Ka Wai Ola - Office of Hawaiian Affairs, Volume 3, Number 8, 1 August 1986 — He Mau Ninau Ola [ARTICLE+ILLUSTRATION]

He Mau Ninau Ola

Some Healih Questions

by Kekuni Biaisdetl, M.D.

Ninau: E kauka, is sodium in pa'akai (salt) the only food substance that causes kokopi'i (high blood pressure)? 1 heard a haole lady say that potassium and ealeium lower the blood pressure. Is this so? Pane: Too mueh sodium appears to be a major dietary factor promoting kokopi'i in sus-

ceptible persons, as explained in recent He Mau Ninau columns. However, as your ninau suggests, it may not be the only food substance of importance in kokopi'i. Potassium is the most abundant mineral element within kino (body) cells, just as sodium is the main mineral element in kino fluids outside of cells. Both are positively-charged "electrolytes" when in solution within or without kino cells. Both are interdependent, one tending to replace the other. Yet, they have very different functions in the kino.

A 1982 study showed that as they age from infancy to adulthood, Americans eat more sodium and less potassium. In contrast, "primitive" man prior to about 12,000 years ago, apparently ate mueh more potassium than sodium throughout his life, and it is thought that he had no arterial hypertension. This has led some to postulate that modern age-related kokopi'i is not due to increased sodium intake, but to decreased potassium ingestion. June Gutmanis, writer on mea Hawai'i for example, has suggested that the high-potassium diet of po'e Hawai'i kahiko (ancient Hawaiians) may have protected them from kokopi'i expected from their known generous food-seasoning with pa'akai, and that modern Hawaiians have lost that protection by not ingesting sufficient potassium. The addition of extra potassium to the diet in experiments elsewhere, however, has revealed variable results: mild lowering of high blood pressure in some, no effect, or occasionally mild elevation of blood pressure in a few. These inconstant outcomes may be due to multiple factors, such as different doses of potassium administered, individual responsiveness, or blood pressure liability. Since potassium tablets are expensive and too mueh potassium ean be toxic to ka pu'uwai (heart), the current prevailing opinion of physicians toward suitable hypertensive patients is to reduce their intake of high-sodium-low-potassium processed foods, like canned meats, and to advise their eating more low-sodium-high-potassium natural foods, such as whole fruit and vegetables. The effect of ealeium on high blood pressure is unsettled, for this depends on particular circumstances. For example, there is some evidence that the narrowing of arterioles (small arteries) in sustained kokopi'i may be due to too mueh ealeium in the vessel wall cells. On the other hand, some studies suggest that too little ealeium intake is associated with kokopi'i. Adding extra ealeium to the diet has had varying results in hypertensive persons. At best, only about half of treated patients have had significant loweringof their high blood pressure, and this has not been confirmed. For the present then, it seems wise to maintain adequate intake of ealeium for all, but to bear in mind that supplementary ealeium for po'e kokopi'i has not as yet been established as effective. Ninau: How about aleohol for high blood pressure? Some kauka say it is good, others say it is bad. Whieh is right? Pane: Although aleohol may help some po'e to relax and relieve emotional tension, the initial effect of aleohol, even in small amounts, is to increase the blood pressure by raising the heart rate and the blood output of ka pu'uwai. Controlled studies also show that drinking more than two ounces of aleohol per day tends to sustain elevated blood pressure in about 10 percent of hypertensives, especially in men. In addition, the blood pressure may rise even further during aleohol withdrawal. No laila, the prudent course is to avoid aleohol, for it also has adverse effects on vital organs such as ke akepa'a (liver), pancreas, pu'uwai, brain, blood cells and the developing fetus in ka wahine hapai (pregnant woman).

Like puhi paka (cigarette-smoking), inu loa (aleoholdrinking) is self-damaging. Both are foreign, introduced morbid habits. They are not only un-Hawaiian, they are anti-Hawaiian. Why too many of us po'e Hawai'i have too eagerly embraced these harmful ways, like our Polynesian cousins and our fellow-strugglers, the American Indians, continues to be debated. Some argue for an inherent, perhaps, genetic, "weakness." Others speak of "culture-loss-stress" with the victims' lives becoming no longer meaningful in an increasingly hostile world. Yet, even many Westerners themselves in their own Western culture seem to have similar pilikia, although perhaps not to the same degree as us indigenous peoples dominated by the West in our own homelands. How some po'e are dealing with these ko'iko'i (stress) factors will be considered in future columns. 'Oiai, e ho'omau e ho'ouna mai i kou mau ninau ola, ke 'olu'olu.