Strategies to Prevent Hypertension

By Dr. Mercola

About one in three American adults have hypertension (high blood pressure), and according to the Centers for Disease Control and Prevention (CDC),1, 2hypertension is "the second greatest public health threat" in the US.

About half of all with hypertension have uncontrolled high blood pressure, which increases your risk for a number of more serious health problems, including heart attack, stroke, congestive heart failure, and end-stage kidney disease.3

Interestingly, 16 million Americans who take blood pressure medication still do not have their blood pressure under control4 — a fact that emphasizes the need for basic lifestyle changes to truly resolve this problem.

According to medical physiology textbooks, 95 percent of the causes of hypertension is idiopathic, meaning the underlying cause is unknown.

This is simply not true. Hypertension is typically a symptom of insulin and leptin resistance. And the vast majority of those who have hypertension can normalize their blood pressure without resorting to drugs.

What Causes Hypertension?

One of the primary underlying causes of high blood pressure is related to your body producing too much insulin and leptin in response to a high-carbohydrate and processed food diet.

As your insulin and leptin levels rise, it causes your blood pressure to increase. Research published in 1998 in the journal Diabetes reported that nearly two-thirds of the test subjects who were insulin resistant also had high blood pressure, so the link is significant.

Elevated uric acid levels are also significantly associated with hypertension, so any program adapted to address high blood pressure needs to help normalize both your insulin sensitivity and uric acid level.

As it turns out, by eliminating excess sugar/fructose from your diet, you can address all three issues in one fell swoop. Other treatment strategies that I'll discuss below also tend to have this effect. But first, let's review some of the basics of what high blood pressure is, how to assess obesity-related hypertension risk, and why drugs aren't an ideal solution.

How's Your Blood Pressure?

There are two num­bers given in a blood pressure reading. The upper or first number is your systolic blood pressure reading. The lower or second number is your diastolic pressure.

Example: 120 / 80 = 120 systolic arterial pressure and 80 diastolic arterial pressure.

Your systolic pressure is the highest pressure in your arteries. It occurs when your ventricles contract at the beginning of your cardiac cycle. Diastolic pressure refers to the lowest arterial pressure, and occurs during the resting phase of your cardiac cycle.

Ideally, your blood pressure should be about 120/80 without medication. If you're over the age of 60, your systolic pressure is the most important cardiovascular risk factor. If you're under 60 and have no other major risk factors for cardiovascular disease, your diastolic pressure is believed to be a more important risk factor.5

According to the latest guidelines6, 7, 8 issued by the Joint National Commit­tee (JNC) on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, published online in the Journal of the American Medical Association(JAMA) in December 2013, the following blood pressure classifications are used to determine whether you might suf­fer from hypertension:9

Blood Pressure Classification	Systolic Pressure(mmHg)	Diastolic Pressure(mmHg)
Normal	<120 td="">	<80 td="">
Pre-hypertension	120-139	80-89
Stage 1 Hypertension	140-159	90-99
Stage 2 Hypertension	≥160	≥100

Primary versus Secondary Hypertension

Hypertension is also categorized as either primary or secondary hypertension. The former applies to about 90-95 percent of those with high blood pressure, and while the conventional medical establishment claim the cause is idiopathic or unknown, primary hypertension (aka essential hypertension) is more than likely linked to insulin/leptin resistance.

Secondary hypertension applies to the remaining five to 10 percent whose high blood pressure is caused by chronic liver disease. The revised blood pressure guidelines issued late last year emphasize when and how doctors should treat high blood pressure. Pre-hypertensive patients should not be treated with blood pressure lowering drugs; rather, they should be encouraged to make appropriate lifestyle changes to address their condition.

If you're between the ages of 18-59 without major health conditions, or if you're 60 or older with diabetes and/or chronic kidney disease, conventional medicine believes drug treatment is advised to begin if your blood pressure is at or above 140/90. In those over 60 who do not have diabetes or chronic kidney disease, the panel suggests delaying drug treatment until you're above 150/90. According to the JNC panel members:10

"For all persons with hypertension, the potential benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized. These lifestyle treatments have the potential to improve BP control and even reduce medication needs. Although the authors of this hypertension guideline did not conduct an evidence review of lifestyle treatments in patients taking and not taking antihypertensive medication, we support the recommendations of the 2013 Lifestyle Work Group."11

What's Your Fasting Insulin Level?

This is a step in the right direction, even if the panel didn't take it all the way. Personally, I believe even stage 1 and 2 hypertension can be successfully treated to where drugs become unnecessary, provided you're aggressive enough in your diet and lifestyle modifications. And there are plenty of clinical success stories that vouch for this stance.12 However, if you have seriously elevated pressures it would certainly be wise to be on medication to prevent a stroke while you are in the process of implementing the recommendations.

In addition to checking your blood pressure, I highly recommend getting a fasting insulin level test done. Remember, high blood pressure and insulin resistance tend to go hand-in-hand, and if your hypertension is the result of elevated insulin levels, you'll know how to nip it in the bud by the end of this article.

The fasting insulin level you want to strive for is about 2 or 3 microU per mL. If it's 5 or above, you definitely need to lower your insulin level to reduce your risk of high blood pressure and other cardiovascular health hazards. Keep in mind that the so-called "normal" fasting insulin level is anywhere from 5-25 microU per mL. Please do NOT make the mistake of thinking that this "normal" insulin range equates to optimal.

How to Avoid a False Hypertension Diagnosis

To avoid a false hypertension diagnosis, keep in mind that your blood pressure reading can vary significantly from day to day, and even from one hour to the next, so don't overreact if you get one high reading here or there. It's when your blood pres­sure remains consistently or chronically elevated that significant health problems can occur. The following variables can also affect the va­lidity of your blood pressure reading:

• Incorrect blood pressure cuff size: If you're overweight, taking your reading with a size "average" blood pressure cuff can lead to a falsely elevated blood pressure reading, so make sure your doctor or health care professional is using the right size cuff for your arm.
• Incorrect arm position: If your blood pressure is taken while your arm is parallel to your body, your reading can be up to 10 percent higher than it really is. Blood pressure readings should always be taken with your arm at a right angle to your body.
• Nervousness: "White coat hypertension" is a term used for when a high blood pressure reading is caused by the stress or fear associated with a doctor or hospital visit. This can be a transient yet serious concern. If this applies to you, stress reduction is key. Below, I will address stress reduction, and provide a technique that can help you control stress that may be contributing to high blood pressure.
Also, to decrease your risk of being falsely diagnosed with hypertension in this situation, take a moment to calm down (be sure to arrive for your appointment ahead of time so you can unwind), then breathe deeply and relax when you're getting your blood pressure taken.

Using Waist-to-Hip Ratio to Assess Your Hypertension Risk

Research suggests your waist size may be an effective measure for assessing obesity-related hypertension risk.13 If you have a high waist-to-hip ratio, i.e. you carry more fat around your waist than on your hips, you may be at an increased risk for obesity-related hypertension.

Certain body compositions do tend to increase your risk of chronic disease, and carrying extra inches around your midsection has been repeatedly shown to increase cardiovascular health risks. Your waist size is also a powerful indicator of insulin sensitivity, as studies clearly show that measuring your waist size is one of the most powerful ways to predict your risk for diabetes.

To calculate your waist-to-hip ratio, measure the circumference of your hips at the widest part, across your buttocks, and your waist at the smallest circumference of your natural waist, just above your belly button. Then divide your waist measurement by your hip measurement to get the ratio. (The University of Maryland offers an online waist-to-hip ratio calculator14 you can use.) The Mayo Clinic uses the following waist-to-hip ratio designations to evaluate your health risk: 

High Blood Pressure Drugs Can Increase Risk of Serious Fall-Related Injuries in the Elderly

Before I review lifestyle modifications that can help you normalize your blood pressure, I want to address the issue of medications. It's important to realize that while blood pressure medications are very effective at lowering blood pressure, they do NOT in any ways shape or form address the underlying cause. Moreover, statistics show that about half of those taking such medications are still unable to manage their condition, so clearly these drugs don't work as advertised for a lot of people. There are also side effects to contend with, some of them quite harmful and/or debilitating.

For example, a recent study published in JAMA15, 16 found that hypertensive patients over the age of 70 who were taking blood pressure medication increased their risk of serious falls requiring hospitalization due to fractures, brain injuries, hip dislocation, or dislocation to the knee, shoulder, or jaw. Risk of falling can increase if your blood pressure drops too low too suddenly upon standing. According to the authors:

"Antihypertensive medications were associated with an increased risk of serious fall injuries, particularly among those with previous fall injuries. The potential harms vs benefits of antihypertensive medications should be weighed in deciding to continue treatment with antihypertensive medications in older adults with multiple chronic conditions."

Some Blood Pressure Drugs Raise Risk of Blindness

Another major population study discovered that some type of hypertension drugs called vasodilators actually increase your risk of early onset of age-related macular degeneration (AMD), which is the most common cause of blindness among American seniors. As noted in a press release:17

"...[R]esearchers... conducted a long-term population-based cohort study from 1988 to 2013 of nearly 5,000 residents of Beaver Dam, Wis., aged 43 to 86 years... The researchers found that, after adjusting for age, sex and other factors, using any vasodilator such as Apresoline and Loniten, which open (dilate) the blood vessels—was associated with a 72 percent greater risk of developing early-stage AMD. Among people who were not taking vasodilators, an estimated 8.2 percent developed signs of early AMD. In comparison, among those taking a vasodilator medication, 19.1 percent developed the disease.

The researchers also found that taking oral beta blockers such as Tenormin and Lopressor was associated with a 71 percent increase in the risk of neovascular AMD, a more advanced and vision-threatening form of the disease. Among those who were not taking oral beta blockers an estimated 0.5 percent developed signs of neovascular AMD. In comparison among those taking oral beta blockers, 1.2 percent developed neovascular AMD."

Arterial Stiffness Linked to High Blood Pressure and Vitamin D Deficiency

According to Norwegian researchers, arterial stiffness (atherosclerosis) is a driving factor for high blood pressure,18, 19, 20 and represents "a major therapeutic target" for treatment. They discovered that as your blood travels from your heart, cells in the wall of your aorta, called baroreceptors, sense the pressure load, and signal your nervous system to either raise or lower the pressure. However, the stiffer your arteries are, the more insensitive your baroreceptors become, and the less efficient they become at sending the appropriate signals.

As a result, your body doesn't get the signal to lower the blood pressure coursing through your arteries. "'This is contrary to existing models, which typically explain high blood pressure in terms of defective kidney function,' said Klas Pettersen, a researcher at the Norwegian University of Life Sciences and first author of the study."21

Take Vitamin D to Relax Your Arteries and Improve Blood Pressure

Vitamin D deficiency and trans fat consumption can lead to stiff arteries. Vitamin D deficiency appears to be associated with both arterial stiffness and hypertension.22 Each cell in your body has a DNA library that contains information needed to address virtually every kind of stimulus it may encounter, and the master key to enter this library is activated vitamin D. This is why vitamin D functions in so many different tissues, and affects such a large number of different diseases and health conditions, one of which is heart disease.

According to researchers from the Emory/Georgia Tech Predictive Health Institute,23 even if you're considered generally "healthy," if you're deficient in vitamin D, your arteries are likely stiffer than they should be, and your blood pressure may run high due to your blood vessels being unable to relax. In their study, having less than 20 nanograms per milliliter (ng/ml) was considered a deficiency state that raises your hypertension risk. Less than 30 ng/ml was deemed insufficient.

According to the researchers: "We found that people with vitamin D deficiency had vascular dysfunction comparable to those with diabetes or hypertension."Previous research24 has also shown that the farther you live from the equator, the higher your risk of de­veloping high blood pressure. (Blood pressure also tends to be higher in winter months than during the summer.) Exposing your bare skin to sunlight affects your blood pressure through a variety of different mechanisms, including the following:

• Sun exposure causes your body to produce vitamin D. Lack of sunlight re­duces your vitamin D stores and increases parathyroid hormone produc­tion, which increases blood pressure.
• Vitamin D deficiency has also been linked to insulin resistance and metabolic syndrome, a group of health problems that can include insulin resistance, elevated cholesterol and triglyceride levels, obesity, and high blood pressure.
• Recent research25 shows that sun exposure increases the level of nitric oxide in your skin. This dilates your blood vessels, thereby reducing your blood pressure. (For comparison, and to show how various factors tie together, uric acid, produced when you eat sugar/fructose, raises your blood pressure by inhibiting the nitric oxide in your blood vessels—the opposite effect of sun exposure. This will be discussed further in a later section).
• Vitamin D is also a negative inhibitor of your body's renin-angiotensin sys­tem (RAS), which regulates blood pressure.26 If you're vitamin D deficient, it can cause inappropriate activation of your RAS, which may lead to hy­pertension.
• Additionally, exposure to UV rays is thought to cause the release of endor­phins, chemicals in your brain that produce feelings of euphoria and relief from pain. Endorphins naturally relieve stress, and stress management is an important factor in resolving hypertension.

Guidelines for Optimizing Your Vitamin D Level

Ideally, you'll want to get your vitamin D through sun exposure on your bare skin, or by using a safe tanning bed. If you opt for an oral vitamin D supplement, make sure you use vitamin D3, not D2, which is typically prescribed by doctors but has been linked to poorer health outcomes. As a general guideline, research by GrassrootsHealth suggests that adults need about 8,000 IUs per day to achieve a serum level of 40 ng/ml. Keep in mind that if you decide to supplement with oral vitamin D3, you also need to boost your vitamin K2 intake, as these two nutrients work in tandem. Together, they produce and activate Matrix GLA Protein (MGP), which congregates around the elastic fibers of your arterial lining, guarding them against calcium crystal formation. 

Vitamin K2 also activates a protein hormone called osteocalcin, produced by osteoblasts, which is needed to bind calcium into the matrix of your bone. Osteocalcin also appears to help prevent calcium from depositing into your arteries. In other words, without the help of vitamin K2, the calcium that your vitamin D so effectively lets in might be working against you -- by building up inside your arteries rather than your bones... Ideally, you'll want to test your vitamin D level at regular intervals to make sure you maintain clinically relevant levels year-round (see table below).

To learn more about the value of vitamin D testing, please see my previous article, "How Vitamin D Performance Testing Can Help You Optimize Your Health." 

References for recommended vitamin D levels

Five Key Lifestyle Strategies for Lowering Your Blood Pressure

Alright, time to get down to the nitty gritty of normalizing your blood pressure. As mentioned earlier, high blood pressure is typically associated with insulin resistance, which results from eating a diet too high in sugar. As your insulin level elevates, so does your blood pres­sure. As explained by Dr. Rosedale,insulin stores magnesium, but if your insulin receptors are blunted and your cells grow resistant to insulin, you can't store magnesium so it passes out of your body through urination. Magnesium stored in your cells relaxes muscles. If your magnesium level is too low, your blood vessels will constrict rather than relax, and this constriction raises your blood pressure.

Trans fat consumption is another dietary factor. It's now known to cause atherosclerosis (hardening of your arteries), which researchers now have pin-pointed as yet another treatment focus for hypertension. So make sure you avoid all trans fats or hydrogenated fats that have been modified in such a way to extend their shelf-life. This includes margarine, vegetable oils, and various butter-like spreads.

I recently interviewed Dr. Fred Kummerow who is nearly 100 years old and was the first scientist to document the dangers of trans fats. In the interview, he explains that trans fats prevent the formation of prostacyclin, which acts as natural blood thinning agent. By diligently avoiding trans fats, your body will make prostacyclin that keep your blood thin, which will reduce your risk of heart attack and stroke.

Now, if you think about these two factors alone—insulin resistance and atherosclerosis—what kind of dietis bound to produce high blood pressure? The answer, of course, is a processed food diet, loaded with carbohydrates (sugar/fructose/grains) and trans fat. Knowing that, the answer to correcting high blood pressure becomes rather self-evident. If your blood pressure is running high, you need to restore your insulin and leptin sensitivity, and the following five strategies are among the most effective for doing so:

1. Avoiding processed foods (due to their being high in sugar/fructose,grains, trans fat, and other damaged fats)
2. Intermittent fasting is one of the most effective ways I've found to normalize your insulin/leptin sensitivity. It's not a diet in conventional terms, but rather a way of scheduling your eating in such a way as to promote efficient energy use. Essentially, intermittent fasting means eating your calories during a specific window of the day, and choosing not to eat food during the rest. When you eat, your body reacts by elevating insulin and leptin.
Starchy carbohydrates cause a far greater insulin elevation than protein, while fat requires no insulin for digestion. If you're constantly snacking (or drinking) on sugary fare, your insulin/leptin levels will remain chronically elevated, which tends to promote high blood pressure. The more sensitive your body is to insulin/leptin, the more likely you'll be to use the food you consume efficiently, which will help improve insulin resistance, and  promote weight loss and the creation of muscle. Your body is most sensitive to insulin/leptin following a period of fasting. (Fasting also boosts growth hormone secretion—another important key to weight loss and muscle growth.)
3. Making whole, ideally organic foods the focus of your diet
4. Swapping carbs for healthy fat. Sources of healthy fats to add to your diet include:



Avocados	Butter made from raw, grass-fed organic milk	Raw dairy	Organic pastured egg yolks
Coconuts and coconut oil (coconut oilactually shows promise as an effective Alzheimer's treatment in and of itself)	Unheated organic nut oils	Raw nuts, such as pecans and macadamia, which are low in protein and high in healthy fats	Grass-fed meats or pasture raised poultry



5. Exercising regularly. On a side note, I recommend training yourself to breathe through your nose when exercising, as mouth breathing during exercise can raise your heart rate and blood pressure, sometimes resulting in fatigue and dizziness. To learn more about this, please refer to my previous article on the Buteyko breathing method.

My optimized nutrition and exercise plan can help guide you step-by-step toward normalizing your insulin and leptin levels, which in turn will help normalize your blood pressure and help you shed excess weight. It's a free resource that can help you improve your health, or take it to the next level if you've already started making some changes. My plan addresses all five of these key strategies in a systematic fashion, but below I will discuss why you really want to take these recommendations to heart if you're struggling with high blood pressure.

Fructose Causes Blood Pressure to Skyrocket

If you are seeking to control high blood pressure without drugs, my strong recommendation for your first step is to remove all grains and sugars,particularly fructose, from your diet until both your weight and your blood pressure have normalized. If you have high blood pressure, eating sug­ars and grains -- in­cluding any type of bread, pasta, corn, potatoes, or rice -- will cause your insulin and leptin levels, and your blood pressure, to remain elevated.

One 2010 study27 discovered that those who consumed 74 grams or more per day of fructose (the equivalent of about 2.5 sugary drinks) had a 77 percent greater risk of having blood pressure levels of 160/100 mmHg (stage 2 hypertension). Consuming 74 grams or more of fructose per day also increased the risk of a 135/85 blood pressure reading by 26 percent, and a reading of 140/90 by 30 percent.

A more recent analysis of the available research,28 reported by Time Magazineunder the telling headline, "Sugar Goes Straight to Your Blood Pressure,"29concluded that the sweet stuff makes your blood pressure soar regardless of your weight, although eating too much sugar will typically cause weight gain that also contributes to hypertension (as discussed above).

Fructose also elevates uric acid, which drives up your blood pressure by inhibiting the nitric oxide in your blood vessels. (Uric acid is a byproduct offructose metabolism. In fact, fructose typically generates uric acid within minutes of ingestion.) Nitric oxide helps your vessels maintain their elasticity, so nitric oxide suppression leads to increases in blood pressure. High levels of uric acids have long been associated with gout, but recent studies reveal its association with many more serious health problems, including hypertension, cardiovascular disease, type 2 diabetes, fatty liver disease, and kidney disease. For more information on the connection between fructose/uric acid/hypertension, please see my previous article, "Fructose: The Hidden and Pervasive Cause of High Blood Pressure."

As a standard recommendation, I recommend keeping your total fructose consumption below 25 grams per day. If you're insulin resistant (about 80 percent of Americans are), have high blood pressure, diabetes, heart disease, or other chronic disease, you'd be wise to limit your fructose to 15 grams or less per day, until your condition has normalized. In his book, The Sugar Fix, Dr. Johnson includes detailed tables showing the content of fructose in different foods, but for a sampling of the fructose content of several common fruits, please see this link.

The Pros and Cons of a Vegetarian Diet to Control Your Blood Pressure

A recent meta analysis30, 31, 32 suggests that a vegetarian diet can help resolve high blood pressure. A vegetarian either excludes or severely limits meat, but typically includes dairy products, eggs, and fish. (Vegan diets, which are even stricter, typically exclude fish, eggs, and sometimes dairy as well.) According to this analysis, removing meat from the diet led to blood pressure reductions similar to losing five kilos of body weight. Compared to blood pressure drugs, a vegetarian diet was found to be about 50 percent as effective for lowering blood pressure.

Most people do not eat enough vegetables, let alone high-quality organic ones, so it makes sense that individuals who consume more vegetables are likely to be healthier. But I still do not believe excluding all meats makes for an ideal diet in the long run. There's ample evidence that abstaining from animal protein altogether can lead to health complications, such as:

• Vitamin B12 deficiency, which can lead to anemia
• Sulfur amino acid deficiency33
• Nervous and digestive system damage34

Both vitamin B12 and sulfur amino acid deficiency increases your risk of heart disease. Claims that B12 is present in certain algae, tempeh, and brewer's yeast fail to take into account that the B12 analogues present in these foods are not bioavailable. The only reliable and absorbable sources of vitamin B12 are animal products, especially pastured eggs.

Quality and Quantity—Two Key Factors to Consider When Buying Meat

It's worth noting that studies such as these are not comparing vegetarians to LOW animal protein diets. The vast majority of non-vegetarians eat far more protein than they need. They also have not compared the health effects of factory farmed versus organic, pasture-raised meats, eaten at varying amounts. From what I've learned, I believe the quality and quantity of the meat may be a major part of the equation.

First, in terms of quantity, there are a number of reasons why I believe it's best to limit your protein intake. The first is that if you eat large amounts of protein your body doesn't need, it will convert most of those calories to sugar. Additionally, it will need to remove the nitrogen waste products from your blood, which stresses your kidneys. Excessive protein can also have a stimulatory effect on mammalian target of rapamycin (mTOR)—a pathway that seems to be largely responsible for the pathology seen in cancer growth. When you reduce protein to just what your body needs, mTOR remains inhibited, which helps minimize your chances of cancer growth.

Nutrition experts like Dr. Ron Rosedale believe most adults need about one gram of protein per kilogram of lean body mass, which equates to one-half gram of protein per pound of lean body weight. (As an example, if your body fat mass is 20 percent, your lean mass is 80 percent of your total body weight).

In terms of quality, meat from organically raised, grass-fed and finished animals is FAR superior to that from animals raised in confined animal feeding operations (CAFOs). CAFO beef and poultry has many disadvantages, including fewer of the most valuable nutrients found in organically-raised meats, while being contaminated with hormones, antibiotics, beta agonist drugs, and pesticides like glyphosate. Furthermore, since most CAFOs feed animals genetically engineered (GE) grains (primarily corn and soy), there's also the issue of whether or not such feed might alter the meat in ways we still have not recognized.

Should You Cut Sodium to Lower Your Blood Pressure?

Insulin also affects your blood pressure by causing your body to retain sodium. Sodium retention causes fluid retention. Fluid retention in turn can cause high blood pressure, which may ultimately lead to congestive heart failure. A standard recommendation if you have high blood pressure is to reduce the amount of sodium in your diet. While it's certainly beneficial to cut out processed salt—the type found in processed foods and regular table salt—limiting sodium is not the hypertension cure that many think it is.

If you're simply opting for low-sodium processed foods, you're hardly doing your health any favors, as such fare is likely compensating for the lack of flavor with harmful fats and/or sugar. You've probably heard of the DASH diet,35 which is claimed to be among the most effective for controlling hypertension. It consists largely of fresh vegetables, fruits, lean protein, whole grains, low-fat dairy, and very low sodium content. But it's ALSO low in sugar/fructose. So, while people on DASH diets do show reduced hypertension, the reason for this is most likely not the reduction in salt, but the reduction in fructose.

Excess fructose promotes hypertension to a far greater degree than excess salt.Salt is actually essential for maintaining and regulating blood pressure, but the crux lies in the type of salt you consume. Natural salt, such as Himalayan salt, contains 84 percent sodium chloride, and 16 percent naturally-occurring trace minerals. Processed (table) salt, on the other hand, contains 97.5 percent sodium chloride and the rest is man-made chemicals. The former is essential for good health; the latter is best avoided altogether.

But there's yet another factor that comes into play when we're talking about sodium and blood pressure, and that's the issue of maintaining a healthy sodium to potassium ratio. Your body needs potassium to maintain proper pH levels in your body fluids, and it also plays an integral role in regulating your blood pressure. It's actually possible that potassium deficiency may be a greater contributor to hypertension than excess sodium (but not likely a greater factor than fructose). 

The Importance of Proper Sodium-to-Potassium Ratio

According to Lawrence Appel, lead researcher on the DASH diet and director of the Welch Center for Prevention, Epidemiology and Clinical Research at Johns Hopkins, your diet as a whole is the key to controlling hypertension—not salt reduction alone. He believes a major part of the equation is this balance of minerals—i.e. most people need less sodium and more potassium, calcium, and magnesium. One of the first papers I ever published, back in 1985, was on the use of calcium supplementation to control high blood pressure,36 so I've been aware of the connection of important minerals like calcium and magnesium in the stabilization of blood pressure for nearly three decades.

According to Appel:37 "Higher levels of potassium blunt the effects of sodium. If you can't reduce or won't reduce sodium, adding potassium may help. But doing both is better." Indeed, maintaining a proper potassium to sodium ratio in your diet is very important, and hypertension is but one of many side effects of an imbalance. A processed food diet virtually guarantees you'll have a lopsided ratio of too much sodium to potassium. So, how do you ensure you get these two important nutrients in more appropriate ratios?

1. First, ditch all processed foods, which are very high in processed salt and low in potassium and other essential nutrients.
2. Eat a diet of whole, unprocessed foods, ideally organically and locally-grown to ensure optimal nutrient content. This type of diet will naturally provide much larger amounts of potassium in relation to sodium.

I do not recommend taking potassium supplements to correct a sodium-potassium imbalance. Instead, it is best to simply alter your diet and incorporate more potassium-rich whole foods. Green vegetable juicing is an excellent way to ensure you're getting enough nutrients for optimal health, including about 300-400 mg of potassium per cup. By removing the fiber you can consume even larger volumes of important naturally occurring potassium.

Exercise, Ideally Outdoors, Is a Potent 'Drug' Against Hypertension

Earlier, I listed exercise as one of the five most effective strategies for lowering your insulin level. Indeed, a comprehensive fitness program can go a long way toward regaining your insulin sensitivity and normalizing your blood pressure. To reap the greatest rewards, I strongly suggest including high intensity interval exercises in your routine. If you are insulin resistant, you'll also want to include weight training. When you work individual muscle groups, you increase blood flow to those muscles, and good blood flow will increase your insulin sensitivity.

If you want to kill several birds in one stone, exercise barefoot outdoors on sunny days. Not only will you get much needed sunshine to promote production of vitamin D, but bright daylight sun exposure will also help maintain a healthycircadian clock, which will help you sleep better. Poor sleep is yet another oft-ignored factor that can cause resistant hypertension.

Going barefoot, meanwhile, will help you ground to the earth. Experiments show that walking barefoot outside—also referred to as Earthing or grounding—improves blood viscosity and blood flow, which help regulate blood pressure.So,do yourself a favor and ditch your shoes now and then. Grounding also calms your sympathetic nervous system, which supports your heart rate variability. And, when you support heart rate variability, this promotes homeostatis, or balance, in your autonomic nervous system. In essence, anytime you improve heart rate variability, you're improving the entire organism—in this case, your entire body and all its functions.

Addressing Stress-Related Hypertension

Although many people believe that the "tension" part of hypertension refers to stress as the cause, the primary cause is actually insulin and leptin resistance. However, the link between stress and hypertension is well documented.38 In fact, it has been shown that people with heart dis­ease can lower their risk of subsequent cardiac events by over 70 percent simply by learning to manage their stress. Suppressed negative emotions such as fear, anger, and sadness can severely limit your ability to cope with the unavoidable every day stresses of life. It's not the stressful events themselves that are harmful, but your lack of ability to cope.

The good news is, strategies exist to quickly and effectively transform your suppressed, negative emotions, and relieve stress. One of the most well-studied of these is an energy psychology method called the Emotional Freedom Technique (EFT). By teaching your body to slow down and relax when stress hits -- essentially short-circuiting your physical stress reaction -- you can protect your health. EFT is easy to learn and can be done just about anytime, anywhere. For a demonstration of how to tap for high blood pressure, please see the video below.

Other Considerations and Alternatives to Help Normalize Blood Pressure

In addition to everything already mentioned, there are still more dietary and lifestyle strategies that can be of help if you struggle with hypertension. Here are several additional alternatives for your consideration:

• Skip breakfast: Research shows that intermittent fasting helps fight obesity and type 2 diabetes, both of which are risk factors for high blood pressure. As mentioned earlier, your body is most sensitive to insulin and leptin after a period of fasting. While there are many types of fasting regimens, one of the easiest to comply with is an eating schedule where you limit your eating to a specific, narrow window of time each day. I typically recommend starting out by skipping breakfast, and making lunch your first meal of the day.
Eating first thing in the morning coincides with your circadian cortisol peak—the time of day when your cortisol (a stress hormone) levels rise and reach their peak. The circadian cortisol peak impacts your insulin secretion, so when you eat during this time it leads to a rapid and large insulin release and a corresponding rapid drop in blood sugar levels, more so than when you eat at other times of the day. If you're healthy, your blood sugar levels won't drop to a dangerously low level (such as can occur with hypoglycemia) but they can drop low enough to make you feel hungry.
So, although skipping breakfast goes against the conventional dogma that you should not skip meals and breakfast is the most important meal of the day, omitting breakfast could actually make it easier for you to control food cravings and hunger throughout the day. Intermittent fasting shifts your body from burning sugar to burning fat as its primary fuel, which can lead to a truly amazing health transformation. Once you are truly shifted to primarily fat burning mode, your hunger dramatically decreases and your desire for unhealthy processed junk foods virtually disappears.
• Normalize your omega 6:3 ratio: Most Americans get too much omega-6 in their diet and far too little omega-3. Consuming omega-3 fats will help re-sensitize your insulin receptors if you suffer from insulin resistance. Omega-6 fats are found in corn, soy, canola, safflower, and sunflower oil. If you're consuming a lot of these oils, you'll want to avoid or limit them. Omega-3 fats are typically found in flaxseed oil, walnut oil, and fish, with fish being by far the best source. Unfortunately, most fresh fish today contains dangerously high levels of mercury. Your best bet is to find a safe source of fish, or if this proves too difficult or expensive, supplement with a high-quality krill oil, which has been found to be 48 times more potent than fish oil.
• Consume fermented foods: If your gut flora is unhealthy, your risk is much greater for heart disease, as well as many other chronic health problems. The best way to optimize your gut flora is by including some naturally fermented foods in your diet, such as sauerkraut and other fermented vegetables, yogurt, kefir, and natto. An additional benefit of fermented foods is that some of them are excellent sources of vitamin K2, which is important for preventing arterial plaque buildup and heart disease.
• Eliminate caffeine: The connection between coffee consumption and high blood pressure is not well understood, but there is ample evidence to indicate that if you have hypertension, coffee and other caffeinated drinks and foods can ex­acerbate your condition.
• Vitamins C and E: Studies indicate that vitamins C and E may be helpful in lowering blood pressure. If you're eating a whole food diet, you should be getting sufficient amounts of these nutrients through your diet alone. If you decide you need a supplement, make sure to take a natural (not synthetic) form of vitamin E. You can tell what you're buying by care­fully reading the label. Natural vitamin E is always listed as the "d-" form (d-alpha-tocopherol, d-beta-tocopherol, etc.) Synthetic vitamin E is listed as "dl-" forms.
• Olive leaf extract: In one 2008 study, supplementing with 1,000 mg ofolive leaf extract daily over eight weeks caused a significant dip in both blood pressure and LDL ("bad") cholesterol in people with borderline hypertension. If you want to incorporate olive leaves as a natural adjunct to a nutrition­ally sound diet, look for fresh leaf liquid extracts for maximum synergistic potency. You can also prepare your own olive leaf tea by placing a large teaspoon of dried olive leaves in a tea ball or herb sack. Place it in about two quarts of boiling water and let it steep for three to 10 minutes. The tea should be a medium amber color when done.
• Quick tricks: Increasing nitric monoxide in your blood can open con­stricted blood vessels and lower your blood pressure. Methods for in­creasing the compound include taking a warm bath, breathing in and out through one nostril (close off the other nostril and your mouth), and eating bitter melon, rich in amino acids and vitamin C.

Take Control of Your Blood Pressure

The best treatment strategy for high blood pressure is to evaluate your lifestyle and make the necessary adjustments, with particular emphasis on normalizing your insulin and leptin levels. We've covered a lot of ground in this report, so here's a summary of key points to remember:

• In addition to checking your blood pressure, check your fasting insulin level. A healthy level to strive for is about 2 or 3 microU per mL
• Avoid processed foods, as most are loaded with sugar/fructose, processed salt, and harmful fats like trans fat and damaged omega-6-rich vegetable oils. Instead, focus on intermittent fasting to boost results which will help normalize your insulin/leptin sensitivity. This is crucial for normalizing your blood pressure. Also consider whole food, ideally organic diet. Meats should ideally be grass-fed and pasture finished. Also keep an eye on your sodium-to-potassium and omega-3/omega-6 fat ratios. This is more or less automatically done if you swap processed foods for whole foods
• Optimize your vitamin D level, ideally through regular sun exposure
• Exercise regularly, ideally barefoot, outdoors during the middle of the day
• Learn how to effectively address day-to-day stress. One effective tool is the Emotional Freedom Technique (EFT). You can also tap specifically for high blood pressure