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 a Resource Like NutritionFacts.org is So Necessary

In a study of the dietary advice given by newspapers in the United Kingdom, “no credible scientific basis” was found for most claims. Indeed, “[m]isreporting of dietary advice…is widespread and may contribute to public misconceptions about food and health”—and potentially not only the public.

Scientists like to think they are not influenced by popular media. One study decided to put it to the test. The New York Times reports on scientific research each week, and researchers found that the studies covered by the Times end up being cited in the New England Journal of Medicine more than those that don’t. Seems like the popular press does indeed have an impact on science? Not so fast. That’s just one potential explanation. Perhaps outstanding studies are more likely to be picked up by the media and, independently, more likely to be cited. It’s possible the Times was just earmarking important science and its publicizing of that research didn’t have any effect on how often it was cited in future studies.

How can we disentangle the two? In 1978, there was a three-month strike during which the Times continued to print copies but couldn’t sell them to the public. So, a natural experiment was set up. Researchers compared the number of citations of Journal articles published during the strike with the number published when the paper wasn’t on strike to “discover whether publicity in the popular press truly amplifies the transmission of scientific findings to the medical community.” If the paper were just earmarking important articles, then the strike would have no effect on the studies’ future impact, but that’s not what happened. As you can see from a graph shown in my video Spin Doctors: How the Media Reports on Medicine, the studies covered by the Times during the strike when no one could read them appeared to have no impact on the medical community.

The next question, of course, is whether the press is simply amplifying the medical information to the scientific community or distorting it as well? “[S]ystematic studies suggest that many stories about new medicines tend to overstate benefits, understate risks and costs, and fail to disclose relevant financial ties.” What’s more, “[o]verly rosy coverage of drugs may also result from the direct and indirect relations between journalists and drug companies”—that is, the financial ties between the reporters and Big Pharma with all its perks.

Scientists and physicians often blame the press for the public being “poorly served” by the media’s coverage of medical science. In fact, the famous physician William Osler was quoted as saying, “Believe nothing that you see in the newspapers…if you see anything in them that you know is true, begin to doubt it at once.” Both parties, however, share the blame. Reporters may only have an hour or two to put together a story, so they may rely on press releases. It’s not hard to imagine how drug company press releases might be biased. But, surely, press releases from the scientists themselves and their institutions would “present the facts fairly, unambiguously, and without spin,” right?

Researchers decided to put it to the test. Critics may blame the media, but where do you think the media gets its information? “One might assume” that press releases from prestigious academic medical centers would be “measured and unexaggerated,” but researchers found they suffered from the same problems: downplaying side effects, having conflicts of interest and study limitations, and “promot[ing] research that has uncertain relevance to human health…”

For example, most “animal or laboratory studies…explicitly claimed relevance to human health, yet 90% lacked caveats about extrapolating results to people.” Indeed, “a release about a study of ultrasonography [ultrasound] reducing tumors in mice, titled ‘Researchers study the use of ultrasound for treatment of cancer,’” failed to add “for your pet mouse.”

“For animal research, it is estimated that less than 10% of non-human investigations ever succeed in being translated to human clinical use. Over-selling the results of non-human [lab animal] studies as a promised cure potentially confuses readers and might contribute to disillusionment with science.”

Although it is common to blame the media for exaggerations, most times, they don’t just make it up—it is what the research institutions are sending out themselves. Researchers found that “most of the inflation detected in our study…was already present in the text of the in their own press releases produced by academics and their establishments.” Medical journals, too. Indeed, sometimes medical journal press releases do more harm than good. An analysis of press releases from some of the most prestigious medical journals found the same litany of problems. I don’t think most people realize that journals sell reprints, which are official-looking copies of the articles they print, to drug companies and others. Reprints can bring in big bucks. Drug companies may buy a million copies of a favorable article. Indeed, they “usually buy reprints of studies that they have funded themselves. Unsurprisingly, they buy them only when the results are positive for their drugs, and they use these reprints as a form of marketing.” What’s more, sometimes a company will submit an article and promise to buy a certain number of reprints if it’s accepted, which “is effectively a bribe…” A long-time editor-in-chief at the prestigious British Medical Journal recalled that a woman from a public relations company called him, offered to take him to a restaurant of his choice, “and stopped just short of saying she would go to bed with me if we took the paper.”

“Another conflict of interest for editors relates to advertising—a major source of income for many journals. Most of the advertising comes from pharmaceutical companies.” If they don’t like a study, they can threaten to withdraw their advertising if it’s published. This potentially leaves editors “faced with the stark choice of agreeing not to publish a particular piece or seeing their journal die.”

Even if journalists, as they’re writing an article, have the time to skip the press releases and go directly to the source to read the studies themselves, they may find them “incomprehensible; utter gobbledygook.” Yet even if they do understand the studies, scientific articles are not simply reports of facts. Authors have many opportunities to add spin to their scientific reports, with “spin” defined as distorting the interpretation of results and misleading readers, either unconsciously or with a willful intent to deceive.  Researchers looked at randomized controlled trials with statistically nonsignificant results, meaning, for example, a drug was compared to a sugar pill and the difference between the two was essentially nonexistent. Would the researchers just lay out the truth and report that they spent time and money, but, in terms of their primary outcome, got nothing? Or would they try to spin it? In 68 percent of cases, they spun it. There was spin in the abstract, the article summary, which is particularly alarming because the abstract is often “the only part of an article [people] actually read.”

Given all of this, it’s no wonder the media often gets it wrong. Spin in the abstracts can turn into spin in the press releases and result in spin in the news. “Therefore, even if journalists [do their due diligence and] are using the original abstract conclusion in good faith, they still run the risk of deceiving their readers.” Researchers presenting new findings can always be careful to stress how preliminary the findings may be. “But let’s be serious. Powerful and reinforcing self-interests” may prevail.

I think the biggest problem with the way the media reports on medicine, though, is the choice of which stories are covered. In 2003, for instance, SARS and bioterrorism killed less than a dozen people, yet generated over a hundred thousand media reports, which is far more than those covering the actual greatest threats to our lives and health. In fact, ironically, “the more commonplace the cause of death, the less likely it is to be covered by the mass media.” Our leading killer is heart disease, yet it can be prevented, treated, and even reversed with diet and lifestyle changes—now that’s what should be front page news.


If we can’t trust the medical literature on its face, where can we turn? We’re talking life-or-death information here. What we need is someone who will dig deep into the data and translate the gobbledygook into actionable tips on keeping us and our families healthy. If only there was a website we could trust to tell us the unbiased truth…

If you appreciate the work we do, please consider supporting us. NutritionFacts.org relies solely on individual donations from users like you!

If you think just a little spin is bad, there is a much deeper rot in the medical literature. For more on this critical topic, see:

Interested in some specific examples of the spin and conflicts of interest we’ve been discussing? See:

It’s no wonder Physicians May Be Missing Their Most Important Tool.

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 Did Doctors Keep Prescribing Cancer?

We’ve known about the role of estrogen in breast cancer going back to the 1800s, when surgical removal of the ovaries seemed to help in some cases. Ovaries were said to send out “mysterious” influences to the rest of the body, which were identified as estrogen in 1923. The medical profession jumped on this discovery and started injecting menopausal women by the thousands, and it was said that “[t]he ‘shot’ gives a ‘respectable’ hook on which to hang the visit to the doctor…” Soon, there were pills and patches, and medical journals like the Journal of the American Medical Association regaled doctors with ads I feature in my video How Did Doctors Not Know About the Risks of Hormone Therapy? on how they can “help the women to happiness by simply prescribing estrogen” and, “[w]hen women outlive their ovaries…,” there is Premarin.

As far back as the 1940s, concerns were raised that this practice might cause breast cancer, noting it would have been nice to figure this out before we started dosing women en masse. But breast cancer risk didn’t seem to matter as much, because heart disease was the number-one killer of women, reviews concluded, and because women taking hormones appeared to have lower heart attack rates, which would outweigh any additional breast cancer. However, women taking estrogen tended to be of a higher socioeconomic class, exercised more, and engaged in other healthy lifestyle changes like consuming more dietary fiber and getting their cholesterol checked. So, maybe that’s why women taking estrogen appeared to be protected from heart disease. Perhaps it had nothing to do with the drugs themselves. Despite the medical profession’s “enthusiasm for estrogen replacement therapy,” only a randomized clinical trial could really resolve this question. We would need to divide women into two groups, with half getting the hormones and half getting a placebo, and follow them out for a few years. There was no such study…until the 1990s, when the Women’s Health Initiative study was designed.

Wait a second. Why did it take the bulk of a century to decide to definitively study the safety of something prescribed to millions of women? Perhaps because there had never been a female director of the National Institutes of Health until then. “Just three weeks after being named NIH Director in 1991, [Bernadine Healy] went before Congress to announce, ‘We need a moon walk for women.’ That ‘moon walk’ took the form of the Women’s Health Initiative, the most definitive, far-reaching clinical trial of women’s health ever undertaken in the United States.”

The bombshell landed in summer 2002. There was so much more invasive breast cancer in the hormone users that they were forced to stop the study prematurely. What about heart disease? Wasn’t that supposed to balance things out? The women didn’t just have more breast cancer—they had more heart attacks, more strokes, and more blood clots to their lungs.

The news that women treated with hormone replacement therapy “experienced higher rates of breast cancer, cardiovascular disease, and overall harm has rocked women and physicians across the country.” Estrogen started out as the most prescribed drug in America before the study, but, after, the number of prescriptions dropped immediately and, within a year, so did the incidence of breast cancer in the United States.

The most important question about this story is why were we all so surprised? There had been “decades of repeated warnings” about the risks of cancer. In fact, the reason breast cancer patients had so much trouble suing the pharmaceutical company was that “the drugs have contained warning labels for decades.” And, with that disclosure, surely any reasonable physician would have included it in their risk and benefit discussions with their patients, right? It’s like the warning labels on packs of cigarettes. If you get lung cancer now, you should have known better. And, so, if you were on hormone replacement therapy and got breast cancer, don’t blame the drug company. They warned you about the risks, right there in the fine print.

Why didn’t more doctors warn their patients? Even after the study came out, millions of prescriptions continued to be dispensed. That’s a lot of cancer in our patients we caused, wrote one doctor. “How long will it take us to discard the financial gains, to admit that we are harming many of our patients, and to start changing our prescription habits?”

“Why did this practice continue in the face of mounting evidence of harm?” Well, it is a multibillion-dollar industry. “Despite an overwhelming amount of evidence to the contrary, many physicians still believe that estrogenic hormones have overall health benefits,” a “non-evidence-based perception [that] may be the result of decades of carefully orchestrated corporate influence on medical literature.” Indeed, “[d]ozens of ghostwritten reviews and commentaries published in medical journals and supplements were used to promote unproven benefits and downplay harms of menopausal hormone therapy…” PR companies were paid to write the articles that were then passed off as having been written by some expert.

What now? “Gynecologists must switch allegiance from eminence-based to evidence-based medicine.” In other words, they must consider what the science says and not just what some so-called expert says. It’s been said that the “current culture of gynecology encourages the dissemination of health advice based on advertising rather than science.”

“Women were placed in the way of harm by their physicians, who acted as unsuspecting patsies for the pharmaceutical companies.” If we really wanted to prevent heart attacks in women, simple lifestyle behaviors can eliminate more than 90 percent of heart attack risk. So, instead of being Big Pharma’s pawns, “recommending a healthful diet, increased exercise, and smoking cessation would truly benefit women’s health.”


The whole Premarin debacle speaks to the importance of putting purported therapies to the test (see, for example, Do Vitamin D Supplements Help with Diabetes, Weight Loss, and Blood Pressure?), as well as to the power of Big Pharma (Eliminating Conflicts of Interest in Medical Research), medical community collusion (American Medical Association Complicity with Big Tobacco), and my most series on mammograms.

What about Plant-Based Bioidentical Hormones and Soy Phytoestrogens for Menopause Hot Flashes? Check out the videos to find out.

In general, patients (and doctors) tend to wildly overestimate the efficacy of pills and procedures. See Why Prevention Is Worth a Ton of Cure and The Actual Benefit of Diet vs. Drugs.

Medical care, in general, may be the third leading cause of death in the United States. See How Doctors Responded to Being Named a Leading Killer.

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: