UPDATE: The Ups and Downs of Blood Pressure

By November 18, 2017 November 23rd, 2017 Lifestyle & Stress, Nutrition
Blood Pressure

For most people, high blood pressure can be prevented and treated successfully through simple lifestyle modification, which, unlike drugs, has no side effects, is inexpensive, and improves overall health.

New definitions of hypertension, or high blood pressure, have just been released by the American College of Cardiology and the American Heart Association. Overnight, millions of people who thought they had “normal” blood pressure will now be told they have hypertension.

In real terms, the new guidelines add an additional 15 million people age 45-75, more than half of all people in this age group. In total, it’s believed more than 100 million American’s now have high blood pressure.

Unfortunately too many of these new hypertensives will be issued pharmaceutical drugs for their condition — a boon to drug companies — while many more will be encouraged to make ineffective and counterproductive lifestyle changes like adopting a high-carb, low-fat diet and high-intensity exercise routines.

Previously, hypertension was defined as blood pressures above 140/90 (the first number is the systolic pressure, and the second diastolic as measured in millimeters of mercury or mm Hg). The new guidelines define hypertension as 130/80.

Over the past decade, research has shown even the once “normal” blood pressure of 120/80, and certainly numbers above that, may be associated with increased risk of cardiovascular disease, including stroke, in susceptible individuals. Reducing it in a healthy way can improve overall health in other ways as well, such as reducing excess body fat. However, this does not mean people classified as having prehypertension should automatically be on medication — lifestyle modification should be the first line of preventing and treating elevated blood pressure.

Blood pressure is literally the force of blood pushing against the walls of the arteries as the heart pumps blood. This pressure is always changing. It lowers during sleep and relaxation, and rises when you’re awake, stressed and excited. It even changes slightly from minute-to-minute to compensate with the body’s need for increased or decreased blood supply. Systolic pressure can normally vary 10-15 mm Hg, with diastolic ranges of 5-10. Lowering blood pressure too much can impair health, especially for the brain.

The people most at risk from high blood pressure are those with heart or kidney disease, diabetes, and the risk of stroke, and those who are overfat. Hypertension is also a risk factor for overall mortality. Those who are overfat — upwards of 90 percent in developed countries with rising rates in developing countries (e.g. 80 percent in India) — often have hypertension.

The new figures do not include children (a growing problem), or those in other age categories. Rates in other countries are similar. For example, in China, 267 million individuals in the 45-75 age group would be labeled as hypertensive. The new guidelines increase the prevalence of hypertension by about 27 percent in the U.S. and 45 percent in China.

The key cause of the problem in most people worldwide is poor dietary habits, something that is easily corrected without drugs.

Treat the Cause

Addressing the real cause of hypertension is a key consideration: Most of those with high blood pressure may also be overfat. The majority are also carbohydrate intolerant or (insulin resistant). This vicious cycle begins with excess body fat that leads to CI triggering elevated blood pressure. Rising insulin levels can parallel elevations in blood pressure.

Lifestyle changes to address the cause of hypertension begin with reducing excess body fat by eliminating sugar and other refined carbohydrates (aka junk food). Those on medication for high blood pressure must be careful during this process to monitor pressures, which can drop quickly once the problem is eliminated.

During the Two-Week Test, for example, it is recommended that, if your blood pressure is high, have it evaluated before, during and after the test. That’s because for many people, significantly reducing refined carbohydrates and sugars, which reduces insulin levels, will lower blood pressure — often dramatically. As a result, if you’re taking medication to control blood pressure, your doctor may need to reduce, or even eliminate it.

The vast majority of hypertensive patients I initially saw in practice were able to reduce their blood pressure significantly just by strictly avoiding sugar and other refined carbohydrates and sugars. Most of these patients were able to eliminate their medication.

Other causes of hypertension include stress, poor aerobic capacity, nutrition as mentioned below, although these may be secondary to being overfat:

  • Stress. An example of stress raising blood pressure is the condition called “white coat hypertension,” where the stress of a visit to the doctor’s office causes an elevation in blood pressure. This can result in a typical blood pressure of, say, 120/80, to jump to 136/88. In such cases, blood pressure should be checked several times during your visit, where it often measures lower numbers over time if stress levels are reduced.
  • Poor aerobic conditioning. Aerobic exercise is an important factor in both prevention and treatment of hypertension. Even one easy aerobic workout can reduce blood pressure for up to 24 hours. Anaerobic exercise may not be nearly as effective and could even aggravate high blood pressure. It’s important to discuss your particular exercise needs with a healthcare professional — especially one who is aware of the potential benefits of food, nutrition and exercise.
  • Nutritional considerations. When certain nutrients are low, such as calcium and vitamins A and C, the blood pressure may elevate. Eating sufficient amounts of plant foods including vegetables, nuts, seeds, berries and other healthy foods can also help normalize blood pressure.

Blood pressure tends to rise with age. Vessels are not as functional and less blood may circulate throughout the body, especially the brain. The body compensates for this by increasing blood pressure. The aging brain may require higher blood pressures to maintain good brain function. So the new guidelines may be less appropriate for older individuals as both hyper- and hypotension can impair brain function. Taking meds to reduce blood pressure can also reduce cognitive function due to cortical atrophy, sometimes is misinterpreted as “normal” aging.

Hypertension is not normal, and indicates something is wrong, often with lifestyle and typically with diet. Eliminating junk food may be the best place to start.


Hypotension — Low Blood Pressure

Hypotension is abnormal and unhealthy. It results in less blood getting to the heart, brain, intestine, muscles, and virtually all the body’s cells. Low blood pressure is considered below 90/60 mm Hg, but many individuals have signs and symptoms when systolic pressure falls under 100.

Hypotension can cause muscle weakness, sleepiness, fatigue, and dizziness, and even fainting. In severe cases, low-blood pressure can cause blurry vision and confusion, and be life-threatening.

Hypotension could be caused by various drugs, including alcohol, antidepressants and anti-anxiety medications, painkillers, and even meds given for hypertension. In addition, dehydration, diabetes, and certain heart problems like arrhythmias can cause low blood pressure.

One specific type of low blood pressure is orthostatic hypotension. It occurs following a sudden change in body position, most often from lying down to standing, although sometimes sitting up after lying down, or just bending over to pick something off the floor while standing can trigger it. Symptoms include dizziness and lightheadedness that usually lasts only a few seconds. Technically, orthostatic hypotension occurs with a pressure drop of 20 mm Hg or more, but many patients get symptoms with much less of a drop in blood pressure. (Postural hypotension can also occur after eating and is called postprandial orthostatic hypotension.)

An imbalance in the autonomic nervous system, often associated with poor adrenal function can also contribute to orthostatic hypotension. Treatment involves finding the cause and eliminating it, with carbohydrate intolerance a common cause.

Following exercise of various intensity and duration, there is typically a normal drop in blood pressure into the lower ranges of normal. This post-exercise hypotension is defined as a pressure that is lower than the pre-exercise value, and can persists for minutes or hours after an exercise session. This phenomenon is one of the reasons exercise can help reduce hypertension.

A grain of salt

A common notion about high blood pressure is that sodium causes it. In some people with existing high blood pressure, too much dietary sodium can magnify the problem. And that amount is very individual. About 30 to 40 percent of those with hypertension may be sodium-sensitive. For these individuals, even moderate amounts of sodium can increase their blood pressure further. Obviously, these patients should regulate their sodium intake, which is most easily done by avoiding packaged and processed foods and maintaining a diet high in fresh fruits and vegetables, and other natural foods. In many cases, reducing excess body fat can reduce or eliminate sodium sensitivity.

But salt modification for those who have normal blood pressure is not necessary, as sodium will not raise blood pressure in healthy individuals.

Like calcium, magnesium and other minerals, sodium is a nutrient essential for good health. Contrary to the common assumption, Many studies have not shown that sodium causes hypertension.


  • Steve Waller says:

    I am 66 years old and coming back from hernia surgeries and a turp. I had gained weight and lost fitness. I am now doing the 108 and am very low carb while my wife is full keto fat adapted. I am now 19% body fat and waist is less than 1/2 height. My blood pressure has been very sporadic for a long time. I will get VERY high numbers for a period of time, and then it will drop back down to normal. I briefly tried several prescriptions but hated the side effects. Docs just continue to want to medicate. I now take CoQ10 and Hawthorne and magnesium. If my BP runs normal part time and very high sometimes what might you think? i have no heart or other CV issues. Thanks

  • Susan Abbott says:

    I tried the two week CI test, and it made no difference in my blood pressure, still having to take my BP pill and if anything the diastolic is running higher(88-90). I did lose weight and lost an inch from my waist. I also seemed to feel more tired when running on the treadmill and I couldn’t run as fast without my heart rate exceeding my MAF. Happy about the positives but disappointed about my BP and decreased exercise performance. Any thoughts?

    • Hi Susan,

      It often takes longer for some adaptations to kick in (such as reduced BP). The reason your performance decreased is because your body is used to burning sugar to fuel that performance. When you take the sugar away, the performance reduces commensurately—but this is a good thing, because it forces the body to regain it through fat-burning. In order to see longer-term effects of healthy eating, we recommend doing the post-test (post two-week test) to figure out what kind of basic diet works well for you.

  • Rosalee Adams says:

    I am on Lisinopril (40mg divided B/D) and Diltiazem (60mg B/D)
    I was running low 100s systolic and 50s/60s diastolic and
    now I am running 149/65 and sometimes even higher systolic
    Every time I take my bp it stresses me out now.

  • sergio says:

    El incremento de pulsos o pulsos altos , es parámetro para el aumento de la Tensión Arteria?
    Si logro pulsos bajos con el programa M.A.F, baja la Hipertensión?
    gracias sergio

  • Iacob Gheorghita says:

    Na “intolerance” may be, also, related to increased cortisol production. It might simulate renine-angiotensine hiperfunction.
    So, most of the effects: insuline intolerance and sodium intolerance may have the same cause: cortisol production disfunction.

  • Thanks Phil and so true. HTN essentially is arterial stiffness. which Reaven discovered years ago to be the result of insulin resistance. for many it takes months to remodel the blood vessels after years of insulin resistance….but trust me it can be done.

  • Plinker says:

    I am wondering if chronic pain may increase BP?

  • David says:

    I really enjoy the reading. Thanks. I just noticed what I think is a typo:

    “Many studies have not shown the common assumption that sodium causes hypertension is not correct.”

    I assume you did not want to include in this sentence both “not shown” and “not correct”. Right?


  • Alec McQueen says:

    Can you pls check the last sentence? Is that correct?

  • Val says:

    I remember reading in one of Phil’s books that a better indicator of health was to measure the pulse pressure (systolic minus diastolic readings). He said that anything between 30 and 50 was fine. This hasn’t been mentioned. Does he still recommend this?

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