A healthy lifestyle controls high blood pressure – but it may not be the complete answer

Adopting healthy daily habits enhances your well-being naturally but some people get frustrated if they continue to suffer from metabolic risk factors such as high blood pressure. This blog uses a case study to explore the issues more comprehensively

Sue, a 60-year-old happily married lady, was found to have high blood pressure in a pre-operative assessment. ECG, chest x-ray and routine blood tests were normal. An ambulatory blood pressure monitor confirmed hypertension, but she did not want to take the BP pill, amlodipine, as it gave her a low mood.

Sue thought her blood pressure was precipitated and worsened by lifelong anxiety. She had had anxiety since she was 4; she cried every morning before school; she was made redundant in her mid-20s, and she was depressed, on pills, for 10 years before she moved back to be close to her family.

She then cared for both parents, who were diagnosed with dementia, for 10 years before losing her father at 60, and suffered emotional trauma due to a lack of family support.

She also had trauma with her pets: she lost her dog in a road traffic accident many years ago, and two other dogs died more recently.

Despite sleeping for 7 to 8 hours, Sue felt unrefreshed in the morning. She was diagnosed with sleep apnoea on a home sleep study, which revealed her waking up 33 times per hour of sleep.

Since being diagnosed with high blood pressure, Sue has eaten a high-fat, low-carb diet, which avoided pasta, rice, bread, sweets, cake, and biscuits. She took a handful of dry fruits in her breakfast, and her diet was high in animal proteins, including chicken, fish, and red meat; she enjoyed a few coffees and teas daily and 14 units of alcohol per week.

Sue pursued a vigorous exercise routine, running with her dog for one hour every day and lifting weights for an hour four times a week. She estimated her energy levels at 7 to 8 out of 10, fluctuating with an afternoon slump.

Sue was diagnosed with endometriosis, had early menopause and had eight dental silver fillings.

Her BMI was normal at 24.2, but waist-hip ratio was high at 0.90 (belly fat); further blood tests showed a high inflammation marker at 1.95, a prediabetic haemoglobin A1C (blood sugar control over the last 3 months) at 44, low HDL (good guy cholesterol) at 0.95 and uric acid high at 370.

“I have a healthy lifestyle. Why is my blood pressure still high?”

Routine test results confirmed Sue’s high blood pressure to be part of a metabolic syndrome. She was disappointed that her blood pressure remained poorly controlled despite sticking to a healthy lifestyle. Hence, she attended the Vitality Clinic seeking answers.

The metabolic problem revolves around insulin resistance and poor blood sugar control. (Insulin resistance means that insulin cannot fulfil its role in channelling sugar into cells to be used for energy, but instead, the sugar ends up being stored as fat, especially around vital organs.)

Sue’s blood sugar remained prediabetic despite a low-carb diet and high physical activity. She was wondering what else she could do to control blood sugar, lower blood pressure, increase the good guy cholesterol, and stop her metabolic syndrome from progressing to diabetes and heart disease.

Suggestions for Sue

Sue did well in adopting a high-fat, low-carb diet. But cutting out dry fruits (high in fructose), reducing animal protein, particularly meat (highly inflammatory), and reducing her caffeine and alcohol would help settle the inflammation and associated metabolic derangement.

As for her anxiety, stress and somewhat excessive physical activity, Sue would benefit from reducing her exercise program and investing more time in practising relaxation techniques.

The routine blood test showed Sue in a state of chronic dehydration. Haemoglobin of 150 g/L is relatively high for a female, urea was high at 9, and sodium and albumin were in the upper normal range. This has a significant metabolic effect, and reducing the intake of dehydrating caffeine and alcohol plus rehydration would restore cell structure and enhance insulin sensitivity.

Again, given her history of endometriosis (high oestrogen), the ongoing generalised anxiety state (high stress hormones), multiple mercury fillings and eating tuna (possible mercury toxicity), Sue would benefit from an intervention that supports her detox system to eliminate stress hormones (may help to settle anxiety) and detoxify mercury.

I suspect Sue may have a genetic variant (COMT) interfering with the detoxification of stress hormones, oestrogen, and heavy metals.

Frustration

It is frustrating for patients with metabolic conditions to continue running high blood sugar despite rigorous efforts to modify their lifestyles. Changing individual lifestyles often helps, but implementing them as a package may prove most effective. For example, having a 15-minute walk after lunch controls blood sugar and prevents detrimental post meal sugar spikes.

You need to think about the impact of simple daily habits on your blood sugar, like drinking coffee at work, a snack of salted and roasted nuts or dried fruits, enjoying a glass of wine with your meal, drinking adequate fluids to keep your cells hydrated and the effect of your prescribed medication on your blood sugar.

A detailed medical history supported by a Continuous Glucose Monitor (CGM) would help uncover which lifestyle choices, in particular, have resulted in insulin resistance and consequent metabolic diseases. This would help map out an accurate action plan to address the real problems, correct metabolism, and improve outcomes.

Let’s take a deep dive to find out which issues discovered in Sue’s clinical history and routine tests have made it difficult for her to control her metabolic process. Let’s start with the big guns.

Chronic anxiety and stress

The stress response is focused on mobilising your body’s resources (including energy stores) for optimal performance to fight or flee the danger. This can result in a fatty liver and the accumulation of belly fat that releases inflammatory cytokines, triggering chronic low-grade inflammation and insulin resistance, which are the hallmarks of metabolic syndrome.

Chronic stress also stimulates the energy balance centre in the brain (hypothalamus) to increase calorie intake and promote the selection of calorie-dense, highly palatable foods over healthier options.

Cortisol, the stress hormone, is a potent insulin antagonist, resulting in insulin resistance and sugar spikes that often mimic panic attacks. Hence, avoid eating carbs (like cereals) at the cortisol peak in the morning. An English breakfast of meat and fat makes much more sense.

High meat intake

Unlike carbs, animal proteins intensify insulin resistance and raise insulin but do not raise blood sugar. This could fuel full-blown metabolic syndrome, including high blood pressure and blood sugar.

Studies have shown that overeating meat increases inflammation, insulin resistance and type 2 diabetes. Red meat contains saturated fat and TMAO – both can trigger inflammation and insulin resistance.

Swapping meat for nuts that contain polyunsaturated fatty acids would protect against disease. Fish and seafood are low in saturated fat and high in omega-3 healthy fat, which is a better option for people with diabetes.

You can limit your daily meat consumption to 60g (the size of your palm). Older adults need 75g of protein daily to promote muscle health, while young adults need 60g.

A study demonstrated that fasting insulin was significantly higher after a dairy diet than after lean red meat. 35g of casein (milk protein) is enough to spike insulin after an overnight fast.

Saturated fat

A high saturated fat intake like trans fat, decreases insulin sensitivity, altering gut bacteria, increasing those that produce lipopolysaccharides (LPS) toxins to trigger inflammation and decreasing those that produce short-chain, anti-inflammatory fatty acids that heal and repair the gut.

Saturated fat causes inflammation in the hypothalamus, the energy balance centre, interfering with satiety, setting a vicious cycle of increased hunger, leading to weight gain and metabolic syndrome.

Dehydration

We live in a culture of dehydration, drinking dehydrating fluids like coffee, tea and chocolate during the day and alcohol at night without adequate hydration. Most people in the UK do not meet the recommended daily water requirements.

Living in chronic dehydration causes your cells to shrink, distorting the cell shape and volume and affecting our ability to sense insulin and process sugar. Studies have confirmed that chronic dehydration results in insulin resistance and increases the risk of type 2 diabetes.

Drinking water before and after (but not during) meals rehydrates your cells, reduces insulin resistance, and prevents sugar spikes.

Alcohol is a processed, energy-dense drink, having 7 calories per gram, almost twice as much as sugar and proteins, slightly less than fat (9 calories per gram), but is nutrient-poor. It is a known risk of insulin resistance, weight gain and type 2 diabetes.

Caffeine

Caffeine blocks the adenosine receptors in the brain, making us wakeful, alert, and energetic. It also stimulates the release of adrenaline to raise blood pressure and release free fatty acids from fat stores, but it inhibits glucose uptake by the big sugar consumers, i.e. the liver, muscles and adipose (fat) tissue.

Clinical studies have demonstrated the negative effect of caffeine, reducing insulin sensitivity by 15% in moderate caffeine consumers, which is significant given the widespread use of caffeine. The effect worsens in people with a genetic weakness in processing caffeine (CYP1A2 gene variant).

Drinking coffee on an empty stomach in the morning may impair blood sugar control, particularly after a disrupted night’s sleep. Eating before coffee may lessen the adverse effects.

There is no need to worry about restricting coffee intake in normal individuals, but it would be relevant in those with diabetes and insulin resistance. We must be careful as the average caffeine intake ranges between 200 and 400mg daily. A cup of coffee may contain 100mg, hot chocolates, and soft drinks contain variable amounts of caffeine, often high in sports drinks.

Sleep apnoea

Sleep apnoea is a common feature of metabolic syndrome, and high blood pressure is part of it. This is due to recurrent airway obstruction during sleep, causing nocturnal hypoxia (low oxygen at night). Activating chronic stress and leading to elevated blood pressure. Studies confirmed that sleep apnoea treatment using CPAP (mask to support breathing at night) controls blood pressure and reduces cardiovascular complications.

Sue’s sleep apnoea improved by wearing a mandible splint at night. This reduced the number of times she wakes up from 33 times (very high) to 5 times (high normal) per hour of sleep, which will have a positive impact on her blood pressure.

So, my friends, you can see that, whilst a healthy lifestyle is important in avoiding metabolic syndrome, it may not provide all the answers to our physical issues, as it did not for Sue. Closer investigation and a look ‘under the bonnet,’ so to speak, to get to the true source of any problems may be in order. And that is where the Vitality Clinic may have a role to play.

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References

Stress and metabolic syndrome

https://thevitalityclinic.co.uk/stress-and-metabolic-syndrome/

20 Reasons for Blood Sugar Swings

https://www.webmd.com/dibetes/ss/slideshow-blood-sugar-swings

Red meat, dairy and insulin sensitivity

https://www.sciencedirect.com/science/article/pii/S0002916523274109

The role of fatty acids in insulin resistance

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4587882/

Caffeine: A Cause of Insulin Resistance

https://diabetesjournals.org/care/article/25/2/399/23287/Caffeine-A-Cause-of-Insulin-Resistance

Effect of diet on insulin sensitivity in humans