetroot juice has the same effect as prescription nitrates.6
NO Promotes Healthy Heart and Brain Function
In one recent study,7,8,9,10 patients diagnosed with high blood pressure who drank beet juice an hour before exercise, three times a week for six weeks, experienced increased tissue oxygenation and blood flow. It also improved brain neuroplasticity by improving oxygenation of the somatomotor cortex (a brain area that is often affected in the early stages of dementia).
As noted by study co-author W. Jack Rejeski, a health and exercise science professor at Wake Forest University in North Carolina, NO is a vital biomolecule that “goes to the areas of the body which are hypoxic, or needing oxygen, and the brain is a heavy feeder of oxygen in your body.”11,12 Your heart, too, requires NO and oxygen for optimal function. As noted by cardiologist Dr. Stephen Sinatra:13
“Adequate NO production is the first step in a chain reaction that promotes healthy cardiovascular function, while insufficient NO triggers a cascade of destruction that eventually results in heart disease NO promotes healthy dilation of the veins and arteries so blood can move throughout your body. Plus, it prevents red blood cells from sticking together to create dangerous clots and blockages.”
Which Foods Contain the Most Nitrates?
As noted by Greger in the featured video, leafy greens top the list of nitrate-rich foods. Beets, which are a root vegetable, are well-known for their high nitrate content, but leafy greens contain even more nitrates per serving. In fact, beets barely made it onto the top 10 list, which is as follows:
1. Arugula, 480 mg of nitrates per 100 grams
2. Rhubarb, 281 mg
3. Cilantro, 247 mg
4. Butter leaf lettuce, 200 mg
5. Spring greens like mesclun mix, 188 mg
6. Basil, 183 mg
7. Beet greens, 177 mg
8. Oak leaf lettuce, 155 mg
9. Swiss chard, 151 mg
10. Red beets, 110 mg
Arugula, in the No. 1 spot, contains more nitrates than any other vegetable, and by a wide margin too 480 mg per 100 grams. The second-highest source, rhubarb, contains about 280 mg per 100 grams, which is about the same amount found in a 100-gram serving of beet root juice, whereas 100 grams of whole red beets provide a mere 110 mg of nitrates.
Other foods high in nitrates include the following.14,15,16 (While garlic is low in nitrates, it helps boost NO production by increasing NOS, which converts L-arginine to NO in the presence of cofactors such as vitamins B2 and B3.17)
Source Mg of nitrates per 100 grams
70 to 95 mg
92 to 195 mg
70 to 95 mg
24 to 387 mg
43 to 161 mg
16 to 136 mg
25 to 42 mg
100 to 250 mg
100 to 250 mg
50 to 100 mg
20 to 50 mg
20 to 50 mg
Less than 20 mg
Less than 20 mg
Less than 20 mg
Nitrate-Rich Foods Protect Against Heart Disease
Previous research has shown that the more vegetables and fresh fruits you eat, the lower your risk of heart disease, with leafy greens being the most protective. As noted by Greger, the reason for this is likely their NO-boosting nitrates. This was confirmed in a May 2017 study published in The American Journal of Clinical Nutrition.18
In this study, nearly 1,230 Australian seniors without atherosclerotic vascular disease (ASVD) or diabetes were followed for 15 years. A food-frequency questionnaire was used to evaluate food intake, while nitrate intake was calculated using a comprehensive food database. As expected, the higher an individual’s vegetable nitrate intake, the lower their risk for both ASVD and all-cause mortality. According to the authors:
“Nitrate intake from vegetables was inversely associated with ASVD mortality independent of lifestyle and cardiovascular disease risk factors in this population of older adult women without prevalent ASVD or diabetes. These results support the concept that nitrate-rich vegetables may reduce the risk of age-related ASVD mortality.”
Leafy Greens and Sports Performance
Most competitive athletes understand the value of NO, and the wise ones take advantage of Mother Nature’s bounty. While research19,20 has shown nitrate supplements can boost sports performance and enhance fast-twitch muscle fibers, you can get the same results using whole foods. For example, research shows raw beets can increase exercise stamina by as much as 16 percent,21 an effect attributed to increased NO.
In another study,22 nine patients diagnosed with heart failure who experienced loss of muscle strength and reduced ability to exercise were found to benefit from beet juice. The patients were given 140 milliliters (mL) about two-thirds of a cup of concentrated beet juice, followed by testing, which found an almost instantaneous increase in their muscle capacity by an average of 13 percent.
There’s one important caveat though: Avoid using mouthwashes or chewing gum, as this actually prevents the NO conversion from occurring.23 The reason for this is because the nitrate is converted into nitrite in your saliva by friendly bacteria. That nitrite is then converted into NO in other places in your body.
More Information About NO
NO24 not to be confused with nitrous oxide, commonly known as laughing gas, a chemical compound with the formula N2O25 serves as a signaling or messenger molecule in every cell of your body. Hence, it’s involved in a wide variety of physiological and pathological processes. As mentioned, it causes arteries and bronchioles to expand, but it’s also needed for communication between brain cells, and causes immune cells to kill bacteria and cancer cells.
Now, your body loses about 10 percent of its ability to make NO for every decade of life, which is why eating a nitrate-rich diet is so important. NO is further synthesized by nitric oxide synthase (NOS). There are three isoforms of the NOS enzyme:
Endothelial (eNOS): a calcium-dependent signaling molecule that produces low levels of gas as a cell signaling molecule
Neuronal (nNOS): a calcium-dependent signaling molecule that produces low levels of gas as a cell signaling molecule
Inducible (immune system) (iNOS): calcium independent; produces large amounts of gas, which can be cytotoxic
Problematically, when fluoride is present (such as when you’re drinking fluoridated water), the fluoride converts NO into the toxic and destructive nitric acid. As noted in “Pharmacology for Anesthetists 3,”26 “[NO] will react with fluorine, chlorine and bromine to form the XNO species, known as the nitrosyl halides, such as nitrosyl chloride.” Hence, avoiding fluoridated water and other halide sources, such as brominated flour, is important to optimize your health and avoid damaging interactions.
Exercise Also Boosts NO Production