A Simple Program Helps Essential Hypertension

By Milton G. Crane, M.D. and Barbara G. Crane, R.D. of Weimar Institute

High blood pressure is a very common condition. It is also very serious if it continues for a prolonged period. Once it is started hypertension tends to perpetuate itself by causing the small arterioles that regulate pressure to get smaller and stiffer.

Twenty million people in America have a blood pressure of 160/95 or above. An additional 40 million people have a blood pressure in the borderline range between 140/90 and the 160/95 values. Thus 60 million Americans have blood pressure levels, which place them at a high risk of developing a heart attack or a stroke. Cigarette smoking and hypertension are the two big controllable risk factors; and they, along with a faulty diet, are the main causes of degeneration of the arteries in civilized societies.

High blood pressure is defined as a level of 160/95 or above. At each heartbeat, the heart puts out about a cup of blood into the larger arteries. As it courses down into the smaller and smaller arteries, the pressure drops gradually. The main resistance to flow is determined by the arterioles just before the capillaries. Assuming that you have adequate blood volume in the body, blood pressure is regulated by three things: (1) the amount of blood that the heart puts out with each beat, (2) the strength and elasticity of the main arteries, but (3) mainly by the inside diameter of small pressure-regulating arterioles just before the capillaries. The capillaries are very thin walled with a single cell layer in thickness. They have to be protected against the much higher pressure in the arteries. The little arterioles constrict down to allow just the right amount of pressure in the capillaries.

Anything that causes the inside diameter of these small arterioles to get smaller will cause the blood pressure to increase so long as the heart is pumping out the blood. A little too much nerve tension, a little too much of the arterial constrictor called angiotensin, or a little too much sodium salt or salt-retaining hormone in the blood will cause the inside of the arterioles to get smaller.

How common is hypertension? It depends upon whether the person is living as a civilized person or whether he is living as an aboriginal native. The blood pressure has been measured in various ages in over ten different populations of natives that live as simple aborigines. As a rule, the blood pressure does not increase in them with increasing age up to 65 years of age. The exceptions are those societies, which live largely on a diet of salt fish. However, if you look at civilized-type nations, you will find that there is a noticeable progressive increase in average blood pressure from teenagers up to the elderly population. In fact, we commonly use the term that the blood pressure should be "100 plus your age." This is not a valid way to look at it since aborigines have no increase with increasing age.

Why should we be so concerned about high blood pressure? The arteries throughout the body are damaged depending on the degree of elevation in blood pressure, the length of time that hypertension is present, and genetic factors. The longer the duration of the hypertension, the greater will be the thickening of the walls of the arteries. In certain arteries the wall becomes so thickened or weakened by pressure that an affected organ cannot function properly. The kidney begins to fail, vision becomes dimmed; the patient may have ballooning, aneurismal formation, of an artery, or rupture of the artery with a stroke. A patient with a stiffened artery has a brisk steep rise in pressure with each heartbeat. It is comparable to pumping fluid into a stiff lead pipe artery instead of a flexible rubber hose type artery. In such patients the systolic reading, the higher number, is quite high while the diastolic, the lower pressure during resting phase of the heart cycle, is usually in the normal or low range.

Why should people get hypertension? What are the causes? There are two categories of hypertension. These are (1) primary (essential) hypertension, and (2) secondary hypertension. It is important to separate these types because secondary hypertension may be curable by surgery or by a specific medicine. For example, some patients may develop damage of the arteries to the kidneys so that the kidneys put out a very potent blood pressure raising chemical. This chemical circulates throughout the arteries, causes them to constrict, and raises the pressure. Other conditions can cause damage to the kidney and cause secondary renal hypertension. A tumor may grow in the adrenal gland and secrete a potent salt-retaining hormone called "aldosterone." Another adrenal tumor may put out too much hydrocortisone and cause hypertension. There is another chemical called adrenalin, which can come from a tumor called a pheochromocytoma. All of these can be corrected by surgery.

There are probably fifty different causes of secondary hypertension, but all of them together make up only about 15% of the hypertensive population. When a physician sees a hypertensive patient, he should take these into consideration in his workup and treatment plan. It is obviously better to find the cause than to treat a patient with medicine for a number of months or years, and then discover that the cause could have been eliminated and thus render the medicines unnecessary.

What is the cause of essential hypertension? This is still in the debating stage among doctors. However, if we look at several bits of "circumstantial" experimental evidence, we can see why the blood pressure is elevated in so many civilized people but is not increased in the aboriginal societies.

Research scientists have found that when cholesterol and a high fat diet are fed to experimental animals, the arteries get boil-like (atheromatous) plugs on the inside or fibrotic thickening of the wall from collagen and elastin tissue. The monkeys that were fed an equivalent of two egg yolks per day with half the calories from fat, developed on the average 58% closure of the coronary arteries from plugging after a year and a half on the diet. It was found by another group of investigators that if the experimental animal was fed peanut oil with the cholesterol, the artery developed the fibrosis type condition. If they were fed coconut oil, the animal developed the boil-like atheromatous lesion that plugs up the inside of the artery. If they ate milk fat, they developed a third kind of a lesion. If they got a mixture of the fats with cholesterol, the animals got a mixed type of change in the artery. In human beings, we see various grades of all three types of these lesions in their arteries.

Other experiments have shown that if you block the growth of this extra collagen fibrous tissue in the arteries, the blood pressure does not go up.

The experiments showed additional good news. When the added fats and cholesterol were discontinued, and the animals ate only their natural monkey chow of cereal and fruit, the arterial lesions gradually regressed. For example, in the studies of monkeys by Dr. Armstrong, after 40 months off the bad diet, the arteries had opened up from the 58% average closure to only a 17% closure. On the good plant food the amount of fibrous elastin had lessened, but it appears that it will take much longer than we had hoped for the stiffened arteries to recover.

What we now know is this. If you eat a diet that is high in fat, your own body manufactures cholesterol in the liver and small intestines in order to make bile salts to digest the fat. A diet low in natural fiber allows much more of the cholesterol to be retained in the body. If the fat contains peanut oil, for example, your arteries will develop a greater amount of fibrosis.

If you eat foods, such as animal products, which contain extra cholesterol and are not only high in fat, but are also lacking in fiber, the process of cholesterol plugging and stiffening of the arteries will develop earlier in life. The more that the small arterioles are affected by the process, the greater will be the elevation of the blood pressure. Under these conditions, whenever the individual has a little too much nervous tension or a little too much salt in the diet, he will develop hypertension. At first, the blood pressure may be elevated only at times. Later on, it will tend to be elevated all the time.

Fat is also implicated as a factor in causing high blood pressure. In the process of refining fat, the oil may be changed so that in the long 18-carbon chain, the double bond may be shifted along the chemical chain. The first double bond may be six carbon atoms from the end rather than three. This changes it from an omega-3 fat to an omega-6 fat. The result is that the body makes the wrong kinds of prostaglandin's and thromboxane chemicals from these raw materials. In animal products the usual type of fat is arachidonic acid. This fat produces a type of prostaglandin and thromboxane, which raises blood pressure. If we subsist on fats from animal sources or refined fats from oil, margarine, or shortening, the body will make the wrong kind of thromboxanes, prostaglandins, and leukotrienes. The wrong kinds of prostaglandins and thromboxanes cause the arteries to constrict and the platelets to become sticky. The wrong kind of leukotrienes interfere with our ability to fight viruses such as cancer as we should.

If you combine the situation in which you have a little too much narrowing of the arteriole by fibrosis from the effect of cholesterol, with the effect of the wrong kind of prostaglandins, you can readily see how a person after a number of years would tend to develop hypertension. With these underlying factors, a little too much salt in the diet, a little too much mental aggravation, and the patient soon has persistent hypertension.

How do we treat a patient with hypertension on the Weimar NEWSTART conditioning program? First of all, we cut out the food in his diet that is a source of cholesterol. This eliminates all the meat " fish, fowl, eggs, and milk. We exclude all the refined foods from the diet so that all the fiber that is naturally possible would be available to haul away the excess cholesterol out through the gut. This eliminates the oil, margarine, sugar, syrup, starch, white flour, white rice, and meat substitutes. Next we cut back on the natural foods that are high in fat to the point that the fat content of the food would be only about 10 to 15 percent of his calories even though they contain their quota of fiber. This eliminates the nuts, olives, avocados, high fat seeds, and soy products such as tofu from the menu. We do that to decrease the manufacture of cholesterol by the body to a minimum and to decrease the absorption of cholesterol from the gut in response to fatty foods in the diet. We advise the patient to eat the whole fruit rather then the juice so that he would get all the fruit pectin possible to remove cholesterol from the body.

All of the food would be prepared without added salt. There are several tasty sodium free seasonings that can be used to make the food palatable. On this diet we would expect the blood pressure of 65% of the patients would come down to normal (below 140/90) within the first week. Those who continue to need medication require much less to keep the level within safe limits.

If the patient has obesity and diabetes, we would have him chew his food very thoroughly, and eat only about 400 calories for breakfast, 300 calories for lunch, and about 150 calories for supper. Most of the patients on the natural high fiber content foods feel satisfied at each meal. We restrict fluids during the meal, but urge them to have an adequate water intake of about eight glassfuls per day between meals.

Calculations indicate that the usual patient can get an adequate amount of the essential vitamins, minerals, protein amino acids, and fatty acids if their daily menu contains the following foods: A citrus fruit; an additional serving of other fruit; a serving of yellow vegetables such as carrots; green leafy vegetables such as mustard greens, radish greens, collards, turnip greens, or broccoli; a legume such as beans, peas, lentils, or garbanzos; and three kinds of whole grains. Of course, coffee, tea, and all alcoholic beverages are excluded. Two words of caution need to be stated. First, the patients who restrict their salt intake should obtain a regular daily source of 200 micrograms of iodine from two kelp pills daily. Second, The only source of vitamin B-12 is from germs. Half of those on a clean, total vegetarian diet develop a below normal serum B-12 within a couple of years. Prevent this by chewing 500 micrograms of B-12 once a week in the food.

We routinely check the patients with a stress EKG by treadmill to advise them how long and how strenuously they should exercise. Usually, most hypertensives need to avoid too strenuous exercises for the first week because of the exaggerated increase in blood pressure with exercise in hypertensives. Nearly everyone can walk two or more miles per day. Speed is not important, distance is. If the patient cannot get sufficient conditioning exercise by walking because of arthritis or other handicap, he should use a stationary bicycle or exercise in a pool. The object is to get on a training program that will raise the pulse rate during exercise into the conditioning range (about 85% of his maximum allowable heart rate) for at least 30 minutes a day as a minimum, and then perform as much additional exercise as feasible. Ideally, exercise should be in fresh air and sunshine to obtain their added benefit to lower blood pressure.

On the above treatment, with hydrotherapy to help relaxation and aches and pains, the patient should be able to sleep easily. He would be urged to put his trust in divine power, trusting God to work with heaven's true natural remedies for the recovery if his health. We would discontinue his medicines as soon as possible consistent with safety.

In our NEWSTART conditioning program, we find that 60 to 75% of hypertensive patients can be controlled without medications. Obese patients lose on the average 11 lbs in three weeks without feeling hungry. Their work capacity, as determined by the treadmill, increases by 40% in three weeks.

In 1982, Dr. Hans Diehl and I enrolled thirty patients from my hypertension clinics at Loma Linda University and the Loma Linda Veterans Hospital into a three hour, once weekly, series of eight group sessions for instruction into a proper diet and exercise program. These were typical of my patients who I had routinely for months endeavored to persuade to change their eating and exercise habits in my office on a one-to-one basis. By the fourth weekly session, it was evident that these 28 patients had a dramatic decrease in their need for antihypertensive medications. Forty percent had control of their blood pressure to below 140/90 without medication. We estimated that if they, as a group, would stay on the program for one year, they would have a combined savings of $4,300 in medication bills alone. They demonstrated conclusively that group sessions do work whereas routine return visits in a doctor's office do not alter lifestyle. Perhaps this is the reason why few doctors believe that a diet and exercise program will really lower blood pressure and control blood sugar in their patients. We see it happening regularly and routinely at our conditioning center.

The figures below illustrate the results of the 25-day NEWSTART program in 73 hypertensives (30 male and 43 female) patients while they were in the live-in portion of the program and who were then followed from six months to eight years after they left the program. Each antihypertensive medication was rated on the basis of relative potency in controlling blood pressure per milligram of the drug to give a "Relative Drug Potency." The relative drug potencies of the drugs in each patient were summed and then averaged for the entire group of 73 patients.

Changes in Pressure and "Drug Potency Rating" from Live-In Program

The figure above indicates that within one week the dose of medication could be decreased. They were not needed. This was evident by the lowering of both the average systolic and diastolic blood pressures.

The figure below shows that after the patients entered the program their need for antihypertensive medications declined and leveled off at an average of 16% of the initial value. The initial dosage of medication was sufficient to keep only 30% of the patients in the normal range (138/88 or below). After the end of the first week, the second week, and the third week respectively, 33%, 51%, and 62% of the patients had blood pressures of 138/88 or below without medication. The follow-up data indicates that 73% of the patients had very good compliance (rated as +++ to ++++) to the diet, and 51% continued to have very good compliance (rated at +++ to ++++) to the exercise program.

Percent of Patients Normotensive Off Medication and "Average Relative Drug Needs" from Live-In Program

The blood pressure begins to come down most noticeably about the fourth or fifth day into the program. This can be illustrated by the findings in one physician in this group. On the fourth day he became so weak that he was unable to walk to the dining room for breakfast. He had been warned of this possibility and had been advised to discontinue his routine dose of two Dyazide tablets per day. Since he was skeptical that the diet would be effective in lowering the pressure so quickly, if at all, he had not cut back on his medication. On that morning, his recumbent pressure was 110/70; but when he stood up, his pressure was unobtainable. With that information, he took about three grams of salt with food and water and discontinued his antihypertensive medication. By afternoon he was feeling very well.

We can highly recommend this approach to the health-threatening problem of hypertension and other degenerative diseases.

Copyright © 1995-2002 Milton G. Crane, M.D. and Barbara G. Crane, R.D., Weimar Institute, Weimar, CA 95736. All rights Reserved.