Keto And Blood Pressure: What's The Link?

The ketogenic diet is a popular but strict weight-loss diet that involves eating 75% of your calories from fat, 20-50 grams of carbohydrates, and the remaining 15% of calories from protein. While the keto diet may result in weight loss and lower blood sugar, it is not sustainable and may lead to weight gain once stopped. The diet has been linked to lower blood pressure, but it can also cause low blood pressure in some cases. It is not recommended for those with certain pre-existing conditions or for women who are pregnant or planning to become pregnant.

Keto and high blood pressure

Blood pressure is the force exerted on the walls of your veins and arteries. There are two numbers used to measure blood pressure: systolic blood pressure and diastolic blood pressure. Systolic blood pressure is the pressure when your heart beats, and diastolic blood pressure is the pressure between heartbeats. For an adult with average blood pressure, a reading will be around 120 (systolic) / 80 (diastolic). High blood pressure is indicated when the systolic reading is above 130 or the diastolic reading is above 80.

The keto diet is a high-fat, low-carbohydrate diet. It is extremely strict and difficult to maintain, as it requires 75% of your calories to come from fat, 5% from carbohydrates, and 15% from protein. This diet is primarily used to manage seizures in children with epilepsy, but it has gained popularity in recent years as a weight-loss method.

The keto diet may be an effective way to lower blood pressure, especially for those who are obese. Obesity is a leading cause of hypertension (high blood pressure), so shedding extra fat can help reduce blood pressure. The keto diet is associated with appetite suppression, increased energy expenditure, and lowered insulin levels, all of which can contribute to fighting hypertension.

Several studies have shown that the keto diet may help treat or prevent hypertension. For example, one study compared keto to three other diets: the Zone diet (30% carbs), the LEARN diet (60% carbs), and the Ornish Diet (10% fat calories). The results showed that those on the keto diet had twice the improvement in systolic blood pressure compared to the other diets.

However, there are some potential risks to consider. The keto diet may not be suitable for those with certain medical conditions, such as chronic kidney disease or low blood pressure. Additionally, a "dirty keto" diet that is high in processed meat and low in vegetables may increase blood pressure due to high sodium intake and low potassium levels.

It is always recommended to consult a medical professional before starting any new diet, especially if you have existing health conditions.

Tips for Managing Blood Pressure

• Exercise regularly: Mild to moderate aerobic exercise is proven to lower blood pressure.
• Get enough sleep: Sleep disorders are independent risk factors for high blood pressure.
• Maintain a healthy weight: Losing weight can help improve blood pressure.
• Consume adequate sodium and potassium: Deficiencies in these minerals can elevate blood pressure.
• Increase fiber intake: Higher fiber intake is linked to lower arterial blood pressure.

Blood pressure medication

High blood pressure, or hypertension, can lead to serious health problems such as heart attack, heart failure, stroke, and kidney disease. It is important to treat high blood pressure early to prevent these and other problems. There are dozens of different medications that can help treat hypertension, and they are called antihypertensives. These medications are divided into many different categories, each working in a different way.

Diuretics

Diuretics are one of the most commonly used drugs for treating high blood pressure. They help the kidneys get rid of excess water and sodium (or salt). This reduces the volume of blood that needs to pass through your blood vessels, which in turn lowers your blood pressure.

Beta-blockers

Beta-blockers work by blocking the actions of hormones in your body that stimulate your heart. This allows your heart to beat with less speed and force, leading to a decrease in blood pressure. Beta-blockers can be selective, meaning they only block beta-1 receptors found in the heart muscle, or non-selective, which block both beta-1 and beta-2 receptors.

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors keep the body from making a hormone called angiotensin II, which causes blood vessels to narrow. These medications help constricted blood vessels expand to let more blood through, thereby lowering blood pressure.

Angiotensin II receptor blockers (ARBs)

This class of drugs also protects the blood vessels from angiotensin II. Angiotensin II must bind with a receptor site in order to tighten blood vessels. ARBs prevent that from happening, resulting in lowered blood pressure.

Calcium channel blockers

Calcium channel blockers help block calcium from entering the smooth muscle cells of the heart and blood vessels. This makes the heart beat with less force and helps blood vessels relax, leading to a decrease in blood pressure.

Aldosterone receptor antagonists

Aldosterone receptor antagonists block a chemical called aldosterone, which reduces the amount of fluid retained in the body and helps lower blood pressure.

Direct renin inhibitors

Direct renin inhibitors (DRI) block a chemical in your body called renin. This action helps widen your blood vessels, which lowers your blood pressure.

Peripheral adrenergic inhibitors

Peripheral adrenergic inhibitors stop neurotransmitters in the brain from conveying a signal that causes the heart muscle to constrict. This helps lower blood pressure.

Alpha-blockers

Alpha-blockers work by blocking catecholamines from binding to alpha receptors. As a result, blood can flow through the blood vessels more freely, and your heart beats normally, lowering blood pressure.

Alpha-2 receptor agonists

These medications block brain signals that can increase heart rate and narrow blood vessels. This lowers blood pressure.

Combined alpha and beta-blockers

These may be prescribed for outpatient high blood pressure use if the person is at risk of heart failure.

Blood vessel dilators (vasodilators)

Blood vessel dilators cause the muscles in the blood vessel walls to relax, allowing the vessel to widen. This allows blood to flow through more easily, resulting in lower blood pressure.

Salt and bouillon

Salt

A low-carb diet like keto can lead to a mild sodium deficiency. This is because low-carb diets lower insulin levels, which causes the kidneys to excrete excess sodium from the body. Therefore, it is important to ensure you are getting enough sodium, as well as potassium, when on the keto diet.

Bouillon

Bouillon is recommended as a tasty way to get extra fluid and salt. It is especially helpful in the first couple of weeks on the keto diet, when side effects like headaches, lethargy and difficulties concentrating are common. These side effects can be moderated or avoided with extra fluid and salt.

Bouillon also replaces the electrolytes lost from drinking a lot of water and can help with constipation, another possible side effect of the keto diet.

It is recommended to start every day with a cup of bouillon, and then in the second week, you can stop having it every day and only use it if you don't feel great. You can make your own bouillon or bone broth at home, or buy it in cube or powder form. However, some shop-bought bouillons may contain additives like MSG and sugar, so it is important to read the ingredients list carefully.

Obesity and hypertension

The relationship between obesity and hypertension is complex and involves multiple mechanisms, including sympathetic nervous system overactivation, stimulation of the renin-angiotensin-aldosterone system, alterations in adipose-derived cytokines, insulin resistance, and structural and functional renal changes. Obesity can lead to higher levels of chronic inflammation, which creates hormonal disturbances that elevate blood pressure. Additionally, obesity can cause physical compression of the kidneys, leading to further renal changes that contribute to hypertension.

The treatment for obesity-related hypertension focuses on weight loss as the primary goal. Lifestyle modifications, including dietary changes, increased physical activity, and behavioural modifications, are the initial approach. However, many individuals struggle to achieve and maintain long-term weight loss through lifestyle changes alone. In such cases, pharmacological therapies and metabolic or bariatric surgery may be considered. Weight loss medications can help reduce food intake and induce early satiety. Metabolic surgery has emerged as the most effective strategy for achieving substantial and durable weight loss, with positive effects on hypertension remission. However, surgery is usually not recommended as a first-line treatment for isolated hypertension.

Overall, obesity and hypertension are significant public health challenges that are closely linked. The treatment of obesity-related hypertension involves a multidisciplinary approach, including lifestyle interventions, weight loss medications, and, in some cases, metabolic surgery.

Ketosis and heart health

The ketogenic diet has gained popularity in recent years as a weight-loss method. It is a very low-carb, high-fat diet that can put the body into a state of ketosis, where it burns fat for energy instead of carbohydrates. While this diet can be effective for weight loss, there are some concerns about its impact on heart health and blood pressure.

Weight Loss and Blood Pressure

Obesity is a leading cause of hypertension or high blood pressure. Therefore, losing weight can help lower blood pressure. The keto diet has been shown to be effective for weight loss, especially in obese individuals. As a result, it may also help reduce blood pressure in this group. However, it is important to note that the keto diet is not a long-term solution and may not be sustainable, as it restricts fresh fruits and vegetables, whole grains, and low-fat dairy, which are important for long-term weight loss and overall health.

There is some evidence that prolonged ketosis (longer than a few months) can have negative health effects on the heart. By depriving the body of carbohydrates, the keto diet may also exclude essential vitamins, minerals, and antioxidants found in fruits, starchy vegetables, and whole grains. This can lead to negative health outcomes such as heart disease. Additionally, the keto diet can cause an increase in LDL or "bad" cholesterol levels, which is a risk factor for heart disease.

Blood Pressure Medication and Keto

For individuals taking blood pressure medication, starting a keto diet may lead to a further decrease in blood pressure. This can be dangerous, and it is crucial to consult a doctor before making any radical changes to your diet or medication. Adjustments to medication dosage may be necessary to avoid the risks associated with low blood pressure, such as dizziness, fatigue, and weakness.

Sodium and Potassium Intake

It is important to monitor sodium and potassium intake while on the keto diet, as an imbalance can affect blood pressure. A "dirty keto" diet, high in processed meats and low in vegetables, can be short on potassium. Too much sodium and too little potassium can raise blood pressure. On the other hand, too little sodium can also increase blood pressure, as it triggers the release of aldosterone, a hormone that raises blood pressure.

Overall Recommendations

While the keto diet may help lower blood pressure in obese individuals, it is not suitable for everyone. It is essential to consult a doctor or healthcare professional before starting any new diet, especially if you have existing health conditions. Maintaining a healthy weight, exercising regularly, and consuming adequate sodium and potassium are essential for heart health and managing blood pressure.

Frequently asked questions