The role of nutrition and nutraceutical supplements in the treatment of hypertension

Table 1 Dietary intake of nutrients involved in vascular biology: Comparing and contrasting the diet of paleolithic and contemporary humans

Nutrients and dietary characteristics	Paleolithic intake	Modern intake
Sodium	< 50 mmol/d (1.2 g)	175 mmol/d (4 g)
Potassium	> 10000 meq/d (256 g)	150 meq/d (6 g)
Sodium/potassium ratio	< 0.13/d	> 0.67/d
Protein	37%	20%
Carbohydrate	41%	40%-50%
Fat	22%	30%-40%
Polyunsaturated/saturated Fat ratio	1.4	0.4
Fiber	> 100 g/d	9 g/d

Table 2 Oxidative stress induces endothelial dysfunction, vascular disease and hypertension. Host protective factors include enzymatic and non-enzymatic defenses influenced by diet and nutrients

The cytotoxic reactive oxygen species and the natural defense mechanisms
Reactive oxygen apecies		Antioxidant defense mechanisms
Free radicals		Enzymatic scavengers
O2•-	Superoxide anion radical	SOD	Superoxide dismutase
OH•	Hydroxyl radical		2O2•- + 2H+→ H2O2 + O2
ROO•	Lipid peroxide (peroxyl)	CAT	Catalase (peroxisomal-bound)
RO•	Alkoxyl		2H2O2→ O2 + H2O
RS•	Thiyl	GTP	Glutathione peroxidase
NO•	Nitric oxide		2GSH + H2O2→ GSSG + 2H2O
NO2•	Nitrogen dioxide		2GSH + ROOH → GSSG + ROH + 2H2O
ONOO-	Peroxynitrite
CCl3•	Trichloromethyl	Nonenzymatic scavengers
		Vitamin A
Non-radicals		Vitamin C (ascorbic acid)
H2O2	Hydrogen peroxide	Vitamin E (α-tocopherol)
HOCl	Hypochlorous acid	β-carotene
ONOO-	Peroxynitrite	Cysteine
1O2	Singlet oxygen	Coenzyme Q
The superscripted bold dot indicates an unpaired electron and the negative charge indicates a gained electron. GSH, reduced glutathione; GSSG, oxidized glutathione; R, lipid chain. Singlet oxygen is an unstable molecule due to the two electrons present in its outer orbit spinning in opposite directions.		Uric acid
		Flavonoids
		Sulfh ydryl group
		Thioether compounds

Table 3 Natural antihypertensive compounds categorized by antihypertensive class

Antihypertensive therapeutic class (alphabetical listing)	Foods and ingredients listed by therapeutic class	Nutrients and other supplements listed by therapeutic class
Angiotensin converting enzyme inhibitors	Egg yolk Fish (specific): bonito, dried salted fish, fish sauce sardine muscle/protein tuna garlic gelatin hawthorne berry Milk products (specific): casein sour milk whey (hydrolyzed) sake sea vegetables (kelp) sea weed (wakame) wheat germ (hydrolyzed) zein (corn protein)	Melatonin omega-3 fatty acids pomegranate pycnogenol zinc
Angiotensin receptor blockers	Celery fiber garlic MUFA	Coenzyme Q10 gamma linolenic acid N-acetyl cysteine oleic acid resveratrol potassium taurine vitamin C vitamin B6 (pyridoxine)
Beta blockers	Hawthorne berry
Calcium channel blockers	Celery garlic hawthorn berry MUFA	Alpha lipoic acid calcium magnesium N-acetyl cysteine oleic acid omega-3 fatty acids: eicosapentaenoic acid docosahexaenoic acid taurine vitamin B6 vitamin C vitamin E
Central alpha agonists (reduce sympathetic nervous system activity)	Celery fiber garlic protein	Coenzyme Q 10 gamma linolenic acid potassium restriction of sodium taurine vitamin C vitamin B6 zinc
Direct renin inhibitors		Vitamin D
Direct vasodilators	Celery cooking oils with monounsaturated fats fiber garlic MUFA soy	Alpha linolenic acid arginine calcium flavonoids magnesium Omega-3 fatty acids potassium taurine vitamin C vitamin E
Diuretics	Celery hawthorn berry protein	Calcium coenzyme Q 10 fiber gamma linolenic acid l-carnitine magnesium potassium taurine vitamin B6 vitamin C Vitamin E: high gamma/delta tocopherols and tocotrienols.

MUFA: Monounsaturated fatty acids.

Table 4 Integrative approach to the treatment of hypertension

Intervention category	Therapeutic intervention	Daily intake
Diet characteristics	DASH I, DASH II-Na+ or premier diet	Diet type
	Sodium restriction	1500 mg
	Potassium	5000 mg
	Potassium/sodium ratio	> 3:1
	Magnesium	1000 mg
	Zinc	50 mg
Macronutrients	Protein total intake from non-animal sources, organic lean or wild animal protein, or coldwater fish	30% of total calories, which 1.5-1.8 g/kg body weight
	Whey protein	30 g
	Soy protein (fermented sources are preferred)	30 g
	Sardine muscle concentrate extract	3 g
	Milk peptides	30-60 mg
	Fat	30% of total calories
	Omega-3 fatty acids	2-3 g
	Omega-6 fatty acids	1 g
	Omega-9 fatty acids	2-4 tablespoons of olive or nut oil or 10-20 olives
	Saturated fatty acids from wild game, bison, or other lean meat	< 10% total calories
	Polyunsaturated to saturated fat ratio	< 2.0
	Omega 3 to omega 6 ratio	1.1-1.2
	Synthetic trans fatty acids	None (completely remove from diet)
	Nuts in variety	Ad libidum
	Carbohydrates as primarily complex carbohydrates and fiber	40% of total calories
	Oatmeal or	60 g
	Oatbran or	40 g
	Beta-glucan or	3 g
	Psyllium	7 g
Specific foods	Garlic as fresh cloves or aged kyolic garlic	4 fresh cloves (4 g) or 600 mg aged garlic taken twice daily
	Sea vegetables, specifically dried wakame	3.0-3.5 g
	Lycopene as tomato products, guava, watermelon, apricots, pink grapefruit, papaya or supplements	10-20 mg
	Dark chocolate	100 g
	Pomegranate juice or seeds	8 ounces or one cup
	Sesame	60 mg sesamin or 2.5 g sesame meal
Exercise	Aerobic	20 min daily at 4200 kJ/wk
	Resistance	40 min/d
Weight reduction	Body mass index < 25	Lose 1-2 pounds per week and
	Waist circumference:	increasing the proportion of lean muscle
	< 35 inches for women
	< 40 inches for men
	Total body fat:
	< 22% for women
	< 16% for men
Other lifestyle recommendations	Alcohol restriction: Among the choice of alcohol red wine is preferred due to its vasoactive phytonutrients	< 20 g/d
		Wine < 10 ounces
		Beer < 24 ounces
		Liquor < 2 ounces
	Caffeine restriction or elimination depending on CYP 450 type	< 100 mg/d
	Tobacco and smoking	Stop
Medical considerations	Medications which may increase blood pressure.	Minimize use when possible, such as by using disease-specific nutritional interventions
Supplemental foods and nutrients	Alpha lipoic acid with biotin	100-200 mg twice daily
	Amino acids:
	Arginine	5 g twice daily
	Carnitine	1 to 2 g twice daily
	Taurine	1 to 3 g twice daily
	Chlorogenic acids	150-200 mg
	Coenzyme Q10	100mg once to twice daily
	Grape seed extract	300 mg
	Hawthorne extract	500 mg twice a day
	Melatonin	2.5 mg
	N-acetyl cysteine	500 mg twice a day
	Olive leaf extract (oleuropein)	500 mg twice a day
	Pycnogenol	200 mg
	Quercetin	500 mg twice a day
	Resveratrol (trans)	250 mg
	Vitamin B6	100 mg once to twice daily
	Vitamin C	250-500 mg twice daily
	Vitamin D3	Dose to raise 25-hydroxyvitamin
		D serum level to 60 ng/mL
	Vitamin E as mixed tocopherols	400 IU