High on Plants for Low Blood Pressure
Elevated blood pressure, or hypertension, as it’s more commonly known in the halls of hospitals, is a real big deal, and you may be dealing with it. My office is full of patients with high blood pressure. This killer is often silent, like the early stages of clogged heart arteries and prediabetes, so you might have it right now and not know it.
Hypertension is a serious problem. In the United States alone, about 1,000 deaths every day involve high blood pressure as a primary or contributing cause.1 Most people suffering a heart attack have hypertension. Almost all stroke victims have high blood pressure. Most patients with kidney failure have hypertension. And most people with congestive heart failure have high blood pressure.
On a global basis, hypertension is a huge issue too. A study called the Global Burden of Disease (GBD) was initiated in 1992 as a collaborative effort between the World Bank and the World Health Organization. The GBD 2010 study had a number of important findings with respect to high blood pressure around the world. High blood pressure ranked as the single leading risk factor for disease. High blood pressure went from being the fourth-leading risk factor in 1990 for GBD to the number-one risk factor in 2010.2
Nobel Prize–Winning Science: Plants in Your Mouth Lower Blood Pressure
When you sit down to eat a meal, you might not be thinking about the Nobel Prize, but you can thank the recipients of this award to help you improve your blood pressure. The 1998 Nobel Prize in Medicine was awarded to three researchers for describing the central role of nitric oxide, or NO, as a signaling molecule in the cardiovascular system (discussed in chapter 2). When arteries make a lot of NO, blood pressure tends to be in the normal range. NO production improves when you adopt healthy lifestyle measures such as eating a lot of fruit and vegetables, along with avoiding smoking and getting regular exercise. Foods rich in polyphenols, including apples and grapes, can activate the enzyme that produces NO. An apple a day and a bunch of grapes may keep your blood pressure medicine away.
Another pathway based on plant-based diets that boosts NO production in your arteries has drawn much attention in the past few years. Leafy greens and some other vegetables, like beets, are rich in dietary nitrates. These are not the nitrates found in bacon and pepperoni, so you still have to ditch those to be healthy. When you chew greens and beets, the dietary nitrates interact with hidden bacteria in the grooves of your tongue and get converted to nitrites. When the nitrates are swallowed, they are absorbed into the blood and are converted to NO by enzymes waiting for you to feed them healthy substrates. Even if you swallow these nitrate-rich vegetables, like kale and beets, in juice or a smoothie—with little time to settle on your tongue—the dietary nitrates are rapidly absorbed in your GI tract and appear in your bloodstream.
This next step is so cool. These nitrates, which have not been chewed much and have not mixed with the bacteria on your tongue, concentrate in your salivary glands, the parotid glands. There they are excreted into your saliva, which then coats your tongue and has time to interact with those hungry bacteria. On this second pass through your body, the dietary nitrates get converted to NO. The green drink you swallowed forty-five minutes ago may be secreted right onto your tongue to enjoy the bacteria-nitrate interaction. In other words, if the bacteria doesn’t get to your dietary nitrates the first time down, this “entero-salivary” recirculation makes sure they get them the second time around. Is that not amazing? The recirculation of nitrates to produce NO is a reason to embrace the Plant-Based Solution by packing in WFPB choices that you chew or drink several times a day. The new advice from a doctor to a patient might as well be, “A kale salad a day keeps the doctor away.”
Study In-Depth: Eat Your Plants to Lower Blood Pressure
You read about the Adventist Health Study, which offers a large and long-term look at dietary patterns and the associations with health and disease. Associations do not always prove that the topic studied, in this case dietary style, resulted in the outcome. However, when studying the Adventists and seeing that the rates of type 2 diabetes, obesity, and cancers are the lowest of any eating style, it is highly likely that it is cause and effect.
In a study that analyzed 592 subjects, 25 percent were either vegan or lacto-ovo vegetarians (labeled “vegetarian/vegans”), 13 percent were pesco-vegetarian, and 62 percent were non-vegetarian.3 Compared with non-vegetarians, the vegetarian/vegans had “odds ratios” for hypertension of 0.56, meaning hypertension was present in about half of them. That constitutes a huge reduction in the risk for hypertension-related cardiovascular disease.
Why are plant-based diets associated with less hypertension? You know about plant-based foods and NO production. Another possibility is that plant-based diets provide greater intakes of potassium, other minerals (like magnesium), and fiber, which may all lower blood pressure. It is also possible that meat increases the risk of hypertension because of its association with fewer vegetables and fruits in the diet and the potential for more inflammation. The lower BMI among many vegetarians may help. Plant foods are also known to protect against insulin resistance, which in turn is related to hypertension and other risk factors for heart disease. There are so many potential ways the Plant-Based Solution may lower your blood pressure.
CASE STUDY
Goodbye Blood Pressure Medicine with Plants
Cheryl is a beautiful woman. At age fifty-five, she will catch your eye. But she has had a few bumps in the health road. She developed chest pains and was found to have serious heart artery blockages in her late forties, requiring heart bypass surgery. She had been on blood pressure medications for twenty years, and her father had heart disease. She did not smoke but worked in smoking environments.
When she began seeing me, I was struck by her warm heart and kind nature. I introduced her to the science of plant-based heart therapy, and she announced a goal of getting off many medications—at the time, she was taking thirteen prescription drugs. For a year she tried to follow a fully plant-based diet but went on and off it around holidays and when facing other common obstacles.
Over a year ago she decided to fully commit to eating a low-fat WFPB diet as part of the Plant-Based Solution. The results followed. Her weight began to decrease, and she has lost over twenty pounds but is never hungry, as nutrient-dense foods fill her up faster than fast foods. Her cholesterol has responded as well as her blood pressure. She has been able to reduce the number of prescription medications from thirteen to three. She has energy, sleeps well, enjoys her job (now out of a smoking area), and teaches others the power of the plate for blood pressure control. She has a new attitude, empowered by controlling her own health destiny, and a boyfriend too! It is startling how making the decision to treat your body as the miracle that it is can improve so many measures of health. Cheryl is an amazing miracle herself. She knows that if she could do it, so can you. 
Hot Question: Do Vegans Need Supplements?
Despite all the benefits of a plant-based diet described in this book, there are supplements that vegans should take and some they might consider taking. Remember, those eating animal-rich diets often take “supplements” called insulin, statins, and chemotherapy. A few vitamins are no big deal compared with those.
VITAMIN B12
Vitamin B12 is important in brain, nerve, and hematologic health and is a factor in a key process called “methylation,” which regulates levels of homocysteine (high levels are associated with heart disease risk). It’s well known that animal products are richer in vitamin B12 than plants. Actually, neither plants nor animals make B12. It’s produced by bacteria that reside in the gastrointestinal tract of animals other than humans. When animal products are eaten, B12 is ingested as a bystander.
By some estimates, 50 percent of vegans and 10 percent of vegetarians are deficient in vitamin B12. I recommend taking about 2,500 mcg once a week of vitamin B12, ideally as a liquid, sublingual, or chewable form for better absorption, or 500 mcg daily if that schedule works better for you.
VITAMIN D
Vitamin D is known to promote bone health but is also proving to be essential in blood pressure and blood glucose control, in heart function, and in brain function. Measurements of blood levels are the best way to assess adequacy of vitamin D. Vegans tend to have lower levels of vitamin D.
Direct sunshine on exposed skin for twenty to thirty minutes a day can provide adequate vitamin D, but for many people oral supplementation is necessary to reach proper blood levels. Vitamin D3 is the form most commonly recommended but is usually derived from animal sources such as lanolin. If this is not acceptable, vegan versions of vitamin D3 are available. Vitamin D2 comes from plant sources, mushrooms being a rich source, but is not as reliably absorbed. While the standard recommendation is to supplement with 800 IU a day, I suggest 2,000 IU of D3 a day.
OMEGA-3
Omega-3 is an important essential fatty acid that in adequate supply helps control inflammation, supports healthy brain function and growth, and contributes to normal blood sugar, blood pressure, and cholesterol levels. Most recognize salmon, sardines, and herring as cold-water fish that can supply these fatty acids directly. However, these fish come with the burden of cholesterol, saturated fats, and potential contamination from mercury and persistent organic pollutants like PCBs. Many of my patients who eat fish have elevated blood-mercury levels, some very high. Ground flax seed as a source of alpha-linolenic acid, or ALA, is recommended in a dose of about two tablespoons daily along with three halves of English walnuts. Beyond this, it may be wise to take algae-based vegan DHA and EPA. I recommend about 250 mg of plant-based EPA/DHA in a capsule form, which is widely available.
IODINE
For those who don’t enjoy sea vegetables, like seaweed or dulce, a 150 mcg a day supplement of iodine is an option.
Science Corner: Vegans Have the Lowest Blood Pressures
If you are looking for more support that your plant-based choices in the grocery store and farmers market can prevent or reverse blood pressure problems, there is more. The Adventist Health Study did additional studies relating dietary choices to blood pressure diagnoses and this time analyzed a subset of white subjects.4 In 500 subjects studied, the vegan/vegetarians had blood pressure lower than omnivorous Adventists. The vegans were also less likely to be using blood pressure medications. The odds ratio for being diagnosed with high blood pressure or taking a blood pressure medication was reduced by 70 percent in the plant-based eaters! This is a huge number that would translate to hundreds of thousands of lives saved yearly in the United States alone.
Two more studies are worthy of consideration. The first is a study of the power of adopting a low-fat vegan diet for only seven days. Most anyone could eat a plant-based diet without oil for seven days, right? Dr. John McDougall, MD, deserves his reputation as a giant and legend in the plant-based medical world. He has been teaching a starch-based low-fat diet for over forty years and runs a popular and effective treatment center in Santa Rosa, California.
Dr. McDougall recently published the results of over 1,600 participants who came to his program for a one-week immersion.5 In a hotel setting, attendees were provided meals that were low-fat (≤10 percent of calories), high carbohydrate (~80 percent of calories), moderate sodium, and purely plant-based for seven days. They all had measures of health assessed, including blood pressure, before and after the week by trained medical professionals. The results showed that even though most blood pressure medications were reduced or discontinued at baseline, systolic blood pressure (the top blood pressure number) decreased by a median 8 mmHg and diastolic blood pressure (the bottom number) by 4 mmHg during the week. These are quite remarkable findings in such a large database. Participants lost an average of three pounds and also had improvements in blood sugar and cholesterol. Patients finished the program at substantially lower predicted heart risk than when they arrived a week earlier, a powerful result.
The second study of note comes from Europe and is called the EPIC-Oxford study. In this major study of nutrition and health, researchers analyzed the impact of dietary patterns and hypertension.6 In the United Kingdom, 11,004 men and women aged twenty to seventy-eight reported on whether they had blood pressure problems and filled out dietary surveys. Self-reported hypertension ranged from 15 percent in male meat eaters to 5.8 percent in male vegans, nearly three times as high in the meat eaters! Hypertension was reported in 12.1 percent of female meat eaters and 7.7 percent in female vegans. Fish eaters and vegetarians had similar rates of hypertension, which were about halfway between the meat eaters and vegans.
Participants had their blood pressure measured. Systolic and diastolic blood pressures were different between the four diet groups, with meat eaters having the highest values and vegans the lowest values. The differences in mean blood pressure between meat eaters and vegans among participants with no self-reported hypertension were 4.2 and 2.6 mmHg systolic and 2.8 and 1.7 mmHg diastolic for men and women, respectively.
The authors concluded that vegans have a lower prevalence of hypertension and lower systolic and diastolic blood pressures than meat eaters, largely because of differences in body mass index. So get your skinny on, get your Plant-Based Solution in gear, and enjoy the lower weight and blood pressure that should follow.
Plant Rant
When it comes to the dietary management or reversal of disease, there is a huge database to recommend the Plant-Based Solution. The data is just too strong to hear much pushback from other diet camps. The only dietary pattern that gets similar accolades is the DASH (Dietary Approach to Stop Hypertension) diet, often rated number one overall. It is interesting that the research group providing guidance to the DASH diet program intended it to be a vegetarian study, funded by the National Institutes of Health (NIH). Yet the NIH believed that acceptance by patients might be higher for an omnivorous dietary pattern, rather than a vegetarian one, and thus removed the study arm that was totally plant-based. I do not doubt that if the scientists were to repeat the study with a plant-based cohort, there would be an even more powerful diet than the DASH diet. The winner would be the Plant-Based Solution, and you do not need to wait. Start that solution today.
THE PLANT-BASED PLAN How to Eat Out
You can plan for success eating in a restaurant locally or around the world with just a little effort. You can search websites like Happy Cow and Veg Dining for grocers and eateries around the world that feature healthier choices. If you are traveling, I recommend you print some of the results you found before you travel so you do not need to depend on finding Wi-Fi to look choices up. Packing a few staples like a nut butter and a few healthy food bars might get you through a pinch in an airport or small town. Salads and side dishes are always a good choice. Finally, calling ahead to alert a chef of your vegan diet is appreciated and often results in amazing presentations of plant-based meals.
Dining with meat-eating friends or family members can be an opportunity to introduce the people you care about to delicious vegan food and to explain the reasons you decided to switch to a healthy and humane diet. But don’t be pushy about it. Let the host know you would like to make a vegetarian dish or two for everyone to try. If someone else is doing all the cooking, offer to help find easy recipes and supply the ingredients. Finally, eat a healthy snack or meal before the gathering so you are not “hangry” over the limited vegan delights.