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:

The Best Source of Resistant Starch

Resistant starch wasn’t discovered until 1982. Before that, we thought all starch could be digested by the digestive enzymes in our small intestine. Subsequent studies confirmed that there are indeed starches that resist digestion and end up in our large intestine, where they can feed our good bacteria, just like fiber does. Resistant starch is found naturally in many common foods, including grains, vegetables, beans, seeds, and some nuts, but in small quantities, just a few percent of the total. As I discuss in my video Getting Starch to Take the Path of Most Resistance, there are a few ways, though, to get some of the rest of the starch to join the resistance.

When regular starches are cooked and then cooled, some of the starch recrystallizes into resistant starch. For this reason, pasta salad can be healthier than hot pasta and potato salad can be healthier than a baked potato, but the effect isn’t huge. The resistant starch goes from about 3 percent up to 4 percent. The best source of resistant starch is not from eating cold starches, but from eating beans, which start at 4 or 5 percent and go up from there.

If you mix cooked black beans with a “fresh fecal” sample, there’s so much fiber and resistant starch in the beans that the pH drops as good bacteria churn out beneficial short-chain fatty acids, which are associated both directly and indirectly with lower colon cancer risk. (See Stool pH and Colon Cancer.) The more of this poopy black bean mixture you smear on human colon cancer, the fewer cancer cells survive.

Better yet, we can eat berries with our meals that act as starch blockers. Raspberries, for example, completely inhibit the enzyme that we use to digest starch, leaving more for our friendly flora. So, putting raspberry jam on your toast, strawberries on your corn flakes, or making blueberry pancakes may allow your good bacteria to share in some of the breakfast bounty.

Another way to feed our good bacteria is to eat intact grains, beans, nuts, and seeds. In one study, researchers split people into two groups and had them eat the same food, but in one group, the seeds, grains, beans, and chickpeas were eaten more or less in a whole form, while they were ground up for the other group. For example, for breakfast, the whole-grain group got muesli, and the ground-grain group had the same muesli, but it was blended into a porridge. Similarly, beans were added to salads for the whole-grain group, whereas they were blended into hummus for the ground-grain group. Note that both groups were eating whole grains—not refined—that is, they were eating whole foods. In the ground-grain group, though, those whole grains, beans, and seeds were made into flour or blended up.

What happened? Those on the intact whole-grain diet “resulted in a doubling of the amount excreted compared to the usual diet and produced an additional and statistically significant increase in stool mass” compared with those on the ground whole-grain diet, even though they were eating the same food and the same amount of food. Why? On the whole-grain diet, there was so much more for our good bacteria to eat that they grew so well and appeared to bulk up the stool. Even though people chewed their food, “[l]arge amounts of apparently whole seeds were recovered from stools,” but on closer inspection, they weren’t whole at all. Our bacteria were having a smorgasbord. The little bits and pieces left after chewing transport all this wonderful starch straight down to our good bacteria. As a result, stool pH dropped as our bacteria were able to churn out so many of those short-chain fatty acids. Whole grains are great, but intact whole grains may be even better, allowing us to feed our good gut bacteria with the leftovers.

Once in our colon, resistant starches have been found to have the same benefits as fiber: softening and bulking stools, reducing colon cancer risk by decreasing pH, increasing short-chain fatty acid production, reducing products of protein fermentation (also known as products of putrefaction), and decreasing secondary bile products.

Well, if resistant starch is so great, why not just take resistant starch pills? It should come as no surprise that commercial preparations of resistant starch are now available and “food scientists have developed a number of RS-enriched products.” After all, some find it “difficult to recommend a high-fiber diet to the general public.” Wouldn’t be easier to just enrich some junk food? And, indeed, you now can buy pop tarts bragging they contain “resistant corn starch.”

Just taking resistant starch supplements does not work, however. There have been two trials so far trying to prevent cancer in people with genetic disorders that put them at extremely high risk, with virtually a 100-percent chance of getting cancer, and resistant starch supplements didn’t help. A similar result was found in another study. So, we’re either barking up the wrong tree, the development of hereditary colon cancer is somehow different than regular colon cancer, or you simply can’t emulate the effects of naturally occurring dietary fiber in plant-rich diets just by giving people some resistant starch supplements.

For resistant starch to work, it has to get all the way to the end of the colon, which is where most tumors form. But, if the bacteria higher up eat it all, then resistant starch may not be protective. So, we also may have to eat fiber to push it along. Thus, we either eat huge amounts of resistant starch—up near the level consumed in Africa, which is twice as much as were tried in the two cancer trials—or we consume foods rich in both resistant starch and fiber. In other words, “[f]rom a public health perspective, eating more of a variety of food rich in dietary fibre including wholegrains, vegetables, fruits, and pulses [such as chickpeas and lentils] is a preferable strategy for reducing cancer risk.”


What’s so great about resistant starch? See my video Resistant Starch and Colon Cancer.

I first broached the subject of intact grains in Are Green Smoothies Bad for You?.

Why should we care about what our gut flora eats? See Gut Dysbiosis: Starving Our Microbial Self.

Did I say putrefaction? See Putrefying Protein and “Toxifying” Enzymes.

Berries don’t just help block starch digestion, but sugar digestion as well. See If Fructose Is Bad, What About Fruit?.

The whole attitude that we can just stuff the effects into a pill is a perfect example of reductionism at work. See Reductionism and the Deficiency Mentality and Why is Nutrition So Commercialized? for more on this.

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: