Hypertension

Orthomolecular Interventions

Orthomolecular interventions are nutrients and actions that support health by supporting the body’s specific biochemical needs. These interventions can include specific diets, foods, nutrients, and lifestyle changes.

Vitamin B6

Vitamin B6 and hypertension
Actions of vitamin B6 in preventing and addressing hypertension include (Tsuda & Nishio, 2004):

  • regulating homocysteine levels which prevents homocysteine-induced damage to the blood vessels
  • supporting nitric oxide production by helping to lower homocysteine levels
  • supporting the synthesis of dopamine, norepinephrine, serotonin, and GABA. These neurotransmitters decrease/modulate sympathetic nervous system function, which decreases blood pressure
  • supports sodium excretion by the kidneys
  • reducing free radicals and pro-inflammatory cytokines
  • regulating cellular calcium levels – excess calcium in endothelial cells causes vasoconstriction (Vasdev et al., 1999)

Deficiency of vitamin B6 can be identified by:

  • the absence of dreams, or the inability to remember dreams
  • having disturbing dreams or nightmares

Causes of vitamin B6 deficiencies

  • inadequate dietary intake
  • medications, including anti-tuberculosis drugs, anti-parkinsonians, nonsteroidal anti-inflammatory drugs, and oral contraceptives, may interfere with vitamin B6 metabolism. (Vitamin B6, 2014)
  • alcoholism – due to low intake and impaired metabolism of vitamin B6
  • long-term diuretic medication therapy (Houston, 2013)

Top sources of vitamin B6 based on serving size

  • salmon
  • potato
  • turkey
  • avocado

Comprehensive food list:
Table 2. Some Food Sources of vitamin B6 (Vitamin B6, 2014)
https://lpi.oregonstate.edu/mic/vitamins/vitamin-B6

Referenced Dietary Intakes
RDAs for vitamin B6 (mg/day)
Adolescents (14-18 years): 1.3 (M) 1.2 (F)
Adults (19-50 years): 1.3 (M) 1.3 (F)
Adults (51 years and older): 1.7 (M) 1.5 (F)
Tolerable Upper Intake: 100 mg/day
(Office of dietary supplements, 2020)

Vitamin B6 Supplementation

  • Amounts of vitamin B6 used in practice and research range from 20–6000 mg/day in divided doses (Office of Dietary Supplements, 2020).
  • In a two-year trial by van Dijk et al. (2001) supplementation of folic acid (folate) and vitamin B6 (pyridoxine) resulted in a 3.7-mm Hg drop in systolic, and 1.9-mm Hg drop in diastolic blood pressure.

SAFETY, SIDE EFFECTS

  • Doses above 100 mg/day may, in some people, cause side effects that include nausea, vomiting, stomach pain, diarrhea, headache, tingling, and sleepiness. The risk of negative effects can be reduced by supplementing magnesium 6.6–8.8 mg /kg in addition to a B-complex vitamin (Prousky, 2015).

VITAMIN B6 AND MEDICATIONS

  • High doses of vitamin B6 have been found to decrease the efficacy of phenobarbital, phenytoin, and L-Dopa (Vitamin B6, 2014).

Vitamin C

Actions of vitamin C in preventing and addressing hypertension include:

  • increasing the availability and action of nitric oxide by (Mullan et al., 2002) by:
    • protecting it from deterioration due to oxidative stress caused by free radicals
    • promoting nitric oxide production (via the enzyme nitric oxide synthase)
    • preventing oxidation of low-density lipoprotein (LDL), which impedes nitric oxide production
    • improving sensitivity of cells to insulin, which can increase the release of nitric oxide
  • decreasing arterial stiffness by:
    • protecting against free-radical damage
    • supporting collagen synthesis which supports healthy elasticity and integrity of the arterial wall (May & Harrison, 2013)
  • decreasing arterial inflammation by decreasing pro-inflammatory cytokines (Ellulu et al., 2015)
  • decreasing the formation of AGEs (which cause arterial stiffening, oxidative stress, and inflammation) (Rabizadeh et al., 2023)

Vitamin C deficiency

Causes of Vitamin C deficiency include:

  • restrictive diets
  • diet lacking in sources of vitamin C especially fresh fruit and vegetables
  • digestive tract disorders, e.g. diarrhea, Crohn’s and colitis
  • smoking
  • alcoholism
  • chronic inflammatory conditions

Signs of vitamin C deficiency:

  • bleeding or swollen gums
  • frequent nosebleeds
  • dry hair, split ends
  • easy bruising
  • slow wound healing
  • fatigue
  • moodiness
  • depression and cognitive impairment (Plevin & Galletly, 2020)

Top sources of vitamin C based on serving size

  • grapefruit and orange juice
  • strawberries
  • kiwifruit
  • orange
  • sweet pepper
  • broccoli

Comprehensive food list:
Table 3. Some Food Sources of vitamin C (Vitamin C, 2014)
https://lpi.oregonstate.edu/mic/vitamins/vitamin-C

Referenced Dietary Intakes
RDAs for vitamin C (mg/day)
Adolescents (14-18 years): 75 (M) 65 (F)
Adults (19-50 years): 90 (M) 75 (F)
Smokers: 125 (M) 110 (F)
Tolerable Upper Intake: 2000 mg /day
(Office of Dietary Supplements – Vitamin C, n.d.)

Vitamin C supplementation

  • Amounts of vitamin C used in practice and research range from 500–6000 mg/day in divided doses.
  • 500 mg/day of oral vitamin C for a period of 4 weeks has been shown to lower blood pressure and improve arterial stiffness in people with type 2 diabetes (Mullan et al., 2002).

SAFETY, SIDE EFFECTS

  • Vitamin C has low toxicity and is not believed to cause serious adverse effects at high intakes (Office of Dietary Supplements – Vitamin C, n.d.).
  • Vitamin C at higher doses can, in some people, cause side effects such as nausea, abdominal cramps, and other digestive tract disturbances

Magnesium

Actions of magnesium in preventing and addressing hypertension include:

  • promoting vasodilation and blood vessel relaxation (Houston & Harper, 2008)
  • reducing the flow of calcium into the heart and arteries by acting as a natural calcium channel blocker (Houston & Harper, 2008)

Magnesium and hypertension

  • Several epidemiological studies have shown an inverse relationship between dietary magnesium intake and blood pressure. A meta-analysis by Jee et al. (2002) reported significant, dose-dependent reductions in blood pressure with magnesium supplementation.
  • A study by Resnick et al. (1992) found that people with untreated high blood pressure had lower levels of free magnesium inside their cells compared to those with normal blood pressure (Resnick et al., 1984).
  • Clinical trials using high-dose magnesium in patients with eclampsia and glomerulonephritis have demonstrated significant reductions in blood pressure 3,4 (Jee et al., 2002).
  • Kass et al. (2012) reported in their meta-analysis reductions in both systolic and diastolic blood pressure with supplementation of magnesium. (Kass et al., 2012).

Magnesium deficiency is common

  • Dietary intake of magnesium has declined significantly over the past 100 years putting people at greater risk of deficiency (Kass et al., 2012)
  • Up to 30% of a given population may have subclinical serum magnesium deficiency (DiNicolantonio & O’Keefe, 2021).
  • Magnesium deficiency is relatively common and often unrecognized in clinical settings, as magnesium is rarely tested (Wallace, 2020).
  • Magnesium deficiency is associated with (Dominguez et al., 2021):
    • increased inflammation
    • increased oxidative stress

Reasons for magnesium deficiencies

  • Increased stress (causes magnesium depletion)
  • Low dietary protein (needed for magnesium absorption)
  • Gastrointestinal disorders (e.g. Crohn’s disease, malabsorption syndromes, and prolonged diarrhea)
  • High doses of supplemental zinc (competes for absorption)
  • Certain diuretic medications
  • Alcoholism
    Elderly adults tend to have lower dietary intake, absorption, and increased loss of magnesium.

Magnesium food sources and supplementation
Top food sources of magnesium by serving size

  • Brazil nuts
  • oat bran
  • brown rice (whole grain)
  • mackerel

Comprehensive list: Table 2. Some Food Sources of Magnesium
(Magnesium, 2014)
https://lpi.oregonstate.edu/mic/minerals/magnesium

Referenced Dietary Intakes
RDAs for magnesium (mg/day)
Adolescents (14-18 years): 410 (M) 360 (F)
Adults (19-30 years): 400 (M) 310 (F)
Adults (31 years and older): 420 (M) 320 (F)

Magnesium supplementation

  • The effect of magnesium on blood pressure is dose-dependent (Houston & Harper, 2008; (Jee et al., 2002).
  • Kass et al. (2012) identified magnesium dosing in studies ranging from 120–973 mg/day, with an average dose of 410 mg/day, and a greater effect in doses greater than or equal to 370 mg/day.

SAFETY, SIDE EFFECTS

  • Side effects of magnesium supplementation are rare but can include a laxative effect, dizziness or faintness, sluggishness, cognitive impairment, and depression.

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