Paleo No More? Reduce high blood pressure?
January 28, 2015 12:02 PM   Subscribe

My husband (5'8, 205 lbs, 39, South Asian) was diagnosed as pre-hypertensive after several months of high blood pressure readings. After a couple years going soft Paleo to great success for my partner & me, I'm finding myself totally confused by the opposing DASH diet and trying to figure out what to do to improve his health.

He's getting a sleep study done in a couple months (he snores like crazy) and his doctor put him on Lisinopril -- checkup in a couple weeks. He's a teacher prone to stress. His primary exercise/stress management tool (tennis) had to be cut back recently from external circumstances.

A year ago at this time he was 195 lbs and we were doing the Paleo diet together. Then 8 months of chaos: the wedding out of state, a month of international travel, a reception in yet another state, and my getting pregnant and being too fatigued to cook, so eating in restaurants sometimes 3x a day for 4 months, not to mention all the dining out we did during the high chaos times prior.

He weighed 220 and smoked for stress relief when I met him 13 years ago. He quit smoking in 2009 when he picked up tennis again and his weight has been 195-200 ever since. He's usually tired, goes to bed at 10:30pm and wakes at 5:30am.

I'm looking for ways to help him lose weight and keep his blood pressure low but also thrown by the differences between DASH and Paleo. We read Why We Get Fat by Gary Taubes and it seemed to support our effective soft Paleo tactics. DASH is lowfat everything, more carbs than we used to have ever, and food like rice cakes which my mom used to eat on crash diets in the 80s.

Meanwhile I'm still pregnant and trying to curb my pregnancy weight gain (23 lbs in 5.5 months -- was not overweight before pregnancy) and my blood pressure is normal. Cooking different meals for us is too tough.

Do I have to throw out the olive and coconut oils and start using cooking spray like some DASH sources say? If I put him on a more Paleo diet like we used to have, would the weight loss lower the blood pressure too? Both seem to embrace vegetables (a reason I liked Paleo more than Atkins) but I'm feeling like I have to start all over again.

Any other suggestions welcome.
posted by Locative to Health & Fitness (21 answers total) 4 users marked this as a favorite
Response by poster: Forgot to add -- based on past Ask MeFi questions I put him on Pycnogenol, Fish Oil, and CoQ10 supplements as well.
posted by Locative at 12:07 PM on January 28, 2015

Best answer: This is just anecdotal and my personal experience, but I did much better with weight loss and blood pressure improvement on a Paleo-ish diet (I say "ish" because I still eat a little dairy). I lost 80 pounds, all of my blood lipids improved dramatically, and my blood pressure has improved so much that my BP meds have been drastically reduced. I also personally think the DASH diet is a load of hooey after seeing family members only get worse on it. I'd say continue eating Paleo and see how he does on the Lisinopril.
posted by bedhead at 12:08 PM on January 28, 2015 [8 favorites]

Best answer: I'm curious, you say that paleo gave both of you great success - why not stick with it?

For what it's worth, the following blog authors are all pretty fantastic in their own way, and open minded. While they all subscribe, more or less, to the paleo/primal/ancestral diet idea, they do not seem to be ideologically driven.

Marks Daily Apple

As for the DASH diet, I don't know much about it, but going low fat is, in my estimation, woefully misguided.
posted by spacediver at 12:10 PM on January 28, 2015 [6 favorites]

What is his Lisinopril dose?
posted by cda at 12:11 PM on January 28, 2015

Response by poster: Lisinopril dose is 10mg 1x a day.
posted by Locative at 12:13 PM on January 28, 2015

My understanding is that the DASH diet was not designed or tested for weight loss, but for lowering overall cholesterol and blood pressure. The science behind it is pretty strong, especially for people who are already hypertensive.

I'm not a nutritionist or a dietician, and I'd encourage you to speak to one in conjunction with your doctor if you're concerned about your doctor's recommendation.
posted by muddgirl at 12:16 PM on January 28, 2015 [10 favorites]

Best answer: He's usually tired, goes to bed at 10:30pm and wakes at 5:30am.

I'm not sure about the eating, but is it possible that he's tired because he's only sleeping 7 hours/night? I know that sleep needs vary pretty widely, but many (most?) people do better on 8 or so hours a night. There's also some research that shows that a lack of adequate sleep can lead to weight gain (this NYT article has some info).
posted by insectosaurus at 12:17 PM on January 28, 2015 [4 favorites]

Have you met with a registered dietitian about your husband's diet? That would be my first step.

I'd be very hesitant going "low fat" - especially when pregnant.
posted by melissasaurus at 12:18 PM on January 28, 2015 [6 favorites]

Best answer: I don't think that DASH is a particularly up-to-date approach and I prefer Paleo or Ketogenic for better health outcomes. I'd stick with what's working for you now and have Husband consider adding a meditation program. There are lots of apps out there that will do a short guided meditation and can have a great impact on blood pressure over time.

I've also recently bought a new fitness band bracelet that vibrates throughout the day to remind me to go walk around a bit. Depending on Husband's schedule, maybe that will help him stay more active now that tennis is not in his regular schedule? I've found the reminder to meet my steps goal and be active in spurts throughout the day has helped quite a bit with lowering overall stress levels.

Try to get the sleep study moved up. He's already sleeping fewer than 8 hours and if he has apnea, the quality of sleep isn't good. That alone can elevate blood pressure.
posted by quince at 12:20 PM on January 28, 2015 [2 favorites]

Best answer: The only times in my life that my blood pressure has been consistently low is when I am on a low carb high fat diet (keto). It's also done wonders for my cholesterol. It's just an anecdote but I could never ever ever encourage anyone to do a DASH diet if they are trying to resolve either of those things.
posted by joan_holloway at 12:21 PM on January 28, 2015 [5 favorites]

Best answer: I say throw out the Paleo and DASH diet books. Calorie-count instead, and also watch for sodium.

A year ago I was suffering. Really suffering. Headaches. Weakness. Dizziness. And then I started going numb on one side of my body for 1 or 2 seconds with loss of vision - the precursor to a stroke.

I went to the doctor and got some medicine. I was pretty stressed and overweight and all that stuff.

The thing is, I couldn't at the time of my diagnosis eat salt, as my blood pressure would noticeably rise and I would become very sick, medication or not.

So I cut out all salt. This meant no store-bought bread, no cookies, no snack - basically no carbs. Can't eat spaghetti because it uses salt. Other noodles tend to have salt in them.

The only carbs I ate were at lunch - two rice balls. Everything else was just greens and fish.

I started to get really motivated to lose weight because every 5kg of weight loss helped bring down my blood pressue.

I eventually lost about 35 kg.

At the time of my diagnosis I also was not permitted to do any kind of cardio because I was at risk of stroke. So I walked. And walked. And walked.

Walking had the benefit of not only helping reset and maintain my metabolism, but was also great for stress-relief.

It's also easy to do - you don't have to put on any gear or go someplace. You put on some shoes, go out your front door, and walk for an hour. There is no barrier to participation.

But the various diet books are also a barrier. Right now you are trying to figure out which diet is right for you. You already *know* what's right: a low-calorie, low-sodium diet that is high in potassium. Base your meal planning on those principles.

Also, after 40 we require fewer calories. It's a fact. For a time I started missing breakfast, making lunch the first meal of the day (I drank coffee and water in the morning).

Of course, I have fallen off the wagon, but a year ago I was a size 42 and now I am still a size 36.

There is no diet book that is going to work. Reduce the calories, reduce the salt, increase the potassium, and get walking.

That's it.

Anything else is a distraction and a barrier.
posted by Nevin at 12:25 PM on January 28, 2015 [9 favorites]

I would try to stay away from strict diet rules/plans and instead meet with a dietician who is up-to-date on your husband's condition (and possibly also someone to talk to you about healthy eating during pregnancy). I like some paleo recipes, but the amount of bacon/red meat can be staggering depending on the source you use, and the idea that you shouldn't eat whole grains is, in my opion, total bunk (obviously unless you have celiac, but that doesn't seem to be an issue). On the other end of the spectrum, trying to avoid all fats forever also strikes me as a really unhealty approach. I find that what works for me is choosing whole/less processed foods, keeping portion sizes in check, and cooking from home as much as possible. I would be willing to bet that if the ONLY change you made was to cut out restaurant and prepared meals, you'd have things heading in the right direction. I feel like trying to fit 100% into a faddish diet (either low carb OR low fat) leads to messing up and falling off the wagon, so instead I'd just focus on healthy home cooking with whole foods.

But, I'm also someone who doesn't have a specific medical condition, so I think in your case it makes sense to ask the doctor for a reference for a dietician so make sure you're covering all your bases.
posted by rainbowbrite at 12:38 PM on January 28, 2015 [1 favorite]

Best answer: I think getting his weight down 40 or so pounds will do more for his blood pressure (and snoring) than anything. So how do you do that in a way he thinks he can maintain? If that's paleo-lite then he needs to make a bargain with his doctor wherein he is given 6 months to dramatically improve his weight and blood pressure his way. Pre-hypertensive is not hypertensive. It's a warning shot over the bow so to speak. If it doesn't help, then he needs to be willing to try something else. There has been some questioning about the link between saturated fat and heart disease, so DASH may not necessarily be the answer.

If it we're me, I would see what losing weight with paleo-lite and consistent exercise can do for him before subjecting him to DASH. As for the exercise, if he can't get tennis in enough, then just plain old brisk walking is a great alternative. Whatever he chooses, he needs to do it regularly.
posted by cecic at 12:42 PM on January 28, 2015 [4 favorites]

Best answer: I followed DASH rigorously for about 6 miserable months (logging everything into MyFitnessPal) with no change in my blood pressure, and I swear I am not lying but my cholesterol and triglycerides both went up; I am now 6 months on a keto diet (still logging in MFP) and just came off Lisinopril.

I don't believe it's for everyone and acknowledge the science is at best controversial, but as someone who could eat roughly an infinite amount of rolled oat and flax cereal with low fat milk I find it much easier to eat an avacado with some salt for breakfast.
posted by Metafilter Username at 1:00 PM on January 28, 2015 [4 favorites]

Best answer: Sleep apnea linked to hypertension: see if you can move up your husband's sleep test to ASAP. "Snores like crazy" and "always tired" are two symptoms of sleep apnea. If he does have apnea, and he gets and faithfully uses his CPAP, chances are good that it will lower his blood pressure.

I have severe sleep apnea and I use my CPAP every night. My blood pressure was inching up to "borderline high" and now it's "wow, PERFECT!" according to my last checkup. And I eat "soft Paleo" - which has also helped me to lose 30 lbs since last May.

Consult a dietician, but Paleo/Paleo-ish/Primal eating plans seem to work better for most people, IME. And it's a lot tastier than DASH, therefore easier to stick to.
posted by Rosie M. Banks at 1:07 PM on January 28, 2015 [4 favorites]

Best answer: Has his thyroid been tested?
posted by Hermione Granger at 1:27 PM on January 28, 2015

Best answer: I agree with cecic that losing weight will do more for his BP and snoring than anything else in terms of resolving these particular health issues. Specifically, lowering his BMI from a 31.2 (obese) down to 25 would be extremely beneficial.
posted by hush at 2:22 PM on January 28, 2015 [1 favorite]

Epidemiologist chiming in. Before I worked in my current field (regulatory toxicology), my primary focus was diet and nutrition. My experiences in that period of my career were so hard to swallow--in that people will fight you tooth and nail to defend their dietary practices of choice despite any evidence that may be relevant--that I still try to respond to questions like this very briefly and without reading or commenting on other comments.

That said, I would be silly to not mention a couple bits to you:

Principally, the Cleveland Clinic's 'heart diet', which has in recent years been called by (and commercialized under) a number of names. Engine 2 is the main one now, I think. This approach to nutrition and exercise largely came out of cardiac research at the Cleveland Clinic connected with the China Study and related population studies. They've been following cohorts of participants for a long time now--maybe 20 years?--with great success, especially in terms of cardiac health.

The gist: vegan, very limited fat (in that refined fats are almost entirely excluded, and the fats that are permitted are still within their source food when consumed--e.g. olive oil is fine, but it needs to be in the olive and not pressed out into a bottle).

There's a fairly full body of evidence to go along with the approach (which I've followed for about six years--it can be a bit of an adjustment for people used to high fat diets, but as with any lifestyle change it's easier to maintain than it is to initiate).
posted by late afternoon dreaming hotel at 2:52 PM on January 28, 2015 [6 favorites]

Best answer: "There is no diet book that is going to work." I disagree with this - but I don't think every diet book is for everyone. I personally am miserable counting calories and watching sodium.

I've been on Slow Carb for 2 years (with a couple breaks for moving/holidays) and my blood pressure is nearly out of medicated range. I had been on BP meds for 10 years and tried just about every diet. And we love the cheat days. Slow Carb is paleo-ish.
posted by getawaysticks at 5:53 PM on January 28, 2015 [3 favorites]

Best answer: With regard to snoring, apnea, and weight loss: it's true that many people can cure their apnea and/or stop snoring by losing weight, but don't count on it. I've lost 30 pounds, and am at a normal weight for my height, but I still have apnea and still need CPAP. I just have a crowded airway, and while weighing more makes my apnea worse, I will probably need CPAP for the rest of my life. I can live with that because I feel So. Much. Better. and need a lot less sleep because my sleep is of immensely better quality.

Paradoxically, getting the CPAP has made it easier for me to lose weight in the first place because I have more energy and my sleep is of better quality.

Losing weight may help your husband's apnea (if he has it) and eliminate his snoring, but if it doesn't, don't be disappointed. My dad - who I suspect had apnea, but he never got a sleep test - snored like a chainsaw even when he was rail-thin.
posted by Rosie M. Banks at 10:48 AM on January 29, 2015

Response by poster: Thanks to everyone for their input. I marked all the answers that applied the most to my situation as "best" -- though I bet that vegan diet detailed above would work for some, it isn't possible for us for a number of reasons.

Got the sleep study done as recommended, and he indeed has sleep apnea. Had thyroid checked but it was ok, vitamin D was the only thing low. Abandoned DASH diet based on comments here and my intuition about it. Going back to soft Paleo for him with an aim for weight loss until we can get a dietitian. Thank you all so much for your suggestions, it was very eye-opening and I feel like the CPAP and consulting a dietitian will help a lot.
posted by Locative at 11:40 AM on April 2, 2015 [1 favorite]

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