Hypertension, COPD, obstructive sleep apnea, poor cardiac function, and aorta stiffness are well known disorders linked with poor brain health and neurodegeneration. Hypertension in midlife has been associated with more brain atrophy in later life, but it is now understood that elderly with low blood pressure have more brain atrophy than those with hypertension. Recent research now shows that low diastolic blood pressure and/or orthostatic hypotension are associated with a greater progression of brain atrophy in the elderly with arterial disease than high blood pressure!

Researchers are expanding their research in cognitive impairments in the elderly. They are looking at the brain’s microcirculation rather than only nerve synapses and large blood vessel flow. In essence, researchers are looking at how well the brain’s own tree like circulatory system is working and keeping the brain nourished. They are looking at the consistency of the amount and quality of nourishment going to the brain in both big and small vessel circulation, i.e. how healthy is the perfusion. When this tree-like circulation in the brain is diminished or has low output as in low diastolic blood pressure or hypotension, it is akin to having a garden hose turned on at a trickle or half pressure. If you are trying to water your garden at this pace, it takes a long time, the nourishment becomes hampered and the garden begins to fail.

Avoiding high blood pressure or hypertension has historically been the focus for health, whereas low blood pressure has commonly been dismissed as being “normal”. Mayo Clinic defines a normal blood pressure as anything at or below 120/80, which leads to wide interpretation. Mayo Clinic also defines low blood pressure as 90 mm Hg systolic or 60 mm Hg diastolic. This means that if you have a blood pressure of 110/55 or 90/60, etc., you have low blood pressure.

While it is good to not have elevated blood pressure, far too often individuals who have low or borderline low blood pressure are dismissed or ignored. There is a bit of a dichotomy going on with blood pressure interpretation. If you were a patient in the ICU hooked up to all kinds of monitors and your BP was at 80/50, the alarms would be going off. Some type of intervention to support blood pressure would take place. Whereas individuals walking into their physician’s office complaining of fatigue, loss of stamina, or poor cognitive function and who have low blood pressure of 80/50 or 110/45 are often dismissed or worse, i.e. referred to the local psychologist and put on an antidepressant. Unless you are a patient who has fainting and dizziness with their low blood pressure, there just seems to be little support for the average person with low blood pressure.

With blood pressure, there are certainly a significant number of variables that affect the interpretation of the numbers. A healthy presentation may be one who has a BP of 110/65 and is an athlete or exercises regularly, non-smoker, normal body weight and does not have concerns of fatigue, brain fatigue, poor stamina, etc. An unhealthy presentation is someone who has a BP of 80/50, poor stamina, and feels mentally and physically exhausted. There are several variables to keep in mind that may need to be checked into with new onset of low blood pressure or symptomatic chronic low blood pressure. These variables include anemia, dehydration, infections, pregnancy, some heart conditions, thyroid, adrenal, diabetes, low blood sugar, kidney problems, and others. Many times, certain medications are the culprit. These include diuretics, alpha blockers, beta blockers, certain antidepressants, drugs for male impotency, Parkinson’s disease and nitroglycerin. Other times, the cause for the low blood pressure may be related with autonomic nervous system disorders and may be related with autoimmunity. Your physician should determine the cause as opposed to dismissing you and saying this is perfectly normal.

Regardless of the cause, if you feel less than perky, and you have low blood pressure, don’t ignore it. While the study reported in JAMA Neurology was focusing on the elderly, if you are having symptoms of brain fatigue and low blood pressure, you need to be proactive. This is your brain not getting enough blood flow and nourishment. That garden hose in your brain is not running well enough to provide nourishment to your garden. Examples of brain fatigue coupled with low blood pressure may include feeling spacey and near black out or blacking out with standing, falling asleep while reading material for work or pleasure, having better comprehension of material when reading lying down, easy forgetfulness, irritability, frequent yawning, craving caffeine or other stimulants, decreased mental energy for learning new material, feeling fatigued or drowsy when driving especially when on a road trip, or going back to school as an adult and feeling exhausted. These are examples of compromised or less than optimal brain function.

It may take years for research to trickle down to mainstream medicine on the impact of low blood pressure and brain health. The fact that low diastolic (60 mm Hg or less) causes identifiable brain atrophy in the elderly should be a wake up call to the medical community. How many individuals have low blood pressure because of being overmedicated, or their physician’s goal is to have “good”, low numbers? How about the millions who have poor thyroid, adrenal, and blood sugar function with altered blood pressures contributing to poor cerebrovascular health? One is too many if it is your parent, your child or you.

As with any disorder, it is always best to identify what has caused the dysfunction if at all possible. In general, there are a number of nutritional tools to help support healthy blood pressure regulation.

1. Stay hydrated. Drink 6-8 twelve ounce glasses of water per day. The more caffeine/coffee you drink, the more you need to pay attention to this. At the same time, don’t forget about the elderly who often skimp on fluid intake for many reasons. Poor hydration challenges blood flow.

2. Address any concerns with anemia. Consider using iron bisglycinate if you need iron support. This is especially relevant to the young girls and women who have a vegetarian/low red meat intake lifestyle, athletic, and heavy periods.

3. Adrenal stress and fatigue is rampant in our society. If you are running yourself into the ground, the more likely low blood pressure is present.

4. Low salt diets often contribute to low blood pressure. Celtic or sea salt is not evil.

5. Certain nutrients like licorice root and tyrosine may help support significant concerns with adrenal fatigue. Work with a qualified health care professional for best results.

6. If there are concerns with autoimmune nervous system disorders, such as POTS, CFS, FM, work on reducing neurological stress and imbalances.

7. Improve blood viscosity to improve blood flow.

8. Try burst training, i.e. very brief periods of physical activity done several times throughout the day. This may include one minute bursts of deep knee bends, push-ups, running up a flight of stairs, etc. Another method may include, brief exposure to cold showers to train the sympathetic nervous system to respond by improving blood pressure tone. For those who are less healthy, before getting up from a sitting or lying position, repetitively squeeze your thigh muscles for several seconds to a minute, and keep them squeezed as you are standing up. This can help push blood to the brain.

9. Above all, if you are on medications that are artificially lowering your blood pressure and de-energizing your brain, work on improving the health of the body. Presently there is no ability to calculate how many people developed brain atrophy while being on high blood pressure medications, and how their overmedication led to the development of Alzheimer’s disease and death. Don’t become a statistic thinking that low blood pressure is a sign of good health.

If you are dealing with low blood pressure, don’t ignore it. By the time your medical provider is able to demonstrate brain atrophy on your MRI or CT scan due to low diastolic blood pressure, you already have major problems. If you have brain fatigue, brain fog, physical fatigue and low blood pressure now - get help. Figure out what the underlying issue is and do what you can to improve blood flow. Common sense, says that if your blood pressure is low, especially with symptoms, you generally don’t have the same blood flow perfusion to the brain than you would if you had healthy blood pressure regulation.