October 16 2019

A Primal Guide to Blood Pressure: 8 Common (and Not So Common) Interventions

By Mark Sisson
31 Comments

Hypertension is a problem. It raises the risk of heart disease; it’s one of the most consistent risk factors for that condition, as well as others like kidney disease. But before you start freaking out about your high blood pressure, make sure you actually have it. A single elevated reading does not a hypertension diagnosis make. Readings are snapshots in time. They can be a part of a trend, or they can be an isolated case. Don’t assume based on one bad reading.

I can remember going to the doctor about ten years ago for a routine checkup, showing 140/100, and almost getting a prescription based on that. It was absurd, so absurd that I took matters into my own hands and got a fancy blood pressure device to measure my own over the next couple weeks. The result?

There was almost no pattern. Maybe it was a lot lower after dinner, due to relaxation, but other than that there weren’t any trends. Sometimes it was high, mostly it was low-normal. It all depends on stress

Okay, say that’s not you. Say you have a legitimate problem with protracted and consistently high blood pressure. What can you do in addition to (or besides, if your doctor says it’s safe to wait) opt for the prescription?

1) Eat More Potassium

A common cause of salt-related blood pressure increases is inadequate potassium intake. Very few of us eat as much potassium as we evolved eating.

The pre-agricultural environment was potassium-rich and sodium-poor. That’s why we have a physiological taste for salt, and why salted food tastes so good: we had to seek it out. That’s why we don’t have a physiological taste for potassium: it was everywhere. Loren Cordain estimates some hunter-gatherer groups got upwards of 10-12 grams of potassium a day, whereas the average American gets about 2.5 grams.

Studies show that both sodium-sensitive and potassium-deficient subjects with high blood pressure see the biggest improvements with increased potassium intake.

I love sodium, and it’s actually beneficial for endothelial health when consumed with enough potassium, but you have to eat potassium too.

2) Improve Your Insulin Sensitivity

Ever since earlier studies established that hypertensive patients tend to exhibit abnormally high insulin responses to standard glucose loads, researchers have wondered about a connection between insulin and blood pressure.  It turns out there is a powerful connection.

  • In non-diabetic people with normal blood pressure, insulin levels and shifts in blood pressure are related—higher insulin, higher blood pressure; lower, lower.
  • In both diabetic and non-diabetic subjects, lower insulin sensitivity predicts elevated blood pressure.
  • Insulin increases sodium retention in the blood, which increases blood volume and pressure. The less insulin sensitive you are, the more insulin you’ll release in response to a given stimulus, and the more sodium you’ll shuttle into the blood.
  • Both insulin resistance and the compensatory hyperinsulinemia (elevated insulin levels) that results have distinct pro-hypertensive effects.

Luckily, there are dozens upon dozens of ways to improve your insulin sensitivity. Choose a few, or all of them (a better proposal, actually), to not only improve your blood pressure but also your health and life in general.

3) Earn Your Carbs With Physical Activity

The ones you earn through physical activity, that is. Let’s look at two scenarios.

First: You eat way more carbs than you actually earn through training. You haven’t trained, so you’re more insulin-resistant than the You from the alternative universe who did train. This means any carbs you eat will cause a greater spike in insulin, which has been shown to increase blood pressure.

Second: You only eat the carbs you’ve earned through training. Since you’re training, your insulin sensitivity is high, and you don’t actually secrete all that much insulin in response to the carbs. Training also upregulates non-insulin dependent glycogen repletion, meaning you can shove glycogen into muscles post-workout without even using insulin.

Once or twice, this isn’t an issue. But if you’re consistently eating more carbs than you need, the resultant elevation in insulin will raise blood pressure. At the very least, it won’t help.

Not only that, but regular training improves endothelial function and reduces the risk of high blood pressure on its own.

4) Eat Fermented Dairy

Milk fermented with the L. helveticus bacteria has been shown to lower blood pressure in people with hypertension in a number of studies.

In one, they drank the fermented milk for 21 weeks.

In another, they drank the milk for 10 weeks.

Look for products that include Lactobacillus helveticus, such as kefir, aged cheese (Swiss, emmental, pecorino romano, cheddar, parmigiano reggiano),

5) Get Your Zinc (Red Meat and Oysters)

Zinc is an essential nutrient for regulating the nitric oxide synthase system in the body. Without adequate zinc, your ability to produce nitric oxide—which increases blood vessel dilation and thus regulates blood pressure—is hampered.

6) Get Sunlight

There are consistent relationships between adequate vitamin D levels and normal blood pressure, though it’s unclear whether this is causal. Studies haven’t found a consistent blood pressure effect of actually supplementing with vitamin D. What might be going on is that vitamin D is acting as a marker for sun exposure, because we know that sunlight increases the production of nitric oxide, a compound that improves the function of your blood vessels.

Sure enough, human studies show that sun exposure causes the conversion of nitrogen oxide in the skin to nitric oxide, lowering blood pressure and improving endothelial function.

7) Address Your Stress

Stress might be the biggest trigger for hypertension, especially since most of us live lives laden with hidden, inevitable stressors—commutes, jobs we don’t like, bills, and the like. It’s everywhere, we can’t really escape it entirely, so we have to figure out how to deal with it.

I know how I do it (paddling, Ultimate, walks, quality time with family, smart supplementation). There are other ways, like adaptogens, or this, or this. You can rethink stress entirely. You can meditate, or try alternatives that achieve similar things. What are you going to do?

If your blood pressure is resistant to dietary, exercise, or lifestyle changes, make sure you manage it with your doctor.

8) Take ACE Inhibitors or AR Blockers If Warranted

The body uses a hormone called angiotensin to raise blood pressure in a couple ways.  First, by directly constricting blood vessels and increasing flow pressure. Second, by promoting the release of aldosterone, a hormone that shuttles sodium to the blood to increase blood volume. ACE inhibitors inhibit angiotensin secretion and AR blockers block angiotensin receptor sites. While I know we’re usually suspicious of drugs that block or inhibit the secretion or action of hormones, ACE inhibitors and AR blockers appear to be quite safe and effective. And there’s even evidence that normotensive subjects who take them live longer than normotensive subjects who don’t.

They do tend to lower zinc status, though, so keep up with your zinc intake.

That’s it for today, folks. The good news is that high blood pressure is manageable with diet and lifestyle changes, and even if that doesn’t work, the available medications seem better than most.

How do you manage your blood pressure? What’s worked? What hasn’t?

References:

Sebastian A, Cordain L, Frassetto L, Banerjee T, Morris RC. Postulating the major environmental condition resulting in the expression of essential hypertension and its associated cardiovascular diseases: Dietary imprudence in daily selection of foods in respect of their potassium and sodium content resulting in oxidative stress-induced dysfunction of the vascular endothelium, vascular smooth muscle, and perivascular tissues. Med Hypotheses. 2018;119:110-119.

Filippini T, Violi F, D’amico R, Vinceti M. The effect of potassium supplementation on blood pressure in hypertensive subjects: A systematic review and meta-analysis. Int J Cardiol. 2017;230:127-135.

Takano T. Anti-hypertensive activity of fermented dairy products containing biogenic peptides. Antonie Van Leeuwenhoek. 2002;82(1-4):333-40.

Seppo L, Jauhiainen T, Poussa T, Korpela R. A fermented milk high in bioactive peptides has a blood pressure-lowering effect in hypertensive subjects. Am J Clin Nutr. 2003;77(2):326-30.

Jauhiainen T, Vapaatalo H, Poussa T, Kyrönpalo S, Rasmussen M, Korpela R. Lactobacillus helveticus fermented milk lowers blood pressure in hypertensive subjects in 24-h ambulatory blood pressure measurement. Am J Hypertens. 2005;18(12 Pt 1):1600-5.

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31 thoughts on “A Primal Guide to Blood Pressure: 8 Common (and Not So Common) Interventions”

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  1. As my weight goes down, so does my blood pressure. After all, my heart doesn’t have to work so hard to move my blood so far.

    1. I wish it were the same for me. I lost 55 kilos, and now I’m on BP meds (only the lowest dose, but still…..).

  2. Thanks for talking about this. I like to read Malcolm Kendrick MD on issues of heart disease and blood pressure. He’s earned a spot at RationalWiki so I consider that a point of honor in his favor. He’s an MD in the UK, and a member of THINCS (a union of doctors who are skeptical that cholesterol causes heart disease). A while back he discussed “Essential Hypertension” which was the mechanism by which formerly normal blood pressure was turned into a disease.

    I noticed the problem with blood pressure meds when my mother in law was given three bp meds suddenly and started falling. She was always fine before that. Questioning the staff led to the realization that they would test her bp when she was trying to make urgent requests which were repeatedly denied. So she was always in a high stress state because the facility was neglectful. We got her out of there and now she gardens without fainting.

    The really creepy thing is that doctors can get into trouble for not offering them to people because the guidelines say to treat it. I’ve stopped allowing the nurse to default test my bp in every doctor’s office. It’s absurd to have it done at a gyno visit for instance.

    My bp is now untreated. I was on a beta blocker and it basically sucked the life out of me. It took about a year to get off of it because the one I took had a week long effect and was for migraines.

    I still manage to be in the 120/80 range. I never needed them except for migraines. Gluten is my biggest trigger and so I’m far better than I was.

    1. i was put on water pills today. also on a beta blocker for high BP. i need a knee replacement, and im in pain ,daily. so frustrated…i have tried every pain medication available to man, they work for a bit then stop. so i dont have my pain under control, so i was put on more Blood pressure medication. i live in canada so we have a wait list for surgeries.

  3. Just make sure your ARB doesn’t include NDMA, a know carcinogen.

  4. Using a bp monitor at home allows you to learn what works for you. I was in the 170/90 range at home, relaxed, and feeling good, but knew I had to do something to get it down. I follow a primal diet (80/20), walk at least 30 minutes everyday and yoga 3 days a week. It really dropped when I cut out fruit! Its now in the 115/75 range. Pretty good for a 63 yr old!

  5. For the past five years, or so, I —a 50-something female—was getting readings consistently in the 135/85 range, with some spikes even as high as 150/90. Yikes! This was even with a healthy weight, walks, meditation and yoga in my regimen. I was prescribed hydrochlorothiazide, which brought it down a bit, but it wasn’t until I started drinking hibiscus tea about 6 months ago that my readings returned to normal. Last week was 116/77. The tea has anti-hypertensive and anti-inflammatory benefits. Seems to be working for me. I take no medicines now.

  6. A word of caution when using medication or other supplements to lower blood pressure. There’s an underlying issue that is causing the heart to pump hard as it’s trying to push blood through out the body. Using medication etc, forces a lowering in blood pressure and thus causes the heart to work harder. High blood pressure is a symptom of a problem somewhere and the Dr should dedicate time and resources to get to the source cause

    1. Hydralazine messed up my heart (temporarily.) It sped up heart. My electrophysiologist put me on med to stop afib, which made me dizzy. Then he wanted to do ablation (burn nodes my heart.) I said no and he said to get another doc, which I did. But I realized I was on Hydralazine for high blood pressure, which I didn’t really have. With primary doc and primary cardiologist ok, I stopped that. No more afib. At functional med doc’s office today, 102/66. Pulse 75.

  7. Any thoughts on “white coat hypertension”? At home, my BP is around 130/80. At any doctor’s office, it goes crazy. Earlier this week I had it taken at a doctor’s office and it was 165/111. Now THAT’S high.

    I hate going to the doc’s office, and it’s showing up in my BP readings. I should mention that my pulse is usually in the 60s.

    Anything you can think of to help?

    1. I am a nurse, around doctors all day long and I still have problems with white coat. Some things that have worked for me: focused breathing and meditation. Try the 4-7-8 breathing technique where you breath in for 4 seconds, hold the breath for 7 seconds, and breath out through pursed lips for 8 seconds. Not only does this help me relax but it also helps me fall asleep.
      Great article!

    2. My mom’s doc now takes her BP twice during each visit–once at the start, like usual (force of habit?) and once later in the visit, after she’s talked to the doc and relaxed some. They seem to get a more reasonable reading then.

  8. Potassium chloride (salt alternative- various brands) sprinkled on food is an option not typically mentioned as a source of potassium

  9. Any advice for chronic low blood pressure? I take plenty of salt but still don’t find much relief. My mum has it too so quite possibly genetic I’m presuming, can be frustrating when it strikes.

  10. Something else to consider:
    “Enter the new advice from ACP and AAFP. If you’re 60 or older and have no other cardiovascular risk factors (diabetes, high cholesterol, a smoking habit), these guidelines recommend maintaining a systolic reading below 150 mm/Hg. That’s appropriate for most people in the group above, researchers say. Here’s why: The two dozen studies reviewed for the guidelines suggested that aggressive treatment to get systolic blood pressure below 140 in people who are over age 60 didn’t extend life or reduce the number of heart attacks. It did, however, possibly lower the risk of strokes.“

  11. Until you earn your MD I suggest avoiding giving people advice on medical topics. I think your suggestions are not based on solid science so they should be ignored.

    1. Why don’t you counter with some links to studies? That would be very helpful.

    2. My wife is a hospital administrator and works with physicians just like you. The stories she tells me in private (as much as she is allowed to share) about the mistakes you guys make every day and the way you all circle the wagons to protect each other are disturbing. Yeah … think I WILL ignore … your advice that is. With all due respect Dr. Wilson, people are allowed to do research and be advocates for their own health in conjunction with consulting with their traditional health provider.

    3. @William Wilson: So your guild has the only answers ? Gotcha.

      And practitioners such as yourself are the superior scientists, exclusively qualified to help us navigate through the paths to health, not because of rigorous training in scientific method and thorough evaluation of experiments and studies, not because your guild routinely takes the time and does the legwork to really look into the historic as well as the emerging science but because you have exclusive rights to the business of Medicine, right?

      I think we all know AMA certified physicians who are very, very good at what they do. But you are not the exclusive bearers of the light. The AMA has worked to hold a monopoly on the business of providing care for too long.

      I hope that others (like Mark) who are not burdened with such hubris as you express here will ignore your suggestion and keep helping us sort stuff out. We need good people who practice good science with good motives and appreciate their help whether they are members of your guild or not.

      I suggest that you come down from your high horse and try to learn where and when you can how you can help your patients. Apply your critical thinking to challenge ideas you find to be poorly founded and see where the information can take us. This is the scientific way and through this we all benefit. An appeal to authority is a poor way to increase our knowledge as a people.

      forbes.com/sites/johngoodman/2014/09/03/the-doctors-union/#2b6a11f14339

    4. Most of the comments that Mark receives are positive and say that he has helped them. People who spent years wondering where their health went wrong found answers here, often after a series of MD’s ignored or scoffed at their problems. Mark has spent years developing these ideas and reporting on medical insights found in actual peer reviewed journals. He has helped direct thousands of people to lifestyle choices that improve their lives. Mark applies his own advice to his own life, as you would know and respect if you followed him for a while and just listened. You came here today and gave a two sentence rebuke to a man who doesn’t deserve it. You didn’t even refute anything he said. You just made an ad hominem attack and haven’t even had the grace to reply to any of the people who replied to you.

  12. I don’t normally have “high” BP but my doctor discovered that I do seem to have “white coat syndrome” which I didn’t know was really a thing. I started checking it with a good monitor, at home and we were amazed to see much lower readings. The few times I thought it was higher than I wanted, losing even a few pounds helped and taking one capsule per day of Grape Seed extract lowered it still further, to the point where I have to be careful with it.
    (Don’t always need the pressure to be quite that low.)

  13. Mark, you left out two very important additions to your list: Vitamin D and magnesium. Just as calcium is necessary for muscular contraction, magnesium is required for muscular relaxation. Correcting Mg alone will drop blood pressure considerably in many people… and as you know, upwards of 90% of the population is Mg deficient. Data in blacks (who are highly susceptible to Vit D deficiency) has shown correcting D will drop systolic BP upwards of 5 mm Hg. As a physician, I’m stunned how few of my compatriots address these deficiencies before going pharmacologic. Besides, it’s SUCH an easy fix!

  14. I’m 76 & at my last review my doctor wanted to put me on medication for my raised BP. I said no until she did a 24 hour BP test. That showed my blood pressure over 24 hours was normal – so no medication needed. I know I suffer from white coat syndrome.

  15. In regards to potassium- is it possible to get the optimal amount on a carnivore diet? I’m just starting and would love to know how an average day of carnivore eats stacks up in potassium. Any tips on how to increase and ensure an optimal supply would be greatly appreciated too.

    Cheers Tim

  16. I’d add bleeding lol.

    Donating blood actually dramatically decreases risk of cardiovascular problems. It’s also commonly used in numerous traditional medicines (Tibetan, Chinese, Middle Eastern, etc.) as a treatment for hypertension.

  17. Once I realized I was hypothyroid, and then got the proper meds to treat it (I use natural desiccated thyroid twice a day) my blood pressure, which had been borderline for over a decade, dropped right down to 120/70. I was SHOCKED. And pleasantly pleased to add that to the list of issues that were resolved.