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Pushing Down Pressure
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— January 6, 2020

Pushing Down Pressure

By Corinne Gaffner Garcia
  • The first sign of hypertension is often a major cardiovascular event—but diet can help you avoid that trip to the ER.

Tracy McKibben found out that one of his co-workers had a debilitating stroke and took a long, hard look at his own life.

A Minneapolis-area IT database administrator, McKibben, 5’8” and 198 pounds, was desk-bound at work. His diet consisted of fast-food lunches and meat-and-potato dinners. His exercise habits were non-existent. 

McKibben had his blood pressure checked at a work-related health fair and discovered it was on the high side, which was later confirmed by a doctor visit. Before he started taking medication, he decided to try lifestyle changes first.

“I knew nothing about high blood pressure,” McKibben says. “But I’m the kind of person, when I see a problem, I fix it.”

Taking his health into his own hands, he started by reading up on hypertension (another term for high blood pressure), checking his pressure regularly with a home monitor, developing an exercise routine and changing his diet by tracking his calories and focusing on lean proteins, good fats and low sodium.

The Silent Killer

As far as blood pressure problems go, McKibben is not unique.

According to the American Heart Association, 103 million American adults have high blood pressure—nearly half of the country’s adult population. Hypertension is defined under the latest AHA guidelines as a reading of 130 or more for the top number (systolic pressure, when the heart contracts) and/or 80 or more for the bottom number (diastolic pressure, between heartbeats). 

High blood pressure is called “the silent killer” because, as Janet Bond Brill, PhD, RDN, author of Blood Pressure Down (Three Rivers Press), puts it, “there are no symptoms, you don’t feel it. It’s very insidious; with years of uncontrolled high blood pressure, you’re probably going to die of a stroke or heart attack.” Hypertension can also affect the brain, kidneys and eyes. 

That’s why it’s crucial for people with high blood pressure to, like McKibben, take their health into their own hands by making the lifestyle changes needed to bring those readings down.

“It’s been scientifically proven beyond a sliver of a doubt that what you eat can lower blood pressure, even as well as medicine,” Brill says.

Attacking Hypertension with Your Fork

In the early 1990s, high blood pressure was becoming more widely recognized as a growing epidemic in the US. Looking for solutions, the National Institute of Health funded research into whether dietary interventions could help.

The scientists found that people who consumed more fruits, vegetables and whole grains had lower pressure levels. What’s more, they discovered that this was enough to significantly decrease systolic blood pressure—the one often seen as posing the greater risk in terms of heart attack and stroke—without other lifestyle modifications being needed.

It was the first solid research to demonstrate that diet did, in fact, have an effect on cardiovascular health.

From this research, the original DASH, Dietary Approaches to Stop Hypertension, diet was conceived.

Today’s DASH diet, which has been fine-tuned over the years, is by far the most common diet recommended for people who have high blood pressure. Other pressure-friendly diets are based on the same principles.

DASH and similar eating plans have the following tenets in common.

Say No to Sodium 

The initial DASH diet research didn’t restrict sodium intake levels—which at that time was 3,000 milligrams per day—but it did recommend cutting out processed foods, which are typically salt-laden. Later on, it was lowered to 2,300, and then to 1,500 milligrams, where it stands today.

“Basically sodium makes you retain fluids, which adds to the whole pressure buildup,” says Jennifer Koslo, PhD, RDN, author of DASH for Weight Loss (Penguin Random House).

Koslo explains that retaining fluids puts more stress on the heart and overall cardiovascular system. Conversely, “with less sodium, there’s less strain, which promotes the relaxation of blood vessels.”

Brill refers to sodium as a slow poison.

“Our food system is tainted with salt, which makes cheap food tasty,” she says. “I tell my patients, ‘If you are going to eat food out of a bag, box or menu, then it has too much sodium.’”

Although restaurant and processed foods are the biggest culprits, Brill says that high sodium levels are found in surprising places.

She points to the Centers for Disease Control’s list of the 10 saltiest food sources: breads and rolls, pizza, sandwiches, cold cuts and cured meats, soups, burritos and tacos, savory snacks (chips, cheese), and eggs and omelets. Brill notes that almost half of the average American’s sodium intake comes from these 10 foods.

Peak on Potassium

Brill says the mineral potassium works as a natural diuretic; it promotes the excretion of sodium, which lowers pressure. Koslo adds that potassium is also important for muscle function and the ability of blood vessels to relax and widen, a process known as vasodilation.

DASH guidelines recommend getting 4,700 milligrams of potassium a day; that can be a challenging level to pack into the average diet. Koslo suggests turning to sources such as potatoes, apricots, winter squash, lentils, spinach, kidney beans and orange juice.

Brill also cites cantaloupe, avocado and white beans for their potassium levels, and notes that each can of low-sodium V8 juice contains over 400 milligrams.

Like Koslo, Brill also suggests eating potatoes, and not just for their potassium content. “I want people to know that potatoes are a superfood; they’re very high in potassium, and an incredibly nutritious, low-calorie, high-fiber food,” she says.

Maximize Magnesium

Magnesium is linked to a long list of benefits, from helping to regulate blood sugar to improving bone development to helping insulin keep blood sugar under control.

Koslo explains that magnesium also helps keep blood pressure in check because it regulates muscle and nerve function. “It invites relaxation, including relaxation of the blood vessels,” she says.

Koslo recommends almonds, spinach, cashews, black beans, avocado and whole wheat as good magnesium sources to help you reach the DASH-approved level of 500 milligrams per day.

Brill adds that magnesium works as a natural calcium channel blocker; that means it moves calcium into the bloodstream, where it needs to be to lower blood pressure.

“When calcium enters the smooth muscle cells, it causes them to contract and that can raise pressure,” Brill says. “Instead, you want calcium in the blood.” 

Concentrate on Calcium

When calcium is channeled properly, it allows blood vessels and heart contractions to relax.

But that’s only if you consume enough. “Eating enough calcium will fix that leak and help to normalize blood pressure,” Brill explains.

Brill recommends non-fat plain yogurt, fortified soy milk, collard greens and low-sodium cottage cheese as good calcium sources.

Koslo also suggests eating more kale, bok choy and broccoli—all members of the brassica family—for reaching the DASH-recommended 1,250 milligrams of calcium per day.

The DASH diet’s concentration on potassium, magnesium and calcium explains why Brill calls it “the mineral diet. We take in so much sodium but not the minerals needed to balance it out.”

These minerals “are incredibly effective at lowering blood pressure while they also decrease sodium,” Brill adds.

Push Fiber and Protein

Along with an increase in the consumption of fruits and vegetables, the addition of healthy sources of protein and fiber are other key elements of the DASH diet.

When it comes to protein, lean, uncured meats—think chicken and fish—and plant-based choices such as soy, tempeh and beans are preferred.

“Eliminate fast food, saturated fats, red meat and cured foods like bacon and those high in sodium,” Brill says. “I hate to say never to eat a food. I’m a dietician who says all foods can fit, but you need to balance it all out with physical activity and moderation.”

In addition to helping prevent cardiovascular disease and decrease blood pressure, “fiber also binds to cholesterol in the body and excretes it,” Koslo says. “And lower cholesterol levels promote heart health.”

Aside from produce, fiber is found in beans and whole grains.

Other Crucial Changes

A pressure-friendly diet is just one lifestyle change that can go a long way toward reducing hypertension without medication.

But when diet is combined with other steps—namely getting more exercise, limiting alcohol consumption, easing stress and eliminating tobacco—there’s a very good chance that, like Tracy McKibben, you can successfully fend off high blood pressure. 

The other key is motivation and drive.

Soon after McKibben made drastic changes to his lifestyle, another co-worker died of a stroke.

“It really brought home the realization that this is something that can happen to anyone at any time,” he says. “It was my second wakeup call that these changes weren’t just a short-term thing.” 


Spanish Lentil and Kale Stew

“Budget friendly and made using pantry staples, this comforting and delicious stew is full of plant protein, fiber, vitamins and minerals, while being low in calories,” says Jennifer Koslo. “Serve with crusty whole-grain bread topped with avocado and tomato slices for a warm and earthy meatless meal.”

1 tbsp extra-virgin olive oil

1 medium red onion, finely diced

1 medium green bell pepper, chopped

3 cloves garlic, minced

5 cups low-sodium vegetable broth

1 bay leaf

1¼ cups brown or green lentils, rinsed

1 medium carrot, chopped

1 medium sweet potato, peeled and cubed

1 (14.5-oz) can no-salt-added diced tomatoes, undrained

1½ tsp smoked paprika

1 tsp ground rosemary

¼ tsp cayenne pepper

½ cup frozen chopped kale, thawed and squeezed dry (half of a 10-oz package)

½ cup chopped fresh parsley

1 tbsp cooking sherry

Salt and black pepper (optional)

1. In a large pot or Dutch oven, heat the olive oil over medium heat. Add the onion and bell pepper, and cook until softened, 4–5 minutes. Add the garlic and cook until fragrant, 2–3 minutes.

2. Add the broth, bay leaf, lentils, carrot, sweet potato, diced tomatoes and their juices, paprika, rosemary and cayenne. Bring to a boil, then cover and let simmer over medium-low heat until the lentils and vegetables are tender, 25–30 minutes.

3. Add the kale, parsley, cooking sherry and salt and pepper (if desired), and continue cooking for 10 minutes to thicken* the stew.

4. Remove the bay leaf and serve.

*This soup can be served thick or thin. Add more water if you want it to be more of a soup than a stew. It also thickens as it cools.

Makes 6 servings

Recipe courtesy of DASH for Weight Loss, copyright ©2019 by Jennifer Koslo, PhD, RDN, LDN, CPT. Photography copyright ©2019 by Hélène Dujardin.  Published by Harmony Books, an imprint of Penguin Random House.

For a mushroom-based taco recipe, see


Supplemental Cardiovascular Support

Blood pressure is only one factor in keeping your cardiovascular system in peak shape: Maintaining healthy levels of blood sugar and cholesterol, and supporting the heart’s pumping action, also play vital roles. Smart supplementation can promote all of these prerequisites for cardio health.

Resveratrol, the compound responsible for red wine’s benefits, stimulates release of nitric oxide, which helps maintain healthy blood pressure. And grape seed extract has reduced blood pressure in clinical trials, especially in younger people.

Coenzyme Q10 helps keep the heart beating by helping its cells generate energy in addition to aiding in control of blood pressure and glucose levels. The most effective supplements provide CoQ10 in the form of ubiquinol along with other nutrients, such as essential fatty acids, for maxiumum absorption.

Garlic and vitamin E have a long history of use in cardiac support. Garlic helps prevent abnormal blood clotting and fights atherosclerosis, a hardening of blood vessel walls, while higher intakes of vitamin E have been associated with reductions in heart attack incidence. (Vitamin D, another fat-soluble vitamin, helps the body secrete insulin, helping to control glucose levels.)

Plant sterols, compounds found in wheat germ, bran and other sources, lower total and LDL cholesterol by hampering cholesterol absorption within the digestive tract. Bilberry, a European relative of the blueberry, helps improve blood flow through veins, while hawthorn has long been used by European herbalists as an all-around cardiac herb.

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