How Not to Die

  The current medical education system has yet to adapt to the great transformation of disease from acute to chronic. Medicine is no longer about just setting broken bones or curing strep throat. Such chronic diseases as diabetes are now the principal cause of death and disability in America, consuming three-quarters of the nation’s health care budget. Medical education has yet to recognize and respond to the changing nature of disease patterns, which now requires a focus on prevention and lifestyle change.126 How far behind the times is the medical profession? A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education has not changed since 1910.127

  Not long ago, I received an e-mail that helps sum up where we are. Tonah, a sixty-five-year-old Native American, had been on insulin for type 2 diabetes for the last twenty-seven years. He was told by his doctor that Native Americans were “genetically predisposed” to the disease. He just had to live with it, including the excruciating nerve pain, three heart stents, and erectile dysfunction. After watching my “Uprooting the Leading Causes of Death” video on NutritionFacts.org, his granddaughter convinced him to try a plant-based diet.

  It wasn’t easy, since the nearest store with fresh food was fifty miles away. Nevertheless, in less than two weeks, he turned his life around. His nerve pain diminished dramatically, to the point where it no longer kept him up at night. He lost thirty pounds in a matter of months and no longer needed insulin. His own doctor couldn’t believe this was possible and ordered a CT scan to check for tumors. There weren’t any. Now he feels better than he has in years.

  “I’m grateful that my granddaughter has stopped seeing me as a sick old man,” Tonah concluded his note. “I feel young again, Doc.”

  CHAPTER 7

  How Not to Die from High Blood Pressure

  The most comprehensive and systematic analysis of the causes of death ever undertaken was published recently in the Lancet, one of the world’s leading medical journals.1 Funded by the Bill & Melinda Gates Foundation, the Global Burden of Disease Study involved nearly five hundred researchers from more than three hundred institutions in fifty countries and examined nearly one hundred thousand data sources.2 The results allow us to answer such questions as “How many lives could we save if people around the world cut back on fizzy drinks?” The best answer? 299,521.3 So soft drinks and their empty calories don’t just fail to promote health—they actually seem to promote death. But apparently soda isn’t nearly as deadly as bacon, ham, and hot dogs. Processed meat is blamed for the deaths of more than eight hundred thousand people every year. Worldwide, that’s four times more people than die from illicit drug use.4

  The study also noted which foods, if added to the diet, might save lives. Eating more whole grains could potentially save 1.7 million lives a year. More vegetables? 1.8 million lives. How about nuts and seeds? 2.5 million lives. The researchers didn’t look at beans, but of the foods they considered, which does the world need most? Fruit. Worldwide, if humanity ate more fruit, we might save 4.9 million lives. That’s nearly 5 million lives hanging in the balance, and their salvation isn’t medication or a new vaccine—it may be just more fruit.5

  The number-one risk factor for death in the world they identified is high blood pressure.6 Also known as hypertension, high blood pressure lays waste to nine million people worldwide every year.7 It kills so many people because it contributes to deaths from a variety of causes, including aneurysms, heart attacks, heart failure, kidney failure, and stroke.

  You’ve probably had your blood pressure taken at the doctor’s office. The nurse reads off two numbers, say, for example, “115 over 75.” The first number (“systolic”) represents the pressure in your arteries as your blood pumps from the heart; the second number (“diastolic”) is the pressure in your arteries while the heart is resting between beats. The American Heart Association defines “normal” blood pressure as a systolic pressure under 120 and a diastolic pressure under 80—or 120/80. Anything above 140/90 is considered hypertensive. Values in between are considered prehypertensive.8

  Increased blood pressure puts a strain on the heart and can damage the sensitive blood vessels in your eyes and kidneys, cause bleeding in the brain, and even lead certain arteries to balloon and rupture. The fact that hypertension can damage so many organ systems and increase the risk of heart disease and stroke, two of our leading killers, explains why it is the number-one killer risk factor worldwide.

  In the United States, nearly seventy-eight million people have high blood pressure—that’s about one in three American adults.9 As you age, your blood pressure tends to get higher and higher. In fact, after age sixty, 65 percent of Americans can expect to be diagnosed with the condition.10 This has led many people, including doctors, to assume that high blood pressure, like wrinkles or gray hair, is just an inevitable consequence of getting older. However, we’ve known for nearly a century that this isn’t true.

  In the 1920s, researchers measured the blood pressure of a thousand native Kenyans who ate a low-sodium diet centered around whole plant foods—whole grains, beans, fruits, and dark, leafy greens, and other vegetables.11 Up until age forty, the blood pressure of the rural Africans was similar to that of Europeans and Americans, about 125/80. However, as Westerners aged, their blood pressure began to surge past the Kenyans. By age sixty, the average Westerner was hypertensive, with blood pressure exceeding 140/90. What about the Kenyans? By age sixty, their average blood pressure had actually improved to an average of about 110/70.12

  The 140/90 threshold for hypertension is considered an arbitrary cutoff.13 Just like having too much cholesterol or body fat, there are benefits to having a blood pressure that is even lower than the “normal” range. So even people who start out with a so-called normal blood pressure of 120/80 appear to benefit from going down to 110/70.14 But is it possible to do that? Look at the Kenyans—not only is it possible, it appears typical for people who live healthy, plant-based lifestyles.

  Over a two-year period, 1,800 patients were admitted into a rural Kenyan hospital. How many cases of high blood pressure did they find? Zero. There also wasn’t a single case found of America’s number-one killer, atherosclerosis.15

  High blood pressure, then, appears to be a choice. You can continue eating the artery-bursting Western diet, or you can choose to take off the pressure. The truth is that eliminating humanity’s primary risk factor for death may be simple. No drugs, no scalpels. Just forks.

  Sodium

  The two most prominent dietary risks for death and disability in the world may be not eating enough fruit and eating too much salt. Nearly five million people appear to die every year as a result of not eating enough fruit,16 while eating too much salt may kill up to four million.17

  Salt is a compound made up of about 40 percent sodium and 60 percent chloride. Sodium is an essential nutrient, but vegetables and other natural foods provide the small amounts of sodium you need in your diet. If you consume too much, it can cause water retention, and your body may respond by raising your blood pressure to push the excess fluid and salt out of your system.18

  For the first 90 percent of human evolution, we likely ate diets containing less than the equivalent of quarter of a teaspoon of salt’s worth of sodium a day.19 Why? Because we likely ate mostly plants.20 We went millions of years without saltshakers, so our bodies evolved into sodium-conserving machines. That served us well until we discovered that salt could be used to preserve foods.21 Without refrigeration, this was a boon to human civilization. It didn’t matter that the addition of salt to our food resulted in a general rise in blood pressure—the alternative was starving to death because all our food rotted away.

  But where does that leave us now? After all, we no longer have to live off pickles and jerky. Humans are genetically programmed to eat ten times less sodium than we do now.22 Many so-called low-salt diets can actually be considered high-salt diets. That’s why it’s critical to understand what the concept of “normal” is
when it comes to sodium. Having a “normal” salt intake can lead to a “normal” blood pressure, which can contribute to us dying from all the “normal” causes, like heart attacks and strokes.23

  The American Heart Association recommends everyone consume less than 1,500 mg of sodium daily24—that’s about three-quarters of a teaspoon of salt. The average American adult consumes more than double that amount, about 3,500 mg daily.25 Reducing sodium consumption by just 15 percent worldwide could save millions of lives every year.26

  If we could cut our salt intake by about half a teaspoon a day, which is achievable by avoiding salty foods and not adding salt to our food, we might prevent 22 percent of stroke deaths and 16 percent of fatal heart attacks. That’s potentially more lives saved than if we were able to successfully treat people with blood pressure pills.27 Simply put, reducing salt is an easy at-home intervention that may be more powerful than filling a prescription from the pharmacy. Up to ninety-two thousand American lives could be saved each year simply by eating less salt.28

  The evidence that sodium raises blood pressure is clear, including double-blind, randomized trials dating back decades.29 If we take subjects with high blood pressure and put them on a sodium-restricted diet, their blood pressure drops. If we keep them on the low-salt diet and add a placebo, nothing happens. However, if we instead give subjects salt in the form of a time-release sodium pill, their blood pressure goes back up again.30 The more sodium we give them secretly, the higher their blood pressure climbs.31

  Even just a single meal can do it. If we take people with normal blood pressure and give them a bowl of soup containing the amount of salt that may be found in an average American meal,32 their blood pressure climbs over the next three hours compared to eating the same soup without any added salt.33 Dozens of similar studies demonstrate that if you reduce your salt intake, you reduce your blood pressure. And the greater the reduction, the greater the benefit. But if you don’t cut down, chronic high salt intake can lead to a gradual increase in blood pressure throughout life.34

  Doctors used to be taught that a “normal” systolic blood pressure is approximately 100 plus age. Indeed that’s about what you’re born with. Babies start out with a blood pressure around 95/60. But, as you age, that 95 can go up to 120 by your twenties. By the time you’re in your forties, it can be up to 140—the official cutoff for high blood pressure—and then keep climbing as you get older.35

  What would happen if, instead of consuming ten times more sodium than what your bodies were designed to handle, you just ate the natural amount found in whole foods? Is it possible your blood pressure would stay low your whole life? To test that theory, we’d have to find a population in modern times that doesn’t use salt, eat processed food, or go out to eat. To find a no-salt culture, scientists had to go deep into the Amazon rainforest.36

  Strangers to saltshakers, Cheetos, and KFC, the Yanomamo Indians were found to have the lowest sodium intake ever recorded—which is to say the sodium intake we evolved eating.37 Lo and behold, researchers found that the blood pressures among older Yanomamo were the same as those of adolescents.38 In other words, they start out with an average blood pressure of about 100/60 and stay that way for life. The researchers couldn’t find a single case of high blood pressure.39

  Why do we suspect it was the sodium? After all, the Yanomamos studied didn’t drink alcohol, ate a high-fibre, plant-based diet, had lots of exercise, and were not obese.40 An interventional trial could prove that sodium was the culprit. Imagine if we took people literally dying from out-of-control high blood pressure (known as malignant hypertension), a condition from which you go blind from bleeding into your eyes, your kidneys shut down, and your heart eventually fails. What if you put these patients on a Yanomamo-level salt intake—in other words, a normal-for-the-human-species salt intake?

  Enter Dr. Walter Kempner and his rice-and-fruit diet. Without drugs, he brought patients with eye-popping blood pressures like 240/150 down to 105/80 with dietary changes alone. How could he ethically withhold medication from such seriously ill patients? Modern high-blood-pressure pills hadn’t been invented yet—Dr. Kempner conducted his work back in the 1940s.41 Back then, malignant hypertension was a death sentence, with a life expectancy of about six months.42 Nevertheless, he was able to reverse the course of disease with diet in more than 70 percent of cases.43 Though the diet wasn’t merely extremely low sodium—it was also strictly plant-based and low in fat and protein—Dr. Kempner is now recognized as the person who established, beyond any shadow of doubt, that high blood pressure can often be lowered by a low-sodium diet.44

  In addition to high blood pressure, salty meals can significantly impair artery function,45 even among people whose blood pressure tends to be unresponsive to salt intake.46 In other words, salt itself can injure our arteries independent of its impact on blood pressure. And that harm begins within thirty minutes.47

  Using a technique called laser Doppler flowmetry, researchers are able to measure blood flow in the tiny vessels in the skin. After a high-sodium meal, there is significantly less blood flow—unless vitamin C is injected into the skin, which appears to reverse much of the sodium-induced suppression of blood vessel function. So, if an antioxidant helps block the sodium effect, then the mechanism by which salt impairs arterial function may be oxidative stress, the formation of free radicals in your bloodstream.48 It turns out that sodium intake appears to suppress the activity of a key antioxidant enzyme in the body called superoxide dismutase,49 which has the ability to detoxify a million free radicals per second.50 With the action of this workhorse of an enzyme stifled by sodium, artery-crippling levels of oxidative stress can build up.

  After one salty meal, not only does blood pressure increase but the arteries actually begin to stiffen.51 This may be how we figured out thousands of years ago that too much salt was bad for us. Quoting from a translation of The Yellow Emperor’s Classic of Internal Medicine, an ancient Chinese medical text, “If too much salt is used in food, the pulse hardens . . .”52 It turns out that we may not need a double-blind trial; maybe we just have to feed someone a bag of crisps and take his or her pulse.

  Unsurprisingly, the salt industry isn’t thrilled about the idea of us cutting back on salt. Back in 2009, the American Heart Association quoted the chair of the U.S. Dietary Guidelines Advisory Committee as saying that Americans should reduce their sodium intake. The Salt Institute, a salt industry trade organization, accused her of having an “unhealthy prejudice” against salt, arguing that she had “pre-judged the salt issue.”53 This is like the tobacco industry complaining that people at the American Lung Association are biased against smoking. Of course, the Salt Institute wasn’t the only aggrieved party. Cheese, it turns out, ranks as a leading contributor of sodium in the American diet,54 and the National Dairy Council stood shoulder-to-shoulder with Big Salt in its condemnation of the Dietary Guidelines Advisory Committee recommendations.55

  The salt industry has its own PR and lobbying firms to play tobacco-industry-style tactics to downplay the dangers of its product.56 But the real villains aren’t necessarily the salt-mine barons—it’s the processed food industry. The trillion-dollar processed food industry uses dirt-cheap added salt and sugar to sell us their junk.57 That’s why it’s not easy avoiding sodium on the typical American diet, since three-quarters of salt comes from processed foods rather than a saltshaker.58 By hooking you on hypersweet and hypersalty foods, your taste buds get so dampened that natural foods can taste like cardboard. Indeed, the ripest fruit may not be as sweet as a high-sugar cereal snack such as Froot Loops.

  But there are two other major reasons the food industry adds salt to foods. If you add salt to meat, it draws in water. This way, a company can increase the weight of its product by nearly 20 percent. Since meat is sold by the pound, that’s 20 percent more profits for very little added cost. Second, as everyone knows, eating salt makes us thirsty. There’s a reason bars put out free baskets of salted nuts and pretzels, and it
’s the same reason fizzy drink conglomerates own snack-food companies. A cold drink and a salty snack go hand in hand. It may be no coincidence that Pepsi and Frito-Lay, a crisp manufacturer, are part of the same corporation.59

  Pop quiz! Which has been reported to contain the most sodium: a serving of beef, a serving of baked all-natural chicken, a large McDonald’s french fries, or a serving of salted pretzels?

  The answer? Chicken. The poultry industry commonly injects chicken carcasses with salt water to artificially inflate their weight, yet they can still be labelled “100 percent natural.” Consumer Reports found that some supermarket chickens were pumped so full of salt that they registered a whopping 840 mg of sodium per serving—that could mean more than a full day’s worth of sodium in just one chicken breast.60

  The number-one source of sodium for American kids and teens is pizza.61 A single slice of Pizza Hut pepperoni pizza can contain half your recommended sodium intake limit for the entire day.62 For adults over fifty, it’s bread, but between the ages of twenty and fifty, the greatest contributor of sodium to the diet is chicken—not the tinned soups, pretzels, or crisps one might expect.63

  How can you overcome your built-in craving for salt, sugar, and fat? Just give it a few weeks, and your taste buds will start to change. When researchers put people on a low-salt diet, over time, the research subjects increasingly enjoyed the taste of salt-free soup and became turned off by the salt-heavy soup they had previously craved. As the study progressed, when the participants were allowed to salt their own soup to taste, they preferred less and less salt as their taste buds became acclimated to healthier levels.64