Weight-Neutral, Non-Restrictive Blood Pressure Management

Blood Pressure - Part 2

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After I published the piece I wrote with Dr. Greg Dodell about weight-neutral, non-restrictive blood sugar management, I received a number of requests to talk about blood pressure. I want to credit Dr. Louise Metz and Tiana Dodson, a lot of the work in this piece was started with the HAES Health Sheet on High Blood Pressure that we created.

Some considerations:

Make sure to check out part one to get an understanding of the ways that blood pressure itself can be inaccurate.

Always remember that getting a diagnosis of high blood pressure/hypertension (or any healthcare diagnosis) does not mean that you did weight-neutral health wrong. People of all sizes get high blood pressure for many reasons and there is no point (just bias) in assigning fault or blame to the person diagnosed. The only ethical approach for healthcare providers is blame-free, shame-free, future-oriented care.

It’s also important to understand that if healthcare providers are coming from a place of weight stigma, they can react differently to fat* people’s blood pressure. First, they can tend to assume fat people’s blood pressure is high and discount issues that might lead to a falsely high measurement. They may also disbelieve a “normal” blood pressure reading (sometimes taking it over and over again.) They may react differently to the same blood pressure levels in a fat versus a thin person. So if a thin person’s blood pressure is a bit elevated they might suggest a few behavior changes, or suggest that they get another reading or two over time before taking any action. But for fat patients (with the exact same blood pressure) they may recommend treatment and even refer patients to weight loss surgery that risks their life and quality of life.

As a reminder, weight loss is not an ethical, evidence-based intervention for anything, and the weight cycling that is the most common outcome can actually increase hypertension.

As always, nothing in this newsletter constitutes the practice of medicine, this is for information purposes only and you’ll want to discuss this with your healthcare provider.

A final note: all bodies are different, so with all of the interventions below, your mileage may vary. One option is to look at this as an ongoing n=1 experiment - an experiment in which you are the only subject. So you’re just collecting data on what works for you and what doesn’t, and everything you learn is just helpful data.

With all of that said, here are some options for weight-neutral blood pressure management:

Medication

There is absolutely no shame in taking medication for high blood pressure.  There are a number of options for both types and brands of medications, so you’ll want to check with a weight-neutral healthcare practitioner to discuss what’s best for you.

Diuretics can help increase sodium and water excretion

Beta Blockers can decrease heart rate and the force of contractions

Calcium Channel Blockers reduce resistance in blood vessels by relaxing the muscles

Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin II Receptor Blockers (ARBs) decrease water and sodium retention and expand blood vessels

Foods

Please note that these are not exhaustive lists, but just some of the options. 

Also, beware of diet culture getting mixed up in food recommendations (for example, basing recommended amounts of food on calories rather than on impact on blood pressure.)

Eat more high potassium foods

Acorn Squash, Almonds, Avocado, Bananas, Beans, Beet greens, Broccoli, Butternut squash, Cantaloupe, Chicken,  Coconut Water, Dried apricots, Lentils, Milk (dairy), Plant milk, Potatoes, Raisins, Salmon, Spinach, Tomatoes, Yogurt

Eat cocoa and dark chocolate

Eat strawberries, blueberries, and raspberries

Increase Calcium Intake

Almonds, Broccoli, Celery, Cheese, Chia Seeds, Figs, Kale, Milk (dairy), Spinach, Tofu, Yogurt. You can also try calcium-fortified foods.

Increase Magnesium

Almonds, Beef,  Black beans, Cashews, Dark Chocolate, Edamame, Peanuts, Potato, Pumpkin Seeds, Soymilk, Spinach,

Supplements

Note that there is limited research on supplements, so be sure to check with a weight-neutral healthcare professional.

You may choose supplements rather than food for the nutrients in the “food” section above. Other supplements that you might try include aged garlic extract, Berberine, Hibiscus, Fish Oil, and Whey protein

Sleep

Getting enough restful sleep can help your blood pressure.

Meditation and/or deep breathing

This might include a yoga practice, meditation practice, or simply deep breathing. There are even apps that can help. Note that it doesn’t have to be a lot, there is research that shows that just six deep breaths in 30 seconds can have an impact.

Movement

Research shows that regular movement including both cardiovascular and resistance (strength) training can help improve blood pressure.

Movement is never an obligation, and if you choose it, please do not feel pressured to make it “joyful” if that’s not what works for you There is nothing wrong with joyful movement, but you can also engage with movement like you might engage with dishes or laundry (something you do to support yourself, but that you don’t love). You can also find the thing you hate the least, and do the absolutely smallest amount necessary to achieve the benefit you are looking for. Or you can choose not to use movement as one of your strategies for blood pressure management.

Finally, please remember that there is no blame or shame in a high blood pressure diagnosis, and that you should be offered weight-neutral treatment on your own terms. If that doesn’t happen, then it becomes your problem but it is absolutely not your fault!

If you are struggling with dealing with fatphobia at the doctor’s office you can check out the free resources here and/or my upcoming workshop with Shelby Gordon on Navigating Weight stigma at the Doctor’s Office (there is a pay-what-you-can-afford option)

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More research and resources:
https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.