The High Blood Pressure Solution: A Scientifically Proven Program for Preventing Strokes and Heart Disease

Preface to the Second Edition

There is absolutely no doubt that the majority of strokes, heart attacks, and cases of high blood pressure can easily be prevented by maintaining the proper balance of potassium to sodium in the diet. The latest demonstration of this is in Finland, where simple dietary changes,*1 outlined and explained in this book, have resulted†2 in a significant decrease in high blood pressure and a 60% decline in death from both strokes and heart attacks¹in the whole country. You haven’t heard of this?

I wonder why?

The knowledge that we can prevent most cases of high blood pressure and strokes isn’t new. As far back as 1993, the Working Group of the National High Blood Pressure Education Program (NHBPEP) stated:

This is an appropriate time for the National High Blood Pressure Education Program (NHBPEP) in conjunction with other interested parties to initiate a national campaign whose specific goal is the primary prevention of high blood pressure.²

Major newspapers heralded that this group, together with the American Heart Association, were preparing to launch a sustained national campaign to greatly reduce the incidence of high blood pressure and its major consequences, such as stroke and heart attacks.

You haven’t heard of this either? I wonder why?

Well, it never happened. This in spite of the fact that every year in the United States, 600,000 people have strokes and 160,000 people die of this mostly preventable tragedy.³ In fact, strokes are the third leading killer in the United States. Extrapolating from the experience in Finland, 360,000 of those strokes in this country could have been prevented, and about 96,000 stroke deaths could have been prevented. Think of the implications of 360,000 families each year needlessly suffering the tragic and often devastating consequences of a family member having a stroke—in most cases a stroke that shouldn’t have happened. And think of the 96,000 each year who lost a loved one forever—in most cases a loss that shouldn’t have happened.

Moreover, the 1993 report on primary prevention of hypertension also pointed out that problems such as strokes can occur before blood pressure rises above the normal range:

. . . vascular complications can occur prior to the onset of established hypertension because the blood pressure–cardiovascular disease risk relationship is continuous and progressive, even within the normotensive [normal] blood pressure range.⁴ (emphasis mine)

Thus, the typical American who feels comfortable because his or her blood pressure is normal (say 120/80 mm Hg) may be living with a false sense of security.

You haven’t even heard of this? Well, again I wonder why?

Actually, all of the above developments are not a surprise to several of us involved in basic biophysical research who, almost twenty years ago, discovered that the fundamental cause of high blood pressure is a greatly reduced ratio of potassium to sodium, the K/Na*3 ratio, or K Factor, in the modern diet. Moreover, from the biophysical analysis, it became clear that every cell in the body is out of balance in a person who has high blood pressure. This clearly indicated that in hypertension there is a lot more going on than just increased pounding of the blood pressure against our cardiovascular system. The elevated blood pressure is a symptom, or marker, of an underlying cellular imbalance involving potassium and sodium. Moreover, it has since become clear that this potassium-sodium imbalance can cause strokes and heart attacks even when it doesn’t increase blood pressure.

It is generally acknowledged that about 80% of strokes are caused by hypertension. Accordingly, since elevated blood pressure is a marker of a general cellular imbalance that is associated with hypertension and strokes, much of our discussion will focus upon hypertension.

The new insights that were discovered by several biophysicists around 1980 came from analysis of the living cell, as described in simple terms in Chapter 4 of this book. But as it turns out, several perceptive physicians (see below and Chapter 6) had also discovered the same thing much earlier—starting in 1904 and again in 1928! Moreover, these physicians all successfully treated their patients’ high blood pressure by increasing the dietary K/Na ratio, or K Factor. They consistently had success.

And I’ll bet you haven’t heard of this either? Hmmm. I wonder why?

SIX LINES OF EVIDENCE POINT TO THE SAME CONCLUSION

Well if you want my take on why, I’ll give it to you later in the Introduction. But first, consider why we can be so confident that increasing the dietary ratio of potassium to sodium, the K Factor, can eliminate most strokes and a large number of heart attacks and can also prevent and cure the vast majority of cases of high blood pressure.

It is important to point out that no one in the medical community has challenged the conclusions in this book in the eighteen years that this message has been out. There has been effort to prevent you from hearing this message, but the message itself hasn’t been challenged.

It can’t be. The message goes unchallenged because six independent lines of evidence all lead to the same conclusion:

Anthropologists who study different cultures are unanimous in their conclusion that hypertension is a result of lifestyle—not your inheritance (see Chapter 5).

Vegetarians, who have a diet with a high K Factor, almost never get hypertension (see Chapter 5).

Animal studies demonstrate that increasing the dietary K Factor decreases elevated blood pressure and protects against strokes (see Chapters 6 and 15).

Experience with humans demonstrates that increasing the dietary K Factor in people with hypertension decreases blood pressure and can prevent most strokes (see Chapter 6).

Clinical studies using drugs to treat high blood pressure show that just lowering the blood pressure does not prevent many of the heart attacks and strokes caused by hypertension (see Chapter 2).

Biophysical research has revealed that every living cell has an electrical system, involving potassium and sodium, that plays a major role in maintaining a normal homeostasis, or balance, of the cell. This research, in which I was involved, clearly demonstrates that if the K/Na ratio, or K Factor, inside the cell decreases, a whole constellation of abnormalities develops in the functioning of cells throughout the body (see Chapter 4).

You will find here, and in my previous book, The K Factor: Reversing and Preventing High Blood Pressure without Drugs, very strong evidence that if 75% of dietary sodium were replaced with potassium, high blood pressure would be virtually eliminated, and well over 80% of strokes could be eliminated!*4

These and other developments require an entirely new way of thinking about strokes and hypertension.

THE NEW PERSPECTIVE: SIX RELATED INSIGHTS

The new revolutionary view of hypertension and strokes is based on six related insights into the true nature of high blood pressure:

IT’S MORE THAN JUST ELEVATED BLOOD PRESSURE

There is a lot more to hypertension than just elevated blood pressure. The increased blood pressure is a marker, or a sign that something is out of balance. Just as a high temperature is a sign that something is wrong in the body, high blood pressure is a sure sign that there is a serious imbalance in cells throughout the whole body. This imbalance often involves increased blood cholesterol, increased levels of insulin caused by insulin resistance, and a tendency to have high blood sugar levels. In the last analysis, these blood abnormalities are the result of imbalances within each living cell.

We’ve long known that hypertension shares many things with adult †5 diabetes, including the elevated glucose levels and elevated insulin levels. Moreover, people with one condition are much more likely to get the other. We’ll discuss how both conditions are now sometimes known as the now famous Syndrome X, first described by Dr. Gerald Reaven⁵ (see Chapter 7). As you will see, the key feature of Syndrome X is insulin resistance, with a resultant increase in insulin levels. Not only is this the main defect in adult, or Type II, diabetes, but it is also found in most people with hypertension.

Because elevated cholesterol, insulin, and glucose levels, and other abnormalities discussed in Chapter 3, involve much more than just elevated blood pressure, we should discontinue calling this condition high blood pressure and instead should call it by its other name: hypertension, or perhaps the hypertensive version of Syndrome X. Calling it high blood pressure*6 focuses our attention on correcting only the obvious part of the problem—the blood pressure—without addressing the fundamental imbalance. This is just as bad as treating a fever while ignoring the underlying infection.

For example, although lowering blood pressure with drugs definitely reduces strokes and stroke-related death, the evidence that drug treatment decreases heart attacks and overall mortality is very weak (see below). On the other hand, even a small increase in dietary potassium, and thus the K Factor, has been found to significantly decrease stroke-related deaths even when the increase is too small to lower blood pressure (see Chapter 6). Moreover—and surprising to many—the extra potassium has been shown to help lower blood cholesterol levels! Just focusing on the blood pressure misses the point.

EVEN MANY AMERICANS WITH NORMAL BLOOD PRESSURE HAVE THIS IMBALANCE

There is now considerable evidence that many strokes in people without noticeably elevated blood pressure are caused by a K/Na imbalance in their body. A blood pressure in the previously defined normal range is not healthy. We now realize that a blood pressure of 120/80 mm Hg—which is still called normal—is above optimal because even people with that blood pressure have an increased chance of strokes and heart attacks compared with those whose blood pressure is lower (see Chapter 1). As a result, the development of complications, such as stroke and heart attack, from hypertension can begin even when blood pressure is in the so-called normal range.

Thus, the typical American who feels comfortable because his or her blood pressure is normal (say 120/80 mm Hg) is living with a false sense of security. The 1993 report quoted above should help shake all of us out of our complacency.

Some of you may have bought this book for a relative or a friend who has hypertension, but feel it is not for you because you have normal blood pressure. But if you want to minimize your chance of a heart attack, or especially a stroke, this book is for you too!

JUST LOWERING DIETARY SODIUM MISSES THE POINT

As emphasized throughout this book, it is not so much the absolute amount of sodium in the diet as it is the balance, or ratio, of potassium to sodium. Accordingly, many low-sodium diets are doomed to fail because they do not have enough potassium. The K/Na ratio, or K Factor, is what counts!

IT’S NOT SO MUCH IN YOUR GENES AS IT IS IN WHAT YOU EAT

Whereas we used to think that if you had inherited the wrong genes you would inevitably get high blood pressure, the evidence is now decisive that 95% of the cases occur because of lifestyle and a dietary K Factor that is too low. This deficiency in the dietary K Factor is caused by readily correctable mistakes in the processing and preparation of food. Lack of moderate exercise, being overweight, and drinking too much alcohol also contribute.

Blacks have a much higher incidence of hypertension than whites. This has been assumed to be a result of genetic differences. However, more recent studies indicate that the main reason is that the typical diet of blacks has an even lower K Factor than that of whites.

HYPERTENSION CAN BE PREVENTED AND CAN BE CURED!

Because hypertension is not inevitable but is caused by mistakes in what we eat and what we do, it can be prevented, reversed, and in most cases even cured by eliminating these same mistakes. Contrast this to the standard dogma—now weakening—that hypertension can not be cured and that the only option is a lifetime of taking drugs, with their many side effects, which can include dizziness, impotence, fatigue, nausea, weakness, nasal congestion, mental depression, short-term memory loss,⁶ and—in the case of beta blockers—reduction of ability to exercise.⁷

For most of those who already have hypertension, the new insights about lifestyle offer the possibility—right now—of working with their physicians to successfully treat their hypertension without drugs. By removing the causes—primarily an inadequate dietary K Factor, but also excess weight, inadequate exercise, or too much alcohol—the promise now exists of actually curing hypertension and thus preventing its dire consequences such as strokes and cardiovascular disease.

It is to be emphasized, however, that once they have occurred, no one can cure some of the complications of hypertension—strokes, heart attack, blindness, and kidney disease, for example. But if the cause—improper lifestyle—of hypertension is corrected in time, one not only can restore blood pressure to normal, but, more importantly, can prevent the dire consequences of this common condition. So make no mistake, if you have elevated blood pressure and do nothing about it, you are taking a huge, and unnecessary, chance of not just a sudden death, but becoming seriously incapacitated by a stroke or heart attack.

Yet, this is a disease condition that can be practically wiped out! Look at Finland, where even a partial improvement in the national dietary K Factor has produced a 60% decrease in strokes and heart attacks.

Waiting until the blood pressure is elevated and then using drugs to lower it is like locking the barn door after the horse is out—it is obviously better to prevent the problem in the first place. However, when the blood pressure has become elevated, an adequate increase in the dietary K Factor can almost always lower it—especially if combined with proper exercise and weight.

Dr. Julian Whitaker, author of the excellent book Reversing Hypertension,⁸ has demonstrated that patients who use a quick start diet, can lower even severely elevated blood pressure to normal levels within a few days. This diet, developed in the 1940s by Dr. Walter Kempner of Duke University (see Chapter 6), consists of rice, fruit, and vegetables and thus has a very high K Factor.

Thus, the new understanding about hypertension is a tremendously significant development. Implementation of the prevention strategy proposed way back in 1993 by the Working Group of the National High Blood Pressure Education Program (NHBPEP) would offer the possibility not only of eliminating up to 80% to 90% of strokes*7 in the United States, but also of significantly reducing heart attacks, kidney disease, blindness, and other consequences of hypertension. Faced with the example of Finland, why haven’t we in the United States even begun to make the simple changes that could eliminate more than half of these medical disasters that shouldn’t happen?

In addition to the health benefits, the prevention campaign advocated in 1993 could have eventually saved most of the several billion dollars per year currently spent in the treatment of hypertension and its consequences. This could have significantly reduced the exploding medical care costs in the United States. The treatment of hypertension contributes significantly to these medical costs. For example, in patients with diastolic blood pressure (the lower number) between 90 and 94, the total cost of drug treatment has been estimated as about $45,000 for the purchase of each year of good health.⁹

DRUGS AREN’T THE BEST TREATMENT

It should not be surprising that synthetic chemicals, such as the drugs used to treat hypertension, cannot compensate for dietary imbalance. As a scientist who has spent more than a third of a century studying the workings of the living cell, I can assert that we don’t know enough about the workings of the human body to predict all the effects of designer drugs—especially the long-term effects.*8 Just look at Rogaine. It was first developed as a drug to treat high blood pressure. Then, when it was discovered that as a side effect it makes hair grow, the manufacturer changed the marketing strategy and now market it for treating baldness. It’s hubris to think that we can always bend nature to our will by using technology.

Although drug treatment does succeed in reducing some complications of hypertension, this success is by no means complete. As the Working Group of the National High Blood Pressure Education Program pointed out in 1993:

Even those who derive optimal benefit from their antihypertensive treatment are likely to have a higher risk of morbidity [damage such as strokes and heart attacks] and mortality than their untreated normotensive counterparts with a similar level of blood pressure.¹⁰

In other words, even when drug treatment successfully lowers the blood pressure, this produces only a partial reduction in damage to health and in death.

The first study to cast doubt about the ability of blood pressure–lowering drugs to actually save lives was the Multiple Risk Factor Intervention Trial¹¹ (or MRFIT, pronounced Mister Fit), which was published in 1982 in the Journal of the American Medical Association. The MRFIT study summarized the results of a seven-year investigation by the National Institutes of Health of 12,866 men who were judged to be at high risk for heart attacks because they smoked, had elevated serum cholesterol, and had high blood pressure. To the surprise of many scientists and doctors, the MRFIT study found that in people with hypertension characterized by initial diastolic blood pressure between 94 and 99 mm Hg, even though drugs did lower their blood pressure, there was no evidence that this affected the rate of death. Only for people with diastolic blood pressure greater than 100 mm Hg—moderate or severe hypertension—was the death rate clearly decreased through the use of drugs. Unfortunately, the results of the MRFIT study—and of its 1990 follow-up study, which did demonstrate a decreased rate of death attributable to drug treatment—are not conclusive, since neither study compared drug treatment with no treatment. Rather, they compared drug treatment with the usual treatment of a patient’s family physician. Another study in Australia produced similar discouraging results.¹²

But the real shocker was provided in 1985 by results from an impeccable study conducted by the British Medical Research Council. The British study was designed from the beginning*9 to confirm that drug treatment would indeed reduce strokes and coronary events—the most common cause of debilitation and death in patients with mild hypertension. In this study, over 17,000 hypertensive patients were monitored for an average of five and a half years.¹³ At the beginning of the study, before treatment, each of these patients had diastolic blood pressure in the range of 90 to 109 mm Hg. About half the patients received a real drug—either a thiazide diuretic (bendrofluazide) or a beta blocker (propranolol)—and the other half received placebo pills that looked like the real thing.

In the patients receiving a drug, the dose was increased rapidly enough so that within six months the diastolic blood pressure would be below 90 mm Hg. In a few cases, achieving this level of blood pressure required addition of a second or even a third drug (methyldopa).

The results were totally unexpected. The authors of this study summarized the outcome:

these results provide clear evidence that active treatment was associated with a reduction in stroke rate in this mildly [diastolic pressure initially between 90 and 109 mm Hg] hypertensive population and show no clear overall effect on the incidence of coronary events. Active treatment had no evident effect on the overall all cause mortality, but there was a beneficial effect in men and an adverse effect in women."¹⁴ [italics mine]

When one looks at the actual data in this study, one sees that drug treatment did produce a 45% overall reduction in strokes and a 34% reduction in fatal strokes. The authors of the study concluded that although drug treatment did reduce strokes, this achievement

subjected a substantial percentage of the patients to chronic side effects, mostly but not all minor. Treatment did not appear to save lives or substantially alter the overall risk of coronary heart disease.

Another study of drug treatment published in 1985¹⁵ did demonstrate a decrease in death from heart attack, although it was not able to demonstrate a clear decrease in the overall death rate. Yet another study published in 1990¹⁶ analyzed data pooled from several of the antihypertensive drug studies mentioned above. Based on the large number of individuals—a total of 37,000 in these combined studies—this analysis concluded that a decrease of 5 to 6 mm Hg in diastolic blood pressure by drugs is associated with a reduction of approximately 35 to 40% in strokes as well as a 20 to 25% reduction in coronary heart disease. But there is a serious flaw in this 1990 analysis in that 10,940 of the 37,000 people lumped together in this analysis were from a study¹⁷ that did not compare drug treatment with no treatment. Rather, in this study the group treated with drugs also had their dietary sodium reduced. Thus, the results claimed for drugs could also have been due, at least in part, to reduction of dietary sodium.

But even increasing the dietary K Factor by eating just one banana a day (see Chapter 6) can reduce strokes just as much as found in the British drug study! Contrast this with Finland, where even a partial replacement of dietary sodium by potassium*10 reduced strokes by 60%—more than drugs have been demonstrated to do. And there is solid reason to think that larger increases in the dietary K Factor would produce even better results than were obtained in Finland.

So it is clear that although the use of antihypertensive drugs has been a partial success, the idea that they are the ultimate answer to hypertension simply hasn’t stood up to scrutiny. Although it is unlikely that any future study of drugs will be as large as that reported in 1985 by the British Medical Research Council, such studies continue (see Chapter 2).

New drugs are being tested, but even though these drugs are designed to lower the blood pressure, they can’t replace the missing potassium in the cells of the body. Moreover, herbs, meditation techniques, and other procedures that can lower blood pressure—but don’t restore a healthy balance of potassium to sodium in the cells of the body are of unproven effectiveness in preventing strokes and heart attacks. This rebalancing of body potassium and sodium can be done only by having an adequate K Factor in the diet.

A DECREASE IN THE K FACTOR OF BODY CELLS HAS AMAZINGLY FAR-REACHING CONSEQUENCES

How can we obtain such great benefits by such a simple, and inexpensive, change in dietary potassium and sodium? How can the K/Na ratio, or K Factor, be so important? The answer has to do with the fact that the cell has its own electrical system—something that even biology and medical textbooks don’t really emphasize.

In this cellular electrical system, the electrical current isn’t carried by electrons. It is carried by sodium atoms carrying a positive charge. This current is driven by the sodium-potassium pump, the Na/K pump, which is a microscopic electrical generator—driving the electricity through the cell’s electrical system. In the process, this microscopic electrical generator produces almost a tenth of a volt across the extremely thin membrane at the surface of each cell. The electric eel demonstrates how powerful this can be: by lining a lot of these Na/K pumps up in the right way, the eel produces a very large voltage—up to 600 volts! (See Chapter 4.)

It is more widely recognized that this Na/K pump acts to move sodium (Na) out of the cell and potassium (K) into the cell. The fact that with each cycle the Na/K pump moves slightly more sodium outward than potassium inward*11 accounts for the fact that this mechanism generates an electrical current. And this also maintains a high level of potassium and a low level of sodium inside the cell—in other words, a high K Factor inside the cell. Thus, the K/Na ratio, or K Factor, inside the cell reflects the activity of the Na/K pump.

It’s obvious that with the slowing of the Na/K pump, sodium will build up inside the cell, and potassium will decrease. But there is a little known fact—and one that is key to understanding the subject of this book: the total of the sodium plus the potassium inside the cell is constant:

Na + K = constant

The reasons for this have to do with the laws of physics and are outlined in Chapter 4. Here’s the bottom line: It is impossible to lower sodium inside the cell without replacing it with potassium. That’s why these two substances are intimately linked in an inescapable balance. A low sodium diet can’t possibly work unless it contains enough potassium to replace the sodium inside the body’s cells. The laws of physics won’t allow it!

For about twenty-some years (see Chapter 15), we’ve known that potassium, and thus the K Factor, is decreased in the body cells of people with high blood pressure. This tells us that the Na/K pump is not as effective as it should be in people with this condition. It also means that people with high blood pressure have an abnormality in almost every cell in the body. This results in, among other things, abnormal metabolism of fats, cholesterol, and carbohydrate.

Just how important is the Na/K pump? The importance of the Na/K pump is highlighted by the fact that it uses about 25% of all the energy consumed by a cell at rest. And if the Na/K pump*12 stops, the cell dies. Of the scores of mechanisms in the cell that use energy, the fact that just one of them uses a quarter of the energy available for all of them certainly tells you that this one mechanism is very important. That is why, way back in 1958 when I was a graduate student in the physics department at Purdue, I decided to investigate just exactly what the Na/K pump, and the potassium-to-sodium ratio it controls, is doing in the cell. Unfortunately, to this day in medical education, the Na/K pump is typically discussed solely in terms of its role in nerves and in kidney cells. The fact that it plays a key role in every cell of the body is usually ignored.

If the Na/K pump slows down, as it does with a deficient K Factor diet and in hypertension (see Chapter 4), the ratio of potassium to sodium, the K Factor, in the cell decreases. In fact, this ratio is an indicator of how effective the sodium pump is in keeping the sodium battery charged up (see Chapter 4).

But so what? How could a decrease in the activity of this pump be so important? Slowing of the Na/K pump leads to a whole cascade of events involving all the cells of the body:

Sodium builds up inside the cells. It’s obvious that decreased effectiveness of the Na/K pump will result in elevation of sodium, Na+, inside the body’s cells.

Increased sodium inside the cells results in accumulation of calcium inside these cells. The increase in sodium in cells must (see Chapter 4) decrease the activity of one of the key mechanisms that moves calcium out of the cell. This tends to result in an increase in the level of calcium inside the cell. But that isn’t the most significant problem. The slight increase in calcium tends to occur in virtually all cells of the body.

Calcium increases the contraction of small muscles around small-resistance arteries. Inside the tiny muscle cells of the small-resistance arteries, the elevation of calcium triggers a slight, but continuous, contraction.

This contraction narrows the small arteries. Of course, this increased contraction, or tone, narrows these small arteries, increasing their resistance to blood flow and thus elevating blood pressure. Hence the high blood pressure, which everybody focuses upon.

Calcium results in insulin resistance. In many cells, the increase in calcium, which is associated with a decrease in magnesium, results in a decreased sensitivity*13 to the hormone insulin (this is called insulin resistance—and is typical of Syndrome X and hypertension).

Insulin resistance results in elevated blood insulin levels. Because the cells are now resistant to the action of insulin to lower blood glucose, blood glucose levels rise. This triggers a release of more insulin from the pancreas. This results in elevated levels of insulin.

Insulin stimulates the kidneys to retain more sodium. Years ago, my own research group and that of Torben Clausen of Denmark showed that insulin stimulates the Na/K pumps in the body (see Chapter 4). Others have shown that in the kidney, this stimulation can cause the kidneys to retain excess sodium in the body. The action of insulin to stimulate sodium reabsorption in the kidneys apparently is not blunted by insulin resistance. Thus, the kidneys retain more sodium in the body. In the early stages of hypertension, the elevated levels of insulin are probably to some extent adaptive. But later, when they begin to cause the kidneys to retain even more sodium in the body, this elevation becomes counterproductive. Once things get too far out of balance, they have a tendency to get worse.†14

pH inside the cell goes up. My own research group was the one that in 1979 first showed that elevated insulin decreases the acidity (raises the pH) inside the cell.¹⁸ It’s likely that the action of insulin to raise pH inside cells is not blunted by insulin resistance.*15 In any case, the pH inside the body cells becomes elevated in people with hypertension. Inside the cell, hydrogen ions, as measured by pH, are involved in regulating several cell functions, including glycolysis and some of those events leading to cell division. So it is obvious that changes in pH inside the cell can have profound effects upon the metabolism and function of the cell.

Increase in pH and in calcium inside the cells of the body together result in

Abnormal metabolism of fats

High cholesterol levels

Abnormal carbohydrate metabolism

Increased tendency for cell division

The net effect of all these changes in both calcium and magnesium ions and in acid inside the body cells is to play havoc with cell functioning. So a decrease in the K Factor is a sure sign that the cells in your body are less than healthy. Thus, people with high blood pressure have a fundamental abnormality in every cell in the body. As discussed above, this results in, among other things, abnormal metabolism of fats, high cholesterol levels, decreased response to insulin, abnormal carbohydrate metabolism predisposing to diabetes, and an increased tendency for cell division in some cells.¹⁹

In fact, hypertension and adult†16 diabetes are two sides of the same coin—Syndrome X. This similarity between adult diabetes and hypertension is now accepted by the medical profession, which came to this realization because of the similar abnormalities in blood chemistry between people with hypertension and those with adult diabetes. At a deeper level, abnormalities in the biophysics of the cell are involved. Since 1985, we biophysicists have understood not only the similarity between these two conditions but at least part of the mechanism underlying Syndrome X.²⁰

Following this line of reasoning, there is a possibility that increasing the dietary K Factor might be beneficial in treating Type II Diabetes. Thus far, I know of no clinical research groups that have tested this hypothesis, so don’t try it on your own. But one anecdote is provocative: a biologist friend of mine discovered that he was diabetic when his blood glucose came back at 400 milligrams per deciliter (normal range 70–110). He had heard me mention this idea and resisted the pressure to be placed on drugs until he tried increasing his dietary K Factor, which had been very low—he had used large amounts of soy sauce. After he did that, his blood glucose decreased to normal—around 100 milligrams per deciliter. So some clinical research group should look into this lead.

The main point here is that high blood pressure is a sign, or symptom,*17 that there is a lot more wrong than just elevated blood pressure.

Yet, almost all other books, articles, and discussions dealing with high blood pressure focus entirely on ways to just lower the blood pressure—whether through drugs, meditation, herbs, or whatever. All these approaches miss the point—they focus only on the symptoms. Focusing on just the blood pressure amounts to assuming that all of the deranged metabolism just described results only from an increase in blood pressure. Is there any evidence for this view? No. On the other hand, I’ve summarized the evidence that it’s the other way round. Something is terribly out of balance in all of the cells of the body†18 and that imbalance is causing all the other problems—plus, of course, the elevation of blood pressure. In this book, you will see the decisive evidence for that fact.

This point can’t be emphasized enough: hypertension involves a lot more than elevated blood pressure. If you don’t fix the underlying imbalance in the K Factor in your body’s cells, you’re just doing a patch-up job. It would be like giving aspirin to someone whose body temperature is elevated by an infection. Treating just the symptom misses the point—and doesn’t produce the desirable results of preventing most strokes and heart attacks.

THE PROGRAM

The program is simple. In fact, if you ate totally unprocessed foods, included ample fruits and vegetables, and didn’t use common table salt (sodium chloride), you wouldn’t have a problem. So you don’t have to go on a diet! Just be careful how food is prepared, and replace table salt with a sodium-potassium mixture—preferably with a 60—70% potassium content and with some magnesium.

The key nutritional changes pointed out in 1986 in The K Factor and in this book are virtually the same as those recommended by the 1993 report on primary prevention of hypertension by the Working Group of the National High Blood Pressure Education Program (NHBPEP). According to this group, to reduce the prevalence of high blood pressure, the most important things to avoid are these:

a high sodium chloride intake many times beyond human physiologic needs, overweight, physical inactivity, excessive alcohol consumption, and an inadequate intake of potassium.²¹

Avoiding both a high sodium intake and an inadequate intake of potassium is identical to keeping the dietary ratio of potassium to sodium—the K Factor—up where it belongs. In fact, these lifestyle changes are the only way to have maximum success in preventing strokes and in preventing and treating hypertension. Indeed, as far back as 1993 these same changes were recommended for initial treatment of most cases of hypertension by the Fifth Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (see Chapter 2).²²

The key to prevention and even cure—and, as claimed in this book, to successful treatment—is not expensive or high-tech. Moreover, the required changes are not only few but uncomplicated. You don’t have to go on a diet. In fact, you can eat almost any type of food you wish. The problem isn’t so much what you eat, but mistakes in how the food is processed and prepared. But to avoid these easily correctable mistakes, you do have to become informed about the nutritional principles outlined in this book.

HOW DO WE KNOW THIS REALLY WORKS?

Actually, the fact that increasing dietary potassium while decreasing dietary sodium can restore normal blood pressure isn’t news. This was first demonstrated by two French physicians in 1904 and then decisively demonstrated by a Toronto physician, Dr. Addison, in 1928.

THE PROOF OF THE PUDDING IS IN THE EATING.

Several other more recent studies confirm that restoring a healthy dietary K Factor not only prevents hypertension but returns blood pressure to normal in existing cases (see Chapter 6). One reader of this book was diagnosed with a blood pressure of 190/160 mm Hg. Moreover, three different drugs given together had only limited success in lowering his blood pressure. Yet, upon applying the principles presented in this book, his blood pressure plunged toward normal and he has been able to discontinue two drugs entirely and reduce the third to a very low dose. Thousands have been treated this way. More importantly, an increased dietary K Factor has been demonstrated, both in experimental animals and in humans, to prevent strokes even when the increase is insufficient to lower blood pressure.

And then we have the example of Finland, where increasing the dietary K Factor has resulted in a 60% decrease in strokes and heart attacks in the whole country!

Finally, there are numerous personal examples, or anecdotes as some like to call them. Well, a few anecdotes don’t prove anything, but a sufficient number can add up to a compelling argument that should make one stop and think and, in any case, provide good demonstrations or examples. Take my own case. At one time, I did not follow my own advice on dietary K Factor. I had gotten cocky and thought I was genetically resistant to developing high blood pressure. Wrong! All of a sudden, my personal physician discovered that my blood pressure was 160/110 mm Hg. I immediately returned to a proper K Factor in my diet. Within a couple of weeks, my blood pressure was down to around 135/90 mm Hg even though at the time I was too busy to exercise and lose weight. But I did have peace of mind, because I knew that I had almost eliminated my chance of a stroke or heart attack, since (see Chapter 6) I had addressed the underlying problem, not just the blood pressure. Since then, I’ve lost part of the excess fat (I’m still about 12 pounds overweight) and resumed exercise. My blood pressure now ranges between about 135/85 and 115/74 mm Hg—all this without drugs and their side effects and cost. There are many other such examples.

Dr. Julian Whitaker is currently—and successfully—treating hypertensive patients at his clinic by restoring a healthy K Factor in their diet.

SOURCES OF CONFUSION

But wait a minute, you say. If the ratio of potassium to sodium in the diet is so critical, how can it be that some studies claim that elevated dietary sodium seems to be good for you?

How many times have you heard of two studies that contradict each other? One study may conclude that we need to decrease our dietary sodium. Another will say that we do not need to decrease the sodium in our diet; maybe we should even increase it. When two studies give opposite results, you know that at least one of them is wrong! The reason for this inconsistency lies not inherently in the scientific method, or style but usually occurs because of defects in the design of at least one of the studies. For example, a study may claim to show whether or not changing dietary sodium affects blood pres-sure—yet ignore the fact that it is not sodium per se that is the important variable, but the ratio between potassium and sodium. Some of these studies of dietary sodium don’t even mention potassium! Many of these studies not only don’t have any qualitative model, the authors don’t even realize that without such a model, they are just dealing with empiricism. These studies have such serious design flaws that the science is often not first rate. In my view, a few of the investigators are first rate and very smart people, but even they usually lack the advanced education in scientific research that one can obtain in a good university Ph.D. program. The background of the majority of the investigators in this field is limited to their medical training, with no advanced education in scientific research.

Frequently, defects in these studies are later pointed out in the medical literature but are not brought out by the press, which seems to thrive on controversy, real or imagined. By now, most of you have learned that the media love to play up disagreement, whether it is real or not. So take all sensational and controversial studies about salt with a grain of salt.

Another way to keep people confused is to admit there is some value to an idea, but downplay its importance by talking about it piecemeal and by being nonquantitative—in other words, by giving it lip service. For example, it seems today that almost everyone mentions potassium when discussing hypertension. But few explain the quantitative aspects of potassium (see Chapters 4, 6, and 15), let alone the fact that it is the relation between potassium and sodium that is the key. Sure, we’re all talking about potassium sends a signal that discounts this book’s message by giving the impression that it is neither new nor different. It’s good spin to portray this book as just another book about various ways to lower blood pressure—to be sure, one that emphasizes potassium a bit more than the others, but not really new. This is a great way to hide a new message—cloak it in conventionality and make it sound just like all the others. To actively suppress the story would be too obvious and would bring attention to it. Better to let the story limp along and portray it as nothing really new or different, and certainly as nothing revolutionary that would greatly cut our dependence on drugs—heaven forbid! However, the confusion and disinformation about the role of sodium and potassium has finally been laid to rest, at least as far as blood pressure is concerned. On January 4, 2001, USA Today ran an article, Dietary approach really does lower blood pressure, based on an article published in the New England Journal of Medicine the same day.²³ This study decisively demonstrated that either lowering dietary sodium or increasing dietary potassium (by using the DASH diet, a diet high in fruits and vegetables) would lower blood pressure. More to the point of this book, this new study demonstrated that the greatest decrease in blood pressure occurred not only when sodium was decreased but when potassium was simultaneously raised.

Unfortunately, the New England Journal of Medicine study continues the practice, common to medical studies, of focusing on blood pressure without even touching on the fact that a cellular imbalance between potassium and sodium can cause strokes and other damage without increasing blood pressure.

So don’t let all the confusion generated by the perennial parade of contradictory studies, of studies that only look at part of the problem, or studies that test blood pressure rather than actual effects on health, muddle your own thinking and make you lose your confidence. When that happens, just remember Finland! And then go back to the basics. You can find them in this book.

INTRODUCTION

Why Haven’t You Heard of These Developments?

There are striking examples of facts that have been ignored be cause the cultural climate was not ready to incorporate them into a consistent theme.

Ilya Prigogine and Isabelle Stengers¹

Here’s my take on why you haven’t been told the truth about hypertension. I don’t by any means know all the details, but I do know—first hand—some of the story. I think there have been many reasons, one of them the fact that the cultural climate was not ready to incorporate them into a consistent theme. And much of the resistance to changing the message is just that: resistance or inertia.

In addition, there definitely is a medical-industrial complex that influences the discussion of health issues so as to maximize financial profit. Moreover, the Salt Institute continues to push the ideas that would result in more salt consumption—for example, the notion that we don’t need to cut down on dietary salt. To get an idea of this group’s activities, visit its website: www.saltinstitute.org.

A lot of the problem is about money, power, and control. A medical-industrial complex has succeeded in inculcating a pro-drug ideology in medical education and thus practice. And the government has gone along.

There is an unholy alliance between the medical schools, the drug companies, and the politicians—a golden triangle—that keeps this dysfunctional system going and prevents the American people from having the health they deserve. What is the reason this golden triangle exists? It’s all about gold. Indeed, universal adoption of the principles presented in this book would result not only in a huge decrease in the drug expenses of the elderly, and a correspondingly high decrease in the financial strain on Medicare and Medicaid, but a corresponding huge decrease—several billion dollars annually—in income of the drug companies! There is a lot of gold at stake! And there are vested interests that want us to think that drugs are the correct answer for hypertension, regardless of the scientific evidence.

The drug companies are subtly manipulating the medical schools so that most future doctors are indoctrinated with the idea that synthetic chemicals—prescription drugs—are the treatment of first choice for almost every ailment that afflicts humankind. And guess what: part of the salary of many of the medical school instructors comes from where? You guessed it: the drug companies. And guess what: some medical journals such as the American Journal of Hypertension are almost entirely funded by drug companies. Just look at a copy, and you will see.*19

It all started innocently enough. In the 1950s, many drug companies were truly dedicated to the health of the public—as much as to profits. In that spirit, it was natural for them to sometimes give research grants to support fundamental biological research in medical schools and in universities. Indeed, one of the first research grants I received for studies into the action of insulin on sodium and potassium exchange in the body was from Eli Lilly. No strings were attached, and none of my salary came from the grant. However, as time went by, more and more the grant money from drug companies began to shift toward an emphasis on drugs per se rather than just on basic research, such as mine had been. Moreover, more and more, drug companies began to pay at least part of the salaries of medical school faculty. Who is going to bite the hand that feeds them? So now, much of the thinking in medical schools is dominated by drug companies. As just one example, recently I went through the bookstore of a large medical school to see how many books it stocked on prevention of heart attacks, strokes, and hypertension. None—not one! Not mine, not those of Dean Ornish, M.D., not those of Julian Whitaker, M.D. But there were books on the use of drugs to treat those conditions. What does this say to the medical students,