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

Distractions from nutrition – a timeline

Goals for the chronically ill often are different than for those who enjoy typical health – avoiding a cold is less difficult than avoiding increased inflammation that can lead to an inability to digest food, or to heal small wounds, or to grow skin in areas where skin cells are replaced on a weekly basis such as in mucous membranes of the nose or mouth or in the ear canal. Those rapidly growing areas represent all of the lining of the intestinal tract. If your skin isn’t healing well from minor scrapes and you have frequent nose bleeds then likely your entire digestive tract isn’t in good shape either. Cells are replaced throughout the body on a regular basis but some areas have a longer life cycle for the replacement than other areas.

(Non-healing sores may be more common in autoimmune condition Lupus, patient forum, may also occur with vasculitis – migraines may involve vasculitis. Patient forums for people with odd diseases can be comforting if only to let them know they aren’t alone. Sunlight exposure can make Lupus worse or be a trigger for some types of vasculitis sores.  The patient forum tips also included a warning not to use petroleum jelly (Vasoline TM) within the nasal passages as it can increase risk for a type of lung infection. Coconut oil was recommended by another forum comment and is the active ingredient in a product that I’ve found helpful for moistening the dry scabby tissue – pain is the common complaint along with bleeding or seeping plasma from the sore tissue. Applying tiny amount within the nasal passage or ear area is not easy but pain is unpleasant. /(After reading the patient forum tips I’ve switched to plain coconut oil as was suggested and it does seem more healing than the thicker chapstick which likely contains some waxes in addition to coconut oil. While a humid, moist air quality is helpful I’ve also found that clean air is important, smoke or smog like air made the skin condition worse whether there was a humidifier or not.)/

I’ve also found relief after a magnesium sulfate/Epsom salt bath and the dryness is reduced with adequate humidity in the air. A damp towel hung near a heating vent can help add humidity to a closed small room if a commercial humidifier isn’t available or seems inadequate. Commercial humidifiers should be cleaned with bleach water or another sanitizing agent occasionally or they may be adding mold or other infectious pathogens to the air – the damp towel dries each night and needs to be remoistened and simply washed occasionally as it doesn’t really get dirty or mold because it doesn’t stay damp. Mold and pathogens can grow on the commercial humidifiers because they tend to always retain some moisture in portions of the machinery. )

Not having a severe headache, migraine pain, and being able to breathe through both nostrils at the same time due to frequent congestion problems are also part of my good days versus bad days. Severe exhaustion and just having the energy to get dressed can be a limiting factor for a day’s goals to get anything else accomplished. Chronic illness is becoming more common rather than less common and how to help prevent or manage it is something that nutrition can help in ways that a bottle of medication can’t because the cell repair throughout the body needs many trace nutrients, vitamins and minerals, and an adequate amount and variety of protein and essential fats and carbohydrates – every day, throughout the day.

Strolling through the distractions used to suggest my concerns about nutrition are unfounded simply reveal the accuracy. (More on the “Weaponization of Social Media” by the U.S. and others) My providing free information is simply in the hope that it might be helpful to someone. I will be fine because I’ve found the research and am using it for my own benefit. Living in a desert is not something that my health can handle however and has never been my goal. The advantage of a virtual world is that if twenty readers find my information valuable then they can benefit from it wherever they are sitting and don’t need me to be present or to be living in a desert area.

Do your own research or find a health care practitioner that is trained in nutrition to help guide you if you are interested in taking better care of yourself now rather than waiting for worse chronic illness or brain degeneration. You could be one of the twenty readers who are interested or not, life is full of choice but consider whether you are choosing for yourself or whether you are accepting society’s Darwin Award of chronic illness via modern lifestyle. The United States is becoming one of the most unhealthy countries on average. Qatar is leading the group too but only since the decades since switching to a modern lifestyle and dietary habits.  (20% diabetes rate in Qatar)(Magnesium deficiency causes insulin resistance)

Supporting big business profit goals is noble but so is survival of the ecosystem over the next thousand years – if we make it through the next one hundred I have hope that we will have figured out more sustainable ways to produce energy and use renewable agricultural methods and that we will survive the next thousand – we are at a turning point where pretending the status quo is working is no longer helpful and is harmful even over the short term.

  1. Obsessive about vitamin D, must be crazy – no my recommendation to not take excessive vitamin D and calcium supplements as it is not a sure way to protect against bone fracture risk and may be harmful, has been since supported by research and is now the standard recommendation. My initial recommendation was in February 2011, this update is December 2017:  https://www.acsh.org/news/2017/12/27/calcium-and-vitamin-d-supplements-still-do-not-prevent-fractures-12329
  2. Some people may truly have low vitamin and hormone D levels while others may have a condition that causes the inactive vitamin D level to be low while the active hormone D level is elevated and likely causing an elevation or tendency to elevation of the body’s calcium levels through increased absorption and decreased excretion and which also leads decreased magnesium absorption and increased magnesium excretion as the minerals are kind of a team. In ancient times magnesium was very plentiful in the water and food supply while calcium is rare so our evolutionary physiology tipped towards conserving calcium and wasting magnesium. Ideally simply ask to have both your inactive vitamin D level (25-D) and your active (1-25-D) hormone D levels to be tested but the current treatment and research recommendations generally just test the less expensive measurement of 25-D. Sarcoidosis, HIV, tuberculosis, Rheumatoid Arthritis are some examples of diseases that may have altered balances of 25-D and 1-25-D. The metabolism of vitamin D is complicated and the commonly used herbicide Roundup which contains glyphosate may be inhibiting the CYP enzymes that are needed to make the active form of hormone D from the inactive form or to make the inactive form with sunshine. This is not a widely accepted theory yet (more on the topic in a previous post) but my own health is better for having reduced my intake of foods that may contain glyphosate and by adding a powdered form of the amino acid glycine to my daily routine. I added the supplemental powder when I had a genetic screening performed that revealed a double gene difference in my ability to digest larger proteins down to the individual glycine. It has active roles within the brain which can help reduce anxiety as well as performing other functions and my health has been much improved. Glyphosate is only one methyl group (-OH, one atom of oxygen and one of hydrogen) different from glycine. (more on glycine & glyphosate in this previous post) Inhibition of CYP enzymes might also increase risk of pancreas problems and diabetes and may play a role in risk of developing autism but it isn’t the only chemical that is likely involved and deficiency of vitamin D is likely not the only nutrient deficiency involved – (more on that in this post.)  By the way, I’m looking for a particular link and just haven’t found it yet – please be patient. Still looking but here is a post with some dietary guidance for prenatal or other people interested in reducing intake of foods that may contain glyphosate: (Self care for prenatal care, part one) Okay I found it, see link [page 19, 1] “Other pathogens that have been shown to reduce the activity of the Vitamin D Receptor, in addition to the pathogen that causes Tuberculosis, include the mold Aspergillus, the viruses that cause Epstein-Barr chronic fatigue syndrome and HIV/AIDS, and the autoimmune diseases sarcoidosis, Crohn’s Disease, and Rheumatoid Arthritis. Elevated levels of 1, 25(OH)2D are seen with the bacterial infections: “Elevated 1,25(OH)2D appears to be evidence of a disabled immune system’s attempt to activate the VDR to combat infection.” [page 19, 1]”  an excerpt from post: [http://transcendingsquare.com/2015/08/11/whether-to-be-compliant-or-to-be-healthy-seems-like-an-easy-question-to-answer/]” which I included in (Preventing autism perinatally – before conception) Newborn umbilical cord samples which are already collected could be tested for more chemicals in order to help identify which infants are likely to be more at risk for developing autism – I would be because of my genetic difference in my ability to digest protein down to the individual amino acid glycine. A researcher found 15 lab test biomarkers/chemicals in common and to save money organized them into three groups – if an infant has the first five, then pay for the screening of the second set of five and if the infant also has those differences then screen for the last set of three chemicals. If all fifteen or most of the fifteen are different than average than the infant may need dietary modifications to help with special methyl forms of B vitamins or supplements of glycine or methionine or help with detoxifying heavy metals for example. See (Newborn Sceening for Autism – 3 sets of 5 potential biomarkers) As an overview and update I will add a link to an article about a recent review of research on the finding that low vitamin D levels are associated with increased risk for many types of cancer – but – excess levels of vitamin D don’t help protect even more than adequate or good levels. Some nutrients and chemicals are safe at elevated levels because they are excreted easily while others are safe and helpful in a -U- shape, too little or too much can be unsafe to health. Vitamin D when activated to the hormone can help control our own immune system’s ability to make antibiotic type chemicals of our own – all day, everyday as long as the nutrient building blocks are available. Too much or too little vitamin/hormone D can increase risk of cancer or of autoimmune disease.
  3. This isn’t about “I told you so” it is about our government or some other agent actively preventing helpful information from being shared. I will keep sharing information that can be helpful because I know how much pain hurts and some chronic degeneration of body and brain function can not be reversed it can only be prevented – seeing your loved ones and having them not remember basic facts about themselves or their family members hurts emotionally – having them forget how to be able to swallow food hurts them physically unless caregivers to spoon feed them can be afforded or are available within the family. You may have to physically massage their throat to help stimulate a swallow reflex, simply putting the spoon in the mouth may not be enough to stimulate a swallow reflex in end stage Alzheimer’s Disease.
  4. Magnesium matters – and Epsom salt baths or foot-soaks (about one cup magnseium sulfate salt to a half bath for 20 minutes every 3 to 4 days or half cup in a tub of water for a 20-40 minute footsoak) can be a better absorbed method – this is now supported by research. It may also help protect against and reverse early stages of Alzheimer’s  Disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182554/
  5. Symptoms of magnesium deficiency can include mood changes such as depression, anxiety, or anger and irritability and physical symptoms such as muscle cramps, eye twitches, or dry eye. https://www.healingtheeye.com/dry_eye.html
  6. Magnesium is nature’s method for blocking calcium channels – and it doesn’t cause the potential side effects that pharmaceuticals may cause (PPIs such as Pprilosec, Nexium and Prevacid.) http://transcendingsquare.com/2015/10/18/magnesium-deficiency-can-cause-irritability-anxiety-and-chronic-degeneration/
  7. Iodine is an essential nutrient for a healthy weight and appetite for adults and infants and moderate deficiency during pregnancy may be an under lying cause of later development of autism. For some reason I can’t imagine the U.S. nutrient database for iodine content was deleted some point in time between when I first started writing about it in 2010/2011 and now. I keep checking in the hope that the information has been restored – but that day isn’t today: https://ndb.nal.usda.gov/ndb/nutrients/index
  8. Zinc, B12 and vitamin D deficiency can mimic symptoms of schizophrenia which is a mental disorder where the brain isn’t recognizing the person’s own subvocal thoughts and mutterings. Treating with psychiatric drugs or only one of the missing nutrients wouldn’t cure the person of the symptoms if multiple nutrient deficiencies were the cause.  Low thyroid levels may also be a risk factor and elevated C-reactive protein or an elevated copper to zinc ratio may also be a factor. http://transcendingsquare.com/2016/03/19/the-voices-that-people-with-schizophrenia-are-hearing-are-probably-their-own-inner-thoughts/
  9. Calcium or vitamin D deficiency can cause hyperparathyroidism which can cause disoriented thinking and may cause self injury or suicidal urges. http://transcendingsquare.com/2016/04/23/self-injurious-behavior-in-autism-patients-with-low-calcium-levels/

That’s the short list.

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.

Calcium and vitamin D supplements are not recommended to help prevent hip fractures

A recent meta-analysis  published in JAMA (2) of research on the efficacy of calcium and vitamin D supplements to help prevent hip fractures and other types of bone fractures in Senior Citizens or post-menopausal women found no benefit compared to placebo or no treatment.  The meta-analysis included 33 clinical trials involving 51,145 participants.

The brief overview article does not mention if harm was found but concludes with the simple statement that the findings do not support a routine recommendation or use of calcium and vitamin D supplements in community dwelling older people. Read more: Thumbs Down on Calcium and Vitamin D to Prevent Hip Fracture (1)

Adequate magnesium in a form the body is able to absorb well, which may require a topical form such as soaking with magnesium sulfate salt (Epsom salt) or magnesium chloride products, is required for maintaining bone health. The minerals silicon and boron are also important and the mineral strontium in microgram amounts may help. Vitamin K from leafy green vegetables and green herbs and spices (or in the form of vitamin K2 supplementally may be helpful) is also important for maintaining bone density. (3)

  1. Jack Cush, MD, Thumbs Down on Calcium and Vitamin D to Prevent Hip Fracture, Medpage Today, Jan 13, 2018, https://www.medpagetoday.com/primarycare/dietnutrition/70497?xid=nl_mpt_DHE_2018-01-16 (Medpage Today)
  2. Jia-Guo Zhao, MDXian-Tie Zeng, MDJia Wang, MDet al, Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis, JAMA. 2017;318(24):2466-2482,     https://jamanetwork.com/journals/jama/article-abstract/2667071?redirect=true (2)

  3. Charles T Price, Joshua R Langford, and Frank A Liporace,

    Essential Nutrients for Bone Health and a Review of their Availability in the Average North American Diet, Open Orthop J. 2012; 6: 143–149.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330619/ (3)