How Not to Die from High Blood Pressure

High blood pressure is the number-one risk factor for death in the world. In the United States, it affects nearly 78 million people, one in three adults. As we age, our blood pressures get higher and higher, such that by age 60, high blood pressure strikes more than half of us.

Given that it affects most of us when we get older, could high blood pressure be less a disease and more just an inevitable consequence of aging? No. We’ve known since the 1920s that high blood pressure need not occur, which I discuss in my video How Not to Die from High Blood Pressure.

Researchers measured the blood pressures of a thousand people in rural Kenya, where their traditional diet included more whole grains, beans, vegetables, fruit, and dark leafy greens. Though our pressures go up as we age, their pressures actually go down.

With blood pressure, the lower, the better. The 140/90 cut-off you may have heard here or there is arbitrary. Even people who start out with blood pressures under 120/80 appear to benefit from blood pressure reduction. Your doctor would likely give you a gold star if you had a blood pressure of 120/80, but research indicates the ideal blood pressure—blood pressure that wouldn’t get benefit from being any lower—may actually be 110/70.

Is it even possible to get blood pressures as low as 110/70? It’s not just possible—it’s normal for those living healthy enough lives.

Over two years, 1,800 patients were admitted to a rural Kenyan hospital. How many cases of high blood pressure were found? Zero. Wow they must have had low rates of heart disease. No, in fact, they had no rates of heart disease. Not a single case of our number-one killer, arteriosclerosis, was found. Rural China, too. There, people are about 110/70 their entire lives—70-year-olds with the same average blood pressure as 16-year-olds.

Those in Asia and Africa traditionally eat vastly different diets, but they do share a commonality: Both were plant-based day-to-day, with meat eaten only on special occasions. Why do we think it’s the plant-based nature of their diets that was so protective? Because in the Western world, as the American Heart Association has pointed out, the only people getting their blood pressures down that low were those eating strictly plant-based diets, coming in around 110/65.

The largest study to date of people eating plant-based diets studied 89,000 Californians. Non-vegetarians were compared to semi-vegetarians (also called flexitarians, those who eat meat more on a weekly rather than daily basis), pesco-vegetarians (those who eat no meat except fish), lacto-ovo-vegetarians (those who eat no meat at all), and vegans (who eat no meat, eggs, or dairy).

The subjects were Seventh-day Adventists, who all tended to eat lots of fruits and vegetables, exercise, and not smoke, and even the nonvegetarians didn’t eat a lot of meat. So, even compared to a group of relatively healthy meat-eaters, there appeared to be a step-wise drop in hypertension rates as people ate more and more plant-based diets, with vegans having lower rates than lacto-ovo-vegetarians, who had lower rates than pesco-vegetarians, and so on—and the researchers found the same for diabetes and obesity.

So, yes: We can wipe out most of our risk by eating a strictly plant-based diet, but it’s not all-or-nothing. It isn’t black-or-white. Any movement we can make along the spectrum towards healthier eating can accrue significant health benefits.

This can be shown experimentally: Give vegetarians some meat (and pay them enough to eat it), and their blood pressures go up. In another study, meat was removed from people’s diets, and their blood pressures went down—and did so in only seven days. What’s more, this was after the vast majority had reduced or even stopped their blood pressure medications completely. Indeed, the subjects had to stop their medications because once you treat the cause, you can’t be on multiple blood pressure pills with normal blood pressure. Your pressures could fall too low and you could get dizzy, fall, and hurt yourself, so your doctor has to take you off the pills. Lower blood pressures on fewer drugs—that’s the power of plants.

So, does the American Heart Association recommend a no-meat diet? No, it recommends a low-meat diet, known as Dietary Approaches to Stop Hypertension, or the DASH diet. Why wouldn’t the AHA recommend a completely plant-based diet? When the DASH diet was being created, were they just not aware of this landmark research, done by Harvard’s Frank Sacks showing those who eat strictly plant-based average 110/65? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Frank Sacks.

As he described, the DASH diet was designed explicitly with the number-one goal of capturing “the blood pressure-lowering benefits of a vegetarian diet, yet contain enough animal products to make them palatable” to the general population. They didn’t think the public could handle the truth.

In their defense, just as drugs don’t work unless you actually take them, diets don’t work unless you actually eat them. So, maybe they thought few would eat strictly plant-based, so by soft-peddling the message, by coming up with a kind of compromise diet perhaps on a population scale they felt it would do more good. Fine, but tell that to the thousand American families who lose a loved one every day to high blood pressure.

Maybe it’s time to start telling the American public the truth.


The first time someone visits NutritionFacts.org can be overwhelming. With videos on more than 2,000 health topics, where do you even begin? Imagine stumbling onto the site not knowing what to expect and the new video-of-the-day is about how a particular spice can be effective in treating a particular form of arthritis. It would be easy to miss the forest for the trees, which is precisely why I created a series of overview videos that are essentially taken straight from my live, hour-long 2016 presentation How Not to Die: Preventing, Arresting, and Reversing Our Top 15 Killers.

The other videos in this overview series are:

Inspired to learn more about the role diet may play in preventing and treating high blood pressure? Check out these other popular videos on the topic:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Why is Extra Salt Injected into Meat?

Why is the salt industry so powerful? It has its own PR and lobbying firms to play tobacco industry-style tactics to downplay the dangers of high salt intake, but salt is so cheap. How much money is the industry really making? As I discuss in my video Big Salt: Getting to the Meat of the Matter, it’s not the salt mine barons who’re raking it in—it’s the processed food industry. Indeed, the trillion-dollar processed food industry uses dirt-cheap added salt and sugar to sell us their junk, and, by hooking us on hypersweet and hypersalty foods, our taste buds get so dampened down that natural foods may taste like cardboard. The ripest fruit may not be as sweet as Froot Loops, so we just continue to buy more and more of the processed junk.

There are two other major reasons the food industry adds salt to food. “The other 2 reasons, however, are entirely commercial and for most foods are the real reason the food industry wants the intake of salt to remain high.” If salt is added to meat, it draws in water, so the weight can be increased by about 20 percent. Since meat is often sold by the pound, that’s 20 percent more profit for very little cost.

Salt also makes us thirsty. There’s a reason bars offer free salted peanuts and soda companies own snack food companies. It is not coincidence that Pepsi and Frito-Lay are the same company. Would we shell out nine dollars for a drink at the movies after eating a bucket of unsalted popcorn? Would we supersize our soda if they didn’t salt our fries and Big Mac?

Salt is also added to meat because it solubilizes the muscle proteins into a gel for “optimum” meat texture, which is one of the reasons the meat and fish industries like transglutaminase, the “meat glue” enzyme. Meat glue can help gel the muscle protein without adding salt.

Some of these salt alternatives leave a bitter aftertaste in the meat, but this problem can be managed by adding chemical “bitter blockers…which work by blocking the activation  of [our] taste receptor cells and thereby preventing taste nerve simulation”—that is, the information is stopped from ever reaching our brain.

The meat industry acknowledges that its products contribute a significant amount of dietary sodium, “maligning their own image,” but salt is just so cheap that using anything else would cost the industry money. However, if the meat industry is able to resolve this cost issue—if it can make it cost-effective—then, one day, perhaps it could end up (as the meat industry itself said) “saving millions of lives as well as dollars.”


You can rejuvenate your taste buds if you cut down on foods with added salt, sugar, and fat. Check out Changing Our Taste Buds.

Did I say meat glue? If you have never heard of it, see my video Is Meat Glue Safe?.

The meat industry’s reaction to salt reminds me of its response to the classification of processed meat as a known human carcinogen. See Meat Industry Reaction to New Cancer Guidelines and The Palatability of Cancer Prevention.

Isn’t there controversy as to how bad salt really is for you? Decide for yourself with the science:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Vegans Should Consider Taking DHA Supplements

We are all fatheads.

Indeed, about half the dry weight of our brain is fat. Lower levels of the long-chain omega-3 fat DHA in some areas of Alzheimer’s brains got people thinking that perhaps DHA is protective. Since the level of DHA in the brain tends to correlate with the level of DHA in the blood, cross-sectional studies of dementia and pre-dementia patients have been done. The result? The dementia and pre-dementia subjects do tend to have lower levels of both long-chain omega-3s, EPA and DHA, circulating in their bloodstream. This doesn’t necessarily mean that lower omega-3 levels cause cognitive impairment, however. It was just a snapshot in time, so we don’t know which came first. As I discuss in my video Should Vegans Take DHA to Preserve Brain Function?, maybe the dementia led to a dietary deficiency, rather than a dietary deficiency leading to dementia.

What we need is to measure long-chain omega-3 levels at the beginning and then follow people over time, and, indeed, there may be a slower rate of cognitive decline in those who start out with higher levels. We can actually see the difference on MRI. Thousands of older men and women had their levels checked and were scanned and then re-scanned. The brains of those with higher levels looked noticeably healthier five years later.

The size of our brain actually shrinks as we get older, starting around age 20. Between ages 16 and 80, our brain loses about 1 percent of its volume every two to three years, such that by the time we’re in our 70s, our brain has lost 26 percent of its size and ends up smaller than that of 2- to 3-year-old children.

As we age, our ability to make long-chain omega-3s like DHA from short-chain omega-3s in plant foods, such as flaxseeds, chia seeds, walnuts, and greens, may decline. Researchers compared DHA levels to brain volumes in the famed Framingham Study and found that lower DHA levels were associated with smaller brain volumes, but this was just from a snapshot in time, so more information was needed. A subsequent study was published that found that higher EPA and DHA levels correlated with larger brain volume eight years later. While normal aging results in overall brain shrinkage, having lower levels of long-chain omega-3s may signal increased risk. The only thing we’d now need to prove cause and effect is a randomized controlled trial showing we can actually slow brain loss by giving people extra long-chain omega-3s, but the trials to date showed no cognitive benefits from supplementation…until now.

A “double-blind randomized interventional study provide[d] first-time evidence that [extra long-chain omega-3s] exert positive effects on brain functions in healthy older adults,” a significant improvement in executive function after six and a half months of supplementation, and significantly less brain shrinkage compared to placebo. This kind of gray matter shrinkage in the placebo might be considered just normal brain aging, but it was significantly slowed in the supplementation group. The researchers also described changes in the white matter of the brain, increased fractional anisotropy, and decreases in mean and radial diffusivity—terms I’ve never heard before but evidently imply greater structural integrity.

So, we know that having sufficient long-chain omega-3s EPA and DHA may be important for preserving brain function and structure, but what’s “sufficient” and how do we get there? The Framingham Study found what appears to be a threshold value around an omega-3 index of 4.4, which is a measure of our EPA and DHA levels. Having more or much more than 4.4 didn’t seem to matter, but having less was associated with accelerated brain loss equivalent to about an extra two years of brain aging, which comes out to about a teaspoon less of brain matter, so it’s probably good to have an omega-3 index over 4.4.

The problem is that people who don’t eat fish may be under 4.4. Nearly two-thirds of vegans may fall below 4.0, suggesting a substantial number of vegans have an omega-3 status associated with accelerated brain aging. The average American just exceeds the threshold at about 4.5, though if we age- and gender-match with the vegans, ironically, the omnivores do just as bad. There aren’t a lot of long-chain omega-3s in Big Macs either, but having a nutrient status no worse than those eating the Standard American Diet is not saying much.

What we need is a study that gives those with such low levels some pollutant-free EPA and DHA, and then sees how much it takes to push people past the threshold…and here we go: Phase 2 of the study gave algae-derived EPA and DHA to those eating vegan diets with levels under 4.0. About 250mg a day took them from an average of 3.1 over the threshold to 4.8 within four months. This is why I recommend everyone consider eating a plant-based diet along with contaminant-free EPA and DHA to get the best of both worlds—omega-3 levels associated with brain preservation while minimizing exposure to toxic pollutants.


A list of my recommendations can be found here: Optimum Nutrition Recommendations.

Why not just eat fish or take fish oil? I explain why in these videos:

How else can we protect our brains? See, for example:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: