Chances are you or a loved one has high blood pressure. One in five people in the United States do, which means that 50 million people are faced with the possibility of a lifetime of drugs and their side effects. But high blood pressure (hypertension) can be beaten. Even if drugs can't be avoided entirely, by taking the right natural measures we can use substantially less.

While many doctors recommend reducing salt intake, following a low-fat/low-protein diet, and exercise, there are important cautions about these recommendations of which many aren't aware. Too many people ultimately resort to prescription drugs. There are many types of blood-pressure medications-calcium channel blockers, diuretics, ACE inhibitors, and beta-blockers are the most common types. Fortunately, there are also natural options. The right combination of nutrients, herbs, and diet modifications that are right for you can lower your blood pressure once and for all.

What works for someone else may not work for you

For some of us, the old saying "you are what you eat" holds true. It might be a good idea in some cases to cut out a few of the eggs, cream sauces, and slices of pizza.  A diet containing more fruits, vegetables, and whole, natural starches rather than high proteins could be your best bet. However, the key words here are "in some cases" and "could."

Decades ago, public-health researchers observed that women and men who had been strictly vegetarian all their lives had lower blood-pressure readings in their 60s and 70s than did men and women who ate considerable animal protein. (Strictly vegetarian women had the best bone density, too, but that's a topic for another time.) A vegetarian diet provides a better potassium-to-sodium ratio. Having more potassium and less sodium helps regulate blood pressure.

But a vegetarian diet isn't the best choice for everyone and, in fact, could cause more harm than good for some.

People with high blood pressure who have a personal or family history of Type II (adult-onset) diabetes usually have insulin resistance/hyperinsulinemia. The term insulin resistance refers to the impaired use of insulin by cell membranes. Hyperinsulinemia occurs when the pancreas overproduces insulin in an attempt to overcome insulin resistance. (Insulin resistance/ hyperinsulinemia is easily diagnosed via a glucose-insulin tolerance test.)

Hyperinsulinemia is a known cause of high blood pressure. To bring insulin overproduction under control, the most necessary dietary changes are total elimination of sugar and refined carbohydrates and a sharp reduction in overall carbohydrate intake, especially such starches as potatoes, beans, pasta, and grains. Obviously, this diet pattern is not vegetarian, but as it helps bring hyperinsulinism under control, blood pressure is also better regulated.

Food allergies may be the culprit

For a minority of individuals with hypertension, elimination or desensitization of food allergies can help lower blood-pressure levels, though no one has been able to successfully explain the connection. If there's a personal or family history of allergy, it's worth investigating. The most notable individual case of allergy-aggravated hypertension I've worked with involved a gentleman who was undergoing maximum antihypertensive drug therapy but still had blood-pressure readings ranging from a minimum 180/120 to a maximum 220/150. Once he discovered and eliminated all food allergies, his blood pressure dropped to a level ranging from 160/100 minimum to 180/120 maximum.

Biofeedback and exercise-old news, but underrated and underused

Biofeedback is another valuable and frequently effective "non-drug" tool for lowering blood pressure. It is not so much a "treatment" as it is a training program. Using external instruments, a reading is obtained of your body's reactions to stress. Through practice, you learn to recognize the physiological responses you have that might be causing unhealthy reactions and teach yourself how to control those responses. Biofeedback centers are found in all major and most midsize cities.

Exercise can also significantly lower high blood pressure. Even light exercise can make a big difference. The amount that's healthy varies from person to person. Caution: If you have more than a little high blood pressure, it's best to check with a doctor or other knowledgeable individual before starting a strenuous exercise program. (See the guidelines cited in the last paragraph.)

Nutrients: which to cut back on and which to increase

Sodium. You've probably heard that cutting WAY back on salt intake is an important step in lowering high blood pressure. It's also a difficult task for some folks. Not everyone is willing to eat boiled chicken and steamed carrots every day. Actually, this severe restriction is less a "universal recommendation" than it once was. In fact, some researchers have found that severe sodium restriction actually increases the risk of premature death.  It's wisest for each person with high blood pressure to determine individually through trial and error whether or not salt restriction makes a difference. (Hint: More often than not, it does.)

Potassium. Sometimes it reduces blood pressure; sometimes it doesn't. Since higher potassium does reduce stroke risk, it's always wisest to take extra potassium if you have high blood pressure, even if it doesn't lower your actual blood-pressure numbers. As vegetarian diets contain considerable potassium and less sodium, potassium supplementation for "vegetarian hypertensives" may be less necessary. For non-vegetarians, 300-500 milligrams daily is advisable. "Juicing" vegetables and low-sugar fruits like apples, pears, and cantaloupe is an excellent way to make potassium more available for absorption. Drinking 24 ounces or more daily can eliminate the need to take potassium pills or capsules and supplies many other important nutrients.

Calcium, magnesium. For some individuals, about 1 gram (1,000 milligrams) of calcium daily can reduce blood pressure by five to 10 points. For others, calcium makes very little difference. It appears to work more often for those with insulin resistance/hyperinsulinemia. If you do supplement with calcium, it's important to balance it with magnesium. Suboptimal magnesium intake is relatively common, since the major sources are green vegetables. Magnesium by itself can lower your blood pressure, since it helps relax muscles, including those of the smaller blood vessels, thus helping to dilate them and improve blood flow. Supplementing with 300-400 milligrams daily is usually sufficient.

Vitamin C. A very recent "research letter" to Lancet reconfirmed that vitamin C lowers elevated blood pressure [1].  Although this study used less, I usually recommend a minimum of 1 gram, twice daily.

Supplement with amino acids

Amino acids are the "building blocks" from which all proteins are made. In certain cases, supplementation has lowered blood pressure.

At least one study for each demonstrated that L-tryptophan [2] and taurine [3] can lower blood pressure in essential hypertension (high blood pressure with no known cause). In the study noted, the effect of L-tryptophan was increased by dietary carbohydrates, suggesting it might be less useful for those on high-protein diets. The amount used was 3 grams daily. (Despite being an "essential-to-life" natural amino acid, L-tryptophan is presently available only by prescription.)

Quantities of taurine used in the study noted were relatively large (but safe)-6 grams daily. I usually recommend less-1 to 2 grams daily-when taurine's used in combination with other nutrients and botanicals. This study also found that taurine lessened the rise in levels of adrenaline produced by stress.

L-arginine has gained considerable "notoriety" lately as the precursor to nitric oxide (NO), the blood-vessel-dilating metabolite essential to male sexual function. However, that same blood-vessel-dilating ability has been found to improve heart function in cases of congestive heart failure. And, although I'm aware of no formal studies yet, I've observed small reductions in blood pressure in hypertensive individuals who've made use of L-arginine. (Caution: L-arginine can sometimes "activate" a dormant herpes infection. It's best to consult with a doctor skilled and knowledgeable in nutritional medicine before using it.)

The benefits of more metabolites: coenzyme Q10 and DHA

Metabolites are molecules made in our bodies from other (precursor) materials. Sometimes, directly supplying the body with extra quantities of certain metabolites can be much more effective than supplying the precursor materials. This is definitely the case with coenzyme Q10, as our bodies make less and less of this metabolite as we grow older.

Coenzyme Q10 aids in metabolism in every cell in the body. It's found in greatest concentration in the mitochondria, the "energy engines" of the cells. It's such an important metabolite that, despite its relative expense, I recommend a small amount (30 milligrams) for everyone over 60 and more (50 to 150 milligrams daily) for everyone with high blood pressure.

Another important metabolite that helps lower blood pressure is docosahexaenoic acid, or DHA (not to be confused with DHEA). This is an omega-3 fatty acid, a metabolite of the essential fatty acid alpha-linolenic acid. A very recent study [4] reported that 4 grams daily of DHA lowered blood pressure in hypertensive patients by a small but significant degree. Other researchers have reported that DHA lowered noradrenaline (a close relative of adrenaline) output in medical students during the stress of examinations [5]. (As mentioned above, one effect of taurine is the reduction of adrenaline levels under stress. It's likely that taurine and DHA would be a good combination for "excitable" hypertension sufferers.)

Botanicals can offer a powerful option

Although you'll encounter  a few foods that your doctor will tell you to stay away from if you have high blood pressure, there are also certain foods and herbs that can help.

Garlic may be smelly, but it lowers blood pressure. An overall analysis of eight trials [6] concluded that 600 to 900 milligrams of garlic powder standardized to contain 1.3 percent alliin, one of the active ingredients in garlic (roughly equivalent to 2 to 3 grams of fresh garlic daily), significantly reduced blood pressure over a 30-90 day period. Typical reductions were 11 points systolic and 5 points diastolic, or 11/5.

A lesser known but still important botanical is olive leaf. I've used it with some patients with success. In one recent study, consumption of a water extract of olive leaf resulted in a significant reduction (average 18/10) in blood-pressure levels. As only powdered olive leaf in capsule form is presently available in the United States, I've been recommending a trial of  amounts similar to those used by the researchers, 500 milligrams  four times daily. Like many of the items noted above, olive leaf can take three to four months to show an effect.

Sarpaganda (better known in Western medicine as rauwolfia) has been used in India for centuries to treat ailments like fevers and snake-bites. Early 20th-century pharma- ceutical chemists searching for "magic-bullet," single-ingredient, process-patentable, FDA-"approvable" drug treatments managed to isolate one of the active ingredients in sarpaganda-reserpine. (A similar "achievement" of the same general time period was the isolation of cocaine from much less harmful whole coca leaf.) Western physicians started using reserpine instead of whole natural sarpaganda to lower blood pressure. Unfortunately, many of them prescribed excess dosages of reserpine. These excess dosages caused ailments including depression and occasional suicide. Although several studies have demonstrated that low-dose reserpine controls blood pressure without causing depression, it is, because of its prior misuse, still infrequently prescribed [7].

Sarpaganda, although 100 percent natural, is definitely a very effective "big gun" in hypertension treatment, but one should use it only when working with a phy-sician knowledgeable in nutritional and botanical medicine. Because of its reputation, I recommend its use when diet modification and everything else in this article have been adequately tried and found ineffective. Following the recom-mendations of physicians more knowledgeable than I in Ayurvedic medicine, I recommend it be used initially in low doses in a traditional Ayurvedic combination.

Herbalists have been telling us for most of the 20th century that it's really better to use the whole herb containing the active ingredient(s), for at least two reasons. First, a smaller quantity of the active ingredient(s) is usually effective because of synergistic effects of other parts of the herb-and the whole herb usually holds less potential danger than the isolated active ingredients. Second, herbalists have told us that combining the whole herb with other selected herbs can further lessen the quantity of active ingredient(s) necessary to achieve significant results and further lessen potential danger.

For these reasons, I usually recommend sarpaganda as found in an Ayurvedic combination, Cardiotone, that contains 50 milligrams of sarpaganda per capsule; take one capsule three to four times daily. It's only occasionally necessary to use sarpaganda (rauwolfia) by itself in higher quantities.

Underactive thyroid: an often overlooked culprit

Dr. Alan Gaby has been chiefly responsible for reminding us that the incidence of hypothyroidism (underactive thyroid) is higher in individuals with high blood pressure as compared with those with normal blood pressure. Following the lead of Dr. Broda Barnes, he also reminds us that even the most up-to-date "thyroid blood tests" not infrequently miss instances of "subclinical" hypothyroidism. Individuals with both hypertension and a weak thyroid, subclinical or otherwise, can lower their blood pressure with thyroid supplementation [8]. Some signs of an underactive thryroid are low body temperature, dry skin, and a slow ankle reflex. It's best to talk to your doctor if you think there's a problem.

If you have high blood pressure, nearly all the diet and supplementation ideas discussed (with the exceptions of sarpaganda and thyroid) are safe to try with or without a doctor. If you don't have high blood pressure but it's "in the family," it can't hurt and may help in prevention to try a few basics: Perhaps you might "trend" toward vegetarianism if there's no maturity-onset (Type 2) diabetes in your family or eliminate sugars and cut down on carbohydrates if there is. Calcium and magnesium are "basic" for many things, including osteoporosis prevention, so why not take them to help prevent high blood pressure too? And coenzyme Q10 is good for any of us past age 60.

If you're concerned about high blood pressure and wonder what yours might be, there are many places to have it measured for free, including drugstores, fire stations (when the firemen aren't fighting fires), health fairs, and "senior centers." Home blood-pressure-monitoring equipment is quite accurate, and most places that sell it will teach you how to use it as well. A reading of 140/90 is still generally considered "the upper limit" for safe blood pressure. If it's consistently higher, it's definitely time to do something....but why not try some of the ideas above before it goes over that limit?

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References

1 Duffy SJ et al. Treatment of hypertension with ascorbic acid. Lancet 1999;354:2048

2 Lehnert H et al. Effects of L-tryptophan on blood pressure in essential hypertensives. Clin Exp Theory Pract 1987;A9(1):208 (Abstract)

3 Fujita T et al. Effects of increased adrenomedullary activity and taurine in young patients with borderline hypertension. Circulation 1987;75:525

4 Hypertension 1999;34:253

5 Sawazki S et al. The effect of docosahexaenoic acid on plasma catecholamine concentrations and glucose tolerance during long-term psychological stress: a double blind placebo controlled study. J Nutr Sci Vitaminol 199;45:655

6 Silagy CA Neal AW. A meta-analysis of the effect of garlic on blood pressure J Hypertension 1994;12:463

7 Fraser IS Reserpine: A tragic victim of myths, marketing, and fashionable prescribing. Clin Pharmacol Therapeutics 1996;60:368

8 Gaby AR Wright JV The Patient’s Book of Natural Healing  Prima Publishing, Rocklin California, 1999. Page 203

9 Cherif  S.  (article in French) J Pharm Belg 1996;51(2):69 (This reference was accidentally not numbered in the issue text. It  is for the study on olive leaf; pg. 5, column 3, June, 2000 in your issue of N&H.)

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