Adults living with high blood pressure (a reading higher than 140/90 mm Hg) often present with a host of comorbidities, most often pre-diabetes/type 2 diabetes, high levels of LDL cholesterol, and obesity. Such conditions render these individuals more vulnerable to such serious health complications as stroke, kidney disease, and cardiac issues. Sadly, this dynamic affects as much as 40-50% of the population in the United States. Eating specific diets to reduce hypertension is often the first recommendation offered by medical providers.
Personal trainers with a background in nutrition/health coaching often help steer clients towards healthier meal plans to support their workouts, especially in light of the prevalence of the aforementioned medical conditions. Studies currently underway point to three very viable options, which we shall discuss in this article: plant-based diets, very low carbohydrate diets, and the trusty DASH Diet recommended to reduce hypertension.
Limiting Salt via DASH
The DASH diet (Dietary Approaches to Stop Hypertension) emerged as a healthy meal plan specially formatted by the American Heart Association to prevent or reduce hypertension. High blood pressure and high LDL cholesterol levels represent two of the most serious risk factors for heart disease and stroke.
This meal plan encourages eating foods rich in potassium, calcium, and magnesium, while limiting foods containing high amounts of sodium and sugar, such as vegetables, fruits, whole grains, fish, poultry, beans, and nuts.
While curbing salt consumption to 2,300 mg/day (the amount found in a mere teaspoon of table salt), the DASH diet also limits fatty meats and full-fat dairy products*, with the intention of reducing serum cholesterol levels.
The American Heart Association’s reasoning for allowing the consumption of meat and dairy when adopting the DASH diet is palatability. They felt that the general public would not be willing to accept a vegetarian diet without specifically allowing for some meat and dairy consumption. Including these food groups will also supply additional calcium and protein. No distinction is made between organic and non-organic, grain-fed or grass-fed origins but research indicates there may be a significant difference on health outcomes.
*It’s worth noting that dairy products are often not easily digested and are the leading source of saturated fat in the diet. Late in childhood or early adulthood, most people lose the enzymes (lactase) that digest the lactose sugar in milk and other dairy products. This is why we have the term lactose-intolerant. It is not a disease but a human condition.
Understanding “Plant-Based” Diets
Studies dating back to the 1920’s report a correlation between the rise in blood pressure and an increase in the consumption of meat and dairy. We often use the term “plant-based” to indiscriminately describe a healthy lifestyle centralizing vegetable consumption, yet not making them the exclusive source of energy, as in vegan and vegetarian diets.
A plant-based diet refers to decreasing the consumption of meat/fully-fat dairy while increasing the consumption of fruits, vegetables, whole grains, and legumes. Any movement on the scale of plant-based eating will increase health by lowering the risks of heart disease via decreasing hypertension/high blood pressure and high cholesterol.
Dan Buettner, an explorer, National Geographic Fellow, award-winning journalist and New York Times bestselling author, discovered the five places in the world – dubbed blue zones – where people live the longest, healthiest lives. He found that these populations accomplished long-term vitality by avoiding junk food and consuming more fruits, vegetables, and whole grains.
Buettner identified the following regions:
- Okinawa, Japan
- Sardinia, Italy
- Nicoya, Costa Rica
- Ikaria, Greece
- Loma Linda, California
A study published in the Journal of the American Heart Association compared four dietary patterns among middle-aged adults and tracked mortality rates. Results indicated that healthful, plant-based diets (those high in nutrient-dense plant foods and low in refined carbs and animal foods) tracked consistently with a decreased risk of cardiovascular disease.
In another study of 89,000 people managing hypertension, those who ate a meat-free diet were able to reduce hypertension by 55% but those who ate a meat-free, dairy-free, egg-free diet lowered their blood pressure by 75%.
Very Low-Carbohydrate Consumption to Reduce Hypertension
The value of plant-based diets in reducing hypertension is only valid when compared to other approaches. Is it the best approach for controlling hypertension?
A new study, the results of which appeared in Annals of Family Medicine, compared a very low-carbohydrate diet to the DASH diet for adults with hypertension, type 2 diabetes, and/or obesity. While both interventions led to improvements in HbA1c (a marker for diabetes), systolic blood pressure, and body weight, the subjects on the low-carb group showed substantially greater improvements.
The study involved 94 adults. Those assigned to a very low-carb diet (VLC) attempted to keep intake below 50 grams of non-fiber carbs per day. The DASH diet participants limited sodium intake to less than 2,300 mg/day, and fat intake to no more than 30% of daily calories. Of course, both groups could consume ample amounts of fruits, lean meats/low-fat dairy, vegetables, and whole grains.
Over a 4-month period, the VLC diet resulted in greater improvements not only in systolic blood pressure, but also glycemic control and weight, than the DASH diet. Reducing refined carbohydrates may be a good recommendation to reduce hypertension.
What about Paleo?
The Paleo diet, a popular diet based on the types of foods presumed to have been consumed by early humans. It mainly consists of meat, fish, vegetables, and fruit. It excludes dairy, grain, and processed foods. This is not a diet generally recommended for someone managing hypertension/high blood pressure.
A study published in the European Journal of Clinical Nutrition indicated that the Paleo diet increased TMAO (Trimethylamine N-oxide: small colorless amine oxide generated by choline, betaine, and carnitine by gut microbial metabolism) levels which are associated with heart disease. The paleo subjects had an increase in cholesterol, fat, and saturated fats which increased the amount of gut bacteria species linked to heart disease and inflammation.
This study on the Paleo diet does include vegetables and fruits. However, if the subjects were consuming higher quantities of fruits and vegetables it would likely balance out the gut bacteria. A more plant-based Paleo diet approach may actually reduce the increased heart disease risk observed in this study.
A meta-analysis looked at the effects of a paleo diet on heart disease risk. It determined that many risk factors were indeed reduced such as body weight, waist circumference, body fat %, total and LDL cholesterol, tryglycerides, even C-reactive protein (a marker of inflammation), and an increase in HDL.
However, the authors qualify these findings by stating that a “sensitivity analysis revealed that the overall effects of a PD on lipid profile, systolic blood pressure, and circulating CRP concentrations were sensitive to removing some studies and to the correlation coefficients, hence the results must be interpreted with caution.”
Better studies are needed to draw more definitive conclusions on whether a paleo diet is effective to reduce hypertension.
Medication versus Lifestyle to Reduce Hypertension
An INTERHEART study showed that diet, exercise, and smoking accounted for more than 90% of the proportion of the risk of having a heart attack. Men who made healthy lifestyle changes over time reduced their risk of a heart attack by 90% while women who made healthy lifestyle changes over time reduced their risk of heart attack by 92%.
Interestingly, solely relying upon medication to manage or reduce hypertension/ heart disease only reduced the risk by 20%-30%. But there is synergy when lifestyle changes are coupled with medication. Harvard Health Professionals’ follow-up study reported that individuals on medication and making healthy lifestyle adjustments further decreased their risk of suffering a heart attack by 78%.
Fitness and Nutrition Coaches
The ideal health and wellness of an individual will vary from person to person. Although people may struggle with similar circumstances, they may differ in how they choose to manage those circumstances. Whether utilizing the DASH diet, designing an easily-sustainable plant-based diet based, or restricting carbohydrate consumption (or some combination thereof), it is clear that what we eat has a tremendous impact on health and the ability to reduce hypertension.
We rely on food for comfort and routine, for communing and celebrating. When a client requires a complete meal plan overhaul following a medical diagnosis. it may feel like their whole world suddenly turned upside down. Knowing such a journey can prove daunting at best, we can best help clients by introducing them to the multitude of tasty food options available within the confines of their chosen diet approach and ease them into the process of change one successful step at a time.
Personal trainers can shift a client’s mindset from one of food deprivation and fear to one of abundance. Over time, the results will speak for themselves