Does a Diet to Lower Blood Pressure = No Salt?

Using diet to lower blood pressure, as part of a comprehensive lifestyle modification, can mean fewer medications and lower your risk for cardiovascular disease.   A combination of genetics and environment contribute to hypertension and optimal nutrition plays a crucial role in the regulation of blood pressure.

In general, sodium intake does not appear to be correlated with many health outcomes.  Higher sodium intakes do appear to be correlated with risk of cardiovascular disease.  However, only a subset of people are “salt sensitive” and a new report from the Institute of Medicine indicates that very low sodium intakes may increase health risks in certain populations.   Multiple factors and many nutrients beyond sodium play a role in the prevention and management of hypertension.

Diet Related Factors & Hypertension

1. Oxidative stress and inflammation:  High blood pressure is associated with increased oxidative stress and inflammation and this may be due antioxidant deficiency and excess free radical production.

2. Genetics:  In general, studies point to a positive association between higher sodium intakes and cardiovascular disease, but the balance of sodium with other nutrients is most important.  Avoiding high sodium intakes is most important for people that are salt sensitive (a key factor associated with cardiovascular events), but not everyone is salt sensitive (has increased blood pressure with dietary salt loading).  Consider doing a blood pressure challenge to determine whether you are sensitive to salt.

If you have a certain gene (apoprotein E2) you may have hypertension due to low levels of a certain amino acid called arginine within this protein component.

3. Standard American Diet “SAD”: A diet with a high sodium to potassium ratio (2:<1), high omega-6 to omega-3 fatty acid ratio and high intakes of “damaged” fats (ie. industrial fats and oils, fried foods, trans fats) contributes to hypertension.

Bottom Line: Using Diet to Lower Blood Pressure

1. Follow the general principles of the DASH diet to lower blood pressure:

Aim for 2300 mg/day of sodium (no lower), especially if you are salt sensitive – manage your sodium intake by cutting out the packaged and processed foods and get your sodium intake with whole foods and by using small amounts of quality sea salt when cooking and preparing food

Focus on a potassium (*use caution if you also have renal insufficiencies and/or are taking certain diuretics, potassium to sodium ratio >5:1), magnesium and calcium-rich diet

Potassium-rich foods include: legumes, nuts, apricots, bananas, prunes, raisins, potatoes

Magnesium-rich foods include: whole grains, legumes, nuts and seeds, dark chocolate (70%+ cocoa), dark green vegetables, bananas

Calcium-rich foods include: dairy products (consider quality, probiotic rich dairy such as organic, plain Greek yogurt), dark-green leafy vegetables, legumes, lime-processed corn tortillas, broccoli, calcium- set tofu, almonds

2. Anti inflammation diet, antioxidant-rich diet to lower blood pressure

Focus on beneficial fats, especially fresh ground flaxseed, walnuts, wild salmon, sardines, herring (2-3 servings per week of these types of fishes) and olive oil, healthy omega-6 and saturated fats & oils such as, grapeseed and coconut and avoid damaged fats such as, fried foods, industrial/processed oils (and food products that contain them) and commercially raised animal products.  Eat a rainbow of fruits and vegetables each day.

3. Fiber rich foods: at least 30 g/day of fiber.  Focus especially on soluble fiber (legumes, psyllium, barley, fruits, vegetables )and foods containing naturally occurring prebiotics such as, onion, garlic, asparagus and Jerusalem artichoke.

4. Adequate protein: especially non-animal protein sources such as whole traditional soyfoods  (fermented is best), hydrolyzed whey protein, (lean grass fed/finished animal protein is OK) and arginine-rich foods like nuts and seeds

5. Adequate zinc (from diet and your high quality multivitamin/mineral):  Zinc-rich foods include: fresh oysters, ginger root, Brazil nuts

6. Aim for 4 cloves of garlic per day

7. Incorporate seaweed (specifically, dried Wakame) and sea vegetables into your daily diet (*seaweed can be very high in sodium)

Consider trying out a high blood pressure meal plan and recipes (use the promotional code "Vitality 1" on the "Sign Up Now" page for 15% off your subscription) from the experts at MyFoodMyHealth as part of your initial steps.

Nutritional supplementation: It’s best to use testing to guide supplementation. Antioxidants and micronutrients should be adjunctive therapy to optimal nutrition, exercise, weight reduction and other therapies.  In general, don’t take high doses of only one or two vitamins or minerals – remember that nutrients work together - and for some populations this has shown to be harmful.  You may consider these and other supplements as part of your diet to lower blood pressure.  

High quality multivitamin with chelated minerals (including potassium, calcium, magnesium, zinc and copper)

Combined nutrients often confer the most benefits and vitamin C may play a significant role in blood pressure regulation – consider 250 mg vitamin C twice daily (in addition to your multivitamin/mineral)

Bacterial imbalance in the gut has been associated with hypertension. Consider supplementing with quality probiotics - 30-100 billion mixed strains per day- especially if you have dysbiosis

Additional nutrients and supplements such as, coenzyme Q-10 (shown consistent and significant antihypertensive effects in patients with hypertension) have been linked with improved blood pressure regulation and you may consider additional supplementation when personalizing your care plan.

In general, low vitamin D levels are associated with chronic disease risk and this includes hypertension and cardiovascular disease.   Check your vitamin D levels and supplement with vitamin D3 based on your blood levels (aim for 50-80 ng/dL).   

These are general guidelines for a diet to lower blood pressure and will need to be modified based on your health condition.  Other factors such as exercise, sleep, stress and weight management and smoking cessation are also important for blood pressure management and cardiovascular health.  

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Some references: Clinical Nutrition: A Functional Approach, 2nd Ed., 2004; IFM Functional Nutrition course, 2012; Center for Mind Body Medicine, Food as Medicine course, 2012; Houston, M. The role of cellular micronutrient analysis, nutraceuticals, vitamins, antioxidants and minerals in the prevention and treatment of hypertension and cardiovascular disease. Therapeutic Advances in Cardiovascular Disease 2010 1-19. Institute of Medicine, Sodium intake in populations: assessment of evidence, 2013; Berkeley Heart Lab, Inc.  – references; Natural Medicine Comprehensive Database             


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