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:

Meat Industry Response to Meat Being Labeled Carcinogenic

The most extensive report on diet and cancer in history is constantly being updated with all the new research. As I discuss in my video The Palatability of Cancer Prevention, in its update on colorectal cancer a few years ago, various meats were implicated, including processed meat as “a convincing cause of colorectal cancer,” which is its highest level of evidence that “effectively means ‘beyond reasonable doubt.’” More recently, processed meat was confirmed as a carcinogen by the World Health Organization. The main message was that “the best prevention of colorectal cancer is the combination of higher physical activity with a fibre-rich and meat products poor diet.” A decrease by half a turkey sandwich’s worth of meat might lower the total number of colorectal cancer cases by approximately 20 percent. There are several implications of this cancer guideline update, but a paper in the industry publication Meat Science decided “to focus on the consumer side of the story, since every consumer is a patient and vice-versa at some point in the future.” But chronic disease need not be invariably a consequence of aging.

“Although the epidemiological evidence for the relationship between colorectal cancer risk (at least!) and processed meats intake cannot be denied,” the Meat Science authors suggest further research. For example, compare the risk of consuming meat to other risky practices—alcohol, lack of physical activity, obesity, and smoking. Compared to lung cancer and smoking, maybe meat won’t look so bad!

Consumers, however, probably won’t even hear about the cancer prevention guidelines. “Consumers today are overloaded with information….It is thus probable that the dissemination of the [World Cancer Research Fund’s] update on colorectal cancer drowns in this information cloud.” And, even if consumers do see it, the meat industry doesn’t think they’ll much care.

For many consumers in the Western world, “the role of healthfulness, although important, is not close to taste satisfaction in shaping their final choice of meat and meat products…It is hence questionable that slightly revised recommendations based on the carcinogenic effects of meat consumption will yield substantial changes in consumer behavior.”

Doctors and nutrition professionals feed into this patronizing attitude that people don’t care enough about their health to change. A classic paper from The American Journal of Clinical Nutrition, a leading journal, scoffed at the idea that people would ever switch to a “prudent diet,” reducing their intakes of animal protein and fat no matter how much cancer was prevented. “The chances of reducing consumptions of fat, protein foods, or indeed of any food to a significant extent to avoid colon cancer are virtually nil.” Consider heart disease. We know we can prevent and treat heart disease with the same kind of diet, but the public won’t do it. “[T]he diet,” they said, “would lose too much of its palatability.”

“The great palatability of ham,” in other words, “largely outweighs other considerations…[although] health and wellbeing are increasingly important factors in consumer decisions.” A 1998 Meat Science article feared that “[u]nless meat eating becomes compatible…with eating that is healthy, wholesome, and safe, it will be consigned to a minor role in the diet in developed countries during the next decade.” That prediction didn’t quite pan out. Looking at a graph of total meat consumption per person over the last 30 years or so, intake rises and rises. In 1998, when that Meat Science article worrying about the next decade of meat consumption was published, we see intake rise even further. It does then seem to kind of flatten out before it starts falling off a cliff. Indeed, meat consumption dipped down about 10 percent  but has surged back up. Still, millions of Americans are cutting down on meat.

So don’t tell me people aren’t willing to change their diets. Nevertheless, we continue to get diluted guidelines and dietary recommendations, because authorities are asking themselves, “What dietary changes could become acceptable?” rather than just telling us what the best available science says and letting us make up our own minds about the cancer risk as we feed ourselves and our families.


How Much Cancer Does Lunch Meat Cause? Good question—watch the video!

Can simply cutting down on meat consumption extend our lifespan? Find out in Do Flexitarians Live Longer?. For my overview on cancer prevention, check out How Not to Die from Cancer.

I think the role of health authorities is to share with patients the pros and cons of all the options and let the patients, their families, and their doctors decide together what’s right for them. I’ve produced a number of videos on this issue, including:

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:

Meat is Heat: The Effects of Diet on Global Warming

One of the most prestigious medical journals in the world editorialized that climate change represents “the biggest global health threat of the 21st century.” Currently, chronic diseases are by far the leading cause of death. Might there be a way to combat both at the same time? For example, riding our bikes instead of driving is a win-win-win for the people, planet, and pocketbook. Are there similar win-win situations when it comes to diet?

As I discuss in my video, Diet and Climate Change: Cooking Up a Storm, the foods that create the most greenhouse gases appear to be the same foods that are contributing to many of our chronic diseases. Researchers found that meat (including fish), eggs, and dairy had the greatest negative environmental impact, whereas grains, beans, fruits, and vegetables had the least impact. And not only did the foods with the heaviest environmental impact tend to have lower nutritional quality, but they also had a higher price per pound. So, avoiding them gives us that triple win scenario.

The European Commission, the governing body of the European Union, commissioned a study on what individuals can do to help the climate. For example, if Europeans started driving electric cars, it could prevent as much as 174 million of carbon from getting released. We could also turn down the thermostat a bit and put on a sweater. But the most powerful action people could take is shift to a meat-free diet.

What we eat may have more of an impact on global warming than what we drive.

Just cutting out animal protein intake one day of the week could have a powerful effect. Meatless Mondays alone could beat out a whole week of working from home and not commuting.

A strictly plant-based diet may be better still: It’s responsible for only about half the greenhouse gas emissions. Studies have suggested that “moderate diet changes are not enough to reduce impacts from food consumption drastically.” Without significant reduction in meat and dairy, changes to healthier diets may only result in rather minor reductions of environmental impacts. This is because studies have shown that the average fossil energy input for animal protein production systems is 25 calories of fossil energy input for every 1 calorie produced—more than 11 times greater than that for grain protein production, for example, which is around 2 to 1.

Researchers in Italy compared seven different diets to see which one was environmentally friendliest. They compared a conventional omnivorous diet adhering to dietary guidelines; an organic omnivorous diet; a conventional vegetarian diet; an organic vegetarian diet; a conventional vegan diet; an organic vegan diet; and a diet the average person actually eats. For each dietary pattern, the researchers looked at carcinogens, air pollution, climate change, effects on the ozone layer, the ecosystem, acid rain, and land, mineral, and fossil fuel use. You can see in the video how many resources it took to feed people on their current diets, all the negative effects the diet is having on the ecosystem, and the adverse effects on human health. If people were eating a healthier diet by conforming to the dietary recommendations, the environmental impact would be significantly less. An organic omnivorous diet would be better still, similar to a vegetarian diet of conventional foods. Those are topped by an organic vegetarian diet, followed by a conventional vegan diet. The best, however, was an organic vegan diet.

The Commission report described that the barriers to animal product reduction are largely lack of knowledge, ingrained habits, and culinary cultures. Proposed policy measures include meat or animal protein taxes, educational campaigns, and putting the greenhouse gas emissions information right on food labels.

Climate change mitigation is expensive. A global transition to even just a low-meat diet, as recommended for health reasons, could reduce these mitigation costs. A study determined that a healthier, low-meat diet would cut the cost of mitigating climate change from about 1% of GDP by more than half, a no-meat diet could cut two-thirds of the cost, and a diet free of animal products could cut 80% of the cost.

Many people aren’t aware of the “cow in the room.” It seems that very few people are aware that the livestock sector is one of the largest contributors to greenhouse gas emissions. But that’s changing.

The UK’s National Health Service is taking a leading role in reducing carbon emissions. Patients, visitors, and staff can look forward to healthy, low-carbon menus with much less meat, dairy, and eggs. “Evidence shows that as far as the climate is concerned, meat is heat.”

The Swedish government recently amended their dietary recommendations to encourage citizens to eat less meat. “If we seek only to achieve the conservative objective of avoiding further long-term increases in [greenhouse gas] emissions from livestock, we are still led to rather radical recommendations” such as cutting current consumption levels in half in affluent countries—“an unlikely outcome if there were no direct rewards to citizens for doing so. Fortunately, there are such rewards: important health benefits…” By helping the planet, we can help ourselves.

There are tons of articles on diet and sustainability. It’s such an important topic that I may review the new science once every year or two. When the U.S. Department of Agriculture entered these waters, the meat industry appeared to freak out, and the Dietary Guidelines debate continues.


What about just cutting down on meat in terms of health impacts? See my video, Do Flexitarians Live Longer?.

What are the health and food safety consequences of buying organic? See my video series that includes:

For information on GMOs, check out: 

I’m thrilled to announce that the How Not to Die Cookbook is out today(!), and there’s a great burger recipe in there that I’m sharing as another sneak peek into the book. Get the recipe here. The book is available at all major outlets now. 

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: