Expert Q&A: Eating to Control High Blood Pressure

An interview with Dean Ornish, MD.

From the WebMD Archives

You know lifestyle can keep high blood pressure at bay. But what if you've already got it?

It's not too late, says Dean Ornish, MD -- even if you already have hypertension or heart disease. The only question is how much better you want to feel.

In his new book, The Spectrum, Ornish points out that there's a wide range of lifestyle changes. Somewhere in that spectrum is the kind of change that's right for you.

WebMD spoke with Ornish about the way lifestyle change can prevent or reverse high blood pressure.

Can I really make the kinds of lifestyle changes that will lower my blood pressure?

Changing your lifestyle is a very personal decision. I never tell patients what to do. But what concerns me, and why I appreciate the chance to talk with WebMD, is that many people don't even know they have a choice.

They go to their doctor or dietitian or nurse and get put on a very moderate diet -- less red meat, more fish and chicken, three or four eggs a week, and so on. It doesn't do too much. Then they are told, "Now you have failed diet, and we have to put you on these drugs for the rest of your life."

What I would like to see people told is, "OK, for some people small changes are enough, because there is a spectrum of healthy choices. But for you, if moderate change doesn't work, it just means you need to make bigger changes than someone else."

Our genes do play a role. But they are more of a predisposition, not a death sentence. If you are genetically unlucky, you just have to make bigger changes. For most people, if the changes are big enough, under their doctor's care they can reduce or get off these drugs. That's what makes our work radical. It gets to the root of the problem.

Salt. If you've got high blood pressure, everyone blames salt. Does everyone need to restrict their salt intake?

Your body keeps a very narrow concentration of sodium. To do that, it can either dilute it or excrete it.

Most people who eat too much salt just pee it out. But when you have high blood pressure, it starts to damage the kidney and that makes it harder to get rid of excess sodium. This causes the blood pressure to go even higher. It's a vicious cycle.

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People who have high blood pressure would be well advised to eat less salt. How much they need to restrict it depends on how high their blood pressure is and how much damage is done to their kidneys.

It's not as hard as it sounds to eat less salt. Yes, at first everything you eat seems to need salt. Then, after a week or two, everything tastes fine. And if you happen to go out to dinner, suddenly the food tastes too salty. Your taste preferences will change if you just stick with it for a week or two.

Which foods are the worst sodium offenders?

Table salt, of course, but sodium is found in a lot of processed foods. Most processed foods are high in sodium, even though you may not think of them as salty foods.

What changes would you make to the DASH diet?

DASH is a good diet, but it doesn't go far enough for people who are trying to reverse heart disease.

In my new book, The Spectrum, we talk about how you really do have a spectrum of choices. The more you need to change, the more you have to change. It's the old "ounce of prevention, pound of cure."

The point is that we need to personalize a way of eating and living that is right for us based upon our needs, our genes, and our preferences. If you just want to lose a few pounds or get your blood pressure, or cholesterol, or blood sugar down, you can start by making just a few changes.

DASH is a good place to begin. If that is not enough to bring your blood pressure down, now you have a choice: You can go on drugs for the rest of your life, or you can make even bigger lifestyle changes.

Not everybody needs to make big changes. And it is not just diet. There is also a spectrum of exercise and a spectrum of stress management.

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What is the advantage of eating a mostly plant-based diet in managing hypertension?

It is not entirely clear why animal protein, particularly red meat, raises blood pressure. But we know that it does.

Dr. Frank Sacks, one of the originators of the DASH diet, did a study where he gave people muffins and measured their blood pressure. The muffins all tasted the same, but he put animal protein in one set of muffins. Sure enough, blood pressure went higher in the group that ate the animal protein, even though they didn't know they were eating it.

Does exercise have an impact in preventing or controlling hypertension?

Of course. What kind of exercise? The kind you enjoy. What is sustainable is pleasure and joy and freedom. If you enjoy exercise, you are going to do it.

And people will often do things for their kids that they would not do for themselves. I am not one of those people who particularly loves to exercise, but I do it on a regular basis because I love my wife, I love my children, and I want to be around to enjoy them fully.

The hardest thing is getting started. A lot of people think, "Man, I've gotta run a marathon or at least five miles three times a week -- or I might as well just roll over in bed." That isn't the case.

It turns out that just walking 20 or 30 minutes a day has almost the same benefits as doing more intensive exercise. You don't have to walk all that far or all that fast or all at once. A single exercise session can lower your blood pressure by 5 to 7 millimeters of mercury, and that may persist for as long as the rest of the day.

But it works both ways. When you stop exercising, after one or two weeks your blood pressure starts going up again. What we are learning, particularly with blood pressure, is how quickly it can get better and how quickly it can get worse.

How does stress affect blood pressure?

Lifestyle is more than just exercise and diet. Emotional stress also affects your blood pressure. Emotional stress makes your arteries constrict and your blood pressure rise -- just as tightening the nozzle on a hose makes the water pressure go up.

Chronic anger and hostility -- and particularly depression and hopelessness -- also have a strong effect on blood pressure. There is nothing wrong with an increase in blood pressure in times of stress. But when these mechanisms that evolved to protect us are chronically stimulated by the stresses of modern times, they can harm us or even kill us.

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What is the connection between alcohol consumption and hypertension?

For some people, the stress management part of drinking helps to reduce their blood pressure. For others, the alcohol itself ups blood pressure. But even for those whose blood pressure goes down, is this the best way to reduce stress?

There are lots of ways to manage stress that are not centered around alcohol. Social support and love and intimacy will not only reduce your blood pressure but also reduce your risk of developing heart disease independent of its effects on blood pressure.

What else, besides diet and exercise, affects blood pressure?

Robert Nerem found that rabbits that were touched and talked to and petted and played with had 50% less blockage in their arteries than rabbits that had been ignored, even though their blood pressure and cholesterol levels were about the same. So it is important to talk about psychosocial factors when we are talking about high blood pressure.

You need a sense of community, a sense of love and intimacy. You need to make time to be with your beloved; you need to go on walks with your friends. My lovely wife, Anne, says, "Walk your dog, whether you have one or not."

These simple changes are just as important as the exercise we get and the food we eat. They have direct benefits for high blood pressure, mostly in terms of reducing stress. But they also have indirect benefits.

We are more likely to smoke or overeat or drink too much or work too hard or abuse ourselves if we don't address the underlying issues of loneliness and depression and isolation. These things are really epidemic in our culture and often underlie the high blood pressure that we doctors see.

How does weight loss affect blood pressure?

For many people losing weight is enough to get their blood pressure down, because your heart doesn't have to work as hard. One of the easiest ways to lower your blood pressure is to lose 5 or 10 pounds.

For many people, that is the difference between having to be on medications for the rest of your life and getting off these drugs altogether.

My approach has always been if you address the underlying cause of the problem, the need for drugs and the need for surgery is often reduced or eliminated. For many people, this is a great motivator.

WebMD Feature Reviewed by Louise Chang, MD on December 03, 2008

Sources

SOURCES:

Dean Ornish, MD, founder and president, Preventive Medicine Research Institute, Sausalito, Calif.; clinical professor of medicine, University of California, San Francisco.

Ornish, D. The Spectrum, 2007, Ballantine Books, New York.

Sources

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