Nowadays natural/ecological systems of medicine have given a new insight into the determining factors of health in general and the etiology of hypertension in particular. Health appears to largely depend on the so-called flow system: the dynamic equilibrium between input, processing and output of nutrients, waste products and toxins. This flux can be divided in seven stages: nutrition, digestion, blood circulation, combustion (metabolism), assimilation, detoxification and elimination. In case of hypertension four major factors (apart from stress and severe chronic conditions) are involved:

1. NUTRITION

Generally people are overemphasizing empty carbohydrates, like white rice and bread, pasta, potatoes and corn, everything often extremely cooked, boiled, fried and baked. Furthermore animal protein like meat, chicken and eggs and low value fats like margarine are usually in excess as well. Therefore, there is often deficiency of vitamins, minerals and oligo-minerals, due to a lack of fruits, raw salads and green vegetables in the diet, effecting the quality of blood vessels, in particular the capillaries. The criteria of a healthy nutrition though, are optimal quality (toxin-free), sufficient amount of fresh (raw) food, excess of "alkaline", limitation of animal protein - except in sub-nutrition - and adjustment to individual digestion.

2. DIGESTION

Secondly it appears, that eating habits like overeating, eating too fast, eating at the wrong time, like taking the main meal late in the evening, causes indigestion with rotting of proteins and fermentation of carbohydrates. Toxic substances are formed, which are being re-absorbed by the bowel and so re-enter the bloodstream. Logically, constipation plays a major role here. Because these toxins are irritable to the blood vessel wall, they are contributing to the permanent contraction of the capillaries. Additionally, environmental pollutants and toxins - through the release of free radicals - are damaging enzymes and therefore the function of cells.

3. BLOOD CIRCULATION

Nowadays, especially the overconsumption of animal protein together with insufficient metabolic - burning - processes, due to a lack of physical exercise are considered to be factor number one in hypertension and arteriosclerosis, due to pathological accumulation of intermediary protein break down substances, stored as collagen and muco-polysaccharides in the connective tissue and the capillary wall. The permeability of the capillary wall becomes increasingly impaired. Because of this, nutrients - which normally have to go through the pores of the capillary wall - are obstructed from leaving the bloodstream in order to feed the cells. The paradox is this: cells suffer from deficiency because of overeating! The cells then send their signals of deprivation to the brain, which takes care of elevation of blood pressure e.g. improvement of diffusion through the capillary wall in order to compensate the deficiency. "Essential" hypertension thus being a "physiological" adjustment.

Another important and often neglected nutritional factor is the lack of enough fluids, like water, fruit juices and herbal teas, with thickening of the blood as a consequence.

DETOXIFICATION

Waste products from normal metabolism, accumulated waste and toxins, have to be continuously detoxified and eliminated by the body in order to stay healthy. Unfortunately, in most cases this balance is chronically disturbed. For example, the consumption of an excess of acid waste producing food like meat, chicken, beans, coffee and tea is responsible for both disturbance of sodium/potassium exchange of cells, increasing impermeability of connective tissue (barrier) , the permanent contraction of capillaries and problems with the permeability of the capillary wall.

According to Prof. Dr. A. Pischinger (Germany) "System der Grundregulation", a "theory" which increasingly is gaining wide acceptance, all nutrients necessarily have to pass the pores of the capillary wall and the connective tissue in order to reach the cell, while on the other hand metabolic waste products from the cell have to cross the same barrier on their way back to either lymph vessel or capillary, in order to become detoxified and eliminated. Hence, the quality and function of capillary wall and connective tissue have gained revolutionary importance in the theory (physiology, pathology) of medicine. Impairment of capillary function because of deficiency of vitamins, minerals and oligo-minerals, damage of capillary wall through toxins from interior and exterior pollution, thickening of blood vessel wall and clogging of connective tissue through collagen storage and accumulation of acid metabolic waste products, self-poisoning of cells and hemo-concentration of nutrients together are responsible for deterioration of capillary function (vice-versa). If the cells do not receive enough nutrients they send a signal to the brain, which in its turn raises the blood pressure to put more power behind the nutrients to get them through the capillary wall. In order to maintain proper function - permeability of capillaries and connective tissue to guarantee free flow of nutrients to the cell - the blood pressure necessarily has to go up. Therefore "high blood pressure" is an adaptive feedback mechanism. If suppressed in too early stages (anti-hypertensiva), which unfortunately is practiced on a large scale, nutrients will be prevented to reach the cells properly, causing further damage. Only where acute failure has to be feared of - apoplexia, decompensatio cordis, kidney damage - anti-hypertensiva are indicated.

Because of the new insights in the origination of hypertension - as described above - we are able to contribute to the problem in quite a considerable way. The surprising thing is, that with a healthy lifestyle program of three months only - which is simple, effective, cheap and comprehensible to everybody - we will be able to considerably bringing down high blood pressure in at least between 30-50% of all participants involved, as is the experience of countless biological/ecological approaches over the last 50 years (Vogler, Haferkamp, Buchinger, Rauch, Stiekema, Wendt, Luetzner, Martini, Heun, Volhard, Kampmann, Hartsilver and many others)

OUR OBJECTIVE IS:

The program is therapeutic, educational and community-oriented. Therefore the first step will be to approach the community leaders of the district and explain our objectives. If they agree to the program, the various health units (unidades de saude) will be approached. Staff, doctors, nurses and a representation of patients of the existing hypertension unit will be informed about the project in detail. In the mean time, representatives of the government of all levels are being asked for their active support. If the government, the community and the health care representatives all agree to our objectives, the program can be started. For reasons of proper evaluation (methodology/ statistics) of this first pilot project an estimated group of at least 70-300 participants will be required. To give our project the status it deserves, a doctoral study, in collaboration with Groningen University, Holland has been agreed upon. Of course co-operation with existing initiatives like the Cidadao Saudavel (IPPUC) will be actively pursued.

The program mainly consists of change in nutritional and eating habits. It requires extensive promotion, because only those who are seriously motivated will be successful. With the help of community leaders and the social assistant, several evenings will be held in the district to explain the people about the project. At the end of every evening, people can subscribe to the program. Motivation, mental and physical ability and social situation will be the criteria for participation. For that every person has to submit to a simple screening and examination procedure. With regard to hypertension "itself", values more than 160 over 95 will be considered to be suitable for participation. The motivation of the person must be good to excellent. He or she must be prepared and able to change food habits considerably for three months. The active support of family and relatives is crucial. Although even arteriosclerosis, decompensatio cordis and certain kidney disorders usually are reacting very well to the program, persons in severe conditions ("terminal" arteriosclerosis, too old age, serious subnutrition, advanced chronic disease, infectious diseases, mental disability), will be excluded from the program.

THE THERAPEUTIC EFFECT OF OUR SCHEME IS DUE TO:

The Hospital Erasmo do Roterdam has a key function in the project. It will initiate, manage, delegate and supervise. With the help of community leaders, the representatives of the government and the local health centers, it initiates the project to the various groups, manages and controls the procedure, delegate tasks to local units and supervises in general. Participants will be working together with a "buddy" (partner) in order to stimulate and support each other. A cooking teacher has to instruct the participants how to cook simple, healthy, cheap and tasteful. We expect a few theoretical lessons given to larger groups will be enough. However, a nutritionist/cooking teacher has to remain available during the project as a consultant to the people. Every month a doctor will give a lecture to a larger group, with the possibility for everyone to ask questions. A translation in Portuguese of this book Dr. H. Stiekema: "Flow System Therapy"" with important background information will be available. Participants will write their own experiences down in a diary. Middle large groups, living in the same area, will meet every week to exchange experience. Participants will be visiting the local health posts, in the beginning twice a week, later every week, to have their blood pressure measured, their medication adjusted and to be examined in case of problems and/or complaints. In case of emergency, participants will be send to Hospital Erasmo do Roterdam, where a doctor will be always available to them. The existing hypertension units will also benefit from our approach. Because, once "lifestyle" has been eliminated as a causing factor, it will be more easy and effective for them to go on with their approach of stress release and medication.

In principle the project will be on a voluntary non-profit basis. For the doctors involved, it is part of their already existing job. The same is true for the social assistant, the community leaders, the cooking teacher, the local health posts and other voluntary workers involved. The main costs will be those for promotion (material), administration, transportation and communication. The food is paid by the participants themselves, which may not give any problem, because it will be cheaper than the costs of living they had before. For the very poor free "dump food" could be asked from the vegetable market in Curitiba. In many cases medicines are not needed anymore, which is another important individual saving. Nevertheless, if (minor) costs have to be made for which there is no existing fund, we hope and expect to receive financial support from existing sources.

The project "Normalization Of Blood Pressure Through A Healthy Lifestyle" is a breakthrough in many ways. First there is the concept of natural/ecological medicine in general and that of the "flow system" (Dr. H. Stiekema) in particular. Through the "flow system", people can easily understand health and what they can do about it themselves. It also could become the base for training doctors and other health care workers throughout Brazil. Furthermore, the benefits to the people will be immeasurable. Hypertension is one of the main sufferings of modern society and of the Brazilian people in particular. Improvement on a large scale will not only contribute to the health and happiness of every individual, but also will save huge amounts of money spent in public health care, social assistance, insurance and because of unemployment losses. The money to be saved will exceed many millions, also because of more similar projects which we intend to do. The "flow system" concept has proved to be suitable for many other "civilization related" chronic diseases, reason why we will start this project enthusiastically, hoping that many others will follow in the near future.

1998 © Copyright Drs. M. Yu & H. Stiekema, MD

Sackett, D.L., Brian Hayes, R., Guyatt, G.H. and Tugwell, P., „Clinical Epidemiology", Boston, USA: Little, Brown and Company, 1991.