According to the Center for Disease Control, one in three American adults have high blood pressure, a primary [preventable] factor in 13% of all deaths worldwide. Left unchecked, hypertension can lead to heart and kidney disease, stroke, and cognitive disorders like dementia and Alzheimer's. With the high risk associated with chronic hypertension, it's no wonder that so many people turn to pharmaceutical products like beta-blockers and ACE inhibitors to control high blood pressure. But is this the best approach to hypertension management?
According to a study published in the Journal for the American Medical Association, current pharmaceutical recommendations for hypertension management in patients with type 2 diabetes and coronary artery disease are not optimal for overall survival. There seems to be no scientific justification for forcing patients below a systolic reading of 130 mm Hg (the modern treatment goal for patients in this demographic), as this causes slightly more fatalities due to heart disease compared with those kept between 130-140 mm Hg.
These perpetually lowering thresholds for pharmaceutical prescriptions are common among treatment recommendations for many conditions. Most notable are statin drugs like Lipitor prescribed to treat high cholesterol. While broader treatment guidelines seek to reduce perfectly safe cholesterol levels, companies like Pfizer and AstraZeneca end up bringing in over $29 billion per year on statins alone. These are among the most widely prescribed medications despite the abundant evidence that they may actually do more harm than good.
What's more troubling is that disorders like high blood pressure are highly preventable in most patients through simple diet and lifestyle modifications. This highly inconvenient fact is largely ignored, with most cases of especially those based on an understanding of the actual root cause of hypertension. The vast majority of cases of high blood pressure are medically classified as essential hypertension, meaning that the cause is unknown. Despite the mountains of evidence linking diet and lifestyle (including stress) to high blood pressure, modern medical science still overwhelmingly sways in the favor of Big Pharma so that yet another of our "mystery" conditions can be magically cured without significantly affecting our consumption habits.
From the perspective of Tibetan Medicine, high blood pressure has variant causes and conditions for each individual, making a one-size-fits-all treatment quite unrealistic. Essentially, it boils down to an understanding of the three nyépa, the energetic "humors" through which the five classical elements manifest in our body. These energies are known as rLung (spelled with the r head letter to avoid confusion with the respiratory organ), which is the motility factor of the body deriving from the air element; Tripa, the "bile" energy deriving from the fire element; and Peken, the "phlegm" energy deriving from the earth and water elements. This tridoshic system of healing may be familiar to those who have studied Indian Ayurveda, but it's worth noting that a similar humoral model was followed by classical western physicians for hundreds of years. Hippocrates himself practiced a form of medicine that was not altogether dissimilar from Tibetan and Ayurvedic humoral tradition. Each of these three humors are associated with different systems, forms, and functions of the body, as well as certain fundamental psychological experiences. The psycho-physical loop is vitally important in Tibetan Medicine, and this ancient concept is finally presenting a strong scientific basis in contemporary medicine. In Tibetan Medicine, these psychological components of disease are regarded as the root causes of the three humors, and therefore the distant causes of all disease. In looking at the particular humoral manifestations of high blood pressure, we can see how individualized management of psychological imbalance can be incorporated into more holistic management of hypertension.
rLung, the Wind energy of the body, is considered to be the foundational manifestation of the air element in our psychophysical constitution. According to the rGyud bZhi (Four Medical Tantras), its primary seat is in the large intestine and lower body, but it moves throughout the body and is involved in all movement functions, respiration, speech, and circulation. When rLung becomes imbalanced due to improper diet and behavior, it accumulates in its own location, the colon, before spreading through the body and contributing to all kinds of disease. rLung is unique in its pervasiveness and ability to assist both heat-natured and cold-natured diseases in causing systemic imbalance, and it is considered to play some kind of role in all disorders. rLung is closely analogous with the Ayurvedic notion of Vata dosha, the humoral manifestation of the air and space elements in the body (Tibetan Medicine, by contrast, identifies space as a basis for the other four elements and all compounded phenomena).
The Wind energy is associated with the fundamental psychological experiences of desire and attachment, and imbalanced rLung attacking the cardiac region is considered to be a primary cause of mental disturbances like anxiety and some forms of depression. People with a rLung-dominant constitution will often struggle with frequent bouts of insomnia and find it difficult to mitigate stress, a leading cause of hypertension (and contributing factor in most chronic disease). Nervous digestion is very common, particularly involving irritation and irregularity with the colon which can instigate more chronic issues in other parts of the body.
rLung-based high blood pressure is predicated by this kind of intestinal accumulation, usually indicated by bloating and constipation, which seeps through the epithelium and ultimately enters into the circulatory system, increasing systemic vascular resistance and causing an increase in blood pressure. Excess rLung also causes activation of the sympathetic nervous system (responsible for the "fight or flight" response), which floods the circulatory system with cortisol and adrenaline, again increasing vascular tension and causing high blood pressure. Nervousness during the blood pressure reading can sometimes lead to a false diagnosis of hypertension, though if such nervous attacks are frequent then this can still have a lasting effect over time.
Management of rLung-based hypertension should focus on pacification of the rough, light, mobile, subtle, cold, and hard qualities of wind. One's diet should include an abundance of Omega-3 fatty acids (especially DHA and EPA), an absolutely essential part of any cardioprotective diet due to their demonstrably beneficial effect on arrhythmias, atherosclerosis, inflammation, endothelial function, and arterial elasticity. According to traditional texts, the supreme fat for pacifying rLung is ghee, clarified cow's butter. When made from the milk of grass-fed cows, this golden oil is high in DHA Omega-3s as well as vitamin K2, and is a valuable tool in reducing many kinds of hypertension. It is famed in the Tibetan tradition for strengthening one's memory (it's able to cross the blood-brain barrier) and encouraging longevity. Omega 3 fats are also excellent for reducing insulin resistance, a frequent companion for hypertension, and are shown to have a positive effect on mental imbalances like depression and bipolar disorder.
Overall, a rLung-pacifying diet should focus on healthy fats, proteins, cooked vegetables, fruits, and a limited amount of aged grains. All foods should be warm and nutritious with oils like ghee (be careful not to cook with olive oil) and heating spices. Legumes, raw vegetables, processed sugar, and cold foods should generally be avoided, as these can be difficult on digestion. Caffeine should be avoided completely, as should any other stimulant substances. Bitter and spicy foods can exacerbate rLung, as the compounds that produce both tastes are considered to be dominant in the air element. However, there are many beneficial spices and herbs that can be used while cooking, such as garlic, which is high in allicin and shown to be effective in regulating blood pressure, or nutmeg, cinnamon, basil, clove, or fennel (especially to reduce excess gas in the colon).
Simple breathing exercises and meditation are tremendously beneficial in the management of rLung-based hypertension. Just 10-15 minutes a day of meditation can greatly increase one's capacity to handle stressful circumstances, which controls the activation of rLung in the body and prevents engagement of the sympathetic nervous system. Breathing exercises outlined in the Tibetan Medical and Indian yogic traditions are particularly powerful in controlling rLung and controlling hypertension. Modern science identifies this link as being a function of the vagus nerve, the main player in the parasympathetic nervous system (the "rest and digest" system). Through activation of the vagus nerve through deep breathing or pranayama exercises, we are able to treat and prevent a long list of ailments, including hypertension.
External therapies such as oil massage, hormé (hot herbal oil compress), and steam therapy are frequently employed for rLung disorders. Ideally one should get a kunyé massage using therapeutic oils, but if that is not available then you can still enjoy the benefit of oil therapy by applying some sesame oil to your crown chakra, palms, and soles of your feet. It's best to do this before bed, as the rGyud bZhi (Four Tantras) lists this as a treatment for insomnia. In the leynga tradition (and the Ayurvedic panchakarma tradition), enema therapy (usually using oil or an herbal decoction) is administered in order to cut the root of the disease, cleansing the colon of any stagnation or excess rLung and encouraging proper function.
There are many herbal formulas that can be used to support a system manifesting rLung-natured hypertension, but these would be chosen based on the individual symptoms of the patient. Some rLung formulas are more appropriate for inflammatory involvement while others are better for the restoration of metabolic heat. They can also vary in intensity, and many are focused on assisting in particular areas of emotional or mental imbalance. For herbal rLung support, please consult with a trained Amchi (Tibetan Medicine Practitioner).
Tripa is the humoral manifestation of the fire element in our body. Translated as "Bile," this humor does have a correlation with the gallbladder and its secretions, which all share the same name (spelled mKhris Pa). However, the Tripa humor is a much more important and distinct concept than this grosser substance. Tripa controls all heat functions in the body including digestion, hormone regulation, and maturation. It's responsible for eyesight and skin complexion, both of which can be easily damaged by excess heat (i.e. through UV exposure).
Tripa is primarily located in the small intestine and duodenum, though it's also closely related to the liver and gallbladder, and is essentially present anywhere that metabolism is taking place. Hydrochloric acid (HCl) is a readily observable component of Digestive Tripa, one of the five major divisions of the Bile humor. This acid breaks down and transforms partially-digested food into chyme, which can then be further processed and transformed into blood through the Color-Changing Tripa located in the liver. Due to Tripa's predominance in the liver, hepatotoxic substances like alcohol can be very aggravating for Tripa-based hypertension, as can many processed foods.
When Tripa accumulates in the GI tract and liver, we become unable to properly assimilate nutrients into clean blood. This is known as "pure indigestion" in Tibetan Medicine. The oily nature of Tripa begins to build up and seep into the bloodstream, increasing blood viscosity and systemic vascular tension, which ultimately leads to high blood pressure. This is usually linked to systemic inflammation, diarrhea, persistent headaches, acute pain, and a predominance of heat-natured symptoms, as well as liver disease.
A Tripa-pacifying diet is essential in managing this kind of hypertension. One should eat plenty of fresh vegetables, light soups, and fruits. Water-rich fruits and vegetables like cucumber and watermelon are particularly good for reducing heat and regulating blood pressure. Lean meats can be good in moderation, as well as egg whites. Salt should be used sparingly, and warming spices should be avoided in favor of more cooling or neutral spices like mint, coriander, saffron, turmeric, and fennel. Excess oil should be avoided, but really we want to make sure that our Omega 3:6 ratio is healthy (around 1:1-1:5 is ideal), and that we're avoiding dangerous hydrogenated oils (esp. margarine), canola oil, and corn oil. Be sure to pay attention to the ingredient list on any pre-packaged foods you buy - you may be surprised to discover exactly how prevalent these highly-oxidized oils are in common processed foods.
One of the worst dietary offenders in Tripa-based hypertension is an insufficient intake of fluids, or regular consumption of soda instead of pure water. Dehydration prevents the body from expelling excess sodium and can easily lead to high blood pressure. Be sure to drink at least eight glasses of purified water per day. Ideally, it should be boiled in order to lighten its effect on digestion then cooled to room temperature. External therapies for Tripa-based hypertension usually include cold water therapy, cold compresses (i.e. strategically-placed river stones), and targa, a sophisticated form of bloodletting performed after careful consolidation of impurities in the veinous system. There are many powerful herbal formulas which could be used to support Tripa-based hypertension, mainly focused on purifying and cooling the blood, detoxifying the liver, reducing inflammation, and restoring healthy digestive function. These are specifically chosen by a skilled practitioner based on the constitution and symptoms of each individual.
Pekén is the energetic principle of Phlegm, the manifestation of the earth and water elements in the body. This is connected to the Ayurvedic concept of Kapha, which has the same elemental construction. Pekén provides stability and form to the body, as well as lubrication for the joints and inner body. It is primarily located in the stomach (especially the fundus), but broadly resides in the upper body, including the head and brain. It plays a central role in the early stage of digestion as our digestive enzymes (known as Decomposing Pekén) break down freshly-ingested food substances so that they can be cooked and transformed by the Digestive Tripa.
In Pekén-based hypertension, an excessive cold-natured diet or lifestyle causes Pekén to conquer the médrö, or metabolic heat, in the digestive system. Our capacity to transform food into healthy bodily constituents is hampered, and impure substances end up building up in the liver, causing waxy buildup of cholesterol and triglycerides in the bloodstream and ultimately leading to atherosclerosis. Effective management of Pekén-based hypertension involves supporting the metabolic heat, dissolving mucus buildup in the stomach, healing the gut lining, and making general dietary changes.
Pekén-based hypertension is often accompanied by obesity, high cholesterol, high triglycerides, high blood glucose, and general indigestion. In Tibetan Medicine, there are distinct phases of Pekén-natured indigestion which are each approached slightly differently, though all involve the basic process of breaking down blockages and mucosal buildup in the GI tract so that the metabolic fire can be reinvigorated.
A diet that is heavy, cold, sweet, and oily naturally increases Pekén in the body, creating the conditions for high blood pressure. Processed sugar is by far the biggest offender in the modern diet. The damage that excess sugar can do to one's system is astonishing. From high cholesterol, to cell death, to Alzheimer's, sugar can be linked in part to most of the diseases that plague us today. Now you may be thinking, "What about fruit - surely they have a lot of sugar?" and you would be correct. However, fruit also contains a proper dose of dietary fiber that binds with a good portion of the fructose, allowing it to pass through the GI tract without being absorbed by the liver. This is an important missing key for those who drink fruit juice under the impression that the "natural sugar" is somehow inconsequential. Once you remove the fiber from the fruit, you are left with a hefty dose of sugar that the liver must process. This not only affects blood pressure through the cholesterol buildup but also because insulin resistance inhibits the body's capacity to absorb magnesium, another vital mineral for relaxation of body tissues and the maintenance of healthy blood pressure.
Those with a Pekén constitution should eat foods that are warm, light, rough, and easily digested, such as lentils with warming spices and steamed vegetables. Pekén individuals should avoid all cold foods, raw foods, and nightshades (like bell peppers, tomatoes, and potatoes). They should also be careful with grains such as wheat, as gluten intolerance can easily develop due to insufficient médrö. Those who have Peken-nature hypertension should start each day with a cup of hot water mixed with raw honey (you can also add lemon), or with a small pinch of sea salt. This helps to dissolve undigested substances that accumulate in the stomach overnight and gives the metabolic fire a chance to "wake up." Breakfasts should then be light and warm in nature. Caffeine is beneficial in moderation, but one should always be wary of becoming dependent and stressing out our adrenals.
External therapies for Pekén conditions include moxibustion, salt compresses, and other kinds of local treatment. Emetic therapy is traditionally employed following a period of accumulation in order to expel the root of the Pekén disorder from the fundus. This is followed by reinvigoration of the digestive fire and general system. Acupuncture is sometimes used as well, often combined with moxibustion. In general, those with Pekén constitutions need to engage in regular vigorous exercise, especially when at risk of heart disease. This is an indispensable part of staying healthy, of course, but no amount of exercise can reverse a bad diet.
Ignorance is the psychological factor associated with Pekèn disorders. Often times Pekén individuals will be prone to sluggishness and become quite sedentary. The dull and heavy qualities dampen the sharpness and quickness of one's mind and makes any kind of activity cumbersome. One obvious way that ignorance (in the most literal sense of the word) leads to Pekén imbalance is through ignoring the dangerous foods that we eat. Processed sugar is arguably more dangerous than cocaine, and yet due to its addictive nature it is extremely difficult to break one's dependency on it despite the obvious danger. It's extremely important that those with Pekén-dominant hypertension reduce their daily sugar intake, but the reality is that everybody should reduce their daily sugar intake to about 15 g or less.
Like the other two humors, there are many herbal therapies that can be employed for those suffering from Pekén-natured hypertension, most focused on melting through the buildup of undigested substances in the GI tract and stimulating digestive heat. Formulas should be selected and administered by a trained Tibetan Medicine Practitioner to ensure that the proper support can be provided to balance the humors and encourage healing.
One factor that affects everybody is vitamin D deficiency, which affects up to 85% of Americans. Numerous studies have tracked the effect of vitamin D of cardiac health, and they have concluded that vitamin D deficiency contributes significantly to premature death overall, but particularly due to heart disease. One study found that older men and women with vitamin D deficiencies had a 378% greater risk of dying from heart disease versus those who had healthy levels.
By far the best method of increasing vitamin D levels is to spend adequate time with direct sun exposure on the skin. For those with a Tripa predominance, this direct sun exposure may be irritating and exacerbate internal heat conditions, in which case an oral D3 supplement could be a good substitute. During the winter months, even direct sun exposure often isn't enough to raise vitamin D levels to therapeutic levels in most places. In this case, it's also important to supplement adequately. Consult with a professional to determine the proper dosage.
Certain unhealthy behaviors and foods should be immediately abandoned by everyone, with or without hypertension, in order to prevent heart disease and many other highly preventable conditions. Smoking cigarettes is extremely harmful to cardiac health (among other things), with over 20% of U.S. deaths due to heart disease linked directly to smoking. Processed sugar is the other major contributor to heart disease (and virtually every other disease) that should be removed from every diet. If we can simply cut daily sugar intake to under 15 g per day, we will see an immediate improvement in our health without any other intervention.
Blood pressure monitoring is essential in staying abreast to the state of one's health, but without taking proper steps towards a more balanced diet and lifestyle, knowledge is worthless. Educate yourself on holistic strategies for managing concerning blood pressure numbers, and as always, consult with your primary care physician before making any changes to an existing treatment regimen, and be sure to seek the guidance of a trained Amchi before undertaking Tibetan herbal therapy.