Blood Pressure Reduction Through Lifestyle Changes

Background

I had been progressively getting out of shape since my mid-20s. Over the years I would make attempts at addressing this, but it would never last, petering out after a few weeks. In mid-October 2015, I went to the doctor to have an irregular shaped and coloured mole on my back checked out (which turned out to be a nothing), and while there (for the first time in 20+ years) the doctor checked my blood pressure. It read 140/90 - the defining point of high blood pressure.

It was obvious that I was out of shape, and I already knew that I had to do something about it with my various token gestures in the past, but a switch was finally flicked in my head when presented with this and the notion that I would be on medication for the rest of my life if things did not improve.

So, I made some changes to my lifestyle, and now having lived through them for the last six months, could be summarised simply as; eat less, drink less and move more.

Results

After just 4 months of lifestyle changes the doctor read my blood pressure as 120/80. Even after reaching this defining normal level, I've continued with what I have been doing - the benefits I feel each and every day make this a no-brainer (and something I regret not doing years ago). Six months in and the differences are significant, pretty much wiping out the badness of the previous 17yrs.

The 4 Pillars

After much reading and research I focused on 4 target areas to build my efforts on:

• Reduce Weight
• Reduce Alcohol
• Reduce Salt
• Increase Exercise

It's key to have the means to record your blood pressure a few times per day. I got this Kinetik blood pressure monitor (I had to go direct to the manufacturer to get a larger cuff as my arm/bicep diameter is larger than the included cuff's max size of 30cm - the wrong cuff size can result in higher or lower readings).

I then used an Excel spreadsheet to log the measurements as I made them. This spreadsheet contains the entries I've been making since reaching 120/80. This one contains the earlier higher readings that I was getting, but I was able to take some comfort with the trendline on the graph pointing downwards - I knew the efforts I was making were having an effect.

Reduce Weight

The equation for weight loss is simple. Less calories should be eaten than what your body requires for any given day - with your body getting the difference from your fat stores. Figuring out what you body requires can take a bit of work to accurately determine, but the general rule of thumb is 2000 calories for a woman and 2500 calories for a man.

There are roughly 3500 calories in 1lb of fat - so that is the difference that needs to be made up to loose a single pound. I settled on 1500 calories for my daily target. Some days I go a little over it (by 100/200 calories), but I endeavour to stay on target.

My general philosophy is to have a simple/light breakfast and lunch, with a proper dinner and minimal (and I mean minimal!) snacks.

I would typically plan my day the night before (I find knowing what's on the menu for the different parts of the day helps fight the urge to snack). Breakfast typically consists of cereal and a portion of fruit. Lunch is a sandwich with another portion or two of fruit, or perhaps a bowl of homemade vegetable soup. Dinner is typically some lean meat, potatoes, onions and gravy. But, I mix it up and play with the calories and get it all to fit - e.g. I might fancy some chips instead of potatoes, and that's fine as I'll end up with less volume in that the chips won't weigh as much as the potatoes, but the calories will be around the same.

MyFitnessPal is an online "Calorie Counter, Diet and Exercise Journal". It can be used in a browser or through an App on handheld devices. It's not the most user friendly experience, but it suffices. What it does well, is that it allows you to group together various ingredients into a 'meal', which saves time when adding them to future days. Over the course of a few weeks your regular meals will be defined, but the setup at the start can be a bit of a chore. Also, their database is full of inaccurate entries, so during this initial phase, I would make sure the values stated were correct - you can modify any incorrect database entries, or create new ones for things that they have no record of.

The following is typical day recorded on MFP. Weetabix and an orange for breakfast, a chicken sandwich, apple and banana for lunch with a steak, baby boiled potatoes, onions and gravy for dinner and a Wispa chocolate bar for a snack before bed:

This day here is a 'bad' one. We're talking a burger and chips and 6 cans of Coors! But, due to the exercise performed that day, I'm still pretty much on target:

On top of a daily reduction in calories, I opted to do the 5 2 fast diet. This means that for 2 days out of the week you fast, with 600 calories allowed for men and 500 calories allowed for women. It is tough - and the first few are horrible - but the benefits mean that I will continue this forever (although down to a single day per week). I use Monday and Thursday's as my fast days as it frees up the weekend.

The following is an example fast day. Breakfast is a single Weetabix, followed with a chicken sandwich for lunch and some eggs and toast for dinner:

This is what I'm currently doing for fast days - and it includes a 3 course meal! It cheats a little in that it exceeds the 600 calories mark a smudge. Breakfast is skipped, with lunch coming around 4:00pm with a bowl of homemade vegetable soup (which I agonised over the ingredients for to get the average calorie count down). Then it's dinner around 7pm, starting with another bowl of the soup. Then it's chicken, baby potatoes, onions and gravy, followed with a bowl of jelly. For supper, a round of toast:

To stand any chance of being honest with yourself as to the calories being consumed then you have to prepare the food by yourself. An accruate scale is a necessity. Take-aways/eating out are consigned to the history bin or 'bad' days, allocating a flat 1000-1200 calories to make sure it's sufficiently covered.

Reduce Alcohol

As an Irish man, it's my birth right to drink too much beer - which I have done patriotically. Not too often to excess (that mainly happens around some traditional family get-togethers!), but I'd have a few (or half-dozen) beer almost every night, which is well outside any health guidelines.

For the first month I didn't touch a drop, but now I have one or maybe two nights at the weekend were I have a beer.

I have noticed spikes in blood pressure readings for a day or two following alcohol consumption. It does have a direct and noticeable effect, but the spike can be countered by stepping down and having a smaller amount of alcohol the following day (who said two wrongs don't make a right ;) - yay, drinking for 'medicinal purposes'!).

Reduce Salt

Salt consists of two elements; sodium and chloride with only sodium having an impact on blood pressure. In the UK, salt intake is recommended to be no more than 6 grams. Sodium is 40% of salt, so that's 2.3 grams maximum. The Hypertension Society in the US recommends only 1.5 grams of sodium a day, so I actually target 1g per day - on a 'bad' day when I'd have a burger or something else with processed meat, then 1.5g is still my limit, and this is usually balanced out of the course of week with fast days where 0.5g sodium intake is typical. I've found that sometimes I can hit my sodium limit before my calorie limit for any given day, with sodium getting the priority.

There is a problem with MFP regarding sodium - in that EVERY entry I checked was wrong! MFP uses milligrams to measure sodium and people have just typed the grams value that is displayed in the nutritional label in the UK. When using a UK label, then it's the salt value in grams multiplied by 400 to get the sodium value in milligrams.

Unfortunately, salt in used to excess in a lot of food types. Soup and bread are some of the worst offenders. There are some nice Weight Watcher soups that are low in calories, but they are so loaded with salt that they can't be considered for anything other than fast days. Conversely, the Weight Watchers bread was actually the lowest sodium content bread I could find - partially based on the fact there was nothing to it! Brennans, who make the Weight Watchers bread actually have their own low calorie loaf that's also low in sodium.

Gravy is another high sodium food, but there are reduced salt alternatives, but I've had to completely remove the likes of beans and peas out of my diet (replaced with fried or grilled onions) as I've not come across any 'reduced' or 'low' salt alternatives with which to plan into a day.

Potassium helps counter-balance the affect of sodium in the body, so I often eat high-potassium foods like bananas and potatoes.

Increase Exercise

Exercise is something like a weekly fast day that I'll just keep doing forever. It's much easier to maintain fitness than gain it, so whatever I have right now I plan on keeping.

For the first couple of weeks I was walking 2.5 miles every second day. After the first two weeks, I started going every day. After a couple of months, I went two walks every day and in the 3rd month I increased the distance to 3 miles. I now do one longer 5 mile walk in the morning, followed by a 3 mile walk in the evening. There are many Apps that record times and distances, like this one which can link with and update MFP. It's important to keep pushing to improve the times over a given route, so that the body is not entering a plateau.

Whatever exercise calories I earn, I rarely use. When I play the occasional game of indoor football I could be looking at a calorie buffer of 1000 for that particular day as I would have also put in a walk earlier too. But, I don't use that to offset my 1500 daily target - on fast days you're not allowed to do that, so it's something I've gotten used to. That said, on a 'bad' day when I'm having a beer I'll eat into those calories, but not to a point were I could actually gain weight.

I think one of the key aspects of the exercise is to sweat. Alcohol and salt make you retain water, and sweating is key to flushing this out of your body (ever wonder why sweat tastes salty?). I wrap up before I go walking, wearing a heavy tee-shirt and sweatshirt underneath my coat, with gloves on too. I literally have to peel my tee-shirt off my back when I'm done. If sweating through exercise is a problem, there's a bodybuilders trick where they go to a sauna and periodically taste their sweat until it's no longer salty.

I drink around 2-3 litres of water a day along with some Cranberry juice which is a diuretic, to help with retained water - trick is to stop around 9:00pm, otherwise you'll be up all night!

Staying Motivated

When faced with an immediate life or death situation, we are hard-wired to react and get out of harms way. But, if that harm is off in the distance we don't react so quickly. High blood pressure is a life or death situation - it's not called the 'silent killer' for nothing. But, it's off in the distance and it's future-me's problem...

Due to the lack of immediacy it is easy to be flippant about it, and I've convinced myself in the past there's plenty of time to 'get around to it', when contemplating the likes of getting back in shape. But, it's all just one big lie and cheat. And, it's not just a decision I should be making for myself. For better or worse, we have a profound impact on those around us, and it's beyond unfair to involve them in what is essentially suicide by a thousand cuts. To compound matters, our loved ones become complicit in this on birthdays, Christmas, Father's Day, etc. by giving gifts of beer and other unhealthy treats, that take the target further and further away...

So, the big picture is there - it's clear what needs to be done, but when your stomach feels like it's eating itself on a fast day, or when your back aches and feet are blistered from all the walking, the big picture retreats off into the distance to a point where it's almost out of sight.

I found that having near-term dates, and goals to reach by those dates, the best way to keep motivated.

After my first reading of 140/90, I was asked to call back into the doctor in 4wks. I decided to make the most of these 4wks and hoped to attain some improvement on that reading. But, I knew next to nothing on the subject, and as far as salt reduction was concerned I only went as far as removing table salt from the table. I was eating the same foods as before, only in smaller portions. I cut out alcohol completely, and starting going walks every other day.

I didn't realise how cheap a decent blood pressure monitor was, so I had no idea when I arrived at the surgery as to whether or not things had improved - but they had, slightly. This reading was 135/85. The doctor again mentioned medication, and due to the look of disappointment on my face, asked if I wanted to take 12wks and see if things could improve further in that time. I readily agreed. But first, me and the wife hit our favourite restaurant for some grub and a drink - having this proposed treat out there for weeks in advance, also helped with the motivation.

I was desperate to make these 12wks count more so that the first 4. That meant an increase in the exercise, but I also spent quite a bit of time reading up on the subject and making diet changes based on what I read (after filtering out all the usual Internet nonsense). I got my own blood pressure monitor and started taking readings 3 times a day. I discovered the sodium issue on MFP and modified the entries for the foods that I use, and kept a tight control on how much I was consuming.

Things steadily improved. There were days when the readings looked good, and others when they looked high. It was sometimes hard to put these high readings to the back of my mind and keep focusing on and believing in what I was doing, but again, having the target of the doctors appointment to aim for helped in that regard - as well as another planned knees-up if things went well!

'Bad' Days

This is hard work, and it is rewarding when goals are reached, but at the same time life is going on and it needs to be lived. Taking a small break every now and then is necessary. If they can be aligned with successfully completed goals, then all the better, but every so often - say, once a month - it's time to let loose a little. It's not a carte-blanche-let's-undo-all-the-good-work-to-date kinda thing, so a modicum of moderation should be used!

Planning and Calorie Finding

I typically plan my day the night before, and occasionally I'd get a craving for something I haven't had in a while. The problem is fitting it into the plan without the nutritional values to hand. Trusting the MFP database is a no-go (once bitten, twice shy), so I tend to use the Tesco website and search for the food there, as they display the nutritional values online.

I'd also use it for estimating something bought from the butchers, which may not have a nutrition label, with the trick being to err on the high side.

Essential Foods

I have quite a limited palette, being a quintessentially meat-and-potatoes man, but the following is what I've been mainly using:

• Lean meats: steak, lamb chops, steak pieces, pork pieces, pork chops, silver-side roast, ribs
• All things chicken: eggs (fried, poached, boiled), breast, occasionally thighs/legs and wings as higher calories than breast
• Butter replacement: Benecol Light,or Bertoli Light
• Bread: Brennans Be Good
• Potatoes: Baby boiled, very occasionally mashed
• Gravy: Bisto Reduced Salt Gravy Granules
• Homemade Vegetable Soup: SuperValu (Longs) on the Strand Road have a great mix bag for £1
• Weight Watcher Soups: Very low in calories, but high in sodium. Can be planned in, or just used on a fast day when overall sodium will be low
• Onions: Replacement for beans/peas. I eat about an ounce per day - they thin the blood which can help BP, and perhaps my stumbled upon secret weapon?
• Fruit: Apples, oranges, pears, bananas, raisins
• Fast day snacks: Pickled onions, raw carrots, baby tomatoes, Hartley's sugar-free jelly
• Treats/Badness
• Chips: McCain oven chips - calories and sodium aren't too bad
• Coors Light: 160 calories a can
• Carbury Wispa Multipack: 31.5g bar is 167 calories
• WOW sausages: 92 calories for 2 bangers!

The Changes from Weight Loss

The weight I gained went on slowly over a period of 17yrs, so the changes were very incremental. Loosing the weight has been very rapid in comparison, and some of what goes on can feel a little weird:

• Face: Who is that? I glimpse the odd look of a brother or two, but me, no?
• Hands: Use them all the time every day, but washing them or crossing my fingers feels like they belong to a stranger.
• Cold: I am always freezing. I have lost many, many layers of insulation and now feel every breeze and draught intently. Even when in the house I wear multiple layers and sometimes finger-less gloves so I can type!
• Sitting: The cushion that I once carried in the back of my trousers is no longer there, so sitting on any non-padded surface is utter torture!
• Hips: Even a memory foam mattress can't stop my hips getting sore if I lay too long on one side!
• Number 2's: Less calories means less food means less waste, but is that it? I'm done already?
• Balance: My centre of mass is not where is once was, which has me falling over (sometimes comically!) when trying to turn fast when playing football
• Lightness: A sense of feeling light on my feet, particularly if walking somewhere familiar that I haven't been to in a while.

I'm sure my body (and mind) will adjust to the 'new me', so I'm enjoying the weirdness in the mean-time.

A Word of Thanks

I literally (in the original meaning of the word) could not have done this without the support of my wife - she has gone above and beyond the call of duty, and I am indebted to her for that. She is now on a bit of a health-kick herself, and I only hope I can somewhat repay her in kind.