High blood pressure and possible ethnic differences

On page 66 of a new book Plagues and the Paradox of Progress: Why the World is Getting Healthier in Worrisome Ways, by Thomas Bollyky, it is mentioned that early Western medical personal working in Africa in the 1920s were surprised to find no cases of hypertension/high blood pressure among the native African people. Only one native woman was known to be overweight and it was noted that she worked in a brewery which led the medical person in the document to speculate whether beer drinking could be fattening (yes it can). The first case of hypertension in a native African person wasn’t noted until the 1940s.

Question: Does the Western style of living or working or export of Western products cause hypertension in native Africans? If native Africans living in their traditional environment using their traditional diet have no risk for hypertension then what changed that caused an increased risk? This topic is also important for prenatal health as preeclampsia can include hypertension/high blood pressure and it does tend to be an increased risk for women with African American ancestry. The DASH diet may be helpful, for more on preeclampsia risk factors and possible tips for prevention or management, see Preeclampsia & TRP Channelseffectivecare.info

I’ve discussed this topic in my early days of blogging when I found a research article from ~ 1970s that noted ethnic differences in health outcomes but did not take into account possible differences in average ethnic diet at the time. (I haven’t found that article in my files yet. I will update this post if I do find it.) To get to the point directly – native African groups may have kidney differences that conserve calcium better, and possibly not conserve as much magnesium, as other ethnic groups. This would be protective when calcium was not very available in the diet but then would be an increased negative health risk if the diet contained a lot of calcium or phosphorus.

Low magnesium levels, particularly when there is also plenty of phosphorus may increase cardiovascular risks. Adequate magnesium levels are protective and elevated magnesium is unusual and may be increase cardiovascular risks. In good health the body maintains magnesium and other electrolyte levels within specific ranges. (5) Higher magnesium levels have also been associated with higher levels of potassium and of albumin, a blood plasma protein, (6), which is important for fluid balance and transport of a variety of chemicals in addition to magnesium (such as steroids, fatty acids, and thyroid hormones (wikipedia/serum albumin), about 30% of serum magnesium is carried in a non-electrically active form on proteins, primarily albumin (Clinical Biochemistry/serum magnesium) (9).

There may be differences in rate of urinary loss of albumin in different ethnic groups. With the presence of excess abdominal weight participants in a renal study of Hindustani-Surinamese, or African-Surinamese ancestry had an increased likelihood of albuminuria than participants of Dutch ancestry with the greatest risk found in the Hindustani-Surinamese group. (7) Asian Americans and African Americans were found to have better blood albumin levels in a renal study and the Asian Americans had better renal biomarkers compared to other ethnic groups in the study. (8)

When looking at hypertension and high blood pressure risk with the same diet in modern research there is a significant increased risk for African Americans to have high blood pressure and to have it occur earlier in life than in whites. (prevalence in the U.S. of hypertension in adults was “42 % for blacks and 28 % for whites,” (2011-2012)). (2)

So it is a good question – how did hypertension frequency in Africans in the 1920s change from zero to 42% for African Americans in the United States, in 2011-2012? Diet differences that were noted in 2009-2010 between white groups and African American groups were more cholesterol and sugar and less fiber, whole grains, nuts/beans/seeds, fruits and vegetables for the African Americans on average. Dairy intake was not mentioned as being significantly difference. In another research comparison calcium intake was lower on average in African Americans but so was magnesium (Table 1). (2)

Within the introduction and Diet and Blood Pressure sections of the article it is mentioned that ethnic differences in cardiovascular metabolism has been noted in African American groups and that their reduction in blood pressure when following the DASH diet was even better than the reduction in people of other ethnic background who followed the diet (it includes a magnesium rich Beans/Nuts/Seeds group as a daily/weekly recommendation). The INTERMAP study found an increased Sodium to Potassium ratio in urinary excretion and less total Potassium urinary excretion for the African American participants than white participants. (2)

Other research has also supported the idea that high blood pressure may have more to do with excess sodium (salt) intake in relation to low potassium intake than just having to do with the amount of sodium in the diet. Potassium is found in all vegetables and fruits in varying amounts, beans/nuts/seeds, and in liquid milk and yogurt. (Kidney dialysis and other patients with Chronic Kidney Disease have to avoid excess potassium so this article includes a list of potassium rich foods for the purpose of educating regarding what needs to be limited but for people of average kidney health it is a list of good sources to include in the diet: Potassium and Your CKD Diet, National Kidney Foundation.

Learning is an ongoing process, in the meantime some possible health tips for people of any ancestry:

  1. Adequate magnesium is essential for kidney and heart health and high blood pressure is an early symptom of low magnesium levels. Dietary sources may not be sufficient if intestinal absorption is poor or if renal losses are excessive. Epsom salt baths or footsoaks or magnesium chloride are topical forms. Adequate protein and phospholipids in the diet are also important to provide the albumin and other specialized transport molecules that carry magnesium and other chemicals within the vascular or other fluids of body tissue. More information about magnesium sources and symptoms of deficiency are available in a previous post: To have optimal Magnesium needs Protein and Phospholipids too.
  2. Adequate calcium and vitamin D are needed for health however excess may cause an imbalance between calcium and magnesium levels as magnesium is excreted along with excess calcium by the kidneys and less magnesium may be absorbed by the intestines as vitamin D causes increased absorption of calcium and magnesium but calcium may be more available in a modern processed food diet. For more information about vitamin D sources see: Light up your life with Vitamin D, peace-is-happy.org. Deficiency of calcium or of vitamin D can cause secondary hyperparathyroidism which can also be more common in renal failure due to excess phosphorus buildup and deficiency of active vitamin D. The healthy kidney is involved in activating vitamin D. (Secondary hyperparathyroidism, National Kidney Foundation) Calcium is plentiful in most dairy products and is also found in almonds, sesame seeds, beans, dark green leafy vegetables and other produce. Variations of a 2000 calorie menu plan shows that even a vegan diet can provide 1000 milligrams of calcium per day and a menu with dairy products can provide an excess with over 1600 milligrams of calcium, see: Healthy Hair is the Proof-of a healing diet.
  3. The DASH diet (Dietary Approach to Stop Hypertension) may help because it encourages potassium and magnesium rich vegetables, fruits, beans, nuts and seeds. Calcium is provided without being over recommended with two to three servings of dairy group foods. See example daily/weekly diet plan recommendations here: What is the DASH diet?, dashdiet.org.
  4. Adequate without excess protein helps protect the kidneys from having to overwork excreting nitrogen from excess protein breakdown. Adequate water is essential for kidney and vascular health as it helps with excretion of toxins and transport of nutrients and oxygen in the vascular system. More information about protein and water recommendations are available in a previous post: Make every day Kidney Appreciation Day.

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

  1. Thomas Bollyky, Plagues and the Paradox of Progress: Why the World is Getting Healthier in Worrisome Ways, 2018, MIT Press, https://mitpress.mit.edu/books/plagues-and-paradox-progress
  2. Chan Q, Stamler J, Elliott P. Dietary factors and higher blood pressure in African-Americans. Curr Hypertens Rep. 2015;17(2):10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315875/“Marked ethnic differences exist in bone metabolism and development of calcified atherosclerotic plaque (CP). Relative to European-Americans, African-Americans have lower rates of osteoporosis (despite ingesting less dietary calcium), form fewer calcium-containing kidney stones and manifest skeletal resistance to PTH (1,2,3). Systemic differences in regulation of calcium and phosphorus appear to be involved (4). Related phenomena may include the markedly lower amounts of calcified CP in African-Americans, despite the presence of more severe conventional cardiovascular disease risk factors (5,6,7,8,9). Together these observations suggest biologically mediated ethnic differences in the regulation of bone and vascular health.” […]  “The DASH/DASH-Na diet BP reduction was more pronounced for blacks compared to whites [313637]. Although the DASH dietary approach has been incorporated into lifestyle changes recommended for patients with HTN [3], data show that few hypertensive Americans consume diets even modestly concordant with the DASH diet and less so for blacks [38]. Only about 19 % of individuals with known HTN from NHANES 1999–2004 had DASH-concordant diets.”
  3. Barry I. Freedman, et al, Vitamin D, Adiposity, and Calcified Atherosclerotic Plaque in African-Americans,J Clin Endocrinol Metab. 2010 March; 95(3): 1076–1083. [ncbi.nlm.nih.gov/pmc/articles/PMC2841532/?tool=pubmed]  
  4. Potassium and Your CKD Diet, National Kidney Foundation, https://www.kidney.org/atoz/content/potassium
  5. Ryota Ikee, Cardiovascular disease, mortality, and magnesium in chronic kidney disease: growing interest in magnesium-related interventions, Renal Replacement Therapy2018 4:1,   https://rrtjournal.biomedcentral.com/articles/10.1186/s41100-017-0142-7
  6. Noriaki Kurita, Tadao Akizawa, Masafumi Fukagawa, Yoshihiro Onishi, Kiyoshi Kurokawa, Shunichi Fukuhara; Contribution of dysregulated serum magnesium to mortality in hemodialysis patients with secondary hyperparathyroidism: a 3-year cohort study, Clinical Kidney Journal, Volume 8, Issue 6, 1 December 2015, Pages 744–752, https://doi.org/10.1093/ckj/sfv097
  7. van Valkengoed IG, Agyemang C, Krediet RT, Stronks K. Ethnic differences in the association between waist-to-height ratio and albumin-creatinine ratio: the observational SUNSET study. BMC Nephrol. 2012;13:26. Published 2012 May 7. doi:10.1186/1471-2369-13-26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492102/
  8. Frankenfield DL, et al., Differences in intermediate outcomes for Asian and non-Asian adult hemodialysis patients in the United States, Kidney International, Vol 64, Issue 2, Aug. 2003, pp 623-631 https://www.sciencedirect.com/science/article/pii/S0085253815493706
  9. M H Kroll, R J Elin, Relationships between magnesium and protein concentrations in serum. Clinical Chemistry Feb 1985, 31 (2) 244-246; http://clinchem.aaccjnls.org/content/31/2/244.long

Make every day Kidney Appreciation Day

In case you missed World Kidney Day (March) today is a good day to appreciate kidney health. The pair of kidneys or single kidney clean the body of daily acidic waste from metabolism and dietary sources and remove other excess minerals and toxins. Adequate water is essential for kidney health as dehydration can cause damage that may not be reversible.

The amount of water a person needs per day varies with the size of the person and the amount of heat, humidity and exercise they experience throughout their day. The eight cups per day for an average person is just an estimate based on typical conditions and average size. Dr. Batmanghelidj specialized in water needs for chronic illness or general health and his rough guideline for adults was to aim to drink ounces of water per day equal to half your body weight (in pounds), so a 150 pound adult might benefit from drinking 75 ounces of water per day ~ about 9 cups of water. The fluid content of herbal tea, juice, milk, or soup would be helping reach the goal, while a diuretic type fluid like coffee or caffeinated black or green teas, or alcoholic beverages would not. His book is older and the validity of some of his theories have been questioned but as a fairly easy to follow overview of the importance of water to health, it is helpful. (Your Body’s Many Cries for Water, pdf)

For more information on the chemistry of water see the collected work on the topic by Martin Chaplin (Water Structure Science), a review of inorganic, organic and biochemistry and physics will be helpful first – I’ve only read a few sections and it is fascinating but slow going. The author explains with enough detail and graphs that even lacking the review of the college courses some of the information can be understood.

For more information on healthy diet for general health or aging and the prevention of chronic kidney or vascular disease see the recently published article about nutrition for health written by a nephrologist. A recent review of organic and biochemistry will be helpful but again some of the basic concepts can be picked up from the thorough description of the issues that may be causing chronic illness and chronic kidney disease.

The summary points – excess protein and sodium and acid producing foods is tasking on the kidneys and may increase risk of chronic illness while adequate to plentiful amounts of potassium rich vegetables and fruit is protective.

How much is considered excess protein?: “The average American consumes 1.2 gm protein/kg/day [23], exceeding the recommended intake (~0.8–1.0 gm/kg/day) for a healthy adult.” (1)

Math – the 150 pound average person is about 68 kilograms (kg) and is averaging an intake of 82 grams of protein per day (1.2 gm/kg/day) instead of the recommended range of 54.4-68 grams per day. For perspective to daily meals – 8 ounces of milk contains about 8 grams of protein, one ounce of meat or one egg or a half cup of beans, about 7 grams, one piece of bread, about 2-3 grams. (Protein content of foods, Today’s Dietitian)

Second only to anyone who doesn’t keep children in cages – nephrologists(kidney/renal health specialists) are my favorite people. The author of the article is saying with a lot of detail that prevention is the best medicine. Treat yourself to healthy habits and you may be lucky enough to never need to meet a nephrologist as a patient. Diets for kidney dialysis patients are extremely restrictive.

Mark your calendars – World Kidney Day 2019 is planned for March 14th. (World Kidney Day)

  • For more information about kidney disease and risk factors see “Who Lives, Who Dies with Kidney Disease,” by Mohammad Akmal and Vasandhara Raghaven, (2018), amazon.com. The book includes personal stories of a variety of patients, real, with some names and identifying details changed for anonymity, starting with some of the first patients diagnosed and treated with kidney dialysis or kidney transplants. The stories may inspire and may leave you reaching for a tissue for tears – they may leave you appreciating kidney health for you and your loved ones and the pioneers who have made treatment more possible. Kidney donors are also worthy of appreciation, today and everyday. The latter part of the book includes an overview of chronic and acute conditions that place [patients more at risk for developing kidney disease, preventative care that may help and current medical treatments that are available.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes. Thanks.

  1. Qi Qian, Dietary Influence on Body Fluid Acid-Base and Volume Balance: The Deleterious “Norm” Furthers and Cloaks Subclinical Pathophysiology, Nutrients 2018, 10(6), 778; Open Access, http://www.mdpi.com/2072-6643/10/6/778/htm  (1)
  2.  Fereydoon Batmanghelidj, M.D., Your Body’s Many Cries for Water, Global Health Solutions, Inc.; Third Ed. (November 1, 2008), https://www.amazon.com/Your-Bodys-Many-Cries-Water/dp/0970245882/ (2), http://www.cci-coral-club.okis.ru/file/cci-coral-club/knigi/FereydoonBatmanghelidj_Your_Bodys_Many_Cries_for_Water_eng.pdf (pdf)
  3. Martin Chaplin, BSc, PhD, CChem, FRSC, Water Structure Science: a website concerned with the physical, chemical and biological properties of water., London South Bank University, (Water Structure Science)   http://www1.lsbu.ac.uk/water/water_structure_science.html (3
  4. Protein Content of Foods, webinar pdf, Today’s Dietitian, (Protein content of foods, Today’s Dietitian)   http://www.todaysdietitian.com/pdf/webinars/ProteinContentofFoods.pdf (4)
  5. World Kidney Day 2019, cute-calendar.com, (World Kidney Dayhttps://www.cute-calendar.com/event/world-kidney-day/33701.html (5)