The American Heart Association (AHA), the American College of Cardiology (ACC, and the Centers for Disease Control and Prevention (CDC) recommend lifestyle modification as the first-line treatment. If that doesn’t work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.
What’s wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs don’t treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue, and muscle cramps.
What are the recommended lifestyle changes? The AHA, ACC, and CDC recommend controlling one’s weight, salt, and alcohol intake, engaging in regular exercise, and adopting a DASH eating plan.
The DASH diet has been described as a lactovegetarian diet, but it’s not. It emphasizes fruits, vegetables, and low-fat dairy, but only a reduction in meat consumption. Why not even more plant-based? We’ve known for decades that animal products are significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.
I’ve talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. They eat plant-based day-to-day, with meat only eaten on special occasions.
How do we know it’s the plant-based nature of their diets that was so protective, though?
Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low on average were those eating strictly plant-based diets, coming in at about 110 over 65.
So, were the creators of the DASH diet just not aware of this landmark research done by Harvard’s Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yetincluding enough animal products to make it “palatable” to the general public.
You can see what they were thinking. Just like drugs never work—unless you actually take them, diets never work—unless you actually eat them. So, what’s the point of telling people to eat strictly plant-based if few people will do it? By soft-peddling the truth and coming up with some kind of compromise diet, then on a population scale maybe you’d do more. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe it’s time to start telling the American public the truth.
Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But, they had to make the diet acceptable. Research has since shown that the added plant foods—not the changes in oil, sweets, or dairy—appear to be the critical components of the DASH diet. So, why not eat a diet composed entirely of plant foods?
A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers, and even death. But, completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But, those eating meat-free, egg-free, and dairy-free may have 75% lower risk.
What if we’re already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70? Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention.
Watermelon also appears to be extraordinary, but you’d have to eat around 2 pounds a day. Sounds like my kind of medicine, but it’s hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may also help a bit.
Kiwifruits don’t seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with a study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy.
The DASH diet is one of the best studied, and it consistently ranks as US News & World Report’s #1 diet. It’s one of the few diets that medical students are taught about in medical school. I was so fascinated to learn of its origins as a compromise between practicality and efficacy.
I’ve talked about the patronizing attitude many doctors have that patients can’t handle the truth in:
For more on what plants can do for high blood pressure, see:
- How Not to Die from High Blood Pressure
- Hibiscus Tea vs. Plant-Based Diets for Hypertension
- Flax Seeds for Hypertension
- Drugs and the Demise of the Rice Diet
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:
- 2012: Uprooting the Leading Causes of Death
- 2013: More Than an Apple a Day
- 2014: From Table to Able: Combating Disabling Diseases with Food
- 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet
- 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers
Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous “meat defamation” trial.
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