Blood Pressure and Salt: What is the Connection?

Digital blood pressure cuffWhen blood pressure begins to rise, the advice always seems to start with reduce salt intake. While this can be good advice, it fails to consider the complexity and possible other causes of elevated blood pressure. Risk factors for high blood pressure, also known as hypertension, includes:

  • Sedentary lifestyle
  • Excessive sodium intake from processed and fatty foods
  • Low potassium intake
  • Being overweight or obese
  • Excessive alcohol intake
  • Smoking
  • Age greater than 60
  • Race – African American adults are at greater risk than Hispanic or Caucasian adults.
  • Certain diseases or medications

If high blood pressure is caused by another disease or condition, it is termed secondary hypertension. If there is no identifiable cause found, it is termed primary hypertension. Primary hypertension is the most common form and can be related to the risk factors above.

To understand the risk for hypertension, we must understand the physiology of blood vessels. The pressure inside the blood vessel is regulated by hormones that control the blood volume and pressure. When the blood volume increases so does the pressure. Coronary artery disease can also increase pressure inside the blood vessel due to constriction. When the diameter of the vessel wall narrows due to hardening of the arteries (loss of elasticity) or plaque build-up, it increases the pressure. Over time this can lead to more damage of the arteries and gradual increase in blood pressure. High blood pressure is a major risk factor for stroke and heart disease. Unfortunately, there are approximately 75 million people in the U.S. living with high blood pressure.

So, how do we treat high blood pressure? Lifestyle factors should be the first consideration unless blood pressure is dangerously high. If this is the case, medications and/or hospitalization may be required. But for slightly elevated blood pressure, making a few lifestyle changes can go a long way. Weight loss will help if you are overweight or obese. Exercise can also improve blood pressure over time. But be cautious about exercising if blood pressure is very elevated as exercise will make it go up. Avoid tobacco and excessive alcohol intake since these will make hypertension worse. Stress reduction can also help. Dietary changes include reducing intake of processed foods that are high in sodium and fat and eating more fruits and vegetables rich in potassium. Potassium seems to be protective against the effects of excess sodium. Diets such as the Mediterranean or DASH diet are known to reduce blood pressure and heart disease risk.  Some studies also found that getting adequate magnesium and calcium can improve blood pressure. Supplements may be beneficial but nutrients from food is always best.

The question remains however, how much sodium is too much? Americans consume 3,400 mg of sodium per day on average. Current guidelines recommend no more than 2,300 mg of sodium per day. The American Heart Association has lowered the guideline to no more than 1,500 mg of sodium per day for those at risk of heart disease. Some researchers argue that recent studies show limiting sodium too much may do more harm than good. According to them, a very low sodium diet increased the risk for heart disease. Several studies confirm reducing sodium intake improves cardiac risk factors, however the question remains how much should sodium be reduced? We know sodium is necessary for the body to work properly. We do not know for certain how much sodium is needed. Until we can determine this for certain, my advice is “sodium in moderation”. And remember, there is no “one-size-fits-all” when it comes to nutrition. You are an individual so listen to your body and stay healthy!

DIABETES: Dealing with a Pandemic

Stop DiabetesDid you know that over 29 million Americans are living with diabetes according to the Center for Disease Control (CDC)? Another 86 million Americans are living with pre-diabetes, a condition where blood sugar is elevated but not to the level needed to be diagnosed as diabetes. The high prevalence of diabetes is not just confined to the United States. Other countries are seeing an increase in cases of diabetes as well. Diabetes is now the 7th leading cause of death in the United States and the leading cause of kidney disease, lower limb amputation and blindness. Diabetes also increases the risk of heart disease and stroke. The cost of diabetes is enormous and makes up over 20% of healthcare spending.

The good news is the risk of developing diabetes can be reduced by up to 58% in people with pre-diabetes or at risk of diabetes when following a healthy diet and lifestyle.  Many people believe they are doomed to develop diabetes at some point in their life because they have a family history of the disease. According to the Joslin’s Center for Diabetes and the Juvenile Diabetes Research Foundation (JDRF), there seems to be a genetic predisposition to developing diabetes. However, not everyone with a family history of diabetes will develop diabetes and not everyone without a family history of diabetes is exempt from diabetes. It seems that some people may be more susceptible to developing diabetes but following a healthy diet and lifestyle is protective and can prevent the “diabetes gene” from expressing itself as diabetes in the person. (And by the way, researchers are not yet sure which gene or genes are affected). Even if someone has a gene that makes them more susceptible to diabetes, there must be an environmental trigger to turn the “diabetes gene” on. Eating a healthy diet, exercising, maintaining a healthy weight and reducing stress can empower the body to function properly and avoid disease. Major risk factors for type 2 diabetes includes obesity, being 45 years of age or older, sedentary lifestyle, history of gestational diabetes or delivering a baby weighing over 9 lbs. or having a family history of diabetes. Consuming excessive amounts of sugar does not cause diabetes but it does overwork the pancreas and causes an increased amount of insulin production which can fatigue the pancreas, lead to weight gain and cause other harmful effects in the body.

So the question is – how do I prevent diabetes in the first place? Knowledge is power so know your risk and learn what you can do to reduce your risk. Maintain a healthy weight, exercise at least 5 days a week for 30 minutes, watch your diet and reduce your stress. A healthy diet includes plenty of fresh fruits and vegetables, whole grains, nuts, seeds and lean meats. Avoid refined carbohydrates such as in sweets, candy, doughnuts or sugar-sweetened beverages. Also avoid unhealthy fats (trans fats specifically) that can increase insulin resistance. A moderate amount of exercise and maintaining an active lifestyle can make a big difference. If your body mass index (BMI) is over 25, consider losing at least 5-10% of your current bodyweight. Even a little weight loss can improve your body’s ability to metabolize glucose. Calculate your BMI here. If you have been diagnosed with diabetes, there is hope. Type 2 diabetes can be treated with diet and lifestyle changes. Even people who start medication for diabetes may be able to reduce the dose or eliminate it altogether once lifestyle changes are made, assuming the pancreas is still making enough insulin. Find a qualified certified diabetes educator here to give you the support you need.

A Healthy Heart is a Happy Heart

Heart with fruits and vegetables

      Heart Health

February is American Heart Month so I thought it would be appropriate to discuss how to keep our hearts healthy. Some tips will not surprise anyone such as don’t smoke, maintain a healthy weight and exercise. But I want to get more specific with what can either prevent or contribute to heart problems. Let’s begin by looking at the top risk factors for heart disease. According to the National Heart, Lung and Blood Institute  (NHLBI) (a division of the National Institutes for Health (NIH)), these include high blood pressure, high cholesterol, diabetes or pre-diabetes, smoking, being overweight or obese, sedentary lifestyle, family history of heart disease, unhealthy diet, having preeclampsia during pregnancy and age (greater than 55 for women). Some risk factors we cannot control such as our age, family history or developing preeclampsia during pregnancy. The good news is we can control the other risk factors in most cases by making some diet and lifestyle changes.  The first thing we need to know is whether we have any risk factors. Do you have a family history of heart disease? Is your blood pressure normal? What are your blood cholesterol levels? Do you have pre-diabetes or diabetes? Do you smoke? Are you considered overweight or obese? Do you get at least 30 minutes of exercise (in addition to your normal daily activity) most days of the week? Do you get 5 servings of fruits and vegetables most days of the week? Do you limit your sodium and saturated and trans fat intake? How about your stress level? Do you have a healthy outlet for managing stress? How you answer these questions determines what areas need focus for making changes. We are going to look at each modifiable risk factor in a series of posts during the month of February. Look for more information on your risk factor(s).

Other articles in this series:

A Healthy Weight for Heart Health

Blood Pressure and Heart Health

Cholesterol and Heart Disease

Diabetes and Heart Health

Diet and Heart Health

Exercise for Heart Health

Stress Management and Heart Health

For more information, you can find a free 127-page book “The Healthy Heart Handbook for Women” from the NHLBI website. There are other resources for men as well but this one is particularly geared to create awareness of heart disease in women. Heart disease is still the #1 killer of both men and women in the United States. Let’s work on making our heart happy and healthy this February.