 High blood pressure ranks as the number one risk factor for death and disability in the world. Previously I showed how a plant-based diet may prevent high blood pressure, but what if you already have it? The American Heart Association, American College of Cardiology, and the Centers for Disease Control and Prevention recommend as the first-line treatment, lifestyle modification. If that doesn't work, you can start the patient on a thiazide diuretic, waterpill, and then you keep piling on the meds until you get their blood pressure down. Commonly, people end up on three drugs, though researchers are experimenting with four at a time, and some people end up on five. Why not just jump straight to the drugs? Well, they don't treat the underlying cause, and they can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to adverse effects such as erectile dysfunction, fatigue, and muscle cramps. So, what are these recommended lifestyle changes? They recommend to control one's weight, salt, and alcohol intake, engage in regular exercise, and adopt a dash eating plan. The dash diet has been described as a lacto-vegetarian diet, but it's not. It emphasizes fruits and vegetables and low-fat dairy, but just a reduction in meat. Why not vegetarian? We've known for decades that food of animal origin is highly significantly associated with blood pressure. In fact, if you take vegetarians and you give them meat, you can watch their blood pressures go right up. I've talked about how there are benefits to getting blood pressure down as low as 110 over 70, but who can get that low populations eating plant-based diets, like in rural China? About 110 over 70 their whole lives with the meats only eaten on special occasions, or rural Africa, where the elderly have perfect blood pressure, as opposed to hypertension. In the Western world, as the American Heart Association has pointed out, the only folks really getting down that low were the strict vegetarians, coming out at about 110 over 65. So when they created the dash diet, were they just not aware of this landmark research done by Harvard's Frank Sacks? No, they were aware. The chair of the design committee that came up with the dash diet was Dr. Sacks. In fact, the dash diet was explicitly designed with the number one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet contain enough animal products to make it palatable to the general public. In fact, Sacks found that the more dairy the lacto-vegetarians ate, the higher their blood pressures, but they had to make the diet acceptable. Research has since shown that it's the added plant foods, not the changes in oil, sweets, or dairy that appears to be the critical component. So why not eat plant-based? Recent meta-analysis showed vegetarian diets were good, but strictly plant-based diets may be better. Vegetarian diets in general confer protection against cardiovascular disease and cancers and death, but completely plant-based diets seem to offer additional protection for obesity, hypertension type 2 diabetes, and heart disease mortality. Based on the study of 89,000 people, those eating meat-free diets appeared to cut the risk of high blood pressure 55%, but those eating meat-free, egg-free, and dairy-free at 75% lower risk. If, however, you're already eating a whole food plant-based diet, no processed foods, no table salt, and you're still not hitting 110 over 70, there are a few foods recently found to offer additional protection. Ground flax seeds, a few tablespoons a day, induce one of the most potent anti-hypertensive effects ever achieved by dietary intervention. Two to three times more powerful than instituting an aerobic endurance exercise program. Watermelon also appears to have extraordinary effects, but you'd have to eat like two pounds a day. Sounds like my kind of medicine, but it's hard to get year-round. Red wine may help, but only if the alcohol has been taken out. Raw vegetables are cooked, and the answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may help a little. Kiwi fruits, though, don't seem to work at all, even though the study was funded by a kiwi fruit company. Maybe they should have taken direction from the California Raisin Marketing Board, who came out with this study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, cheez-its, and chips ahoy.