How Not to Die

  The same may be true for sugar and fat. It’s likely that humans actually taste fat, just like they taste sweet, sour, and salty flavors.65 People placed on low-fat diets start preferring low-fat foods over fatty options.66 Your tongue may actually become more sensitive to fat, and the more sensitive your tongue becomes, the less butter, meat, dairy, and eggs you eat. On the flip side, if you eat too much of these foods, you may blunt your taste for fat, which can cause you to eat more calories and more fat, dairy, meat, and eggs and ultimately gain weight.67 This can all happen in just a matter of weeks.68

  There are three things you can do to shake the salt habit.69 First, don’t add salt at the table. (One out of three people may add salt to their food before even tasting it!)70 Second, stop adding salt when cooking. The food may taste bland at first, but within two to four weeks, the salt-taste receptors in your mouth become more sensitive, and food tastes better. Believe it or not, after two weeks, you may actually prefer the taste of food with less salt.71 Try any combination of such fantastic flavorings as pepper, onions, garlic, tomatoes, sweet peppers, basil, parsley, thyme, celery, lime, chili powder, rosemary, smoked paprika, curry, coriander, and lemon instead.72 Also, it’s probably a good idea to avoid eating out as much as possible. Even non-fast-food restaurants tend to pile on the salt.73 Finally, do what you can to avoid processed foods.

  In most countries studied, processed foods provide only about half of people’s sodium intake, but in the United States, we consume so much sodium from processed foods that even if we completely stopped adding salt in the kitchen and dining room, we’d still only reduce our salt intake by a small fraction.74 Try to buy foods with fewer milligrams of sodium on the label than there are grams in the serving size. For example, if it’s a 100 g serving size, the product should have less than 100 mg of sodium.75 Alternatively, you can shoot for fewer milligrams of sodium per serving than there are calories. That’s a trick I learned from one of my favorite dietitians, Jeff Novick. Most people get around 2,200 calories a day, so if everything you ate had more calories than sodium, you would probably make it at least under the Dietary Guidelines for Americans’ upper limit of 2,300 mg of sodium a day.76

  Ideally, though, you’d buy mostly food without any labels at all. It is considered almost impossible to come up with a diet consisting of unprocessed natural foods that exceeds the strict 1,500 mg a day American Heart Association guidelines for sodium reduction.77

  Whole Grains

  On average, high blood pressure medications reduce the risk of heart attack by 15 percent and the risk of stroke by 25 percent.78 But in a randomized, controlled trial, three portions of whole grains a day were able to help people achieve this blood-pressure-lowering benefit too.79 The study revealed that a diet rich in whole grains yields the same benefits without the adverse side effects commonly associated with antihypertensive drugs, such as electrolyte disturbances in those taking diuretics (also known as water pills);80 increased breast cancer risk for those taking calcium-channel blockers (like Norvasc or Cardizem);81 lethargy and impotence for those on beta blockers (like Lopressor and Corgard);82 sudden, potentially life-threatening swelling for those taking ACE inhibitors (like Vasotec and Altace);83 and an increased risk of serious fall injuries for apparently any class of these blood pressure drugs.84

  Whole grains do have side effects, though. Good ones! Whole-grain intake is associated with lower risks of type 2 diabetes, coronary heart disease, weight gain,85 and colon cancer.86 Take note of the whole, however. While whole grains, such as oats, whole wheat, and brown rice, have been shown to reduce your risk of developing chronic disease,87 refined grains may actually increase your risk. Harvard University researchers, for example, found that while regular consumption of brown rice was associated with a lower risk of type 2 diabetes, consuming white rice was associated with higher risk. Daily servings of white rice were associated with a 17 percent greater risk of diabetes, whereas replacing one-third of a serving a day of white rice for brown rice might lead to a 16 percent drop in risk. And it looks like replacing white rice with oats and barley may be an even more powerful step, associated with a 36 percent drop in diabetes risk.88

  Given the improvements in cardiac risk factors seen in interventional trials of whole grains,89 it’s not surprising to see a reduction in the progression of arterial disease among those who regularly eat them. In studies of two of the most important arteries in the body, the coronary arteries that feed the heart and the carotid arteries that feed the brain, people who ate the most whole grains had significantly slower narrowing of their arteries.90,91 Since atherosclerotic plaque in the arteries is our leading killer, ideally, you should not just slow down the process but actually stop or even reverse it altogether. As we saw in chapter 1, this appears to require more than just whole grains; whole vegetables, whole fruits, whole beans, and other whole plant foods are needed, along with a significant reduction in your intake of trans fats, saturated fats, and cholesterol, the food components that contribute to clogging your arteries shut.

  What About the DASH Diet?

  What if you are among the seventy-eight million Americans who already have high blood pressure? How can you bring it down?

  The American Heart Association (AHA), the American College of Cardiology (ACC), and the Centers for Disease Control and Prevention (CDC) all recommend that patients first try lifestyle modifications, such as reducing body weight, limiting sodium and alcohol intake, getting more exercise, and eating a healthier diet.92

  However, if their recommended lifestyle changes don’t work, then it’s off to the pharmacy. First up is a diuretic (water pill), and before you can spell “pharmaceutical cocktail,” the medications begin piling up until your blood pressure comes down. High blood pressure patients commonly end up on three different antihypertensive drugs at a time,93 yet only about half tend to stick to even the first-line drugs.94 (This is due in part to all their side effects, which can include erectile dysfunction, fatigue, and leg cramps.)95 At the end of all of this, the drugs still haven’t gotten to the root cause of the problem. The cause of high blood pressure isn’t medication deficiency. The underlying cause is what you eat and how you live.

  As we discussed earlier, the ideal blood pressure, defined as the level at which lowering it further yields no additional benefit, is probably around 110/70.96 Can you really get it that low without medication? Remember, this was the average blood pressure of men more than sixty years old in rural Africa on no treatment other than their traditional, plant-based diets and lifestyles.97 In rural China, we find similar results: 110/70 throughout life without any increase with age.98 The reason we suspect that the plant-based nature of their diets is responsible is because, in the Western world, the only group able to routinely achieve these blood pressure readings is vegetarians.99

  So do the AHA/ACC/CDC guidelines recommend that people with high blood pressure eat a meat-free diet? No. They recommend the DASH diet, which stands for Dietary Approaches to Stop Hypertension, an eating plan specifically designed to lower blood pressure.100 Although it’s been described as a lactovegetarian diet101 (dairy, but no meat or eggs), that isn’t accurate. The DASH diet emphasizes fruits, vegetables, and low-fat dairy, but meat is still present—you’re just supposed to eat less of it.102

  Why not recommend an even more plant-based diet? We’ve known for decades that “food of animal origin was highly significantly associated with systolic and diastolic B[lood] P[ressure] after the age and weight effects were removed.”103 That’s a quote from a series of studies performed by renowned physician Frank Sacks and colleagues back in the 1970s, but there are studies going all the way back to the 1920s demonstrating that adding meat to a plant-based diet can significantly elevate blood pressure in a matter of days.104

  Why isn’t the DASH diet meatless? Based on the work of Dr. Sacks at Harvard University, the American Heart Association acknowledged that “[s]ome of the lowest B[lood]P[ressure]s observed in industrialized countries have been
documented in strict vegetarians. . . .”105 Were the designers of the DASH diet just not aware of Dr. Sacks’s work? No, the chair of the committee that designed the diet was Dr. Sacks.106

  The reason that the DASH diet was modeled explicitly after vegetarian diets but was not meat-free itself might surprise you. The primary design goal of the DASH diet was to explicitly create eating patterns “that would have the blood pressure lowering benefits of a vegetarian diet yet contain enough animal products to make them palatable to nonvegetarians. . . .”107 Dr. Sacks had even shown that the more dairy vegetarians consumed, the higher their blood pressure appeared to rise.108 But he figured there was no point in calling for a diet he believed few would follow. This is a recurring theme in official dietary recommendations. Instead of simply telling you what the science shows and then letting you make up your own mind, experts patronize the population by advocating what they think is practical rather than ideal. By making the decision for you, they undermine those willing to make even greater changes for optimal health.

  The DASH diet does help to bring down blood pressure, but the primary effect seems to arise not from the switch to low-fat dairy and white meat or the reduction in sweets and added fats but from the added fruits and vegetables.109 If the benefits are due to the added plant foods, why not strive to center people’s diets more around these healthiest of foods in the first place?

  This question is even more pointed given a 2014 meta-analysis (a compilation of many similar studies) showing that vegetarian diets may be particularly good at lowering blood pressure.110 And the more plants, perhaps, the better. Meat-free diets in general “confer protection against cardiovascular diseases . . . some cancers and total mortality,” but completely plant-based diets “seem to offer additional protection for obesity, hypertension, type-2 diabetes, and cardiovascular mortality.”111

  There appears to be a stepwise drop in hypertension rates the more plant-based foods you eat. Based on the same study of eighty-nine thousand Californians featured in chapter 6, compared with people who eat meat more than once a week, flexitarians (those who eat less meat, perhaps a few times a month) had 23 percent lower rates of high blood pressure. Those who cut out all meat except for fish had a 38 percent lower risk of high blood pressure, and those who cut out all meat had a 55 percent lower rate. People who cut out all meat, eggs, and dairy did the best, with a 75 percent reduced risk of high blood pressure. Those eating completely plant-based diets appeared to have thrown three-quarters of their risk for developing this major killer out the window.112

  When scientists looked at diabetes and body weight, they found the same apparent progressive improvements as consumption of animal products decreased and plant foods increased. Those eating plant-based diets had just a fraction of the diabetes risk even after factoring out the weight benefits,113 but what about hypertension? On average, those who eat completely plant-based foods are about thirty pounds lighter than those eating conventional diets.114 Maybe they have such great blood pressure just because they’re so much thinner? In other words, do omnivores who are as slim as vegans enjoy the same blood pressure?

  To answer this question, researchers would have to find a group of individuals who eat the standard American diet but are also as thin as people eating plant-based diets. To find an omnivorous group that fit and trim, researchers recruited long-distance endurance athletes who had run, on average, forty-eight miles per week for twenty-one years. Running almost two marathons a week for twenty years, pretty much anyone can become as slim as a plant eater no matter what they eat! The researchers then compared these hard-core athletes to two groups: sedentary meat eaters who exercised less than an hour per week and sedentary vegans who ate mostly unprocessed, uncooked plant foods.

  How did the numbers come out? Not surprisingly, the endurance runners on a standard American diet had a better blood pressure average than their sedentary, meat-eating counterparts: 122/72 compared with 132/79, which fits the definition of prehypertensive. But the sedentary vegans? They averaged an extraordinary 104/62.115 Apparently, eating standard American fare even when running two thousand miles a year may not bring down your blood pressure as low as a being a couch-potato vegan.

  Foods for Additional Hypertension Protection

  A low-sodium diet centered around whole plant foods appears to be the best way to bring down high blood pressure. What if you’re already eating this way but that 110/70 still eludes you? There are a few foods in particular you can try that may offer additional protection.

  I’ve already touched on whole grains and will go into detail about flaxseeds, hibiscus tea, and nitrate-rich vegetables. Ground flaxseeds alone “induced one of the most potent blood-pressure-lowering effects ever achieved by a dietary intervention.”116 Eating just a few tablespoons a day appears to be two to three times more powerful than adopting an aerobic endurance exercise program117 (not that you shouldn’t do both—incorporate flaxseeds into your diet and exercise).

  Consumption of both raw and cooked vegetables is associated with lower blood pressure, but raw veggies may be slightly more protective.118 Studies have also found that loading up on beans, split peas, chickpeas, and lentils may help a little,119 so add those to your shopping list. Red wine may help, but only nonalcoholic brands. Only wine that has had the alcohol removed appears to lower blood pressure.120

  Watermelon appears to offer protection, which is great (and delicious) news, but you may have to eat about two pounds of it per day to achieve an effect.121 Kiwifruits flopped, though. In a study funded by a kiwifruit company, kiwi failed to offer any protection.122 Perhaps the kiwi industry should take a cue from the California Raisin Marketing Board, which funded a study designed to show that raisins can reduce blood pressure. To inflate the benefits of raisins, they used junk food as the control group. So the study found raisins may lower blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy!123

  Flaxseed

  In chapters 11 and 13, we will see how effective flaxseeds can be against breast and prostate cancers, but you have to be a little skeptical when scientists throw around words like “miraculous” to describe them. (One medical journal published a review titled “Flaxseed: A Miraculous Defense Against Some Critical Maladies.”)124 But a remarkable intervention trial published in the journal Hypertension suggests that in this case, the term “miraculous” may not be too far off.

  Rarely does one see a dietary study of this caliber: It was a prospective, double-blind, placebo-controlled, randomized trial. That’s hard to pull off with food. With a drug trial, a blinded study is easy: Researchers give someone a sugar pill that looks identical to the drug, so that neither the study subject nor the person giving the pill knows which one is which (hence, double-blind). But how do you do that with food? People tend to notice if you try to sneak 25 grams of ground flaxseed into their lunch.

  The researchers tried a clever tactic to overcome this problem. They created a number of recipes for common foods including muffins and pasta in which they could disguise placebo ingredients like bran and molasses to match the texture and color of the flax-laden foods. This way, they could randomize people into two groups and secretly introduce tablespoons of daily ground flaxseeds into the diets of half the participants to see if it made any difference.

  After six months, those who ate the placebo foods started out hypertensive and stayed hypertensive, despite the fact that many of them were on a variety of blood pressure pills. On average, they started the study at 155/81 and ended it at 158/81. What about the hypertensives who were unknowingly eating flaxseeds every day? Their blood pressure dropped from 158/82 down to 143/75. A seven-point drop in diastolic blood pressure may not sound like a lot, but that would be expected to result in 46 percent fewer strokes and 29 percent less heart disease over time.125

  How does that result compare with taking drugs? The flaxseeds managed to drop subjects’ systolic and diastolic blood pressure by up to fifteen and seven points, respect
ively. Compare that result to the effect of powerful antihypertensive drugs, such as calcium-channel blockers (for example, Norvasc, Cardizem, Procardia), which have been found to reduce blood pressure by only eight and three points, respectively, or to ACE inhibitors (such as Vasotec, Lotensin, Zestril, Altace), which drop patients’ blood pressure by only five and two points, respectively.126 Ground flaxseeds may work two to three times better than these medicines, and they have only good side effects. In addition to their anticancer properties, flaxseeds have been demonstrated in clinical studies to help control cholesterol, triglyceride, and blood sugar levels; reduce inflammation, and successfully treat constipation.127

  Hibiscus Tea for Hypertension

  Hibiscus tea, derived from the flower of the same name, is also known as roselle, sorrel, jamaica, or sour tea. With a distinct tart, cranberry-like flavor and bright red color, this herbal tea is served and enjoyed both hot and cold around the world. In a comparison of the antioxidant content of 280 common beverages, hibiscus ranked number-one, beating out other heavyweights, including the oft-lauded green tea.128 Within an hour of consumption, the antioxidant power of your bloodstream shoots up, demonstrating that the antioxidant phytonutrients in the tea are absorbed into your system.129 What effects might this infusion have on your health?

  Unfortunately, efficacy against obesity has been disappointing. After giving hibiscus tea to overweight individuals for months, researchers have only been able to show about an extra half pound of weight loss per month over a placebo.130 Early studies on cholesterol-lowering effects looked promising, suggesting that drinking two cups of hibiscus tea a day for a month may provide as much as an 8 percent drop in cholesterol,131 but when all such studies were put together, the results were pretty random.132 This may be because, for some reason, hibiscus tea only seemed to have an effect on about half the study subjects. If you’re in the lucky half, you may be able to get as much as a 12 percent drop in cholesterol.133