It’s been assumed for years that patients with high blood pressure (BP) should cut back on salt. When we eat carbohydrates (sugars and starches) our pancreas releases insulin into the blood. This pushes glucose into the cells. Insulin has hormonal effects far wider than just controlling blood sugar. It causes the release of anti-diuretic hormone (ADH). The kidneys then retain water and salt. Blood volume is increased and BP rises.

Insulin resistance.

If we eat more carbohydrates than the body can cope with our cells start to resist the action of insulin. The pancreas initially responds by producing more of the hormone to over come this. The tissues reply by becoming further resistant.

The wise Dr Unwin.

Dr David Unwin has created a series of infographics at https://phcuk.org/sugar/. These illustrate how many common foods convert to equivalent teaspoons of sugar. He also has a lecture on you-tube about how we have blamed salt for what sugar does. Dr Unwin is a Family Physician from the North of England.

High blood pressure and carbohydrates.

If someone with high BP cuts back on the total grams of carbohydrates to say 25 a day their blood sugar spikes will flatten and their insulin level will drop. Less ADH is produced and a natriuresis occurs. That is salt and fluid are shed by the kidneys. The patient experiences weight loss and a drop in their BP. For this reason if a patient is taking medication BP the change in diet needs to be medically supervised. Medication may need to be de-prescribed to avoid low BP or hypotension.

In Functional Medicine we look for the root cause of medical conditions. This is instead of palliating symptoms with a pharmaceuticals. High blood sugar from our artificial, species inappropriate diet may unwittingly be contributing to a common and preventable medical problem.

Hypertension (HTN) or high blood pressure is very common. About a 1/3 of people are affected half of whom are poorly controlled. The consequences of HTN are stroke, heart disease, erectile dysfunction and heart failure. These conditions are sadly on the horizon for many patients.

Getting an accurate measure.

Getting the measurement of blood pressure accurate is essential. Firstly you need the correct size of cuff. Prior to the obesity epidemic we used a standard cuff but nowadays we have to use a broader one as people have bigger arms. A narrow cuff on a broad arm will give a false high reading.

The patient needs to be relaxed sitting in a chair for 5 minutes with both feet on the ground. Avoiding tea and coffee for at least an hour prior to the reading is important. Heavy exercise just before a reading can also produce a high reading.

Some patients have a high reading in the doctor’s office but not at home. This is so called white coat HTN. I often get patients to measure their blood pressure at home to get a more accurate assessment. If I am uncertain about the diagnosis I will order a 24 hrs ambulatory blood pressure. The patient has the cuff on their arm for a day and is attached to a small monitor that records the readings. The beauty of the 24 hr reading is I can see what happens to blood pressure at night. There should be a 15% drop compared to the day time.

Risk begins early.

The risk for HTN can begin very early on in life even in the womb. If the mother has gestational diabetes the baby has an increased risk for HTN later on in life. Also either being too large or too small at birth can also confer greater susceptibility. In Functional Medicine we would see these as antecedents that eventually contribute to the expression of disease.