Nutraceuticals for Healthy Blood Pressure

When we think about the top cause of death and disease around the world, hypertension — that is, high blood pressure — probably doesn’t immediately come to mind.

However, as some recent data show, cardiovascular diseases (defined in large part by the presence of high blood pressure) are the leading cause of death worldwide.

What is perhaps so astonishing (and disheartening) about this statistic is that, in contrast to something like traffic accidents, “acts of god”, and “genetic” diseases, high blood pressure is largely PREVENTABLE.

This isn’t to neglect some genetic/family component of high blood pressure. However, I’m pretty confident in saying that high blood pressure CAN be prevented or at least managed by lifestyle. Unfortunately, our Western “lifestyle” isn’t exactly conducive to this end goal. We’ve done a pretty poor job as a society of mitigating CV risk factors — the prevalence of which most seem to be only rising exponentially.

What are the “lifestyle factors” that can either help prevent or aid in the development of CVD?

The obvious solutions come to mind — exercise, not smoking, eating a healthy diet, and reducing daily stress (physical and psychological) are all super important for limiting your chance of getting high blood pressure, among other modern ailments.

Colloquially, we might refer to these as the “conventional” or “traditional” lifestyle strategies.

Since it’s 2020 and we are all now obsessed with “biohacking” our way to good health and longevity, there is an increasing interest in products/”chemicals”/bioactive compounds that can give us the health benefits we can traditionally derive through a good-old healthy diet and lifestyle, but in a “consumable” form. Many of these are actually found in the diet, but are also formulated into supplements for a more potent dose.

The idea behind taking a formulated or high-dose of something found “naturally” in things like meat, fruits, vegetables, etc. is that we might be able to target and isolate the benefits on a specific pathway in the body. For instance, if “X” found in broccoli lowers blood pressure, then supplementing with “X” at a high dose might be great at lowering blood pressure in the long term.

Supplementing with various compounds like these isn’t necessarily new, but what IS new is that we’ve repurposed them for their ability to prevent disease development or even act as a replacement or adjunct to traditional drug (pharmaceutical) therapy.

That being said, you shouldn’t replace your medications with a natural dietary supplement without consulting your doctor or another health professional…FYI.

Specific to today’s post are bioactive compounds called nutraceuticals. They’re the subject of a recent European Society of Hypertension position stand document on the potential ability for these compounds to reduce blood pressure. All of the nutraceuticals discussed below are found in the article — but the commentary is my own.

What are nutraceuticals?

The term was “created” in 1989 — being a portmanteau of the words “nutrition” and “pharmaceutical” — with the formal definition as: “a food or part of a food…which has a potential health promoting activity in humans, related to a described pharmacological activity.”

That last little bit is key — “related to a described pharmacological activity.” Most of these compounds have effects similar or identical to those of many pharmaceutical compounds used as medicine.

A nutraceutical can be a nutrient: vitamin, mineral, fatty acid, amino acid, peptide, or polyphenol. They can also be botanicals/herbs, molecules like melatonin, carnitine, alpha-lipoic acid, coenzyme Q10, resveratrol, and many others discussed below.

Nutraceuticals can also come in the form of an actual food that CONTAINS one or more of these molecules. As such, nutraceuticals are a broad category of “supplement”.

Like the traditional supplement industry, it’s nearly impossible to regulate the production and sales of nutraceuticals, resulting in a pharmacological wild west. This also makes it hard to really find evidence for if a certain supplement even works.

Sure, we have studies — but even then, many are poorly controlled (if controlled at all) and thus lack an ability to find a significant effect of consumption on a desired outcome.

For this reason, we have groups (such as the ESH) that conduct reviews on the efficacy and effectiveness of various nutraceuticals. Position stands like the one referenced here are a good reference for consumers and “dealers” of these possibly-beneficial agents.

With that being said, let’s take a look at some of the recommended nutraceuticals, their effectiveness at lowering blood pressure, and how/why they might work.

Green Coffee

Green…coffee? Right, I’d never heard of it either. But, apparently, green coffee is a variation of regular coffee that’s less roasted (or “lightly roasted” and therefore higher in certain phytochemicals and phenols that the roasting process would have otherwise “roasted” out.

Specific molecules found in green coffee relevant to health include chlorogenic, gallic, and caffeic acid.

While large analyses of GREEN coffee haven’t been done, the articles cites a meta-analysis of 36 studies on coffee showing that people who drank 1.5–3.5 cups of coffee per day had a lower relative risk for cardiovascular disease than people in the lowest coffee consumption category.

So, theoretically, with a lower caffeine content (caffeine can raise BP) and a higher phenol content, green coffee may be more beneficial for cardiovascular outcomes vs. regular old joe.

Pomegranate Juice

While the hype around pomegranate juice has been largely overblown (fruit juice in general…just not that good for us), it nonetheless has been a topic of study in terms of it’s potential benefits for the cardiovascular system. These benefits are proposed to come from the high polyphenol content found in the juice (and concentrate) and anthocyanins — both which have the effect of reducing oxidative stress.

Reviewing the randomized clinical studies on pomegranate juice, the ESH summarized results of 8 trials, finding that supplementation reduced systolic and diastolic blood pressure by around 5 and 2 mmHg, respectively.

Green and Black Tea

Along with coffee, tea is probably the most consumed beverage in the world (other than water). The green and black varieties, in particular, and not only popular, but touted for their health properties (especially green).

The clinical data do show an improvement in blood pressure. The article cites one meta analysis of 18 studies on green and black tea, showing that consuming 2–6 cups of tea for anywhere from 4–24 weeks can significantly reduce blood pressure. Interestingly, green tea showed greater effects than black, an effect that might be attributed to the higher content of polyphenols found in green tea vs. black.

Omega-3 Fatty Acids

Typically associated with fish oil, the omega-3 fatty acids DHA and EPA are popular supplements, but can also be obtained in the diet by consuming fatty fish and through some plant sources.

How do omega-3s contribute to cardiovascular health and, in particular, blood pressure? Two lines of evidence show a benefit. For one, populations and/or individuals who consume high amounts of dietary omega-3s have better blood pressure control. In addition, studies have shown that supplementation of 2–4 grams per day of omega-3s can significantly reduce blood pressure — but this might only be in people who have diseases like hypertension (i.e. high blood pressure), diabetes, or high blood lipids.

Resveratrol

I’ll try to stay off my soap box on this one. Resveratrol is the molecule that made red wine drinking healthy — it’s found in high quantities in the skins of grapes and other plants. However, the actual concentration of this molecule would be extremely low in wine, and you’d have to drink several liters to get the benefits observed in drug studies (don’t try this at home, kids). If you’re going to supplement, taking a pill with a high dose of resveratrol will be the preferred route.

A meta-analysis of resveratrol studies (17) showed that the molecule lowers blood pressure in type 2 diabetic patients by around 9mmHg, but only when the dose was >300mg/day.

Cocoa

Another potentially misleading health claim has been that dark chocolate is “good for you.” For the soul…maybe…but likely less so for your cardiovascular system.

This notion arose because cocoa flavanols — the compounds found in high amounts in cocoa beans, are antioxidant-like compounds that could benefit cardiovascular health and function.

There have been many studies on the effects of cocoa on blood pressure, and an analysis of 40 studies found that supplementation can lower blood pressure by around 2mmHg (for both systolic and diastolic) in people with baseline high blood pressure.

Coenzyme Q10

Also known as CoQ10 or ubiquinone, this compound (really an enzymem) can be found in organs meats, fatty fish, and fruits and vegetables. However, it’s also marketed as a supplement.

CoQ10 is actually present in our body as part of the energy-producing portion of our mitochondria known as the electron transport chain, which produces ATP from molecular oxygen.

While it might not seem then that CoQ10 has anything to do with blood pressure, it also might have an antioxidant role in the body. For this reason, some studies have investigated whether CoQ10 can reduce blood pressure.

Out of a total 17 trials of CoQ10 supplementation, 7 found a positive effect on blood pressure.

Probiotics

The #gutmicrobiome is a hot topic in health recently, for (potentially) a good reason. Gut dysbiosis (imbalance of good and bad bacteria) can be associated with many diseases such as diabetes, obesity, and others. As such, “fixing” the gut through the use of probiotics might be a viable strategy to limit or reverse the effects of poor gut health on disease of the cardiovascular system (i.e. high blood pressure). This has resulted in the explosion of an industry.

Consumption of probiotics has been shown to reduce systolic and diastolic blood pressure, and the effect appears to be greater in people with higher blood pressure, with a longer supplementation period, and with a supplement containing multiple difference probiotic species.

The supplement industry is a nasty one, and as an exercise physiologist, I am an advocate for “natural” remedies like exercise and diet to improve health…at least as a first-line strategy. However, this aspect makes the concept of nutraceuticals rather attractive to me and others.

They’re not pharmaceutical drugs, but many have the same effect. Really, nutraceuticals are just isolated compounds of things we probably get a little bit of through our diet already. Nutraceuticals just allow us to consume them at a greater than physiological dose. And, due to the fact that many of our fruits and vegetables contain considerably less nutrition than they once did, supplementing might be a way to give us what we’re lacking, and then some.

There are MANY more nutraceuticals that have been investigated for a variety of other health-related functions. Maybe I’ll cover some of these in an upcoming post.

For now, it might be fun to experiment with different natural compounds that you can pick up at a health foods store and see how you respond. There really isn’t a downside to nutraceutical consumption. If they don’t work, you’ve lost a few bucks. The safety of most of these things is extremely high.

With that being said, I’m a fan of any intervention targeted at improving individual and population-level health. Maybe we should start pumping nutraceuticals into our drinking water.

Referenced study:

Borghi C, Tsioufis K, Agabiti-rosei E, et al. Nutraceuticals and blood pressure control: a European Society of Hypertension position document. J Hypertens. 2020.