A billion people worldwide including 79 million Americans (that’s one out of three adults over the age of 20) has high blood pressure (HBP or hypertension). Hypertension represents a real threat to public health since it is now the greatest mortality risk factor in both men and women and its prevalence is increasing.
Why has HBP reached such epidemic proportions? The conventional answer is that nobody knows. In fact, 95 percent of hypertension is considered “essential” meaning it has no known cause. It’s clear, however, that like other diseases of civilization such as diabetes, Alzheimer’s, and osteoporosis, our modern lifestyle plays a paramount role.
It is extremely rare to find HBP in contemporary hunter-gatherer societies and like other chronic diseases of civilization, the rise of HBP follows our movement out of hunter-gatherer and pastoral lifestyles and into an increasingly high tech, urbanized world. We adapt enough to survive in this world, but do not thrive in it due to:
- Our processed food diets
- Exposure to environmental toxins both physical and psychological
- Inadequate sleep, sun, and exercise
- Disturbed circadian rhythms
- Weakened microbiome
Current treatment recommendations for hypertension involve lifestyle modifications and medication. (6) However, all too often we rely on meds over lifestyle changes because, as we all know, change is hard. Friends, I’m here to tell you that taking the Paleo plunge is worth it! The Paleo diet and lifestyle can have therapeutic value for HBP and that’s what this post is about. (7)
Let’s talk about blood pressure and what we can do about it with a Paleo approach!
What is Blood Pressure?
Blood pressure is the strength of your blood pushing against the arteries, veins, and capillaries of your circulatory system. Every time your heart beats it creates a force against your blood vessels known as systolic blood pressure (systole) and every time your heart rests between beats, it creates a second force known as diastolic blood pressure (diastole).
When you or your doctor takes your blood pressure, it is these two forces that are measured and reported as millimeters of mercury (mm Hg) with systole before or over diastole. (Millimeters of mercury is the gold standard of blood pressure measurement whether a column of mercury or a more portable digital converter is used.) For instance, a blood pressure reading of 115/75 mm Hg means that your systolic pressure is 115 mm Hg and your diastolic pressure is 75 mmHg.
There are four categories of blood pressure risk that are recognized by leading heart health organizations including the American Heart Association (AHA), the American College of Cardiology (ACC), and the Centers for Disease Control and Prevention (CDC):
- Normal (healthy) blood pressure: systolic pressure under 120 and/or diastolic pressure under 80
- Prehypertension: systolic pressure of 120-139 and/or diastolic pressure of 80-89
- Stage 1 hypertension: systolic pressure of 140-159 and/or diastolic pressure of 90-99
- Stage 2 hypertension: systolic pressure of ≥159 and/or diastolic pressure of ≥99
Indications for Health
Even in the prehypertension category, your circulatory system is working harder with less efficiency. There are no symptoms and when left undetected or untreated, chronic HBP damages blood vessels in a variety of ways such as creating small tears in artery walls, contributing to plaque buildup, and reducing blood vessel elasticity. At any stage of hypertension, you’re at greater risk for development of debilitating and life-threatening conditions:
- Heart attack—Blood cannot get to the heart due to narrowed and blocked arteries.
- Stroke—Damaged blood vessels in the brain become blocked or burst.
- Heart failure—An enlarged but weakened heart cannot supply enough blood to the body.
- Kidney disease or failure—Damaged arteries starve the kidneys of oxygen and nutrients and affect the filtration process. Eventually the kidneys can fail.
- Vision loss—When oxygen and nutrients can’t get to the eyes, sight is reduced.
- Sexual dysfunction—The result of a lack of blood flow to sex organs in both men and women.
- Angina—Chest pain from tiny vascular tears.
- Peripheral artery disease (PAD)—The narrowing of the arteries that causes pain or fatigue.
A Paleo Approach for Hypertension Risk Factors
In its most basic form, following a Paleo diet means eating nutrient dense vegetables, fruits, meats, fish, healthy fats, nuts, and seeds while avoiding grains, beans, soy, dairy, refined vegetable oils, and refined sugar.
In its broadest form, the Paleo diet places value on locally grown food that is produced ethically and sustainably and mimics the traditional human diet by including pastured meats and wild fish from animals that ate appropriately for their species and plant foods grown free of pesticides, herbicides, and other potential toxins. Paleo also places a premium on certain unrefined fats and oils such as coconut oil that are known to have health benefits.
In addition to eating well, Paleo lifestylers prioritize sun time, fun time, exercise, and sleep and you’ll see that all of the following HBP risk factors can be addressed with Paleo lifestyle modifications. Of course, if you are under a doctor’s care for HBP, and especially if you are on any blood pressure lowering medications, you should consult your doctor before making any major dietary or lifestyle changes.
Age, Ethnicity, and Family History
The field of epigenetics explores how external stimuli such as our environment doesn’t change our genes but changes how they express themselves. Even the seemingly immutable factors of age, ethnicity, and family history may be favorably influenced by a supportive environment more like our Paleo past. (8)
Although weight loss may not affect the consequences of HBP, it can lower pressure enough to prevent further damage and perhaps avoid the need for medications. (9) The Paleo diet promotes weight loss by addressing food sensitivities, eliminating processed food, and minimizing high glycemic carbohydrates.
The Paleo lifestyle encourages fitness because it can do you a world of good on so many levels. It’s so important that it’s a pillar of Paleo, right up there with diet and sleep! Both moderate intensity aerobic exercise and dynamic resistance exercise, but not necessarily isometric resistance training, can help in the prevention and management of stage 1 hypertension. (10)
Chronic heavy drinking (which is only three drinks a day for men and less for women) is associated with an increased incidence of hypertension. Conversely, following public health advice to imbibe with a maximum of two drinks a day for men and one for women has been shown to lower blood pressure. (11) If you’re curious about what to drink and what not to drink on Paleo, here is a post for you. Paleo Margarita, anyone?
Smoking is just bad for you. Bad. Bad. Bad. Don’t do it.
Lack of Sleep
Like diet and exercise, sleep is a pillar of wellness. If you want to improve anything in your life, it starts with sleep! Sleep heals illness and reduces stress. Over the past 50 years, the average American’s sleep has decreased from eight or more hours to less than seven hours, while chronic diseases such as HBP have been on the rise. We spend a lot of time in the Paleo community talking about food, but in all honesty, sleep is just as important to our health! Addressing sleep disorders and getting at least seven hours a night is a helpful blood pressure hack. (13)
Hypothyroidism, diabetes, gout, kidney disease, and adrenal fatigue are all associated with blood pressure changes. Autoimmune hypothyroidism, or Hashimoto’s thyroiditis, is associated with low blood pressure (LBP), and adrenal fatigue is associated with both high and low blood pressure. So, how does Paleo address LBP? Much the same as it does HBP: by addressing conditions or risk factors that cause low blood pressure in the first place. The best foods to support adrenal and thyroid health are the foods that promote good health in general: whole, unprocessed foods that are packed full of nutrients. Vegetables, low-glycemic fruits, nuts, seeds, grass-fed meats, eggs, and fish. For more detailed food lists, read more about thyroid health and adrenal health in detail.
High Carbohydrate Diet
Although not strictly defined as such, the relatively low carb nature of the Paleo diet may help lower blood pressure via improved glucose tolerance and lower blood triglycerides and improved arterial distensibility even without weight loss. Reducing carbohydrates to purposely induce ketosis has also been shown to lower blood pressure. (14,15)
Excess Salt Intake: Minerals and High Blood Pressure
Adequate dietary intakes of sodium and potassium are essential for optimal health. The RDA for sodium is less than 2,300 mg/day (1 teaspoon) or even less at 1,500 mg a day if you’re 51 or older, or if you are African American, have high blood pressure, diabetes, or chronic kidney disease. The RDA for potassium in an adult diet is 4,700 mg/day.
A person eating a standard American diet typically consumes about 3,400 mg of sodium a day or 1½ teaspoons salt, mostly from processed foods and only 2,640 mg potassium day, again a result of a mostly processed foods diet.
Compare that to our ancestors who likely ate around 768 mg sodium/day and greater than 10,000 mg potassium/day! Although reducing sodium intake is hallmark of conventional HBP treatment, many studies have shown that the ratio of sodium-to-potassium is a better predictor of HBP than either sodium or potassium alone, and a diet moderate in sodium and high in potassium may be the healthiest bet. (16)
Studies on the efficacy of salt reduction are mixed and it’s unclear if reducing salt to recommended levels is universally beneficial. In fact, it may even be harmful for some people. For example, salt restriction is associated with insulin resistance, elevated triglycerides, and elevated stress hormones. (17,18)
In fact, sodium restriction appears to lead to the very things it is supposed to decrease, including risk for stroke and heart disease. A very large study published in the New England Journal of Medicine found that people who consumed a moderate amount of sodium, between 3000 to 6000 mg/day, were healthier than people who consumed either more than this or less. (19)
If you follow a diet free from processed food, use high-quality salt to taste (like Himalayan salt) and eat plenty of fruits and vegetables. On a plan like that, your sodium-to-potassium ratio will naturally fall into a desirable range.
The following is a list of common Paleo foods and their potassium content. (Incidentally, animal foods typically provide about 1,500 mg potassium per pound.)
Need some great recipes full of potassium? Go ahead and whip up a big batch of Traditional Mashed Potatoes. Or if you prefer sweet potatoes, believe it or not you can slow cook them! Our Slow Cooker Bacon and Spinach Stuffed Sweet Potatoes just about cooks itself. If you’re really short on prep time, try our beautifully hued Beets and Berries Smoothie (and throw a handful of beet greens in for extra potassium!).
Potassium isn’t the only mineral to star in the show. Both calcium and magnesium appear to have an inverse relationship to blood pressure but their therapeutic value takes a back seat to potassium. Although the actual effect of these two minerals on blood pressure remains questionable, maintaining dietary adequacy is recommended. (20)
It’s easy to get enough calcium on the Paleo diet, if you’re mindful about it and eat your greens as well as some bones. Greens and bones? Yes, calcium is very well absorbed from these foods. Bones such as the soft ends off soup bones or small soft fish bones, collard greens, canned salmon with bones, and turnip greens, all provide more absorbable calcium than milk. Sardines with bones are a very close second to milk with bok choy, broccoli, kale, and mustard greens following. (21,22)
Here are some Paleo recipes rich in calcium and magnesium:
Foods & Nutrients That Benefit Blood Pressure Health
Within the Paleo diet are certain foods that are extra beneficial for your blood pressure health:
- Beets (Beets again! Beets and their greens win the MVP award for best potential therapeutic value for HBP!)
All of these foods have something in common: they’re high in naturally occurring nitrites that our bodies can convert to nitric oxide. Nitric oxide increases vasodilation and lowers blood pressure. It’s believed a diet rich in nitrite-containing vegetables is a main reason the DASH diet works to reduce blood pressure. Getting sun and exercise also helps boost nitric oxide. (23) Incidentally, bacon contains nitrites but cooking it at high heat turns them into nitrosamines so eat bacon because you love it, not for a boost in nitric oxide.
Despite the fact the caffeine can cause a temporary spike in blood pressure, both green and black teas are associated with overall improvements in systolic and diastolic pressures. Hibiscus tea has been shown to act as well as the ACE inhibitor lisinopril by relaxing blood vessels and reducing the amount of water reabsorbed by the kidneys. (24,25)
Eating fatty fish such as salmon, tuna, mackerel and sardines provides the omega-3 fatty acids EPA and DHA which at high enough doses, may help to reduce high blood pressure. However, it takes a commitment to eating enough fish to make a difference. A meta-analysis showed that omega-3 intake of greater than 2 grams/day can reduce both systolic and diastolic pressure and 1-2 grams/day can reduce systole. For perspective, a 3-ounce serving of wild salmon (coho, sockeye, chum, and pink) provides 500-1000mg omega-3 fatty acids. (26)
Garlic is well known as a functional food for hypertension. Garlic contains 33 sulfur compounds that are responsible for its medicinal effects. Allicin is one of the most biologically active sulfur compounds in garlic but to activate it, you have to cut or crush the cloves. It only takes 1-3 cloves of fresh garlic to elicit blood pressure lowering effects. (27)
Summing Up Blood Pressure Health & Paleo
Contemporary hunter-gatherer societies live in accordance with their environment and they do not suffer from high blood pressure. Neither should we! Mimicking the hunter-gatherer lifestyle encourages practices that are aligned with our genetic inheritance and can act as an epigenetic reset for our health.
Getting exercise, time in the sun, and hacking stress responses are all in a day’s work for Paleo lifestylers. In addition to placing a premium on foods with the highest nutritional value and the lowest toxic loads, Paleo eaters can maximize their omega-3 fatty acid intake and maintain a favorable sodium-to-potassium ratio and benefit from way more vitamins, minerals, phytonutrients, and healthy bioactive compounds than conventional diets can provide.
The Paleo diet is part of a lifestyle that turns your body into the highly efficient, optimally functioning machine it is meant to be. This is what nature has always intended. By living and eating closer to the way our ancestors did, we can harness the ancient power of our genes to our modern advantage and turn the tide on all the chronic diseases of civilization, including high blood pressure.
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