4 lifestyle changes that lower high blood pressure | Dr Sanjay Gupta

27:00and I know that hypertension is often called the silent killer. Are there any symptoms that people at home could look out for themselves? Yeah, I think, I mean, certainly things like fatigue, headaches, breathlessness when you're exercising because your heart has to work against a higher pressure. Will everyone who has high blood pressure have symptoms and therefore know that something is going wrong? Not at all. Only a minority of people who have elevated blood pressure actually develop symptoms to the extent that they know something is wrong? That does not sound good. I think I now understand anything that's called the silent killer is something that clearly I don't want to have.

27:38I think we understand now that this can be really serious condition, that also that there's nuance beyond just like one single number, and that it's really common. I'd love to understand what causes the high blood pressure, because I assume that, you know, my six-year-old daughter probably does not have high blood pressure and that most of the people who come to see you also when they were six years old did not. So this is something that develops over time. The only thing I know about is somehow eating lots of salt is supposed to be bad. I think that's what I grew up being told and being very stressed.

28:13Is that the answer? No, I think there's a lot more to it than that. And we're beginning to realize it. And I think that our nutrition plays a huge role. My belief is that the food industry is bothered about our taste, not about our health. And so a lot of compromises are made, and we're consuming all sorts of things that we have no idea of because they're packaged in a way which is sold to us as healthy. I think alcohol plays a role. I think lack of sleep, I think, is huge. There are certain supplements which have been eroded in our diet, magnesium, for example, due to modern farming methods and processing.

28:51And all those things probably also have an impact on blood pressure. So I think there are a ton of things in our environment, in our lifestyle, which contribute to essentially premature aging of our blood vessels, which then become stiffer and the blood pressure keeps going up. Obesity being a big thing, lack of exercise being a big thing. Something that I'm really interested in is the variability in response to salt. Now, I know at a population level, if you reduce your salt intake, about 75 % of people will get some sort of reduction in blood pressure. What we see is about 25 % of them actually get a really big reduction, so a really big benefit.

29:33They're salt sensitive. And yet we see that there are a proportion of people that actually have no benefit from reducing their salt intake. So as a kind of public health policy, many countries are focused on salt as a target, which is great because, yes, at a population level, it's important. But I think we should be thinking about it a little bit differently. And I'd love to hear your view on potassium and how important that is, because I think we need to change the narrative a little bit around this. Absolutely. I completely get that. With regards to your question about potassium, absolutely.

30:05There are data to show that actually a higher potassium increases salt excretion. It's better for endothelial function. It's a vasodilator. It suppresses the hormonal mechanisms in the body which regulate pressure. So potassium supplementation will also do these things. And those are all things. And I don't think it's necessarily also going to be for everyone, just like salt. Maybe these are things that we need to understand that patient and we need to see whether that works for that patient. And then we need to have ways by which we measure that pressure again to get an accurate representation of what it's doing, you know.

30:43So they have to be proper clinical studies and they have to go on for a long period of time. And ideally, they need to be measuring hard outcomes. What are the key things that are most likely in our modern world to lead to high blood pressure? Certainly age contributes, and you can't do much about that. But I think all those things that come along with a Western lifestyle, putting on weight, more stress, a reliance on fast foods, reliance on processed foods, all those things that are designed to make our lives easier, in some ways probably have an impact on all that. and may contribute to our pressures going up.

31:27If you look at the data, the prevalence of hypertension under the age of 40 is 10%. It goes up 40 to 60, it becomes almost 30, 40%. And then above 60, it's over 60%. So more than one in two people have high blood pressure once you get to 60. This is with all the research, with all the tools that we have at our disposal, clearly it isn't working. Why is this happening? And therefore, we have to have the courage to start thinking differently. And I think this is where holistic, individualized healthcare comes in, where we should be integrating and we should be collaborating with nutritionists and all these people, you know, for that person.

32:10And Sanjay, I've seen estimates that about 70 % of the variability in blood pressure, i.e. the chance of you developing high blood pressure, is due to modifiable factors, so factors that are within our control. You've listed a few of these. Age obviously isn't one of them, but you've listed diet, stress, and body weight. Are there any other factors that are also within our control that we can do something about to prevent this rise in blood pressure? I think sleep is really important. Exercise is important. Diet, what you're putting in your body, things like smoking, alcohol excess, and stress.

32:48Yes. And why is it that stress impacts our blood pressure? Because stress is in so many ways associated with all those kind of hormones that are produced, which actually constrict our blood vessels. So if you're in a state of chronic stress, our blood vessels are going to be much tighter in general, and that will then contribute to the blood pressure going up. And of course, stress will affect your sleep. When you don't sleep, you develop a predilection for sweet foods. When you develop a predilection for sweet foods, you get these huge surges in insulin. So it's all interlinked. And it's also very important, I think, that people become a lot more aware of the food industry and what the food industry is all about and what kind of compromises are made with your food before it ends up on your table.

33:38It's important to understand that sometimes your blood pressure is a manifestation, and outwardly manifestation of the compromises you're placing on your body. And therefore, it shouldn't be looked upon as, oh, blood pressure is the worst thing in the world. It should be what you're doing to your body. That Western lifestyle is probably more harmful. Stress is probably more harmful. If you're smoking 100 cigarettes a day, that's more harmful than trying to control the blood pressure that has risen as a consequence of that. Yeah, I think it's a great way of looking at it as a symptom of our lifestyle, as a symptom of what's in our supermarket and our grocery stores.

34:16A hundred percent. And if you look at diabetes, type 1 diabetes is a condition, but type 2 diabetes for most people is a symptom. That, I think, is really important. What about our gut microbiome? Sarah, I know you've done some research on this. What have you found? Yeah, so we've done quite a lot of work at ZOE and at King's College London looking at microbiome and links with blood pressure. So firstly, we've run a study in the twins department, which Tim Spector, one of the co-founders at ZOE, oversees. And what we found was that there's a different microbiome composition between those people who have hypertension, so have high blood pressure versus those that have normal blood pressure.

34:58We also see a difference in the diversity. So how diverse that microbiome is, which we know is quite important in terms of health. We've also looked at this in our own Zoe studies. So in up to 35 ,000 people now, we've looked at this. And what we see is that there's actually a microbial signature. so there's this signature of specific species so specific bugs in our gut that are linked with a high blood pressure and conversely a signature that's linked with low blood pressure and we've actually replicated this and recently published it a couple of weeks ago in nature we've looked at this in lots and lots of different cohorts and consistently we see it's these same bugs associated with a higher blood pressure same bugs associated with low blood pressure we don't fully understand why.

35:44We think one of the reasons going back to low-grade inflammation, we know that these species release different chemicals like short-chain fatty acids. They're involved in how they process other food debris that's reaching our gut that may also impact how the lining of our blood vessels interact, how constricted they are and so forth. So the mechanistic stuff is I think where it gets interesting, where we need to learn a bit more. But I think the results that we've seen are really exciting and could be a potential target for the future as well, because instead of just treating the symptom, we'll be treating one of the underlying causes.

36:19And this is why diet is so important. We know diet impacts those microbes. And I think this is exactly where we need to be heading. And it would be really interesting to see whether what your findings are not only benefit people with high blood pressure, but also with type 2 diabetes, also with obesity, because I think they're all different streams from an unhappy body. And I see this all the time. I see this. So I will go up to my coronary care unit and I'll have a patient there who's had a heart attack. So let's say a 60-year-old man, heart attack. And I'd say, well, what are his risk factors?

36:57And the doctor who's presenting the patient will say, oh, he's had diabetes and high blood pressure. And I said, how long has he had diabetes and high blood pressure? Oh, well, he's had diabetes and high blood pressure for 20 years. And I say, okay, and has he been treated for those? And they say, yeah, he's been on tablets. And I say, so why has he had a heart attack? Because he's got diabetes and high blood pressure. So what were we treating him for? But no one looks at it like that. No one says, okay, perhaps that is a failure in the treatment that we've been giving that patient, that he has still ended up having the outcome.

37:34you know, we have to be a little bit more reflective. We can't just say, oh, he's been on treatment, but hey-ho, people on treatment still have heart attacks. And Sanjay, is that why you were saying things aren't working in terms of treating high blood pressure? Is this what you're saying? Absolutely. I think more people are having heart attacks. I think younger people are having heart attacks. I think places like America, where they have stricter guidelines, still are having more heart attacks than other places. So the current treatment for blood pressure isn't actually reducing the heart attacks and the dementia and these other sorts of things you've been talking about.

38:07Yeah, and if you look at the data, the number needed to treat is the number needed to treat being an idea as to how many people you have to treat to achieve benefit in one person, be that some kind of reduction in a hard endpoint, death or a heart attack or something like that. And the number needed to treat is big. You may have to treat between 30 and 60 people for several years to achieve benefit in one person. So the question then is, we have to look at that and say, is that good enough? If those were the returns in a bank, I wouldn't be putting my money in that bank. So I would love to switch here actually into there for what people can do, because I think lots of listeners like me are probably coming away saying, well, this high blood pressure of thing sounds quite serious.

38:55I'd like to know what I can do to not just lower my number, it sounds like, of blood pressure, but actually lower my risk of having these heart attacks and strokes and so on. How would you advise me to get that sort of one good reading to see whether or not I should be worried about this? I don't think it'll be a case of one reading because I think the first reading tends to be a little bit higher and then the second reading's a little bit lower and the third reading's even better. But whatever you do, you're looking for changes. You want to do the same thing every time so that you're comparing apples with apples.

39:26So I would say perhaps, you know, you measure your blood pressure twice a day, do three recordings, record the third one on each occasion and do that for a few days. And you calculate a general average from that. And if that's okay, and you're doing the best you can in terms of your lifestyle, that's okay. And what's the number that you would say it's worth going and having a conversation with your physician? Well, I certainly think if it's like 160, you know, some people would say even over 140 persistently, then it's a good idea to go and see your physician. And you take those readings with you and show them to them.

40:07Because at the end of the day, when the physician measures it, it's going to be higher. So I don't understand why one would put more credence on that. And I think it's always really, really important that the minute you start thinking about your blood pressure, you must think of your lifestyle. That is the thing that I think a poor lifestyle probably kills more people than anything else. We know that diet and lifestyle plays a huge role in this. I'd love to hear from you in order of what you think is the most important, the diet and lifestyle factors that people can think about changing. Certainly, there's a lot of reliance on kind of fast foods, you know, unhealthy foods, some of which we know are unhealthy but we still do it because it makes our lives easier and some which we don't even know are unhealthy and i think that would have an impact on everything else as well yeah sleep stress weight gain i think it'll have an impact on all that's and nutrition i think is perhaps the most important thing of all because stress is huge but it's very difficult to quantify stress.

41:15Food is something that people can make a change to. And I think exercise, cardiovascular exercise is important, but people are becoming more conscious of exercise, etc. And they are doing more. But all those things, you cannot do lots of exercise and then be really proud that you can get away with four hours of sleep every night. You have to do it all. Now, I think the four pillars of health that you're talking about, sleep, stress, activity, and diet are not just going to help blood pressure, they help every single disease, but they help how you feel in the here and now. And I think that's really important from a motivational point of view.

41:52From a dietary perspective, what are the kind of recommendations that you would make to someone coming to your clinic who has high blood pressure? I personally think sugar is the enemy because sugar causes a bunch of insulin spikes, whereas a lot of blood pressure is about cut down salt, cut down salt. I think sugar is the more important thing and I think that processed foods, refined oils, all those kind of things, additives. And Sarah, what's your experience in terms of thinking about blood pressure specifically and what dietary changes you might suggest to someone based upon your research and others?

42:27So I think that what constitutes a general healthy dietary pattern for everyone will also help with blood pressure. So that's a diet high in unprocessed foods, a diet high in whole fruits, vegetables, beans, whole grains, a diet low in processed red meat, low in sugar sweetened beverages, a diet low in refined carbohydrates that causes these big peaks and dips that can lead to inflammation. There are a few additional recommendations. So one is to increase your potassium intake but to increase your potassium intake actually through diet constitutes a healthy diet it's mainly achieved through increasing your intake of fruits vegetables pulses you know beans for example they're really high in potassium so plant foods are very high in potassium some are higher than others so if we think about fruits for example typically bananas figs apricots they're very high in potassium if we're thinking about vegetables lots of green leafy vegetables like spinach are high in potassium interestingly in the uk most of our potassium actually comes from potatoes because we're a nation of potato lovers and crisps they are quite high in potassium obviously be careful how you're having your your potatoes to contribute towards your potassium because they don't have much else unless you're keeping all the skin on for the fiber they don't have much else that's necessarily uh improving your diet i love it's first time you've ever managed to find an excuse for why we should be eating potatoes sarah gone Jonathan doesn't like potatoes by the way and so potassium is one single nutrient that yes we know from clinical trials that use potassium supplementation as well as supplementing through the diet can reduce blood pressure I did a randomized control trial on this many years ago we also know salt is important but the really important point to make here is that reducing your salt intake isn't going to benefit everyone that you will have some people who are salt sensitive who have a really large benefit from reducing their salt in order to reduce their blood pressure.

44:32Some people have no benefit. Generally, at population level, if we reduce our salt, yes, we benefit. And where is most salt in our diet today? So most salt in our diet is in food that's pre-prepared, that's pre-packaged. Only about 20 % of salt comes from food that we make or that we add at the table. And so we call this discretionary salt that there's actually very little salt now added at the table about 70 to 80 percent of the salt that we consume in the uk in the us in many countries come from heavily processed foods pre-packaged foods pre-made meals and so really if you're just following a basic healthy diet cutting out all of these heavily processed pre-packaged foods if you're switching to a more whole food plant-based diet you're naturally going to increase your potassium are naturally going to reduce your salt.

45:25You're adding in fibre, which we also know can reduce our blood pressure through various mechanisms, one of which is through improving the composition of the gut microbiome. And you're also adding in, by going to a very whole plant-based diet, you're also adding in lots of other nutrients that we know are important. And Sanjay mentioned earlier about magnesium. It might only play a small role, but again, you know, accumulatively, you're adding in lots of components of the diet that are going to help your blood pressure, improve your microbiome, reduce inflammation and so forth. And you talked earlier about this new study showing like these particular microbes linked to, you know, high blood pressure or not.

46:07Is it possible to get more of the good ones and fewer of the bad ones through my diet? So we've recently published research from our Zoe studies where we've seen that by changing your diet, you can change these specific microbes, that you can change the microbiome signature that you have. And so you can increase the microbes that are associated with lower blood pressure and you can reduce the microbes that are associated with higher blood pressure from switching from a typical kind of UK diet to the kind of diet that we promote at Zuri. Going back to the microbiome as well, I think we're starting to see studies emerging where people are given probiotic supplements and these are often single strains or they might have multiple different strains in them.

46:52And they see reductions in blood pressure specifically through adding in particular species. And so this is where I think, again, it's getting really interesting that you'll see an even greater effect by changing your microbiome through the diet to reduce your blood pressure. We've covered a lot of the different things you could do. I'd just like to talk about exercise a little bit more. Is there evidence that doing more exercise can reduce my blood pressure? Absolutely. So some data indicate that if you do cardiovascular exercise, your blood pressure can come down by an average of six millimeters of mercury.

47:27Sanjay, is that good? It's comparable to some medications that we get. Okay, so that's a lot. It's good, yeah. And then there is additional benefit because with the weight loss for every kilo you lose, your blood pressure comes down by one to two millimeters of mercury, your systolic blood pressure. So not only is the weight loss helpful, but weight loss plus exercise, there are data to suggest that they benefit. So it's interesting what you just said. So you're saying in all of these things, if they also help you to reduce your weight, then you're going to reduce your blood pressure because this extra weight is pushing up your blood pressure.

48:05Yeah, and you're going to reduce your blood pressure and you're going to reduce your reliance on medications, some of which also increase your blood pressure. What we're not doing is we're not making a healthier population at this point in time. We're making it a medicated population. And I think we have to start going back and focusing on the things that we can do to make our population healthier, slimmer, more mobile, less stressed, less medicated. And that is the way we will achieve something different to what we are at this point in time. If our listeners started making these sorts of changes that you're talking about, how fast could they expect to see it have an impact on their blood pressure and how big an impact can that be versus taking the pill that otherwise you're offering to them?

48:57Well, the first thing is they'll feel better. And that feeling better will become noticeable after only a few weeks, I suspect. It's very dramatic. And if for no other reason, rather than just saying, oh, I'll do these things because my number will come down, you should do it because you will feel better. You will have a better quality of life. If you feel more rested, you're happier, you're putting good stuff in your body, you're feeling more confident, you go to the doctor, the blood pressure will be lower. And I think this is really motivational because we know from our own research, people changing their diet, changing their lifestyle, you start to feel better within days.

49:32And we know from published research on dietary studies looking at dietary modifications to improve blood pressure, you can see improvements in blood pressure in as little as two weeks. So it's not something that's going to take months and months. Make that change now. Start with small changes, build them up, and you will feel better, but you will see a difference in your numbers as well quite quickly. Amazing. Thank you so much. This was definitely a new topic for me, quite complicated to understand. I'm going to try and summarise it, and please correct me if I've got anything wrong, both of you.

50:01I feel like I'm about to do an exam. So the thing that I'm actually most amazed by is this new discovery that there are specific bugs in our gut linked to high blood pressure and low blood pressure, which is extraordinary. We don't fully understand why, but we think it might be linked to this long-term inflammation. About a quarter of people are told by their doctor they have high blood pressure, but they don't because when you go in and see your doctor, you're really anxious and your heart rate goes up And so you have this measurement that is higher than your average would be. And I think you said about 30 % of people globally have high blood pressures.

50:38The short-term high blood pressure is fine. Like I run for the bus, it's nothing to worry about. But this like long-term high blood pressure over years and decades can be really harmful. And that affects things like my brain. So dementia could be starting 15 or 20 years earlier with these like tiny damage to blood vessels from the high blood pressure, strokes, heart attack, heart failure, but also, you know, your eyes could get damaged your kidneys. So this is really important. The numbers that we use to measure it, they have these two numbers. And the first one is the one that you're saying I should really worry about the big number, the systolic number, because that's what happens when my heart is pressing really high.

51:18That interestingly, doctors do not agree around the world even about what that number is that you should worry about. So in America, it's 130. In Europe, doctors are more relaxed and you can get up to 140. It is good to measure your own blood pressure, but not to obsess about it. And, you know, if you're going to measure it at home, then you said multiple times in the day that each time you do sort of three recordings, sort of write down the last one, do it for a couple of days. that gives you sort of average, which is going to be much more accurate than this sort of one single measurement. And I think you said, well, you know, if that is above the guidelines in your country, then it's worth going and talking to your physician and share this data.

51:57But for the reasons you talked about, it needs to then be looked at in the context of your overall health. And then we talk about what could you actually do. And I think interestingly, there's this really big alignment, Sanjay, between you and Sarah. And of course, Sarah is going to focus on nutrition as a nutrition scientist. But actually, you said like diet is the number one thing that you think is affecting high blood pressure, which is extraordinary. The overall healthy diet for blood pressure is the same as the overall diet for everything else, but there are some interesting specific things there.

52:26And what I caught was particularly increasing your potassium intake, and that means more fruits and vegetables. And you had some particular examples. I think I got bananas, figs, apricots, green leafy vegetables like spinach. These are particularly high in potassium. Reducing salt is good, but actually the salt isn't where I guess I would think it is which is adding lots of salt to the table, this is mainly in heavily processed food. So it's sort of hiding in a lot of these meals and sort of ready meals and things like that. So actually, if you can cut back on that, I can still add salt to the eggs that I make at home without feeling so bad about it.

53:01Absolutely. And I think what's really interesting is that your taste buds change very quickly. We become so used to that salty taste. So actually, if you can cut down your salt intake from these heavily processed foods, quite quickly you'll realize you don't need to be adding much salt at the table because you become more sensitive to it. And finally more fiber supports the microbiome hopefully helps to give you those good bugs that you want to have fighting the blood pressure but then it's not only about diet we talked about stress a lot but also that it's hard to adjust for so these other things like sleep and exercise that we know are so important for many other aspects of our health like very strong data to support the fact that it can reduce our blood pressure.

53:42And not only will we reduce our blood pressure at the end of this, Sanjay, but we're all going to feel better, which sounds a great way to wrap up. As you can imagine, hosting this podcast, running Zoe, juggling family life, it all keeps me pretty busy. So I try as best I can to stay energized and show up well in all those parts of my life by fueling my body with the right food, by exercising, and by adding a scoop of Daily 30 to my meals every day. If you haven't heard of Daily 30 yet, it's the gut supplement designed by our gut health scientists here at Zoe. It's made of over 30 high quality hand-picked plants, including seaweed, fungi, and different types of fiber.

54:24Better yet, it contains ingredients that support gut health, digestion, and energy, which is ideal for packed calendars and busy lives. Simply add one scoop a day to any meal for an extra boost of fiber and plant diversity. And because it tastes delicious on just about anything and adds a satisfying crunch, it quite quickly slots into your life, becoming a daily healthy habit you'll always have time for. By the way, whenever we talk about Daily 30 as a good source of fiber, we're required to say that it contains four grams of total fat per serving. Obviously, that's all amazing healthy fats from plants.

55:00so order yours today at zoe.com daily 30 thanks for listening and see you next time