The Use Of Nutritional Supplements In Hypertension
by Carl Germano, M.A., R.D., CNS
With over 58 million people in the United States known to be hypertensive, it is rather amusing to witness that a low salt diet and maintaining proper weight is the best that modern medicine can offer in the way of nutritional intervention. Ninety percent of these individuals have essential hypertension of which there is no known cause. Importantly, there can be no doubt that left untreated, hypertension can be devastating and lead to stroke, heart attack or kidney failure. The seriousness of such should warrant the most comprehensive, non-invasive approach to treatment that includes nutritional therapy above and beyond prehistoric thinking. In clinical practice, I was amazed at the myopic view taken by physicians of the role of minerals and blood pressure regulation. For the longest time, the primary focus has been on the relationship of sodium (salt), weight reduction and complete avoidance of calcium, magnesium and potassium's role in intracellular and extra cellular electrolyte balance. Why were they ignoring the potential benefit these minerals have on blood pressure regulation. Why were several other documented components such as sugar, antioxidants, garlic, CoQ-10, hawthorn and omega 3 fatty acids (fish oils) also ignored. Why was modern medicine turning their backs to emerging scientific evidence on the role of various nutrients in blood pressure regulation and supplementation above and beyond the pre-Neanderthal recommended dietary allowances (RDA).
With health care costs expected to reach 1 trillion dollars, either you better hold on to your wallets or consider a safer, less costly alternative to blood pressure regulation - nutritional therapy. A major role in the development of hypertension exists in the literature. From the volumes of studies available., the majority of hypertensive patients (those with mild elevated blood pressure) do not obtain a cardiac benefit from drug therapy and that the risk of some drugs outweighs the small benefit. Therefore, diet and other non pharmacological approaches represent a safer approach to treating this disease with the added benefit of decreased cost.
Scanning The Literature
As mentioned, most cases of hypertension can be controlled through changes in diet, lifestyle and nutritional supplements. Yet despite this, antihypertensive medications rank among the most widely prescribed medications and have a plethora of undesirable effects. Therefore, the following information is a brief focus on the available research on selected adjunct nutritional supplementation that may play a significant role in the regulation of blood pressure. This represents a brief overview which is to be continued in a future issue. It is this information that you will not hear from your doctor and what the FDA does not want you to know.
Certainly overlooked and never discussed is the role sugar plays in high blood pressure. Several studies have confirmed that high sugar intake increases arterial pressure in both animals and humans (1,2). It is interesting to note that high sugar intake potentiates the effect of sodium chloride's (salt) influence on blood pressure. Excess sugar consumption may result in a high insulin response which may decrease the release of sodium out of the body and increase blood pressure (3). Therefore, a high sugar intake exerts increase sodium retention, elevate insulin release and increase adrenaline; all of which may have deleterious effects on blood pressure (4). Avoidance of sugar, sweets and high refined carbohydrate's, with particular attention to adequate chromium intake, is recommended. Good chelated yeast free choices include chromium picolinate, chromium polynicotinate and chromium nicotinate/glycinate for allergic individuals. GTF forms of chromium from yeast are biologically active.
A great deal of interest has been focused on the role of dietary fatty acids and their influence on the cardiovascular system. Studies have demonstrated the role of omega 3 fatty acids and linoleic acid, an essential fatty acid, exert hypotensive effects in humans (5). Studies of hypertensive patients taking large doses of fish oils offer both blood pressure and triglyceride lowering responses (6). In general, fish oil supplements were associated significant reductions in both systolic and diastolic readings (7). While others have reported profound hypotensive effects of dietary linoleic acid (8). These effects are principally due to their influence on potent chemical regulators called prostaglandins which affect various systems, in the body, from blood pressure to immunity (9). Excellent sources of the essential fatty acids include primrose, borage and flaxseed oils. The benefits of fish oils require higher doses than consumed in the diet and can be obtained from Max EPA or salmon oil supplements.
Considerable benefits of CoQ-10 on the cardiovascular system exist in the literature. From congestive heart failure to hypertension, CoQ-10 has paved a path as one of the most important nutritional agents to treat disorders of the cardiovascular system to date. It has been determined through enzymatic assays that many hypertensives are deficient in CoQ-10 levels in the body (10). Several studies have confirmed the efficacy of CoQ-10 in the treatment for hypertension. CoQ-10 supplementation resulted in a reduction in high blood pressure in 80% of the patients demonstrating benefit from decreasing peripheral resistance and total cholesterol (11,12). Other studies confirm the significant reductions in both systolic and diastolic blood pressure using CoQ-10 supplementation (13,14). Significant results in many studies were achieved with CoQ-10 supplement dosages of 60 -100 mg per day or greater.
The critical role and importance of electrolyte (calcium, magnesium, potassium and sodium ions) balance cannot be overemphasized in the regulation of blood pressure. The results of numerous studies suggest integral roles of each mineral individually as well as together in the treatment of hypertension.
Magnesium's beneficial profound effects on the cardiovascular system have been elucidated in the literature. Levels of magnesium in hypertensive patients have been consistently low when compared to normal controls. Studies have revealed magnesium's role as a natural calcium channel blocker (common medication used to treat hypertension) exerting a dilating effect in blood vessels leading to blood pressure reduction (15,16). While other studies demonstrate magnesium's role in hypertension to be a reasonable single therapy or adjunct to hypertensives and diuretics (17,18). What one needs to look for are the chelated forms of magnesium and to distribute the dake and high blood pressure in pregnant women (21,22) while several population studies showing a relationship between calcium deficiency and increased prevalence of hypertension (23,24,25). Most of the clinical trials have used supplements of 1000 to 1500 mgs of elemental calcium. It is most interesting to note that their exists a few studies that demonstrated no significant reduction in blood pressure using dietary sources of calcium from dairy products (26). There should be no surprise to the insignificant results achieved by increasing dairy since the increased protein may actually increase the loss of calcium in the body. Once again, look for chelated calcium supplements, preferably the citrate and citrate/malate forms.
Epidemiological evidence exists suggesting that high blood pressure is inversely related to dietary potassium and that increasing potassium intake can lower blood pressure in those with essential hypertension. Other studies show that potassium depletion in normal individuals causes sodium retention and an increase in blood pressure (27). Potassium plays a critical role in cell membranes that help regulates smooth muscle in blood vessels. It has also been demonstrated that increasing the level of potassium can increase the release of sodium out of the body and reduce antihypertensive medications while deficiencies can increase one's sensitivity to salt and can lead to constriction of blood vessels (28,29). The benefits of a high potassium intake may go beyond helping blood pressure since recent data suggests that high potassium intake decreases the risk of stroke, morbidity and mortality (30,31). The best way to achieve high potassium intakes is not through supplements in pill form since there are limitations of only 99mg potassium which can be provided without a prescription. Therefore, high potassium drinks, vegetable juices and high potassium foods such as apricots, bananas, tomatoes, carrots and beans are advisable.
Sodium and salt consumption in the United States has been shown to be quite excessive above and beyond healthy physiological needs. It has been well established in numerous studies that excess sodium in the diet can lead to or complicate high blood pressure. It is my intention not to elaborate on this much talked about nutrient. Therefore, clinical trials have demonstrated that sodium restriction will lower blood pressure in many patients while lowering their need for medications. It has been established that in salt sensitive individuals, high levels of salt (sodium) can increase blood pressure by 10%. It is imperative that your customers pay particular attention to food labels which must report the amount of sodium. Understand that several "health food" items contain appreciable amounts of sodium including soy and tamari sauces, snack items and frozen goods. While low sodium diets ranging from 1 to 3 grams of sodium per day are commonly prescribed, the amount of sodium in just 1 teaspoon of salt is equivalent to 2.4 grams!
Lastly, several other nutritional components including garlic, vitamin C, antioxidants and hawthorn have also shown promise in the nutritional treatment of blood pressure and will be discussed in a future issue. This paper outlined some of the research pertaining to nutritional factors important in treating hypertension. It is imperative that the individual always seek the attention of a medical practitioner when embarking on treatment. If your physician cannot work with nutritional supplements, find yourself a better educated practitioner! The following is a protocol that I have used in conjunction with medical care. Obviously, it is a guideline and must be adjusted to the individual and the medical concerns presented.
Nutritional Protocol For Hypertension
1) Presuss, H.G., et al,: Life Science, 30:879-886, 1982