Nutritional Treatments for Hypertension
By Alex Vasquez, ND, DC
Clinical problems associated with hypertension can be divided into two categories, dependent upon the severity and duration of the elevated blood pressure. Mild elevations in blood pressure sustained over a period of many years and decades increases the risk of atherosclerosis, stroke, myocardial infarction, heart failure and renal failure.
Acute elevations in blood pressure, even if sustained for a relatively short time, can cause hypertensive encephalopathy, stroke, retinal hemorrhage, acute myocardial infarction and acute left ventricular failure with pulmonary edema. Many different etiologies exist for hypertension including, but not limited to, metabolic syndrome, hypothyroidism, renal failure and adverse drug effects; the scope of this article is limited to uncomplicated pre-hypertension and stage-one hypertension. Obviously, the goals of therapy are to bring the blood pressure down into the normal range and to prevent end-organ damage, especially to the heart, brain, eyes and kidneys.
Guidelines for the assessment and management of hypertension change periodically based on new consensus and new research data. "Pre-hypertension" or early hypertension begins at 120 systolic over 80 diastolic, while "stage-one hypertension" is in the range of 140/90 to 160/100. Patients beyond stage-one hypertension or those with a complex clinical presentation generally should be co-managed pharmaceutically (at least initially); a table describing hypertensive categories is provided (Table 1). Doctors choosing to manage hypertension in their patients must include proper history, physical examination, laboratory assessment (e.g., chemistry/metabolic panel, urinalysis, thyroid and cardiovascular panels), and the treatment plan must include frequent follow-up (e.g., every two to four weeks) until the problem is resolved. If effectiveness cannot be obtained, sustained or documented, the patient should receive both verbal and written referral to another physician, particularly an internist or cardiologist.
Nutritional Treatments for Hypertension
Nutritional treatments for hypertension include the following considerations, which generally can be used in combination (rather than in isolation, as studied in the research). These will be listed and discussed in order of general effectiveness (Table 2).
- Short-term supervised fasting: Short-term, inpatient, supervised fasting appears to be the most effective documented treatment for chronic hypertension. Working closely with his multidisciplinary team, pioneering chiropractic physician Alan Goldhammer, DC, documented reductions in hypertension of 60/17 in patients with severe hypertension and reductions of 37/13 in patients with moderate hypertension.1-3 Generally, the program begins with four to seven days of a raw vegetarian diet, followed by one to two weeks of fasting, and concluded with reintroduction of a vegetarian and health-promoting diet. Laboratory tests and professional supervision help ensure patient safety.
- Healthy diet and exercise: Health-promoting diets (e.g., Paleo- and Mediterranean-style diets) can lower blood pressure by as much as 17/13 according to some reports.4
- CoQ10: Coenzyme Q10 in doses of 100-225 mg/day can lower blood pressure quite effectively, as documented in several clinical studies, some of which showed that CoQ10 is more effective and safer than the use of antihypertensive drugs.5-7 Reductions in blood pressure generally are in the range of 17/12 and are dose-dependent. A patient who does not respond to 100 mg per day might respond very well to 200 mg per day. Since it's a fat-soluble nutrient, CoQ10 should be administered with dietary fat and/or consumed in a "pre-emulsified" form to enhance absorption, a prerequisite for clinical effectiveness. Several trials have been reported showing enhanced absorption of CoQ10 when administered in pre-emulsified form. CoQ10 is very safe and drug interactions are rare; caution should be used in patients taking coumadin.
- Sodium restriction: Clinical responsiveness to low-sodium diets ranges from minimal to a maximal reduction in the range of 22/14 - 16/9.8 Contraindications to low-sodium diet are uncommon (e.g., hyponatremia); low-sodium diets generally should be a component of all anti-hypertensive treatment plans.
- Vitamin D and calcium: Vitamin D3 (cholecalciferol) and calcium supplementation can reduce blood pressure in hypertensive patients by approximately 13/7.9 As I have discussed in extensive detail elsewhere, a reasonable dose of vitamin D3 for adults is in the range of 2,000 to 4,000 IU per day, and doctors new to vitamin D therapy should read my clinical monograph published in 2004 and available online.10 The most important drug interaction with vitamin D is seen with hydrochlorothiazide, a commonly used anti-hypertensive diuretic that promotes hypercalcemia; vitamin D therapy in patients taking hydrochlorothiazide must be implemented slowly, with professional supervision and with weekly laboratory monitoring of serum calcium. Vitamin D probably corrects hypertension via several mechanisms, including, but not limited to, increased absorption of magnesium and reduction in intracellular calcium, as I described previously in this publication.11 Since vitamin D absorption decreases with age and in patients with intestinal disease (including dysbiosis12), absorption of fat-soluble vitamin D3 is enhanced when administered in pre-emulsified form.13
- Prescription drugs: Use of the nutritional treatments described in this article can complement or replace anti-hypertensive drug therapy in many patients. When used alone, prescription anti-hypertensive drugs average a reduction in blood pressure of approximately 12/6. Initial reductions of 20/10 require combination therapy, according to a review article published in American Family Physician in 2003.14
- Exercise: Moderate exercise can reduce blood pressure by approximately 7/7 in the short term. Longer-term exercise, particularly along with diet improvements and weight loss, can result in synergistic and curative benefits. Patients who have been sedentary for years and those with probable or documented cardiovascular disease should be evaluated by a physician and ECG before beginning an exercise program.
- Fish oil: Fish oil supplementation has been shown to reduce blood pressure by approximately 3/2. For reasons I have detailed elsewhere,15 fish oil should be co-administered with a source of GLA, such as borage oil, in order to maximize effectiveness and minimize subtle biochemical adverse effects. More importantly, fish oil is safer, less expensive and more effective than "statin" anti-hypercholesterolemic drug treatment for reducing total and cardiovascular mortality.
- Food allergy elimination: According to a clinical study of migraineurs published in The Lancet, identification and avoidance of food allergens can normalize blood pressure in approximately 25 percent of migraine patients.16 The anti-hypertensive response to food allergy avoidance can be seen clinically, even in patients who do not have migraine or other manifestations of allergy; but the more allergic symptoms seen and the more complete the response to allergy elimination, the more likely a reduction in blood pressure.
Many nutritional treatments for hypertension are documented in the research literature; several of these treatments appear safer and more cost-effective than pharmaceutical anti-hypertensive drugs. Furthermore, the synergistic use of the nutritional and lifestyle interventions described above - supplemented Paleo-Mediterranean diet along with exercise, fish oil, vitamin D, CoQ10, and sodium restriction - results in clinical benefits that far exceed the results published in the single-intervention clinical trials documenting the effectiveness of the individual components. The major drug interaction one must look out for is the combination of vitamin D with hydrochlorothiazide. Switching from pharmaceutical drugs to nutrients for the management of hypertension requires diligent follow-up, informed consent and documentation of beneficial clinical response, and should be undertaken only by skilled and experienced clinicians.
- Goldhamer A, et al. Medically supervised water-only fasting in the treatment of hypertension. J Manipulative Physiol Ther, 2001 Jun;24(5):335-9.
- Goldhamer AC, et al. Medically supervised water-only fasting in the treatment of borderline hypertension. J Altern Complement Med, 2002 Oct;8(5):643-50.
- Goldhamer AC. Initial cost of care results in medically supervised water-only fasting for treating high blood pressure and diabetes. J Altern Complement Med, 2002 Dec;8(6):696-7.
- Vasquez A. "A Five-Part Nutritional Protocol that Produces Consistently Positive Results." Nutritional Wellness, 2005 Sep. and www.optimalhealthresearch.com/protocol.
- "RESULTS: The mean reduction in systolic blood pressure of the CoQ-treated group was 17.8+/-7.3 mm Hg (mean+/-SEM). None of the patients exhibited orthostatic blood pressure changes. CONCLUSIONS: Our results suggest CoQ may be safely offered to hypertensive patients as an alternative treatment option." Burke BE, Neuenschwander R, Olson RD. Randomized, double-blind, placebo-controlled trial of coenzyme Q10 in isolated systolic hypertension. South Med J, 2001 Nov;94(11):1112-7.
- "These findings indicate that treatment with coenzyme Q10 decreases blood pressure possibly by decreasing oxidative stress and insulin response in patients with known hypertension receiving conventional antihypertensive drugs." Singh RB, Niaz MA, Rastogi SS, Shukla PK, Thakur AS. Effect of hydrosoluble coenzyme Q10 on blood pressures and insulin resistance in hypertensive patients with coronary artery disease. J Hum Hypertens, 1999 Mar;13(3):203-8.
- "...51% of patients came completely off of between one and three antihypertensive drugs at an average of 4.4 months after starting CoQ10." Langsjoen P, Langsjoen P, Willis R, Folkers K. Treatment of essential hypertension with coenzyme Q10. Mol Aspects Med 1994;15 Suppl:S265-72.
- "The average fall in blood pressure from the highest to the lowest sodium intake was 16/9 mm Hg." MacGregor GA, Markandu ND, Sagnella GA, Singer DR, Cappuccio FP. Double-blind study of three sodium intakes and long-term effects of sodium restriction in essential hypertension. Lancet, 1989 Nov 25;2(8674):1244-7.
- "A short-term supplementation with vitamin D(3) and calcium is more effective in reducing SBP than calcium alone. Inadequate vitamin D(3) and calcium intake could play a contributory role in the pathogenesis and progression of hypertension and cardiovascular disease in elderly women." Pfeifer M, Begerow B, Minne HW, Nachtigall D, Hansen C. Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. J Clin Endocrinol Metab, 2001 Apr;86(4):1633-7.
- Vasquez A, Manso G, Cannell J. The clinical importance of vitamin D (cholecalciferol): a paradigm shift with implications for all healthcare provid-ers. Altern Ther Health Med, 2004 Sep-Oct;10(5):28-36 Click to view it online.
- Vasquez A. "Intracellular Hypercalcinosis. A Functional Nutritional Disorder with Implications Ranging From Myofascial Trigger Points to Affective Disorders, Hypertension and Cancer." Naturopathy Digest, 2006 Sep.
- Vasquez A. Reducing pain and inflammation naturally. Part 6: nutritional and botanical treatments against "silent infections" and gastrointestinal dysbiosis, commonly overlooked causes of neuromusculoskeletal inflammation and chronic health problems. Nutritional Perspectives, 2006 Jan. Click to view it online.
- Vasquez A. Subphysiologic Doses of vitamin D are sub-therapeutic: comment on the study by The Record Trial Group. Lancet 2005; published online May 6. Click to view it online.
- Magill MK, Gunning K, Saffel-Shrier S, Gay C. New developments in the management of hypertension. Am Fam Physician, 2003 Sep 1;68(5):853-8 Click to view it online.
- Vasquez A. Reducing pain and inflammation naturally. Part 2: new insights into fatty acid supplementation and its effect on eicosanoid production and genetic expression. Nutritional Perspectives 2005 Jan: 5-16. Click to view it online.
- Grant EC. Food allergies and migraine. Lancet, 1979 May 5;1(8123):966-9.