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:

How Can Animal Protein Intake Increase Childhood Obesity Risk?

If pregnant crickets are exposed to a predatory wolf spider, their babies will hatch, exhibiting increased antipredator behavior and, as a consequence, improved survival from wolf spider attack. The mother cricket appears to be able to forewarn her babies about the threat when they are still inside her, so they would be pre-adapted to their external environment. This even happens in plants. If you grow two genetically identical plants—one in the sun, one in the shade—the sun-grown plant will produce seeds that grow better in the sun, and the shaded plant will produce seeds that grow better in the shade—even though they’re genetically identical.

What’s happening is called epigenetics, external factors changing gene expression.

Vole pups born in the winter come out growing thicker coats. Vole mothers are able to communicate the season to their babies in utero and tell them to put a coat on even before they’re born. We’re no different. You know how some people have different temperature tolerances, resulting in “battles of the bedroom”? Do you turn the AC on or off? Open the windows? It’s not just genetics. Whether we’re born in the tropics or in a cold environment determines how many active sweat glands we have in our skin.

What does this have to do with diet? As I discuss in my video Animal Protein, Pregnancy, and Childhood Obesity, can what a pregnant woman eats—or doesn’t eat—permanently alter the biology of her children in terms of what genes are turned on or off throughout life?

What happened to the children born during the 1944 – 1945 Dutch famine imposed by the Nazis? They had higher rates of obesity 50 years later. The baby’s DNA gene expression was reprogrammed before birth to expect to be born into a world of famine and conserve calories at all cost. But when the war ended, this propensity to store fat became a disadvantage. What pregnant women eat and don’t eat doesn’t just help determine the birth weight of the child, but the future adult weight of the child.

For example, maternal protein intake during pregnancy may play a role in the obesity epidemic—but not just protein in general. “Protein from animal sources, primarily meat products, consumed during pregnancy may increase risk of overweight in offspring…” Originally, researchers thought it might be the IGF-1, a growth hormone boosted by animal product consumption, that may increase the production of fatty tissue, but weight gain was tied more to meat intake than dairy. Every daily portion of meat intake during the third trimester of pregnancy resulted in about an extra 1 percent of body fat mass in their children by their 16th birthday, potentially increasing their risk of becoming obese later in life, independent of how many calories they ate or how much they exercised.  But no such link was found with cow’s milk intake, which would presumably boost IGF-1 levels just as high.

Given that, perhaps instead of IGF-1, it’s the obesogens in meat, chemicals that stimulate the growth of fatty tissue. “[E]merging evidence demonstrates that environmental factors can predispose exposed individuals to gain weight, irrespective of diet and exercise.” After all, even our infants are fatter, and we can’t blame that on diet and exercise. Animals are fatter, too, and not just our pampered pets—even rats in laboratories and subways are bigger. “The likelihood of 24 animal populations from eight different species all showing a positive trend in weight over the past few decades by chance was estimated at about 1 in 10 million” so it appears something else is going on—something like obesogenic chemicals.

One such candidate is polycyclic aromatic hydrocarbons (PAHs), which are found in cigarette smoke, vehicle exhaust, and grilled meat. A nationwide study of thousands found that the more children were exposed to PAHs, the fatter they tended to be. The researchers could measure the level of these chemicals right out of their urine. Exposure can start in the womb. Indeed, prenatal exposure to these chemicals may cause increased fat mass gained during childhood and a higher risk of childhood obesity.

If these pollutants sound familiar, I’ve covered them before in relation to increasing breast cancer risk in the Long Island Breast Cancer Study Project. So, perhaps they aren’t just obesogens, but carcinogens, as well, which may help explain the 47 percent increase in breast cancer risk among older women in relation to a lifetime average of grilled and smoked foods.

If we look at one of the most common of these toxins, smokers get about half from food and half from cigarettes. For nonsmokers, however, 99 percent comes from diet. The highest levels of PAHs are found in meat, with pork apparently worse than beef. Even dark green leafies like kale can get contaminated by pollutants in the air, though, so don’t forage for dandelion greens next to the highway and make sure to wash your greens under running water.

These are fat-soluble pollutants, so they need lots of fat to be absorbed. It’s possible that even heavily contaminated plant-based sources may be safer, unless you pour lots of oil on your food, in which case the toxins would presumably become as readily absorbed as the toxins in meat.

The good news is they don’t build up in our body. As I show in my video, if we expose people to barbecued chicken, they get a big spike in these chemicals—up to a hundred-fold increase—but our body can get rid of them within about 20 hours. The problem, of course, is that people who eat these kinds of foods every day could be constantly exposing themselves, which may not only affect their health and their children’s health, but maybe even their grandchildren’s health.

Being pregnant during the Dutch famine of the mid-1940s didn’t just lead to an increase in diseases among their kids, but even apparently their grandkids. What a pregnant woman eats now may affect future generations. “The issue of generation-spanning effects of poor conditions during [pregnancy]…may shed light on the epidemic of diabetes, obesity and cardiovascular disease,” which is associated with the transition towards Western lifestyles.


Epigenetics is the science of altering the expression of our genes. No matter our family history, some genes can be effectively turned on and off by the lifestyle choices we make. See, for example:

For more on “obesogenic” chemicals, see:

I previously touched on PAHs in Meat Fumes: Dietary Secondhand Smoke.

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 Can Cause Stress Hormone Levels to Rise and Testosterone levels to Drop

A critique of the scientific validity of the dietary advice in Men’s Health magazine discovered nuggets claiming meat can give men “a testosterone boost,” but we’ve known for a quarter century that a meal with that much fat can drop testosterone levels by nearly one-third within hours. In fact, a significant drop of both free and bound testosterone in the bloodstream occurs within just one hour of it going in one’s mouth, whereas a low-fat meal of mostly carbs has no such effect. Based on in vitro studies on the effects of fat on testicle cells in a petri dish, researchers suspect fat in the blood may actually suppress testosterone production in real time. If you feed people lots of eggs and meat, including fish and poultry, and then switch them to a diet with bread, fruit, vegetables, and sugar—but about the same amount of fat—all their testosterone levels go up. Even more importantly, however, all their levels of cortisol, a stress hormone produced by our adrenal glands, go down.

Having low stress hormone levels is good, because high cortisol levels may “strongly predict cardiovascular death” in men and women both with and without pre-existing cardiovascular disease. In fact, this may help explain “death from a broken heart,” the heightened heart attack and stroke risk in the immediate weeks following the loss of a spouse. Higher cortisol levels days, months, or even years after losing someone you love may increase cardiac risk and reduce immune function. And, the rise in stress hormone levels from the loss of a spouse, a bump of about 50 points, is less than the bump you get by eating high-meat diet.

Cortisol may also help explain why those who are depressed tend to put on abdominal fat. The reason obesity around the middle is associated with elevated cortisol secretion may be that abdominal fat kind of sucks it up, so the accumulation of fat around our internal organs may be an adaptation by which our body deals with excess stress.

These spikes in stress hormone levels every time we eat a lot of meat may not just affect our health, but that of our children, which I discuss in my video Maternal Diet May Affect Stress Responses in Children. “Substantial evidence now suggests that maternal diets of high protein density have adverse effects on the fetus.” For example, back in the 1960s, an experiment was performed on pregnant women in Motherwell, Scotland, in which they were told to eat a high-meat diet in hopes of preventing preeclampsia, a disease of pregnancy. It didn’t work. In fact, the lowest preeclampsia rates I’ve ever seen were among women eating strictly plant-based diets—only 1 case out of 775 pregnancies. Preeclampsia normally strikes about 5 percent of pregnancies, so there should have been dozens of cases, suggesting a plant-based diet could alleviate most, if not all, of the signs and symptoms of this potentially serious condition. So what did happen when pregnant women went from eating about one daily portion of meat to about two portions a day? Mothers who ate more meat and fewer vegetables during pregnancy gave birth to children who grew up to have higher blood pressures.

“One explanation proposed for the adverse effects of high-meat/fish consumption is that this may increase maternal cortisol concentrations, which, in turn, affect the developing fetus,” resetting his or her stress hormone thermostat to a higher level. But, we don’t know until we put it to the test. And indeed, researchers found higher blood cortisol levels “in both the sons and daughters of women who had reported higher meat/fish” consumption, about a 5 percent increase for every meat serving per day. Such diets may present a metabolic stress to the mother and kind of reprogram the adrenal axis of their children, leading to lifelong hypercortisolemia, elevated levels of stress hormones in the blood. This may help explain why every daily portion of meat during late pregnancy may lead to a 1 percent greater fat mass in their children by the time they reach adolescence. So, this could increase the risk of their children becoming obese later in life and thus has “important implications for public health and in terms of prevention of obesity.”

What if they’re already born? We may be able to bring down children’s stress hormone levels with similar dietary changes, but this is just baseline stress hormone levels. Do children of mothers who eat more meat during pregnancy also have exaggerated responses to life stressors? Researchers put them through a stressful challenge—public speaking and mental arithmetic—and then measured their cortisol responses. If their mom ate less than two servings of meat/fish a day while she was carrying them, they got little shots of stress hormones from their adrenal glands. Those whose moms ate more really got stressed out, and those whose moms ate the most—17 or more servings a week, which is more than 2 servings each day—appeared to be really quaking in their boots. In a way, you are what your mother ate.


Want more craziness from Men’s Health magazine? Check out my video Changing a Man’s Diet After a Prostate Cancer Diagnosis.

Here are some other popular videos about eating healthfully during pregnancy:

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: