High Blood Pressure: Sifting Through the Salt  for Evidence 

 by Kumara Sidhartha, MD

This year's theme for the World Health Organization is high blood pressure - a disease that increases the risk of getting heart attacks, strokes, and kidney failure.

High blood pressure is common and can be lethal. The 2010 Behavioral Risk Factor Surveillance System data from Barnstable County Human Services reveals that one in three individuals in Barnstable County has high blood pressure. The rate of death from heart disease and stroke doubles with every 20 point systolic or 10 point diastolic increase in blood pressure.

Understanding the reasons behind the disease will empower you with easy and effective solutions. For instance, adding too much salt in our diet can be harmful. If all of us reduce our the daily salt intake by an average of half a teaspoon per day, 11 million fewer people in the U.S. will get high blood pressure, according to the Center of Disease Control and Prevention, with potential savings of $18 billion in health care costs annually.

Dutch researcher Johanna Geleijnse and her team looked at various dietary and lifestyle factors contributing to blood pressure in Western populations. Here are the top five, along with ways you can address each factor.

1. Excess dietary salt: More than one and a quarter teaspoons per day is excessive for a person with normal blood pressure. More than three-quarters of a teaspoon per day is excessive for those with high blood pressure. If you have diabetes or if you are on diuretics for heart failure, you should aim for a slow and modest reduction of salt intake rather than making abrupt and drastic changes. Reducing salt over 6-8 months is advisable if you are in either of these groups.

2. Lack of dietary potassium: The safest way to correct this is through foods very rich in potassium. They include spinach, chard, yams, carrots, lentils, peas, lima beans and soy beans.

3. A ratio of high dietary Omega-6 fatty acid with low dietary Omega-3 fatty acid: To better balance this ratio, cut back on vegetable oils and baked products and increase low-calorie sources of Omega-3 fatty acid such as walnuts or ground flax seeds (but not more than two tablespoons daily).

4. Lack of dietary magnesium: Think spinach, chard, spelt, brown rice, buckwheat, ground flax seeds, pumpkin seeds, sunflower seeds, sesame seeds, almonds, halibut, lima beans, kidney beans and black beans for high magnesium foods.

5. Excess body weight: Eat mostly high-nutrient, low-calorie foods from plants and participate in regular, brisk physical activity for at least two and a half hours per week.

If you think it is time to change your lifestyle, you can start with these three steps:

• Cook more meals at home and freeze leftovers. If eating out, be picky and choose low-salt options. 77% of dietary salt comes from eating away from home and from packaged, processed food,
• Stock your kitchen with herbs and spices to flavor your food while cutting down on salt, and
• Make sure half of your meal portions include a minimum of two colors of vegetables from the aforementioned list of vegetables. 

Finally, a few words about blood pressure medications. Individuals need to be vigilant to get the best effects and avoid the worst from prescription medications. You can achieve this by approaching blood pressure management as a team with your physician and the nurse - all three working together for one goal: safe patient care. Here is a pneumonic using the word 'SALT' to remember what to consider when seeing your doctor for blood pressure medications:

• Side effects of medication
• Appropriate dose, timing & awareness about potential drug-drug interactions                                                            
• Lab tests for monitoring potential problems from starting certain new medications
• Tweaking the dose up or down after you start the medication. Reducing your dose is preferred and is possible by implementing the lifestyle practices listed in this article.

You can optimize your salt intake and other lifestyle factors to prevent death and disease related to high blood pressure, reducing the need for high dosages of blood pressure medication.  With prescription medicines topping the list of out-of-pocket expenditures for the average household, reducing medications can give a much-needed break in individual health care spending. The old adage 'a pinch of prevention is worth a pound of cure' may well be worth pounds of dollars in savings as well.

Kumara Sidhartha MD, is a primary care physician accepting new patients at the Cotuit office of Emerald Physicians.  He divides his professional time between primary care work, teaching, and earning a Master of Public Health in Nutrition (MPHN) online at UMass Amherst School of Public Health. Dr.Sidhartha assists patients by applying cutting-edge nutritional preventive plans against cancers, heart disease & arthritis and works with patients to develop effective nutritional treatment plans for heart diseases including high blood pressure.

Ideas on Healthy Living from Dr. Sid 

Here are a few more tips from "Dr. Sid", as he is commonly known as in the Emerald patient community!

Why does Dr. Sid recommend adding 1 teaspoon of cocoa powder to oatmeal in the morning?

Plain cocoa power (non-dairy, no sugar added kind) has one of the highest anti-oxidants among food, and who wouldn't want their breakfast to taste like chocolate yet be healthy?

What are the 3 common "healthy" snack foods that aren't so healthy when it comes to snacking?

Cheese and crackers, nuts and mega butter popcorn.  Cheese is highly processed, and crackers and mega butter popcorn have unhealthy trans fats.  Nuts, though healthy in very small portions, are not ideal when you are hungry and snacking because the caloric-dense nuts will pack too many calories before you know it.  Nuts are best taken in 1-2 tablespoon portions, added to salad or morning cereal/oatmeal.

So what are better alternatives for healthier snacks?

Apple slices with a thin layer of almond butter, carrot stocks dipped in hummus and low fat popcorn.  The idea in snacking is to choose food with more bulk (or fiber) and more nutrients...less calories and less junk!

Looking to be spice wise?  Here's a tip about including spice synergy to improve your health:

Curry power or turmeric (the yellow spice that is in mustard) has anti-oxidant, anti-viral, anti-cancer and anti-bacterial properties.  When cooking with this spice, add a dash of black pepper.  This will increase your gut's ability to absorb the turmeric's nutrient (called Curcumin) by 1000%!

What are your thoughts about garlic?

When it comes to garlic and cancer prevention, CHOP & STOP! Garlic and onions belong to the allium group of veggies.  Garlic's key anti-cancer nutrient is called Allinin.  This nutrient is what gives that smell released when you crush or chop the garlic.  It is fragile right after it is exposed to air and is lost by heat if cooked right away. However, if you chop the garlic and leave it alone for 10 minutes, the Allinin becomes heat-stable (meaning it won't be destroyed by cooking).  so, when cooking with garlic, CHOP & STOP for 10 minutes.  Let the cancer-kicking begin after 10 minutes!

What are Dr. Sid's recommendation for protein that is heavy in nutrition and light on your heart?

1, 2, 3 protein basics for heart disease are:

• Have 1 full day of meatless meals once a week
• Swap 2 red meat dishes for fish recipes each week
• Pass 3 chicken dishes and instead, explore nutrient-heavy beans or lentils (hummus sandwich, veggie burger, bean burrito, pasta with pesto, beans & veggies, bean chili, lentil "shepherd's pie" where lentils replace the meat, etc.