Since 1998, when the Nobel Prize in medicine was awarded for the work on nitric oxide (NO) as a signalling molecule that was responsible for dilation of the blood vessels, research in NO has accelerated rapidly. In the mid 1990’s two independent research teams from University of London and the Karolinska Institute in Sweden found that NO could be generated from nitrates that were abundant in green leafy vegetables like spinach, lettuce, kale and especially beetroot. This requires the activation of the NOx 3,2,1 pathway to be fully operational. In effect, nitrates consumed in foods are reduced by oral bacteria
What is blood pressure and how does it relate to health?
Blood pressure is a measurement of how hard your heart has to work to pump blood out to the body. It calculates the volume of blood leaving your heart (cardiac output) by the resistance it faces when it leaves (peripheral resistance.) There are many contributing factors to make up this number: How healthy is your heart? How much blood volume do you have? Did you lose blood? How strong and flexible are your arteries? How old and what sex are you? What is your genetic susceptibility or risk? What is your diet and stress like?
On its own, this value may or may not be important- sometimes acting as the canary in the mine alerting us to an issue, while other times it is completely benign, but within context of a patient’s cardiovascular risk, blood pressure is incredibly important to understand.
What is a normal blood pressure?
There is a normal for everyone and there is a high tolerance for an abnormal, which is why regular checks are necessary. It is normal to have your blood pressure fluctuate throughout the day and you can have a transient increase in blood pressure if you are nervous, consumed stimulants like coffee, or have endocrine dysfunctions like hyperthyroidism. Therefore, it’s best to get three separate readings on three separate days in a relaxed environment to begin to establish your normal readings.
A few tips on how to get the best reading:
- Make sure the cuff is the right size, just like Goldilocks it can’t be too big and it can’t be too small. You should be able to snuggly place two fingers just under the cuff when its wrapped around your arm.
- Positioning is everything! If you are with a practitioner manually taking a reading fully relax your arm. Uncross your legs and plant them firmly on the ground, this works on two levels preventing you from increasing peripheral resistance by crossing and clenching muscles, but also acts to calm and ground you.
- Avoid stimulants and hydrate. You probably know by now caffeine can make your heart race fast enough to think its flying out of your chest. Make sure to avoid stimulants such as coffee, black tea, sugar, and drugs like cocaine and ephedra. On the flip side we may see a decrease in blood pressure in individuals who are very dehydrated.
- Get a comparison of both arms, and if you are prone to getting dizzy when you stand up ask to screen for orthostatic hypotension.
What can I do right now to achieve optimal blood pressure?
There are many pharmaceutical options for elevations in blood pressure that can prevent high-risk cases from developing into harmful events, such as cardiac arrest, optic neuritis, edema, retinal detachment, and other adverse sequelae of high blood pressure. Some of these include beta-blockers, diuretics, and renin inhibitors. While these may be appropriate, we can often start optimizing our blood pressure before we get to the point of needing these. Here are some options you can incorporate right away:
- Diets, diets, diets! From Mediterranean, DASH, and portfolio these diets are all correlated with improvements in blood pressure control. While there are some differences, they all incorporate healthy omega 3 fatty acids from fish, nuts, and seeds, with lots of leafy green vegetables. This whole food approach limits highly processed and packaged foods.
- Beets: Here’s the lowdown on beets. It ultimately boils down to the vegetable’s indirect ability to provide nitric oxide (NO) to the body. NO is a small molecule composed of nitrogen and oxygen. While it seems far too simple to be of any significance this molecule is involved in a multitude of physiologic processes, including blood pressure regulation, nerve transmission, brain function, immunity, erectile function, kidney function and more. This small molecule, NO, is able to move rapidly into and out of cells and can participate in reactions throughout the body. One such reaction is related to the widening and relaxation of blood vessels; this means reduced blood pressure and helps more oxygen get to active tissues which helps recharge tired muscles and improve endurance. The life of nitric oxide begins in the mouth. The nitrates found in foods such as spinach, cabbage, bok choy, lettuce, beets, celery, collards, leeks, and others are reduced into nitrite by bacteria found in the back of the throat.
- Epicatechin flavonoids are found in high levels in green tea leaves (Camilla sinensis) as well as dark chocolate (Theobroma cacoa). Research has also shown the effects of epicatechin on muscle, and heart health by providing polyphenols that support arterial flexibility.
- Restrict salt intake and possibly fluid intake (<1.5-2L/day) in those with difficulty controlling fluid retention
- Quit smoking (if relevant)
- Reduce/eliminate alcohol