Your Guide To Drink Choices & BP Impact

Michael Greger, MD, FACLM

I’m doing great. Let’s do this.

Laurie Marbas, MD, MBA

Awesome. Well, we’ll just jump right in. Dr. Greger, for our audience, who may not be familiar, could you explain what hypertension is, including, let’s say, maybe its primary causes and risks, and what’s why it’s considered a major public health issue?

Michael Greger, MD, FACLM

Yes, the number one risk factor for death in the world is high blood pressure, also known as hypertension. There’s a way for about 9 million people worldwide every year. The reason it kills so many people is because it contributes to death from such a variety of different causes, including aneurysms, heart attacks, heart failure, kidney failure, and stroke, predominantly. You probably had your blood pressure taken at your doctor’s office. 

Two numbers: 115 or 85, or whatever the top is, the systolic; the bottom is diastolic; the normal or ideal or resting blood pressure you typically hear about is 120 over 80, with 135 over 90 being considered hypertensive these days. But the ideal blood pressure—I mean, we don’t want normal pressure in a society where it’s normal to drop dead of a heart attack or stroke. Most of the leading killers want ideal blood pressure, so we want to push our blood pressure down to about 110 over 70 is probably the ideal blood pressure. We can do that through diet and lifestyle interventions.

Laurie Marbas, MD, MBA

Perfect until this gets to my next question. In your extensive research into nutrition and health, what specific foods or dietary patterns have you found to contribute most significantly to the development of hypertension?

Michael Greger, MD, FACLM

Well, probably the number one thing that we should all do is cut down on sodium. The American Heart Association recommends that we only get 1500 milligrams a day, which is almost impossible for people eating lots of processed foods or eating out. That’s probably one of the most important things if you add salt to the table. I would encourage people to explore potassium salt and what’s called potassium chloride as opposed to sodium chloride, or regular salt. The only issue would be for those who have difficulty with potassium regulation, such as those on certain diuretic drugs or those with kidney disease. But other than that, potassium chloride is something that I use. 

We have randomized controlled interventional studies that prove that you can dramatically decrease the risk of premature death by switching people from regular salt to just half potassium. wouldn’t even be able to taste the difference and see a significant drop in mortality. That would be number one: decreasing sodium intake. Then we can also increase our intake of whole grain drinks and herbal tea called hibiscus tea, which can work as well as when taking blood pressure drugs. But without the side effects, encourage people to eat vegetable nitrates, which are found predominantly in beets, beet greens, beet juice, and most concentrated in dark green leafy vegetables. This helps your arteries relax and open. These are some of the foods you try to include in your diet while at the same time decreasing your sodium intake.

Laurie Marbas, MD, MBA

Could you elaborate just a little bit on the mechanism of sodium? Because I feel like so many people think that sodium is no big deal. Still, what is the actual mechanism for why it’s an issue?

Michael Greger, MD, FACLM

Yes. First of all, just say there’s no controversy. There’s a scientific consensus, and we have double-blind, randomized controlled trials dating back decades. You take people with high blood pressure, put them on a sodium-restricted diet until their blood pressure drops, keep them on a low tide, and add a placebo. Nothing happens, but on that same low-salt diet, you put a bomb on a slow-release salt pill, unbeknownst to them. Of course, what happens is that their blood pressure goes back up again. Look, even a single meal can do it. You take people with normal blood pressure and give them a bowl of soup containing the amount of sodium you’d find in just a typical American meal. Blood pressure steadily climbs within the next 3 hours compared to the same soup without the added salt. 

We have dozens of studies showing that reducing your salt, reducing your blood pressure, and lowering your blood pressure. But it’s not just blood pressure. You said, Well, wait a second, I eat lots of vegetables. My blood pressure is fine. What do I have to worry about? There are other adverse effects of salt, not only on artery health but also immunity, worsening autoimmune disease. Sodium is one of the big things that we’ve changed since our ancestral past, dramatically increasing our sodium consumption and dramatically decreasing our potassium consumption, some because we’re not eating a lot of the healthy plant foods we used to be eating. 98% of Americans don’t even reach the recommended minimum intake for potassium, which is 4700 milligrams a day. Most people, of course, are getting too much sodium. 

In terms of what’s happening, you can use something called laser Doppler flowmetry, which measures the amount of blood flow in tiny capillaries at your fingertips. You can show that you give people a salty meal, and you can see that blood flow constricts. We recognize this as an approach to the oxidant effect, a free radical effect because if you eat a salty meal and inject that fingertip with vitamin C, for example, you can start dilating back up again. Salt appears to impair arterial function through a free-radical mechanism. It turns out that sodium intake suppresses the activity of a key antioxidant enzyme in our body called superoxide oxide dismutase, which is this power horse and an enzyme that detoxifies a million free radicals a second. But that wonderful antioxidant enzyme, which is our first line of defense against free radicals, is stifled by sodium. Artery-damaging levels of oxidative stress can build up when we eat salt because it suppresses this enzyme.

Laurie Marbas, MD, MBA

You mentioned the free radicals. Could you just highlight exactly what that is for them? 

Michael Greger, MD, FACLM

Yes. Chemical free radicals have to do with the molecules that steal extra electrons molecules to have paired electrons. If you only have one electron, you can go around and rip electrons off on other things in your DNA, causing DNA damage and potentially mutations that can lead to cancer. This is so-called oxidative stress. These free radicals can rip electrons away from fat, causing oxidized rancid fats to do the same with proteins in our bodies. There’s what’s called the mitochondrial theory of aging, which is probably the most well-recognized theory of aging, suggesting that it’s the only theory of aging we know of that can account for the wide range in lifespan in animals, which can range a thousandfold from a clam whose heart beats for 600 years to the little, little mayflies that may only last a few weeks. What accounts for that? There’s only one thing that we know, and that’s the amount of free radicals spewing from our mitochondria, little power plants in our cells. Less free radicals spewing from those mitochondria can extend life, and we can slow down that free radical production with two things: aerobic exercise and a fining restriction, acid concentration which is the amino acid concentrated mostly in animal products. We can either reduce our protein intake overall to the recommended levels or just switch from plant protein sources to more animal protein sources. We can decrease in fine and hopefully slow down the rate of aging because we slow down the amount of free radicals that are leaking out of our mitochondria.

Laurie Marbas, MD, MBA

Do you mean to switch from animal-based to plant-based?

Michael Greger, MD, FACLM

I’m sorry. From animal protein to plant protein sources.

Laurie Marbas, MD, MBA

Yes, no problem. Speaking of plant-based diets, could you explain how this compares to animal-laden diets? Why is this a better choice for health in general? I love the free radical discussion.

Michael Greger, MD, FACLM

Well, I mean, look, a plant-based diet can reverse hypertension, the leading cause of mortality. It can also reverse other leading killers such as type 2 diabetes, obesity, and heart disease, the number one killer of men and women, and so, look, if that’s all the plant-based could do, reverse the number one killer. I mean, shouldn’t that be the default rather than the proven otherwise? The fact that a plant-based diet can also be so effective in preventing, treating, resting, and reversing these other leading killers would seem to make the case for plant-based eating simply overwhelming at this point.

Laurie Marbas, MD, MBA

Perfect, and you hinted around to aging. I know you have a new book out and how much of it, so did we speak to how, besides reducing the methionine and the mitochondrial burden, I mean, what else can we, as you said, do with aerobic exercise? What does that do exactly to the mitochondria that allow this free radical production to decrease or reverse?

Michael Greger, MD, FACLM

Yes. Why does aerobic exercise improve the efficiency of our mitochondria? That’s a good question. I don’t know if we know exactly why that happens. Oxidation is one of the 11 aging pathways discussed in the book. That’s in the first part; it’s a four-part book. The first part is the nerdy section, where I go through these 11 anti-aging pathways and talk about the practical takeaways in terms of diet and lifestyle to be able to reverse some of these or block some of these aging pathways. 

It’s all about boosting the anti-aging enzymes and hormones Ampk FGF 21 certain inflammatories, suppressing the pro-aging enzymes and hormones, MTHFR, and IGF 1 decreasing glycation, oxidation, inflammation, and senescence while preserving our telomeres and slowing the epigenetic clock. I know these are all sorts of fancy-sounding scientific terms, but I do try to break everything down into easily understandable, doable, and practical takeaways.

Laurie Marbas, MD, MBA

No, and it’s very usable and easy to access. You just need to set aside several months to get through it all, having seen it.

Michael Greger, MD, FACLM

It’s a lot.

Laurie Marbas, MD, MBA

Yes, absolutely. You mentioned aerobic exercise. Is there any specific type of other lifestyle factor that might help influence hypertension reduction that we need to be paying attention to?

Michael Greger, MD, FACLM

Weight control. Excess body fat can increase the hypertension and functional ability of your arteries to relax normally, probably through an inflammatory process. That’s yet another reason why we should lose weight. It’s not just to help with osteoarthritic knees, it is not just to decrease your risk of diabetes but can also bring your blood pressure down.

Laurie Marbas, MD, MBA

How does a plant-based diet help you lose weight?

Michael Greger, MD, FACLM

Plant-based diets are the most effective intervention ever published in the peer-reviewed medical literature. That doesn’t mean constrained portions, no calorie counting, and no enforced exercise. But based on those types of studies, nothing works better than a plant-based diet. That’s for all the reasons I described in my book, How Not to Diet. When I go through all the different properties of an optimal weight loss diet and why, such as high fiber consumption and low-calorie density, they are all reasons why eating healthy plant foods can help people lose weight.

Laurie Marbas, MD, MBA

Does alcohol or caffeine consumption affect hypertension?

Michael Greger, MD, FACLM

Well, I mean, so excess alcohol can certainly lead to something called heart failure, as can high blood pressure. The most concerning thing about alcohol is its cancer risk. Even light drinking, which is defined as 0 to 1 drink per day for women, can increase breast cancer risk. The safest level of drinking is none, ideally, but in terms of caffeine consumption, some coffee drinkers tend to live longer lives. Lower rates of cancer overall can increase bone loss. Glaucoma, acid reflux, but otherwise healthy beverage. Though every cup of coffee is a lost opportunity to drink something even healthier, a cup of green tea is probably the healthiest beverage besides water.

Laurie Marbas, MD, MBA

We’ve always heard that moderate alcohol consumption is better than teetotalers. How did that get flipped? How did that change?

Michael Greger, MD, FACLM

Yes, well, so everybody agrees that heavy drinking, drinking during pregnancy, and binge drinking are bad ideas. But there’s been this controversy about moderate drinking—those who tend to live the longest, not the teetotalers, but those who drink a few drinks a week. Unfortunately, this appears to be a result of what’s called the sick quitter effect, arising from the systemic misclassification of former drinkers as lifelong abstainers. 

For the same reason, studies can find higher mortality rates among those who quit smoking compared to those who continue to smoke. It’s not that abstention led to poor health, but poor health led to abstention. When you correct that, there’s no longer any benefit to light or moderate drinking. There’s just this straight-line increase in rates of disease with more and more alcohol. According to the Global Burden of Disease Study, the World Health Organization, and the World Heart Federation, we should try to cut our consumption of alcohol, at least on a day-to-day basis, down to zero. Grapes, barley, and potatoes are best eaten in their non-distilled forms, and Johnnie Walker is no substitute for actual walking.

Laurie Marbas, MD, MBA

Perfect. I think this is a great place to pause, and I want to say thank you to the audience for joining us today. I hope you find our conversation insightful and engaging. If you’re a summit purchaser, stay here because we’re about to dive even deeper with Dr. Greger. If you’re not, click on the button below or the site to get access to this conversation. If you’re watching this, thank you for being a valuable member of the community, and I want to continue Dr. Greger with the aging piece. A lot of people think that just because we get older, our blood pressure will climb with age. Is that true?

Michael Greger, MD, FACLM

That used to be what we thought. We used to think that, look, I mean, it’s just a natural, inevitable consequence of getting older until we started looking around the world and found that there were cultures that did not believe that blood pressure did not go up as they aged. For example, in this famous study done on those living in rural Kenya, or over a thousand people, there was no rise in blood pressure with age. In rural China, there is a very similar effect written about, 121 reading that their entire lives are more or better than that of 110 over 70 in rural Kenya, and you say always again, Chinese diet, African diet, vastly different diets. What they share in common is that they are plant-based from day to day, with meat only eaten on special occasions. 

You said, Well, wait a second, how do we know it’s the meat? Well, it’s because the only folks getting down to low on average in the Western world are those eating strictly plant-based diets. Indeed, you can show you can randomize people to plant-based diets. See the significant drop in blood pressure. The average blood pressure of those eating strictly plant-based diets, where we want about 110 over 75. That’s the target. The whole Dash diet, which you often hear about being prescribed for people with high blood pressure, was based on that data, where they were trying to replicate the blood pressure, lowering the benefits of a more plant-based diet. They included animal products like dairy, not because there was any benefit, but because they just thought it would be more acceptable to the general population if they included some limited animal products.

Laurie Marbas, MD, MBA

One final question. If someone approached you as a physician who had hypertension, what are the top five things you would tell them to do starting today to help improve and hopefully reverse their hypertension?

Michael Greger, MD, FACLM

Okay. Well, the most important thing I would tell them is that it’s not something to be ignored. Hypertension is a silent killer because you don’t feel high blood pressure. With high blood pressure, you typically don’t feel any different. First of all, don’t ignore it. There are and I would, and typically we go to a regular physician; you’re prescribed blood pressure pills. Even though technically the clinical guidelines say lifestyle should always be the first-line approach, doctors tend to skip that thinking this patronizing add to the patients isn’t going to change their diet or lifestyle. Let’s just skip drugs. Unfortunately, the drugs don’t work very well. I’m sure they will. Why improve your life? You can just pop a pill. 

Well, the absolute risk reduction is quite slight for these so-called lifestyle drugs, such as blood pressure, blood sugar, or cholesterol-lowering drugs. There’s a greater benefit in treating the cause of why you have high blood pressure in the first place, which is these diet and lifestyle choices: being sedentary, eating too much sodium, not getting enough of these blood pressures, and lowering fruits and vegetables in one’s diet. 

I would encourage people to take advantage of the Physicians Committee for Responsible Medicine. Has this 21-day Kickstart program. Go to The 21-DayVeganKickstartProgram.org and it is completely free and starts on the first of every month. Hundreds of thousands of people have done it. A bunch of different languages. On signing up. It’s a little social media group, and you share recipes and get daily advice and tips. The hope is they just dive in three weeks, go all in, just try it as an experiment, as a free sample, and just see what happens to your blood pressure in that time. 

Now, if you are on blood pressure medications, make sure they do this with your physician to make sure your blood pressure doesn’t bottom out. Drop too low. Both patients and physicians underestimate the power of diet and lifestyle. You can find yourself critically, critically low. Same thing with blood sugars. You’re on blood sugar-lowering drugs. You have to do this. Make these lifestyle changes in conjunction with your medical practitioner so they can monitor and withdraw these drugs. Wean you off these drugs as your levels normalize naturally when you treat the cause with that lifestyle.

Laurie Marbas, MD, MBA

That’s perfect. Yes. No, I can attest as a physician. The first time I realized this was 12 years ago, I had to stop some plant-based food overnight. I was so excited to encourage people to lose 60 units of insulin in 72 hours as adults and also your family members if they’re eating with you and they’re able to measure your medications.

Michael Greger, MD, FACLM

Exactly.

Laurie Marbas, MD, MBA

What they’re.

Michael Greger, MD, FACLM

I am going to call patients in the E.R. That’s why the blood sugar does what exactly? No serious business but it just shows the power of diet and lifestyle. Yes, hopefully, they stick with it.

Laurie Marbas, MD, MBA

Yes, absolutely. Well, thank you, Dr. Greger, for your time today. Thank you, everyone, for listening.

Michael Greger, MD, FACLM

Thank you so much.