How to Treat High Blood Pressure with Diet

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The first-line treatment for hypertension is lifestyle modification, which often includes the DASH diet. What is it and how can it be improved?

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High blood pressure ranks as the #1 risk factor for death and disability in the world. Previously, I showed how a plant-based diet may prevent high blood pressure. But what if we already have it?

The American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention recommend, as the first-line treatment, lifestyle modification. If that doesn’t work, you start the patient on a thiazide diuretic, or water pill, and then you keep piling on the meds until you get their blood pressure down. Commonly people will end up on three drugs, though researchers are experimenting with four at a time, and some people end up on five.

Why not just jump straight to the drugs? Well, they don’t treat the underlying cause, and they can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to the adverse effects such as erectile dysfunction, fatigue, and muscle cramps. So, what are these recommended lifestyle changes? They recommend to control one’s weight, salt, and alcohol intake, engage in regular exercise, and adopt a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it’s not. It emphasizes fruits and vegetables and low-fat dairy, but just a reduction in meat. Why not vegetarian? We’ve known for decades that food of animal origin is highly significantly associated with blood pressure. In fact, you can take vegetarians, give them meat, and watch their blood pressures go right up.

I’ve talked about how there are benefits to getting blood pressure down as low as 110 over 70, but who can get that low? Populations eating traditional whole food plant-based diets. Like in rural China, about 110 over 70 their whole lives, with meat eaten only on special occasions. Or rural Africa, where the elderly have perfect blood pressure as opposed to hypertension.

In the Western world, as the American Heart Association has pointed out, the only folks really getting down that low are the strict vegetarians, coming out about 110 over 65. So, when they created the DASH diet, were they just not aware of this landmark research, done by Harvard’s Frank Sacks? No, they were aware. The Chair of the Design Committee who came up with the DASH diet was Dr. Sacks. In fact, the DASH diet was explicitly designed with the #1 goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet containing enough animal products to make it palatable to the general public. In fact, Sacks 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 it’s the added plant foods, not the changes in oil, sweets, or dairy that appear to be the critical component, so why not eat plant-based?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. Vegetarian diets in general confer protection against cardiovascular diseases, some cancers and death, but completely plant-based diets, vegan diets, seem to offer additional protection for obesity, hypertension, type 2 diabetes, and heart disease mortality. Based on a study of 89,000 people, those eating meat-free diets appeared to cut their risk of high blood pressure 55%, but those eating meat-free, egg-free, and dairy-free had 75% lower risk.

If, however, you’re already eating a whole food plant-based diet, no processed foods, no table salt, and you’re still not hitting 110 over 70, there are a few foods recently found to offer additional protection. Ground flaxseeds, a few tablespoons a day, induced one of the most potent antihypertensive effects ever achieved by a dietary intervention, two to three times more powerful than instituting an aerobic endurance exercise program.

Watermelon also appears to be extraordinary, but you’d have to eat like two pounds a day. Sounds like my kind of medicine, but it’s hard to get year-round. Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? And the answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may help a little. 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 this study showing raisins can reduce blood pressure–but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy!

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to via Mikalai Maminau via 123rf. Images have been modified.

High blood pressure ranks as the #1 risk factor for death and disability in the world. Previously, I showed how a plant-based diet may prevent high blood pressure. But what if we already have it?

The American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention recommend, as the first-line treatment, lifestyle modification. If that doesn’t work, you start the patient on a thiazide diuretic, or water pill, and then you keep piling on the meds until you get their blood pressure down. Commonly people will end up on three drugs, though researchers are experimenting with four at a time, and some people end up on five.

Why not just jump straight to the drugs? Well, they don’t treat the underlying cause, and they can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to the adverse effects such as erectile dysfunction, fatigue, and muscle cramps. So, what are these recommended lifestyle changes? They recommend to control one’s weight, salt, and alcohol intake, engage in regular exercise, and adopt a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it’s not. It emphasizes fruits and vegetables and low-fat dairy, but just a reduction in meat. Why not vegetarian? We’ve known for decades that food of animal origin is highly significantly associated with blood pressure. In fact, you can take vegetarians, give them meat, and watch their blood pressures go right up.

I’ve talked about how there are benefits to getting blood pressure down as low as 110 over 70, but who can get that low? Populations eating traditional whole food plant-based diets. Like in rural China, about 110 over 70 their whole lives, with meat eaten only on special occasions. Or rural Africa, where the elderly have perfect blood pressure as opposed to hypertension.

In the Western world, as the American Heart Association has pointed out, the only folks really getting down that low are the strict vegetarians, coming out about 110 over 65. So, when they created the DASH diet, were they just not aware of this landmark research, done by Harvard’s Frank Sacks? No, they were aware. The Chair of the Design Committee who came up with the DASH diet was Dr. Sacks. In fact, the DASH diet was explicitly designed with the #1 goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet containing enough animal products to make it palatable to the general public. In fact, Sacks 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 it’s the added plant foods, not the changes in oil, sweets, or dairy that appear to be the critical component, so why not eat plant-based?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. Vegetarian diets in general confer protection against cardiovascular diseases, some cancers and death, but completely plant-based diets, vegan diets, seem to offer additional protection for obesity, hypertension, type 2 diabetes, and heart disease mortality. Based on a study of 89,000 people, those eating meat-free diets appeared to cut their risk of high blood pressure 55%, but those eating meat-free, egg-free, and dairy-free had 75% lower risk.

If, however, you’re already eating a whole food plant-based diet, no processed foods, no table salt, and you’re still not hitting 110 over 70, there are a few foods recently found to offer additional protection. Ground flaxseeds, a few tablespoons a day, induced one of the most potent antihypertensive effects ever achieved by a dietary intervention, two to three times more powerful than instituting an aerobic endurance exercise program.

Watermelon also appears to be extraordinary, but you’d have to eat like two pounds a day. Sounds like my kind of medicine, but it’s hard to get year-round. Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? And the answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may help a little. 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 this study showing raisins can reduce blood pressure–but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy!

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to via Mikalai Maminau via 123rf. Images have been modified.

Doctor's Note

This is the companion video to How to Prevent High Blood Pressure with Diet.

The DASH diet is one of the best studied, and 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:

What would hearing the truth from your physician sound like? See Fully Consensual Heart Disease Treatment and The Actual Benefit of Diet vs. Drugs

For more on what plants can do for high blood pressure see:

2020 Update – I just did a new series on blood pressure. See: 

And if you haven’t yet, be sure to watch How Not to Die from High Blood Pressure. 

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