Uncover Your Plant-Powered Blood Pressure Plan

Andrew M. Freeman, MD, FACC, FACP

I’m great, and thanks for having me.

Laurie Marbas, MD, MBA

Absolutely. Well, thank you for joining us at the summit. I can’t wait to hear your pearls of wisdom as we look to understand blood pressure, regulation, and maybe the plant-based perspective, which gets me to my first question. What are the foundational principles of sustained blood pressure regulation, especially from a plant-based perspective?

Andrew M. Freeman, MD, FACC, FACP

Yes. Maybe I should even back up and let people know that the scope of the problem is enormous; something in the range of 50% of Americans suffer from high blood pressure, commonly known as hypertension in medical jargon. It is incredibly prevalent. The reason why it matters to people like me and it should matter to all doctors is that it’s super low-hanging fruit to improve cardiovascular outcomes. This means that for roughly every 20 points that we go up, on average over 120 systolic, the top number, the risk of dying, doubles. You can imagine that this is an exponential problem that very few people do well with. The truth is the vast majority of Americans who are, quote, under treatment, unquote, for blood pressure don’t necessarily have aggressive enough approaches.

We know that aggressive blood pressure control in community-dwelling individuals, meaning not people in institutions or nursing homes, etc., improves outcomes. The major principles are that first it should be guideline-directed. There’s a lovely, humongous document from the now ACC/AHA and several other societies on the management of hypertension. It goes into all the different pearls of wisdom and facets, classes of drugs, where to start, and so forth. The truth is, the goal is to get people under 120, ideally over 80. There’s a lot that has to be done to measure blood pressure. Well, a lot of people don’t realize this. Even doctors don’t realize that when someone zips into your clinic from the parking lot, they’ve got their traffic. You throw them into the medical-assisted workup booth, and you throw the blood pressure cuff on them, and their blood pressure is high. That’s the blood pressure that we record. Of course, that’s not their accurate blood pressure. I always tell people to doctors about blood pressure, as I always take it with a grain of salt, you’re supposed to sit quietly, you’re supposed to pee, and you’re supposed to empty your bladder. Believe it or not, you’re supposed to have both feet on the floor. Your arms uncrossed, your arm and heart level, and like all these things that none of us do at any doctor’s office. Our blood pressure is often wrong. The other thing that patients need to do is periodically calibrate their blood pressure cuffs, meaning they need to bring them in and either have them tested against what someone can hear or a medical-grade calibrated blood pressure cuff.

Once you get all that out of the way, then you’re like, okay, does this person have high blood pressure or not? Then what do we do about it? The truth is, that most people with high blood pressure don’t fully understand why they develop it. We call it essential hypertension, which is a weird thing to call it. It’s certainly not an essential thing to have, and it’s certainly not something that anyone wants to have. Most of it is what we call idiopathic. We don’t always know why, but what we are learning is that as people get heavier, their lifestyle gets more sedentary, and they have untreated sleep apnea, untreated diabetes, or undertreated diabetes, their blood pressure tends to go up, and their cardiovascular risk goes up. These are all interconnected in every way possible. When we treat blood pressure, we often start the guideline-directed therapy for all comers, which is typically a drug like chlorthalidone, which is in the same class of drugs as hydrochlorothiazide, although chlorthalidone turns out to be three times more potent and very effective. Although there is a slightly increased risk of diabetes with using it hyperkalemia and hyponatremia can occur. You have to always monitor for that. But that said, it’s a very effective drug. 

Then, from there, we go into the various classes of ACEs and ARBs, calcium channel blockers, beta-blockers, and all these other things. But in general, the goal is to hit multiple pathways to control blood pressure. That’s an important concept because it used to be that four generations ago, and the people who trained me right, you would start one drug and then maximize it to the maximum possible dose, and then you would add another drug. Now we started to do a little smattering of this and a smattering of this to try to hit all the different pathways at once, which is much more effective. That said, what is the most effective antihypertensive? It’s probably exercise and diet together. What does that mean? Well, it turns out that if you can get 30 minutes of breathlessness every day, this has an amazing effect, lowering blood pressure. For those of you who want to geek out on this, as you probably know, if you start exercising, your blood pressure will go up a bit. Then, when you stop, it comes out lower than when you started. That’s the effect we’re after. 30 minutes a day there. 

The other thing that most people don’t realize is that we consume far too much salt. Salt used to be incredibly scarce in the diet, but now it’s incredibly prevalent in the diet. We are quite avid as human beings for salt because it is so scarce, and animals do this to rightly see this scarce animal-based diet. If you’re a deer and you’re eating grass or whatever it is, you would go find a salty rock or a salt lake and get salt in your diet. If they had chips on every corner, they would just eat that, which is what Americans do. That said, salt content, and believe it or not, salt hides in everything. For those of our listeners who may still eat meat, poultry, for instance, is one of the number one sources of salt in the American diet. That’s even before it leaves the grocery store. Salt is an amazing component. The other part of it is that there’s something quite magical about eating plants, and it could be the potassium content, the naturally occurring nitrate content of many green leafy vegetables and beets, or other things like that. But they all have factors that seem to relax blood vessels, keep blood pressure low, and improve vascular health. That’s where the magic is. 

How many times have I had a patient call me up and say, Doc, you put me on all these great medicines? I changed my lifestyle because I thought what you said made a lot of sense, and now my blood pressure is 90. I can barely get out of the chair. I’m like, Great, let’s get you off of these blood pressure pills. I would say that there are certainly people out there who have, and there’s more of an emerging epidemic of this hyperaldosterone, in which people respond to a lot of hyperaldosterone, and a lot of that also has to do with lifestyle. But there are lots of reasons for people to have high blood pressure. But I think it responds to lifestyle probably more than almost any other disease. That was a very long-winded answer. 

Laurie Marbas, MD, MBA

No, I think it gets to the point of, I like how you’re saying you need to hit multiple systems at once. That’s how we’ve changed our principles of treatment with medications. Then maybe that’s also the next question. How do whole plant-based foods contribute to stabilizing blood pressure levels, and are there any specific foods or nutrients that are particularly beneficial?

Andrew M. Freeman, MD, FACC, FACP

Yes, so a great question. You are probably familiar with the Portfolio Diet and the Dash Diet. The Portfolio diet is one of the very first medically tested plant-based diets and the Dash diet is a dietary approach to stopping hypertension. They’re, if they’re not fully plant-based, mostly whole and unprocessed with limited added salt, highly effective in lowering blood pressure for a variety of reasons, as you mentioned. We already know that’s the case. But it also turns out that many athletes, as you may know, are doping, if you will, with beets and beet greens these days. They’re surprisingly effective, with no drug effects. Which is pretty great. The only thing beets might do is turn your urine and stool red, which can be scary for some but, in general, very effective. There was a study several years ago that showed that the equivalent of roughly a can or 256 ounces of beet juice a day can lower your blood pressure as well, or better than many of the pills we commonly use. Beets are a great thing. Greens are a great thing. Potassium-rich fruits and vegetables are an amazing thing, and there’s not one superfood if you will. Then I say, This is what’s going to lower your blood pressure. 

But when you cut out junk, when you cut out processed food, when you cut out all of the highly ultra-processed foods we eat, it works great. But I would be remiss to not tell you about lifestyle factors beyond food, which I know you’re going to get into. But stress is an incredibly important thing. I know you’re probably going to ask me about this, but maybe I’ll jump. But the medical term for high blood pressure, of course, is hypertension. There is too much tension. There is something to be said for that. We all notice that if you almost get into a car accident, watch a scary movie, or get into a fight with your significant other, whatever it is, you can feel your blood pressure rise. Some people turn beet red because their blood pressure is so high. These things do happen. We live in a maxed-out stress world. Is there a way to get rid of stress? The answer is definitely and that will contribute for sure.

Laurie Marbas, MD, MBA

That’s exactly right. I was going to speak about stress. Are there any particular evidence-based strategies for stress reduction that can contribute to improved blood pressure?

Andrew M. Freeman, MD, FACC, FACP

Yes. You’ll get a kick out of this. You probably already know this, but there are the so-called Type A or Type One personalities that most of us doctors have. It turns out that that puts us at risk for a variety of cardiovascular conditions. figuring out how to de-stress by any mechanism, but I would tell you that more recently, things like yoga and other mindful meditation approaches have been very effective at lowering blood pressure. Simply focusing on your breathing, whether you call that yoga or focusing on your breathing, also works. In many parts of the world, they do interesting things. They go for hikes, or in Japan, they call it forest bathing, right where they go out in the woods. It works to keep their blood pressure down and so forth.

I guess what I would say is, yes, I think there are a lot of things out there that can certainly lower blood pressure, with physical activity being a key one, diet, and then, of course, some form of stress relief or mindfulness is a powerful approach. There haven’t been a lot of randomized controlled trials here because, as you can imagine, it’s difficult to tease out all the different things. For instance, some of my patients say, Well, I find myself most mindful when I’m at church, synagogue, mosque, or whatever it may be. We haven’t thrown blood pressure cuffs on people while they’re in intense prayer or whatever, although we probably could. That would be a neat study and see what happens. Anyway, the bottom line is, that I think there’s a lot out there and a lot emerging. But it appears that getting rid of stress or turning disease into ease seems to do wonders for people’s blood pressure.

Laurie Marbas, MD, MBA

I think that’s great. Just a quick story. I had a patient who had elevated blood pressure. I think it was close to 140, close to 90 diastolically. What was interesting was that she had a lot of anxiety, so we just had to do the four, seven, and eight breaths. It’s four repetitions of breathing in, holding your breath for seven, and releasing over eight in her blood pressure. I checked it with my ears. It wasn’t like any type of electronic blood pressure cuff. It dropped 15 points diastolically, literally in a matter of minutes. I think it speaks to the importance of being mindful of how we’re responding to stress because we all see stress, but how are we responding?

Andrew M. Freeman, MD, FACC, FACP

Absolutely. A lot of that breathing that you talk about is one of the cornerstones of many of the different mindful techniques for interested listeners. There’s this wonderful institute you may have heard of called The Art of Living Institute, and they offer a variety of meditation classes that are designed for doctors in many cases to help with burnout and resiliency. Some of their breathing techniques are very similar to that, and they’re pretty effective at getting rid of stress. 

Anyway, food for thought. If you’re looking for some outlets, do that. then I would also say many religions are quite welcoming to outsiders I would encourage you to visit and learn mindfulness in various parts of our country. I would encourage people to check out Buddhism, Harikrishna, and a handful of others that all incorporate many of these. It’s interesting and unique to hear about this. Many of them practice plant-based diets as part of their beliefs, which is pretty neat. 

Laurie Marbas, MD, MBA

Yes. Well, one of the blue zones right here in California, Loma Linda, is Seventh-day Adventist and mostly vegetarian. Vegan. Absolutely. Another question I think is interesting is: can you explain the role of sodium and potassium in blood pressure regulation and the importance of their balance? Because I do know that consuming maybe soy-based miso even gives you that a little bit of salt is less likely to raise blood pressure versus some of the others. We’d love to hear your explanation of that, please.

Andrew M. Freeman, MD, FACC, FACP

Yes. I don’t know if there’s a clear set of guidelines here or if this is what the experts all say. What I would say is this: salt is salt. In theory, if you consume salt, be it potassium chloride, sodium chloride, or magnesium chloride, which most people don’t since it’s road salt, so is potassium chloride, for that matter. But, in theory, they all can raise blood pressure via cardiac mechanisms and several other things. What seems to be the case is that things that are higher in potassium seem to lower blood pressure. The mechanisms behind that, I don’t think, are entirely clear. What I usually tell people is that you probably don’t ever need to add salt to your food.

Of course, it tastes good. We all get that. Then the things that occur naturally in your fruits and vegetables will probably lower your blood pressure better than anything. I’m not sure there’s an exact balance. I think you’re right that some of the fermented soy and other soy products, miso, etc., which are quite tasty and may be more than naturally salty by their production, don’t seem to have the same potency as, say, eating a bag of chips or a hot dog or something like that. I think there are a variety of factors at play, and it would be hard to say, Well, how is it that soy’s not all of its antioxidants playing a role? How’s it not this? I guess what I would say is, Do your best if it comes from a package; try not to eat it.

The thing I often say to my patients is that the longer the shelf life, the shorter your life. If they can get to a place where they’re eating a predominant, produce-rich, minimally processed diet, great. Then, when it comes to things like miso paste, use them sparingly. They come in these little, tiny tins because they should be used sparingly. They’re tasty and they can be yummy; feel free to do it. Just don’t overdo it. Then there are people among us, and you probably know many of these people that if they go off for a salty meal, they can’t get their rings off, their bracelets get too tight, or their socks get so deep that you can’t see them in their calves anymore. Those types of people might have to be extra careful with salt. They’re very salt-sensitive. Why they’re salt-sensitive, I don’t know. It may be genetic. It may be something else altogether. I wish I could just tell you, but I would say that there’s not an easy, clear set of guidelines about how much sodium versus potassium. But what it turns out is that more potassium seems to be beneficial.

Laurie Marbas, MD, MBA

Absolutely. Well, this is segueing into the salt. Can you explain the salt mechanisms and how that dries the blood pressure up? Did you give us a hint of it? 

Andrew M. Freeman, MD, FACC, FACP

Yes. I don’t claim to be a nephrologist. They’re much more cerebral than I could probably ever be. That’s the person who might know the answer. If you haven’t had a chance to speak with Dr. Joshi yet, he’s pretty smart and could probably give you a much better answer than I could. But when we consume salt, the right salt and water stick together just to keep it simple. Salt and water stick together. That sodium chloride solution, if you will, can often stay in the blood vessels and raise blood pressure, and when it’s done behind the scenes, it triggers your body to produce a whole bunch of chemicals like renin, aldosterone, and angiotensin, and all these things that we now have drugs for that block, that effect can raise blood pressure or lower blood pressure, depending on what’s going on.

Most of these mechanisms are adaptive. They’re designed as if you were to become acutely hyperventilated, bulimic, or something that your body would constrict down as a result of all these different things being released to keep your blood pressure up and your mind profused. In modern society, where we are typically not bleeding out, although I guess it happens when you eat a lot of salt, it triggers all sorts of mechanisms that contribute to blood pressure elevation. Part of that is also to help push the salt back out into your urine so that you can excrete the salt. Then, when it becomes chronic, it starts to become much more disarray. That’s my overly simplistic cardiology answer. I don’t know if that was in line with what you were thinking, but.

Laurie Marbas, MD, MBA

No, I think that’s fine. Yes. It just speaks to bringing in more fluid into the vessels and hardening the arteries with that basic salt.

Andrew M. Freeman, MD, FACC, FACP

I didn’t talk much about the hardening of the arteries. A lot of people, if you go to probably you’re in my parent’s generation when they would forget things as they were older, they would say, That’s hardening of the arteries. There was probably some truth to that. Hardening of the arteries is simply atherosclerosis or calcification of their sclerosis, which is a marker of coronary disease or cerebrovascular disease, whatever it may be. As we eat junk food and don’t exercise, atherosclerosis becomes more prevalent, and our blood vessels lose their elasticity and suppleness. They also don’t respond well to things like nitric oxide and all these other things that relax blood vessels. There’s a whole variety of mechanisms that, as we start to eat poorly, if we develop diabetes, for instance, impair all sorts of endothelial functions, which are the blood and the cells that line the blood vessels. We end up with the inability to significantly dilate our blood vessels when we might need to.

You can imagine that if you have very stiff blood vessels and you eat a lot of salt and water, that pressure has nowhere to go except to raise the pressure in the vessel. It’s funny that in many of my patients that I see, typically the men who come in later in life and have erectile dysfunction, I always screen them for ankle-brachial index, which is blood pressure on the arm compared to the leg. Many times, the blood pressure in the leg is so much higher than in the arm. We’re, of course, looking for the opposite lower end, which means that the blood vessel has become non-compressible or nearly non-compressible. They can’t tell if there are significant blockages in there that way. Anyway, very interesting stuff. The more you look, the more you find these things. 

Laurie Marbas, MD, MBA

Yes, that’s true. The more you look, the more you find. Absolutely. Which brings me to the conclusion, at least for this part of our conversation. But I want to say thank you to the audience for joining us today, and I hope you found our conversation insightful, inspiring, and engaging. But if you’re a summit purchaser, stay right here. We are going to dive a little bit deeper into this conversation. If not, you can click on the button below to get to the site or access the deeper conversations. Get ready to reclaim your health.  All right. If you’re watching this, thank you for being a valuable member of our community, and we are going to continue our conversation. Dr. Freeman, I have a question regarding a few different things at home and maybe some resistant hypertension, but could you discuss the importance of managing blood pressure at home and how frequently patients should do that?

Andrew M. Freeman, MD, FACC, FACP

Yes, if you are somebody who is suffering from hypertension, and especially if you’re trying to change your lifestyle, what I want to point out is that it’s very important to get that blood pressure under control as quickly as possible. This may sound strange to some of your listeners, but my suggestion is that I do is have my patients come back weekly for medication titration to get their blood pressure under control, usually in under a month. Then from there, we can. I always tell people to put out the fire before they can plant flowers. Planting the flowers is changing your lifestyle and getting off of these medications. A lot of people think that when they get medicine, it’s permanent. For many, it is. But for people who are willing to make these massive lifestyle changes, they can get off of their pills, which is awesome when they do it.

In general, when I first see a patient, we used to prescribe these things called ambulatory blood pressure monitors. I don’t know if you have any experience with these. Then they were largely denied insurance. There’s all that. To get it now, you have to prove all these crazy things. What I usually tell people to do is go on to a website called validateBP.org and find a blood pressure cuff that they like. They’re usually around 50 bucks. Some of the good ones are from like Omron, O-M-R-O-N, and others, and they get a good blood pressure cuff. Then I want them to spot-check. One of the things that I hate the most is when a patient comes in and has checked their blood pressure for six years at 7:00 in the morning, every day. Then they tell me their blood pressure at 7:00 in the morning is always normal. I said, I bet it is, but what about the rest of the day? You want to spot, check, and do it randomly. 

When you’re first diagnosed with high blood pressure, it makes sense to spot-check three, four, or five times a day whenever you have time. The ambulatory blood pressure monitors we used to use would check every 30 minutes or an hour, depending on how we had them set. We got a lot of data, and we could figure out what was going on. Interestingly, we often found that people had nocturnal hypertension, which would often be an indicator of sleep apnea, which is also highly associated with daytime hypertension. Nevertheless, I recommend people check it three or four times a day, randomly throughout the day, and get a running average. Now, remember, you don’t have to call your doctor if your blood pressure hits 140 once. If you’re watching a scary movie or you get into a car accident, that is, you decide to check your blood pressure. It might be high. That’s okay. Blood pressure is an adaptive mechanism to keep you alive, and safe, fight or flight,  whatever it is. 

But at the same point, if it’s staying, and usually I tell people over 130 that normally our action threshold, even though we want blood pressure to be lower, is to give your doctor a call to get that under control more quickly. Typically we’ll have weekly visits where we adjust meds and check bloodwork and adjust meds and check bloodwork until we get it under control. The bottom line is to be aggressive with your doctor. Remember that your doctor or nurse practitioner, your PA, whoever it is, works for you, and you want them to be aggressive with your care to keep you out of harm’s way. If you’re not finding that, take it into your own hands. Check your blood pressure and say, Dr. Smith, my blood pressure has been running 138 every time I check it. I need you to adjust my medications while I change my lifestyle. Very reasonable.

Laurie Marbas, MD, MBA

Perfect. I also like to say to make sure you’re checking in at least once without medications because that will give me an indication of how you are outside of medications. Right. If you take medications and they get low, we’ll get an idea of whether doing this will either slightly titrate you or take you off completely. That’s always helpful.

Andrew M. Freeman, MD, FACC, FACP

I know, and I did do that one just a little bit differently, only because some of the medications have longer half-lives. I wait until they get closer to, like, 110 most of the time, and then I’ll back off the drug.

Laurie Marbas, MD, MBA

Yes, absolutely. Especially if they’re symptomatic at all while standing, getting dizzy upon standing, or if they had great energy and now they’re super fatigued. Then also, speaking to people who are improving their health, if there are others in the home who are also on high blood pressure medications, please convey this information to them because they might also be finding some benefit. I call it positive collateral damage. 

Andrew M. Freeman, MD, FACC, FACP

Accountability partners.

Laurie Marbas, MD, MBA

Yes, exactly. Share the information. But getting to a little bit tougher cases for those with resistant hypertension, which doesn’t seem to respond or like common interventions. What advanced strategies or treatments might be considered or reasons why that’s happening?

Andrew M. Freeman, MD, FACC, FACP

Yes, so resistant hypertension and it depends on which definition you like. Most people would say that they’re usually on more drugs, one of them a loop diuretic. I would tell you that sadly, a lot of those cases that I see are not on loop diuretics, and those are drugs like furosemide or torsemide, or whatever your favorite is. A lot of those are aiming to get rid of that extra salt and water. For those of you that are on a loop diuretic and it is not working. First, most of them are threshold drugs, meaning that if you take furosemide at 20 and it doesn’t make you pee much more and it doesn’t have a major effect on your blood pressure, you might need to double the dose because your body has gotten used to it. Some people would refer to that as tachyphylaxis. That’s one. Two, there are a lot of people who take a water pill, and this is like the bane of my existence: they get thirsty, and then they drink a lot of water and eat a lot of salt, and they completely defeat the pill. I always tell people that if you remember that Seinfeld episode with the soup Nazi saying, No soup for you, soup is truly the antidote to a water pill. It’s salt water. I usually tell people, No soup for you. Be wary of hidden salt in a variety of things you’d never think of as salty. 

Once you exclude that, then you typically have to try to get somebody on a drug like Spironolactone because many people do respond. You don’t have to do all the formal testing for Hyperaldo and all these other things. But you can. Then after that, I typically will reach for less commonly used drugs, believe it or not, things like minoxidil, clonidine, or whatever, which I don’t love using for one reason or another. I won’t bore all your listeners unless you want to know those details. Then I hesitate to reach out to either an endocrinologist or a nephrologist for them to weigh in with us, because many of these advanced cases of refractory hypertension have some underlying endocrine issue or nephrology kidney issue, and nephrologists are surprisingly beneficial entities when it comes to managing resistant hypertension.

Use them well. Then, most importantly, many people are not necessarily doing a lot of lifestyle coaching. For many of the patients that I see, I’m the first one to ever talk to them about their diet, their exercise, their sleep apnea, or their stress. I would tell you how many times I have had a case of, quote, refractory hypertension where the spouse says, Joe snores like he could wake up the whole neighborhood, and we sent him for a sleep study. Lo and behold, he is reporting sleep apnea, and we treat it. All of a sudden, his blood pressure is normal, or Joe starts exercising and loses as little as 3% of his body weight. Blood pressure can drop. There are so many amazing lifestyle things that people are never told about for one reason or another that are effective and sometimes effective.

Laurie Marbas, MD, MBA

That’s exactly right. Lots of conversations that should continue, maybe with a specialist or cardiologist like yourself, make perfect sense. I think the final question would be great. With the focus on a plant-based diet, how can individuals ensure they’re getting all the necessary nutrients while also working on improving their blood pressure? Are there specific food categories that you would highlight over others?

Andrew M. Freeman, MD, FACC, FACP

Yes. First, a lot of doctors out there are in the habit of giving out supplements on their first visit in large quantities. Many of those doctors sell supplements, which, as you can imagine, have their conflicts of interest, and sometimes they need them. That’s great, but sometimes not. Remember that eons and eons of human beings survived without vitamins and whatnot. We have made it this far without it, and now people are eating poorly. If you eat a grain that has been stripped of all of its nutrients through bleaching, processing, or whatever, you’re going to be nutrient deficient. But I would say that first of all if you eat a well-balanced diet, which means that you’re eating all the colors of the rainbow, you’re eating whole grains for starches, energy, and so forth. The likelihood of a deficiency in anything is low. The only thing you might become deficient in is B12, and that typically can be gotten either through nutrition or brewer’s yeast, if you like that in your food, or through a multivitamin. 

Most of us who live in Colorado and above and other parts may be vitamin D deficient. You can get a lot of that from mushrooms that are grown in the sun as precursors and then some sun exposure yourself, if not a supplement. Then there are some people out there who might have, like, DHEA or EPA deficiencies. This is pretty controversial in terms of how they may represent themselves and show up in the clinic. But if you eat an occasional walnut or ground flaxseed or something like that, or if you want, you can take algal oil, which is where your fish get their fish oil from. Or just eat algae, if you prefer. But you’ve got to eat a lot of it. Our bodies are not that efficient at making that, but they’re efficient enough that they can do it. In general, I think you can do fine. For me personally, I’ve been plant-based for, I don’t know, more than a dozen years. If I remember to take a multivitamin once in a while, I’m proud of myself. But in general, I usually eat well enough that I don’t need it. I usually try to take B12 a couple of times a month. As you may know, the pill that you all will take is something like 10,000% of your RDA, your recommended daily allowance. That’s because it’s not absorbed all that well. Do take that from time to time if you can. 

But I think, in general, you probably won’t go nutritionally depleted anyway. One of the things that has been told for years is that if your kids grow up vegan, they’re going to grow up as these little pinheads and be mentally slow and unathletic. The truth is, that’s all been disproven, and in today’s massive childhood obesity epidemic, we should all be going plant-based for our children’s sake as it is. But of course, the American curse is that you eat, you grow up your whole life, you save your money, you retire, and then you look forward to heart attacks, strokes, and dementia. We should be doing this early in life anyway. That’s it. 

I think if you eat a well-balanced diet, the likelihood of nutritional deficiencies is low, and if you’re worried about it, they make a variety of multivitamins designed for vegans. There’s one out of Boulder and a handful of others that are out there that are surprisingly effective and can help you maintain. But there are a lot of people out there who are going for those dried fruit and vegetable powder pills. I just tell people to eat fruits and vegetables. It’s working. It’s tastier, and it’s filling. You can’t feel full on a little pill full of dry powder. You just won’t. The water weight that you eat with the fruits and vegetables helps to keep people going. Anyway, so the long-winded answer to saying you don’t usually need supplements, but there are some occasions or special cases where you might.

Laurie Marbas, MD, MBA

Absolutely. Again, it goes to fruits, vegetables, beans, legumes, whole grains in nuts and seeds, and looking for a variety of colors in a variety of plants throughout the week. I think that’s fabulous. Absolutely. 

Andrew M. Freeman, MD, FACC, FACP

Just to make sure the audience is comfortable, one last point is that you don’t have to eat things like beans and rice together. That’s all been proven. I just want people to know that if you have beans today and rice tomorrow, you’ll be just fine.

Laurie Marbas, MD, MBA

Yes. All plants have all the elements of all the amino acids, just in varying amounts. That’s why you should eat different foods as well. Interesting research coming from Stanford on that. But again, thank you so much, Dr. Freeman, for making you want to call it unique by trying to be your trailblazer. We appreciate your valuable service to our community as a cardiologist. Thank you for being at the summit.

Andrew M. Freeman, MD, FACC, FACP

My pleasure. It’s been a lot of fun.

Laurie Marbas, MD, MBA

Absolutely.