Two-thirds of Americans have either prehypertension or hypertension, both of which are major risk factors for cardiovascular disease (CVD), the leading cause of the death in the United States. However, prescription drugs may not be necessary to treat high blood pressure. Read on to learn what dietary changes, lifestyle strategies, and supplements can help lower blood pressure naturally.
Eighty million U.S. adults, or one in three, have hypertension (1). Another one in three have prehypertension, defined as blood pressure in the range of 120–139/80–89 mmHg. In addition to costing $48.6 billion annually, hypertension is a major risk factor for cardiovascular disease, congestive heart failure, chronic renal failure, and stroke (1). Even prehypertension increases the risk of death from CVD (2). Because of its severity, hypertension requires immediate treatment, but prescription drugs may not be the answer.
Risks of Blood Pressure-Lowering Medications
Blood pressure-lowering medications include diuretics, beta-blockers, ACE inhibitors, and calcium channel blockers. Often, more than one is needed to control hypertension.
Initially, these medications were only recommended for people whose blood pressure exceeded 160/100 mmHg, but they are now routinely prescribed when blood pressure approaches 140/90 mmHg, even in the absence of any previous cardiovascular event. Treating mild hypertension with drugs has not been shown to be effective, yet it is common practice (3, 4).
Some of the risks of blood pressure-lowering medications include headaches, dizziness, depression, sleep problems, erectile dysfunction, and renal or cardiac dysfunction. Often, these side effects lead to additional prescription drugs like testosterone or Viagra. The good news is that dietary changes, lifestyle strategies, and supplements have the potential to reverse high blood pressure without the need for lifelong prescriptions.
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Nutrients for Lowering Blood Pressure
Hypertension affects 33 percent of American adults, yet only 1 percent of hunter–gatherer populations following a traditional diet develop high blood pressure (5). The Standard American Diet, full of added sugars, refined grains, and industrial seed oils, sets the stage for hypertension to develop. The following nutrients and food guidelines, as part of a Paleo diet, can help lower blood pressure.
High potassium intake is associated with lower blood pressure (8, 9, 10). The average American only consumes 2,800 mg per day, far below the recommended 4,700 mg (11). Paleo diets, on the other hand, average 10,500 mg per day. Starchy vegetables and tubers are terrific sources.
Increasing serum measurements of DHA/EPA, markers of fish intake, are related to lower blood pressure (12, 13, 14). However, steer clear of most fish oil supplements and instead have patients obtain beneficial nutrients from whole foods whenever possible. A recent analysis showed that the three top-selling fish oils in the United States contained oxidized lipids that may be causing more harm than good (15). Beyond DHA and EPA, fish also have selenium, zinc, iron, and a highly absorbable protein that also may reduce blood pressure (16). Aim for cold-water fatty fish three times a week.
High magnesium intake is associated with lower blood pressure and may have a synergistic effect with potassium. Increasing both nutrients while moderately reducing sodium can lower blood pressure to the same extent as a single medication (17). Magnesium stimulates vasodilators and can inhibit free radical formation in blood vessels (18). Nuts, seeds, spinach, beet greens, and chocolate are good whole food sources.
Adequate vitamin K2 helps keep calcium from residing in blood vessels, thereby preventing hypertension and calcification (19). Vitamins K1 and K2 have different forms and functions. Vitamin K1 is abundant in leafy greens and many other foods, while vitamin K2 sources are more uncommon: natto (fermented soy), some cheeses, butter from grass-fed cows, goose liver, and egg yolks.
Vitamin D deficiency is associated with increased risk of developing hypertension (20), and large doses of vitamin D (50,000 IU per week) have been shown to lower blood pressure over eight weeks (21). One mechanism by which vitamin D may lower blood pressure is through suppressing renin, which regulates mean arterial blood pressure (22). Sun exposure is an easy and cheap way to get vitamin D.
Despite what mainstream medicine claims, restricting salt too much can actually increase the risk of death from CVD (23). Unless your patient is part of the small minority of salt-sensitive people, there is no reason to advise consuming less than 1.5 teaspoons, or 3,600 mg, per day, which is the average American consumption.
A host of other foods have been correlated with lower blood pressure: nuts (24), beet juice (25, 26), blueberries (27), seaweed (28), chocolate (29, 30, 31), and hibiscus tea (32). Not surprisingly, all of these can be part of a Paleo diet, which has been shown to be blood pressure-lowering itself (33, 34).
Lifestyle Changes Are Safe, Effective, and Underutilized
What we eat is only part of the picture of good health. Lifestyle choices carry equal weight, yet they are often only considered as afterthoughts. Take some time to seriously discuss with patients what changes need to be made.
Some patients will cringe at the suggestion of exercise, because they envision a chronic cardio scenario like a mouse on a running wheel. Spread the good news: exercise of all kinds—endurance, dynamic resistance, HIIT, isometric resistance—has the potential to reduce blood pressure (38). Whatever exercise your patients will actually do on a regular basis is the best recipe for success. In patients with extreme hypertension, be cautious with exercises that may further increase blood pressure to an unsafe zone (39).
Short and poor-quality sleep are both associated with raised blood pressure (40). On the other side of the spectrum, excessively long sleep may also be harmful. One study found increased blood pressure in those who got fewer than five hours of sleep per night and in those who averaged more than nine hours of sleep per night, when compared with people who slept around seven hours (41). I suspect that it’s not the long sleep itself that is the problem, but that some underlying condition is both increasing sleep requirement and raising blood pressure.
Sunlight exposure increases the vasodilator nitric oxide and can lower blood pressure. UVB rays also help manufacture subcutaneous vitamin D3, a nutrient already discussed above (42).
Meditation of all types is associated with blood pressure control, enhanced insulin resistance, and reduced lipid peroxidation (43). Its relaxing effects on the nervous system are effective in both young and older adults (44, 45).
I have several articles about the importance of stress management, as stress is a major risk factor for high blood pressure and CVD (46). Self-care, proper sleep, and letting go of “busyness” are several strategies.
Knowing what changes to make is only the first step; following through in sustainable, practical ways is the tougher aspect of healthy living. This is where health coaching, one of the fastest-growing professional fields, can make all the difference. Many patients know what diet and lifestyle changes are needed, but they have trouble following through day to day. A health coach can provide the more frequent support and accountability that a general healthcare provider cannot.
As you can already conclude, treating hypertension without conventional drugs is a tedious process that requires proactive patient behavior that requires more than just a regular doctor visit. It includes a multitude of actions from habit change to nutrition which can only be achieved if the patient is given the proper time and support.
Functional medicine is based exactly on the premise of stronger physician-patient relationship through extensive visits and proactive patient role. If you wish to learn more about functional medicine and take your practice to the next level check out the ADAPT Practitioner Training Program.
Supplements for Lowering Blood Pressure
Below are supplements I recommend for lowering blood pressure. However, prescription medications should be considered if diet and lifestyle aren’t adequate or if blood pressure has been high for a while because high blood pressure is such a significant risk factor for CVD and death.
CoQ10 is an antioxidant that has vasodilation effects (53). Levels are generally lower in patients with high blood pressure, CVD, and type 2 diabetes. Newer formulas help improve absorption of this fat-soluble supplement.
Allicin, found in garlic, is a vasodilating agent and can reduce blood pressure (54, 55). Because heat during processing can lower the allicin content of supplements, not all products are equal. My preference is Garlicin.
Supplementing with 1,000 to 2,000 milligrams per day of potassium can be effective, especially when dietary potassium is inadequate, such as when a patient is on a low-carb diet and avoiding starchy foods like potatoes, sweet potatoes, plantains, and bananas (58).
Cod Liver Oil
If patients are not eating cold-water fatty fish a few times a week, one gram per day of cod liver oil may help.