Salt: another public health hazard

Scientists have shown that sugary beverages may be responsible for 180,000 deaths per year, and the same group of scientists has reported an estimate of the number of deaths due to excess salt consumption.

High sodium intake is associated with poor health outcomes, including elevated blood pressure, heart attack and stroke (even in the absence of high blood pressure), kidney disease, ulcers, gastric cancer, osteoporosis, and autoimmune inflammation.1,2  Elevated blood pressure, a consequence of excess sodium intake, is a significant threat to one’s health, and its prevalence is rising. Hypertension is one of the leading causes of death in the U.S., contributes to heart attack and stroke risk, and is associated with dementia.3

Using data gathered from the World Health Organization, the average worldwide daily sodium intake was found to be more than double the American Heart Association’s recommended limit of 1500 mg/day. Average worldwide sodium intake was 3,950 mg, and American adults came in just under that average at 3,600 mg.  Most of the world – 119 of the 187 countries studied, or 88% of all adults – consumed more than 3,000 mg sodium a day. Out of the 187 countries, only one (Kenya) had an average sodium intake meeting the American Heart Association’s guideline of 1,500 mg a day. Excess sodium has clearly become a global issue.

With excess sodium consumption now common throughout the entire world, are more people dying from heart attacks and strokes?

Higher sodium intake is consistently associated with greater risk of heart attack, stroke, and cardiovascular death in healthy populations.1 The scientists gathered data on deaths in 50 different countries and concluded that 2.3 million deaths per year worldwide may be due to excess salt consumption, and 40% of those deaths occurred in individuals under the age of 70 – suggesting that excess sodium is needlessly cutting many lives short. They estimated that excess salt contributes to one in 10 deaths of American adults, and that 15 percent of all deaths from cardiovascular disease were a consequence of excess salt intake.4-6

Could reducing sodium intake really prevent some of these deaths?

Clinical trials have clearly shown that reducing sodium intake reduces blood pressure in both healthy and hypertensive subjects.1  Additional clinical trials have shown that cardiovascular events could be  reduced by 20% with sodium reduction.7 A publication in the New England Journal of Medicine used mathematical models to estimate that a 1200 mg reduction in daily sodium intake population-wide in the U.S. could result in 60,000 fewer cases of CHD, 32,000 fewer strokes, and 54,000 fewer heart attacks every year.8 The effort to reduce sodium intake is substantially worthwhile.

Added salt is ubiquitous in processed foods and restaurant meals, and is contributing to the rampant cardiovascular disease in the modern world. Since most of the added sodium in the American diet comes from these foods, it is simple to avoid added salt by preparing most of your meals at home.  Sodium is an essential mineral that becomes dangerous in excess; by consuming only the sodium present in natural foods, we get adequate but not disease-causing levels of sodium. 


1. Whelton PK, Appel LJ, Sacco RL, et al: Sodium, blood pressure, and cardiovascular disease: further evidence supporting the American Heart Association sodium reduction recommendations. Circulation 2012;126:2880-2889.
2. Tsugane S, Sasazuki S: Diet and the risk of gastric cancer: review of epidemiological evidence. Gastric Cancer 2007;10:75-83.
3. Murphy SL, Xu J, Kochanek KD: Deaths: Preliminary Data for 2010. Natl Vital Stat Rep 2012;60.
4. Phend C: Whole World Uses Too Much Salt, Study Finds. 2013. MedPage Today. Accessed
5. Armour S: High Salt Consumption Tied to 2.3 Million Heart Deaths. 2013. Bloomberg. Accessed
6. Gray N: High salt intake causes 2.3 million deaths per year. 2013. Food Navigator. Accessed
7. He FJ, MacGregor GA: Salt reduction lowers cardiovascular risk: meta-analysis of outcome trials. Lancet 2011;378:380-382.
8. Bibbins-Domingo K, Chertow GM, Coxson PG, et al: Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med 2010;362:590-599.

Almost 20% of young adults have hypertension

Many people believe that it is normal for blood pressure to rise as we age, but this is not true.  Cultures whose diet does not contain excessive added fats, animal protein and salt, and is high in fresh, whole plant foods do not experience the age-related increase in blood pressure that we see in the Western world.1,2 These age-related elevations in blood pressure are not related to age itself – instead they are due to the cumulative destructive effects of a poor diet and insufficient exercise on the circulatory system over years and years. 

Hypertension (blood pressure at or greater than 140/90) is on the rise – between 1996 and 2006, hypertension prevalence in the U.S. increased by 20%.3 More recent results from the National Longitudinal Study of Adolescent Health have produced an estimate that 19% of young adults (24 to 32 years old) have hypertension.

Plus, more than half of these individuals were unaware that they had high blood pressure. This 19% figure is markedly higher than previous estimates, and was based on in-home measured blood pressure in 2008 in a population of over 15,000 participants.4,5 This elevated blood pressure will only progress as they continue to harm their blood vessels with salt and processed food. 

If almost 1 in 5 already have blood pressure higher than 140/90 by age 32, just imagine how much trouble this generation is in. First of all, the risk of death from heart attack and stroke begins to increase when blood pressure climbs over 115/75.6  Plus, high blood pressure is an important risk factor for hemorrhagic stroke, kidney disease, stomach cancer, dementia, osteoporosis, hardening of the arteries, arrhythmia, blindness, and enlargement of the heart.7-11

Many people in this age group, who were born between 1976 and 1984, have grown up on diets made up primarily of processed foods and fast food, and this study has revealed that their bodies are starting to show signs of the damage.  If they do not change their habits, they will be prescribed medication that they will have to take for the rest of their lives to control their blood pressure.  But this will not remove the cause of the problem, and will put them at risk for harmful side effects. And their poor lifestyle habits will continue to cause worsening of their cardiovascular disease. Of course, this outcome is avoidable with lifestyle changes.  This generation of young adults can enjoy a long, healthy life without blood pressure-lowering medication by starting to follow these guidelines now:

How to reduce blood pressure naturally

  • Avoid salt.   A population-wide 1200 mg decrease in sodium consumption has been estimated to reduce coronary heart disease cases by 60,000, strokes by 32,000, and heart attacks by 54,000 each year.  Plus, remember that salt does damage unrelated to blood pressure too.

  • Avoid added sugars.

  • Minimize caffeine and alcohol.

  • Focus preferably on plant protein rather than animal protein.12,13

  • Get plenty of minerals, phytochemicals and antioxidants by eating primarily whole plant foods. For example, flavonoids from berries have a blood pressure-lowering effect, and nuts can enhance endothelial cell function, which promotes proper blood pressure regulation. Also, a dietary pattern high in fruits and vegetables is consistently associated with healthy blood pressure levels in observational studies.14-16

  • Exercise regularly and vigorously.

  • Follow my micronutrient rich dietary program and regain a normal weight.





1. Freis ED: Salt, volume and the prevention of hypertension. Circulation 1976;53:589-595.

2. Sever PS, Gordon D, Peart WS, et al: Blood-pressure and its correlates in urban and tribal Africa. Lancet 1980;2:60-64.

3. American Heart Association: High Blood Pressure Statistics. Accessed June 2, 2011.

4. Nguyen QC, Tabor JW, Entzel PP, et al: Discordance in National Estimates of Hypertension Among Young Adults. Epidemiology 2011.

5. Neale T: 1 in 5 Young Adults May Have Hypertention. MedPage Today. Accessed June 2, 2011.

6. Lewington S, Clarke R, Qizilbash N, et al: Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-1913.

7. Heart Disease and Stroke Statistics: 2010 Update At-A-Glance. Accessed January 11, 2011.

8. Sonnenberg A: Dietary salt and gastric ulcer. Gut 1986;27:1138-1142.

9. Tsugane S, Sasazuki S: Diet and the risk of gastric cancer: review of epidemiological evidence. Gastric Cancer 2007;10:75-83.

10. Go O, Rosendorff C: Hypertension and atrial fibrillation. Curr Cardiol Rep 2009;11:430-435.

11. DellaCroce JT, Vitale AT: Hypertension and the eye. Curr Opin Ophthalmol 2008;19:493-498.

12. Elliott P, Stamler J, Dyer AR, et al: Association between protein intake and blood pressure: the INTERMAP Study. Arch Intern Med 2006;166:79-87.

13. Wang YF, Yancy WS, Jr., Yu D, et al: The relationship between dietary protein intake and blood pressure: results from the PREMIER study. J Hum Hypertens 2008;22:745-754.

14. Alonso A, de la Fuente C, Martin-Arnau AM, et al: Fruit and vegetable consumption is inversely associated with blood pressure in a Mediterranean population with a high vegetable-fat intake: the Seguimiento Universidad de Navarra (SUN) Study. Br J Nutr 2004;92:311-319.

15. Fu CH, Yang CC, Lin CL, et al: Effects of long-term vegetarian diets on cardiovascular autonomic functions in healthy postmenopausal women. Am J Cardiol 2006;97:380-383.

16. Utsugi MT, Ohkubo T, Kikuya M, et al: Fruit and vegetable consumption and the risk of hypertension determined by self measurement of blood pressure at home: the Ohasama study. Hypertens Res 2008;31:1435-1443.


Berries help keep blood pressure down

Over 5,000 different flavonoid antioxidants have been identified, many of these in commonly consumed plant foods – there are many different types of flavonoids:

  • Flavanols are the most common, and are abundant in onions, kale, leeks, broccoli, apples, blueberries, red wine, and tea.
  • Less common are the flavones, which are found in celery and parsley.
  • Citrus fruits have high levels of flavanones.
  • Flavan-3-ols, which include catechins, are found in grapes, tea, and cocoa.
  • Soybeans contain isoflavones.
  • Anthocyanins (derivatives of anthocyanidins) are potent antioxidants and pigments that color red, blue, and purple foods like berries, grapes, currants, blood oranges, eggplant, red cabbage, red onions, and some beans and grains.1

In addition to their antioxidant capacity, flavonoids may help the ability of the muscle layer of blood vessels to relax (vasodilation). Endothelial cells, which make up the inner layer of blood vessels, produce nitric oxide in order to regulate blood pressure. There is evidence that flavonoids increase the activity of the enzyme (eNOS; endothelial nitric oxide synthase) in endothelial cells necessary for nitric oxide production.2 In agreement with the idea that flavonoids have beneficial effects on blood pressure, a meta-analysis of 15 studies concluded that regular cocoa consumption can reduce blood pressure in hypertensive and pre-hypertensive individuals.3

Photo of strawberries and blueberriesOne notable study focused on the anthocyanins in berries and their effects on blood pressure. Men and women from the Health Professionals Follow-Up Study and Nurses’ Health study, respectively were followed for 14 years, and their flavonoid intake was calculated based on the foods they reported eating. Reduced risk for hypertension was found for high intake of anthocyanins (an 8% decrease in risk), as well as apigenin (a flavone) and catechin (a flavan-3-ol). The foods that contributed the bulk of the anthocyanin in the diets of the subjects were blueberries and strawberries.

When the researchers analyzed blueberry consumption specifically they found that compared with those who ate no blueberries, those who ate one serving per week decreased their risk of hypertension by 10%. 4,5

If there was a 10% decrease in hypertension risk for one serving of blueberries per week, imagine how protective it would be to eat one serving of berries every day! Also flavonoids act in several other ways to protect against heart disease, for example by reducing inflammation, LDL oxidation, and platelet aggregation. 1,6 As a result of these effects, several prospective studies have found associations between high flavonoid intake and considerable reductions (up to 45%) in the risk of coronary heart disease.7-10 Flavonoids also have documented anti-cancer properties.11,12

Berries truly are superfoods – they are low in sugar, and high in fiber and phytochemicals, with the highest nutrient to calorie ratio of all fruits. Eating berries daily will not only promote vasodilation, but also provide the body with protection against free radicals, inflammation, and cancer.



1. Erdman JW, Jr., Balentine D, Arab L, et al: Flavonoids and heart health: proceedings of the ILSI North America Flavonoids Workshop, May 31-June 1, 2005, Washington, DC. The Journal of nutrition 2007, 137:718S-737S.
2. Galleano M, Pechanova O, Fraga CG: Hypertension, nitric oxide, oxidants, and dietary plant polyphenols. Current pharmaceutical biotechnology 2010, 11:837-848.
3. Ried K, Sullivan T, Fakler P, et al: Does chocolate reduce blood pressure? A meta-analysis. BMC medicine 2010, 8:39.
4. Cassidy A, O'Reilly EJ, Kay C, et al: Habitual intake of flavonoid subclasses and incident hypertension in adults. The American journal of clinical nutrition 2011, 93:338-347.
5. Bioactive Compounds in Berries Can Reduce High Blood Pressure. In ScienceDaily; 2011.
6. Chong MF, Macdonald R, Lovegrove JA: Fruit polyphenols and CVD risk: a review of human intervention studies. The British journal of nutrition 2010, 104 Suppl 3:S28-39.
7. Huxley RR, Neil HA: The relation between dietary flavonol intake and coronary heart disease mortality: a meta-analysis of prospective cohort studies. Eur J Clin Nutr 2003, 57:904-908.
8. Knekt P, Kumpulainen J, Jarvinen R, et al: Flavonoid intake and risk of chronic diseases. The American journal of clinical nutrition 2002, 76:560-568.
9. Mursu J, Voutilainen S, Nurmi T, et al: Flavonoid intake and the risk of ischaemic stroke and CVD mortality in middle-aged Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study. The British journal of nutrition 2008, 100:890-895.
10. Mink PJ, Scrafford CG, Barraj LM, et al: Flavonoid intake and cardiovascular disease mortality: a prospective study in postmenopausal women. The American journal of clinical nutrition 2007, 85:895-909.
11. Androutsopoulos VP, Papakyriakou A, Vourloumis D, et al: Dietary flavonoids in cancer therapy and prevention: substrates and inhibitors of cytochrome P450 CYP1 enzymes. Pharmacol Ther 2010, 126:9-20.
12. Ramos S: Effects of dietary flavonoids on apoptotic pathways related to cancer chemoprevention. The Journal of nutritional biochemistry 2007, 18:427-442.


Salt increases heart attack and stroke risk, even if blood pressure is normal

Excess dietary salt is notorious for increasing blood pressure – blood volume increases, placing more stress on blood vessel walls. This forces the heart to pump harder against the pressure, and also structural changes that harden the vessel wall (this hardening is called stenosis) occur in response to these high pressures.

About one-third of all American adults and over 50% of those over the age of 55 have hypertension, and hypertension carries significant risks. Elevated blood pressure accounts for 62% of strokes and 49% of coronary heart disease. [1] Notably, the risk for heart attack and stroke begins climbing with systolic pressures (first number in the blood pressure reading) above 115 mm Hg – considered “normal” by most standards.[2] Also, dietary salt is not only dangerous to the cardiovascular system, but also contributes to kidney disease, osteoporosis , ulcers, and stomach cancer. [3]

There is new evidence that excess dietary sodium intake promotes atherosclerotic plaque development and heart disease, even in those without elevated blood pressure.

In the 1990s, it was found that the relationship between salt intake and stroke mortality was stronger than the relationship between blood pressure and stroke mortality; this suggested that salt may have deleterious effects on the cardiovascular system that are not related to blood pressure.[4] Excess sodium in the diet affects sodium concentrations in the blood, which affects the cells of the blood vessel wall and blood volume, even if blood pressure itself does not change. The eventual results are long-term changes in vessel wall structure, including thickening of the vessel wall and arterial stiffening. Excess dietary sodium prompts changes in hormonal systems and also gene expression in endothelial cells (the cells that make up the inner lining of blood vessels). These changes in turn promote excessive growth of vascular smooth muscle cells, which contributes to thickening of vessel wall, and altered production of structural proteins, such as collagen, elastin, and fibronectin, which contributes to arterial stiffening. Dietary salt has also been associated with endothelial dysfunction (the inability of endothelial cells to properly regulate blood pressure), which is one of the initiating events of atherosclerotic plaque formation. [5-8]

The study population consisted of overweight and obese individuals withoutelevated blood pressure. Their sodium intake was evaluated by measuring the amount of sodium excreted in the urine. The authors found that higher urinary sodium (indicating higher sodium intake) was associated with greater carotid artery intima-media thickness – a predictor of future cardiovascular events. Intima-media thickness (IMT) is an indicator of atherosclerotic plaque development and is established in the medical literature as an accurate predictor of future cardiovascular risk. IMT testing is a non-invasive ultrasound technique for imaging any abnormal thickening in the intima (inner lining) and media (smooth muscle layer) layers of the carotid artery. Thickening indicates atherosclerotic plaque formation, and therefore increased risk of heart attack or stroke. [9] I use this test to assess cardiovascular risk and track patients’ progress in my medical practice.

Reducing dietary salt is not only important for those who already have elevated blood pressure – limiting added salt is essential for all of us to keep our cardiovascular systems in proper working order. On top of consuming the vast majority of our calories from phytochemical-rich, unrefined plant foods, salt avoidance adds another layer of protection against heart attack and stroke. It is also important to remember that a low fat, flexitarian or vegan diet plus a low cholesterol level does not protect you from developing high blood pressure later in life from years of using too much salt; it also does not protect you against the risk of later life hemorrhagic stroke, as long as you overly salt your food.




1. He, F.J. and G.A. MacGregor, A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens, 2009. 23(6): p. 363-84.
2. Lewington, S., et al., Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet, 2002. 360(9349): p. 1903-13.
3. Tsugane, S. and S. Sasazuki, Diet and the risk of gastric cancer: review of epidemiological evidence. Gastric Cancer, 2007. 10(2): p. 75-83.
4. Perry, I.J. and D.G. Beevers, Salt intake and stroke: a possible direct effect. J Hum Hypertens, 1992. 6(1): p. 23-5.
5. Simon, G., Experimental evidence for blood pressure-independent vascular effects of high sodium diet. Am J Hypertens, 2003. 16(12): p. 1074-8.
6. Sanders, P.W., Vascular consequences of dietary salt intake. Am J Physiol Renal Physiol, 2009. 297(2): p. F237-43.
7. Safar, M.E., et al., Pressure-independent contribution of sodium to large artery structure and function in hypertension. Cardiovasc Res, 2000. 46(2): p. 269-76.
8. Dickinson, K.M., J.B. Keogh, and P.M. Clifton, Effects of a low-salt diet on flow-mediated dilatation in humans. Am J Clin Nutr, 2009. 89(2): p. 485-90.
9. Lorenz, M.W., et al., Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation, 2007. 115(4): p. 459-67.


High blood pressure increases dementia risk

The small arteries of the brain are sensitive to elevations in blood pressure, and long-term hypertension carries the risk of injury to these small vessels, impairing blood flow and resulting in damage to or atrophy of brain tissue. As such, high blood pressure is hazardous to the brain, contributing to the development of vascular dementia, Alzheimer’s Disease, and cognitive impairment: [1]

  • High diastolic blood pressure at age 50 predicts poorer cognitive function at age 70. [2]
  • Even in younger subjects - 40 and under - higher blood pressure correlates with poorer cognitive performance.[3]
  • An MRI study determined that higher systolic blood pressure is associated with white matter lesions – a type of damage to brain tissue that arises due to poor circulation and poses risk for dementia. [4]
  • According to long-term (20-year) studies, the risk of Alzheimer’s and other forms of dementia is more than doubled if systolic blood pressure is in or above the range of 140-160 mmHg. [1]

Most cognitive impairment is not age-related, it is lifestyle-related.

Over many years, the Western diet combined with high blood pressure inflicts a great deal of damage on the brain’s delicate small vessels. Keeping your blood pressure in the favorable range is an important step toward maintaining your brain function as you age.

Blood pressure cuff

Dr. Fuhrman’s strategies for healthy blood pressure levels:



1. Nagai, M., S. Hoshide, and K. Kario, Hypertension and dementia. Am J Hypertens, 2010. 23(2): p. 116-24.
2. Kilander, L., et al., Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men. Hypertension, 1998. 31(3): p. 780-6.
3. Suhr, J.A., J.C. Stewart, and C.R. France, The relationship between blood pressure and cognitive performance in the Third National Health and Nutrition Examination Survey (NHANES III). Psychosom Med, 2004. 66(3): p. 291-7.
4. Kuller, L.H., et al., Relationship of hypertension, blood pressure, and blood pressure control with white matter abnormalities in the Women's Health Initiative Memory Study (WHIMS)-MRI trial. J Clin Hypertens (Greenwich), 2010. 12(3): p. 203-12.
5. Utsugi, M.T., et al., Fruit and vegetable consumption and the risk of hypertension determined by self measurement of blood pressure at home: the Ohasama study. Hypertens Res, 2008. 31(7): p. 1435-43.
6. Sesso, H.D., et al., Alcohol consumption and the risk of hypertension in women and men. Hypertension, 2008. 51(4): p. 1080-7.
7. Sacks, F.M., et al., Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med, 2001. 344(1): p. 3-10.
8. Winkelmayer, W.C., et al., Habitual caffeine intake and the risk of hypertension in women. JAMA, 2005. 294(18): p. 2330-5.
9. Bogaert, Y.E. and S. Linas, The role of obesity in the pathogenesis of hypertension. Nat Clin Pract Nephrol, 2009. 5(2): p. 101-11.
10. Pescatello, L.S., Exercise and hypertension: recent advances in exercise prescription. Curr Hypertens Rep, 2005. 7(4): p. 281-6.


Blood pressure control with medication does not prevent heart attack, stroke, or death

One in 3 adults in the U.S. has hypertension. In those over the age of 55, more than 50% have hypertension, which is a significant risk factor for heart attack and stroke. Sixty-nine percent heart attack sufferers and 77% of stroke sufferers have blood pressure higher than 140/90 mm Hg.1 Many organizations recommend that blood pressure be kept below 130/80 in order to prevent heart attack and stroke. However, a meta-analysis of 61 studies has concluded that risk for heart attack and stroke begins to increase when blood pressure is elevated above 115/75.2

The INVEST study involved 22,576 hypertensive participants aged 50 years or older. This particular portion of the study focused on participants that had both diabetes and coronary artery disease, in addition to hypertension . Subjects were given anti-hypertensive drugs (either a calcium channel blocker or a beta-blocker), and were placed in one of three groups according to their level of blood pressure control: tight control (<130), usual control (130-139), or uncontrolled (>139). Incidences of heart attack, stroke, and death were recorded over an 8-year period. Scientists found no differences in any of these outcomes between tight and usual control groups.3,4

This is a classic example of treating the symptom rather than the cause. Of course heart attacks and strokes were not prevented – one specific symptom, blood pressure, was addressed with medication, but the patients already had heart disease and diabetes, and they did not eliminate the toxic diet style that was the initial cause of these conditions. Therefore, their heart disease continued to progress.

Blood pressure can be kept under control naturally. High blood pressure is almost non-existent in non-Westernized populations.5-7 Salt and added sugars are significant contributors to elevated blood pressure, and these must be minimized. Reducing salt consumption alone has the potential to save millions of lives.8 A diet of whole plant foods also provides a favorable ratio of potassium to sodium. another important factor in blood pressure regulation.9

Most importantly, a diet based on natural plant foods does not merely address the problem with blood pressure; by maximizing protective nutrients, it reduces every risk factor for heart disease – LDL cholesterol, inflammation, insulin resistance, oxidative stress, etc. – a high nutrient diet is the most comprehensive preventive measure.

Also remember that anti-hypertension medications have plenty of side effects, including fatigue, headaches, and lightheadedness, plus increased risk of developing cardiac arrhythmias and diabetes. 10-12 In fact, excessive blood pressure lowering with medication can be dangerous, especially for the elderly, because it can prevent adequate blood flow to the heart leading to cardiac arrthymias and sudden cardiac death.13 Dietary modifications and exercise can radically prolong your life, not only are they much safer than drugs, but they also prevent dementia, cancer and other diseases simultaneously. If you have not read it already, please read my book Eat For Health, so you can more fully understand some of these basic concepts to take back control of your health destiny. Drugs don’t do it.


1. American Heart Association. High Blood Pressure - Statistics. Statistical Fact Sheets - Disease/Risk Factors 2010 August 26, 2010]; Available from:
2. Lewington, S., et al., Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet, 2002. 360(9349): p. 1903-13.
3. Cooper-DeHoff, R.M., et al., Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease. JAMA, 2010. 304(1): p. 61-8.
4. Schwenk, T., Blood Pressure Control in Patients with Diabetes and Coronary Artery Disease: No benefit for lowering BP to <130/80 mm Hg, in Journal Watch General Medicine. 2010.
5. Murphy, H.B., Blood pressure and culture. The contribution of cross-cultural comparisons to psychosomatics. Psychother Psychosom, 1982. 38(1): p. 244-55.
6. Cooper, R., et al., The prevalence of hypertension in seven populations of west African origin. Am J Public Health, 1997. 87(2): p. 160-8.
7. He, J., et al., Body mass and blood pressure in a lean population in southwestern China. Am J Epidemiol, 1994. 139(4): p. 380-9.
8. He, F.J. and G.A. MacGregor, Reducing population salt intake worldwide: from evidence to implementation. Prog Cardiovasc Dis, 2010. 52(5): p. 363-82.
9. Cook, N.R., et al., Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study. Arch Intern Med, 2009. 169(1): p. 32-40.
10. Swaminathan, R.V. and K.P. Alexander, Pulse pressure and vascular risk in the elderly: associations and clinical implications. Am J Geriatr Cardiol, 2006. 15(4): p. 226-32; quiz 133-4.
11. Mitchell, G.F., et al., Pulse pressure and risk of new-onset atrial fibrillation. JAMA, 2007. 297(7): p. 709-15.
12. Elliott, W.J. and P.M. Meyer, Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet, 2007. 369(9557): p. 201-7.
13. Messerli, F.H., et al., Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med, 2006. 144(12): p. 884-93.







Fructose from added sugars linked to high blood pressure

The consumption of fructose has increased significantly since the 1970s, when high fructose corn syrup (HFCS) was introduced into the United States food supply. The use of HFCS now exceeds that of sucrose (table sugar) in sweetened foods in the U.S.

Absorption of fructose and glucose:

Sucrose is composed of one fructose molecule and one glucose molecule.   There are differences between fructose and glucose metabolism. Fructose is absorbed in the small intestine, transported to the liver through the portal vein, and then metabolized via the same process that breaks down glucose to make energy – however, fructose is only broken down in the liver, whereas glucose can be used by any cell in the body.  Ingesting glucose raises blood glucose levels, and ingesting fructose does not raise glucose as quickly or as much, but raises triglyceride levels much more.1

Fructose was once regarded as a “safe” sweetener for diabetics, because of its small effect on blood glucose levels.   However, fructose is a reducing sugar, which means that it contributes to the formation of advanced glycation end products (AGEs), which contribute to diabetes and its complications, Alzheimer’s disease, and cardiovascular disease.2 Since fructose consumption also elevates triglycerides and diabetics are already at risk for cardiovascular disease, increasing triglycerides adds to this risk. Added fructose consumption has also been associated with non-alcoholic fatty liver disease, and elevated cholesterol and retinopathy in diabetics.1


Fructose in natural foods vs. fructose in HFCS:

Fructose makes up half of the sucrose molecule, and HFCS contains similar proportions of fructose and glucose as sucrose does (HFCS is 55% fructose).   Fructose may be found alone (free) or complexed with glucose as sucrose. In most fruits, much of the fructose is bound to glucose. Fructose entry into blood is slowed when it is in sucrose form, because sucrose must be first split by enzymes in intestinal cells. Fructose molecules in HFCS, however, are free, and therefore absorbed more rapidly. It is thought that the enzymes in the liver responsible for breaking down fructose are overwhelmed by the large loads of fructose delivered by HFCS-sweetened beverages, allowing for large quantities of fructose to be released into the blood.1


Fructose and elevated blood pressure:

The current study examined data from 4528 adults, whose median fructose intake from added sugars was 74 grams per day. As a reference point, 74 grams of fructose is roughly the amount present in 2 ½ twenty-ounce soft drinks or 13 bananas.1,3 The researchers determined that fructose intake at or above the median 74 grams per day increased the risk of elevated blood pressure. 

Subjects who consumed 74 grams or more of fructose each day in added sugar increased their risk of blood pressure elevated above 135/85 by 26%, above 140/90 by 30%, and above 160/100 by 77%.4

Essentially, the average fructose intake in the U.S. is a quantity that increases chronic disease risk – and not just risk of diabetes. Elevated blood pressure contributes to risk of heart attack, stroke, heart failure, and kidney disease.

There are no “safe” sweeteners - whole fruits and root vegetables are the only sweet-tasting foods that are health-promoting.   Added sugar in any form is calorie-dense and deficient in nutrients, and therefore detrimental to health.



1. Teff KL, Grudziak J, Townsend RR, et al. Endocrine and metabolic effects of consuming fructose- and glucose-sweetened beverages with meals in obese men and women: influence of insulin resistance on plasma triglyceride responses. J Clin Endocrinol Metab. 2009 May;94(5):1562-9.

2. Glenn JV, Stitt AW. The role of advanced glycation end products in retinal ageing and disease. Biochim Biophys Acta. 2009 Oct;1790(10):1109-16.

Loy CT, Twigg SM. Growth factors, AGEing, and the diabetes link in Alzheimer's disease. J Alzheimers Dis. 2009 Apr;16(4):823-31.

Peppa M, Uribarri J, Vlassara H. Aging and glycoxidant stress. Hormones (Athens). 2008 Apr-Jun;7(2):123-32.

Peppa M, Stavroulakis P, Raptis SA. Advanced glycoxidation products and impaired diabetic wound healing. Wound Repair Regen. 2009 Jul-Aug;17(4):461-72.

Yamagishi S. Advanced glycation end products and receptor-oxidative stress system in diabetic vascular complications. Ther Apher Dial. 2009 Dec;13(6):534-9.

Barlovic DP, Thomas MC, Jandeleit-Dahm K. Cardiovascular disease: what's all the AGE/RAGE about? Cardiovasc Hematol Disord Drug Targets. 2010 Mar;10(1):7-15.

3. Nutrition Data.

4. Jalal DI, Smits G, Johnson RJ, Chonchol M. Increased Fructose Associates with Elevated Blood Pressure. J Am Soc Nephrol. 2010 Jul 1. [Epub ahead of print]

Drugs used to treat preventable diseases carry serious risks (Part 2 - ARBs)

Part 2:

Angiotensin receptor blockers - anti-hypertensive drugs – linked to lung cancer and heart-related deaths


Angiotensin-receptor blockers (ARBs) are used to to treat hypertension, heart failure, and diabetic nephropathy (kidney dysfunction). They work by blocking a hormone system that regulates vascular tone and water and salt balance to control blood pressure.

Because angiotensin can affect cell survival and angiogenesis (formation of new blood vessels), two important factors in tumor growth, angiotensin is thought to play a role in cancer progression.1 To determine whether taking ARBs affected cancer risk, scientists performed a meta-analysis of several studies to uncover any possible links between ARBs and cancers. They determined that ARBs carry a increased risk of new diagnosis of any cancer (8%), and a significantly higher risk of lung cancer (25%).2

One ARB in particular, olmesartan (Benicar), was under scrutiny by the FDA for potential cardiovascular risks. In a clinical trial testing olmesartan’s efficacy for slowing kidney damage in diabetics, there were increased rates of sudden cardiac death and death from heart attack and stroke in the subjects taking the drug compared to those taking placebo.3

In my practice, and from results recorded from members at, even people with dramatically high blood pressure readings and dramatically high cholesterol levels have successfully returned their levels to normal without medications. In fact, as published in the medical journal Metabolism, the nutritarian diet is the most effective method to lower high cholesterol, even more effective than drugs.4 If people were very informed of these results and the risks involved with taking medications many more would certainly embrace nutritional excellence as therapy. High cholesterol and high blood pressure are lifestyle-created conditions, and the safest and most effective treatment is a high nutrient diet and exercise.




1. Li H, Qi Y, Li C, et al. Angiotensin type 2 receptor-mediated apoptosis of human prostate cancer cells.Mol Cancer Ther. 2009 Dec;8(12):3255-65.

Feng Y, Wan H, Liu J, et al. The angiotensin-converting enzyme 2 in tumor growth and tumor-associated angiogenesis in non-small cell lung cancer. Oncol Rep. 2010 Apr;23(4):941-8.

Zhao Y, Chen X, Cai1 L, et al. Angiotensin II / Angiotensin II type I receptor (AT1R) signaling promotes MCF-7 breast cancer cells survival via PI3-kinase/Akt pathway. J Cell Physiol. 2010 May 10. [Epub ahead of print]

2. Sipahi I, Debanne SM, Rowland DY, et al. Angiotensin-receptor blockade and risk of cancer: meta-analysis of randomised controlled trials. Lancet Oncol. 2010 Jun 11. [Epub ahead of print]

3. Reuters: UPDATE 2 – FDA looking into death risk from Daiichi’s Benicar.

4. Jenkins DJ, Kendall CW, Popovich DG, et al. Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metabolism. 2001 Apr;50(4):494-503.

Drugs used to treat preventable diseases carry serious risks (Part 1 - statins)

Never forget, you don’t get something for nothing when it comes to medications. All medications have side effects, most of them potentially serious.Typically a drug has to be on the market for many years to discern all the long-term risks. News has exposed serious adverse effects of two types of drugs that are used to treat high cholesterol and high blood pressure – statins and angiotensin receptor blockers.  The pharmaceutical industry performing their own “research” has a long and consistent record of covering up discovered dangers of their products and embellishing the advantages. Of course, physicians also give the impression that drugs are necessary, when in fact they are not. 

Pill bottle


1. Statins – cholesterol-lowering drugs

Researchers examined medical records of over 2 million statin users in England and Wales in order to quantify side effects during the first 5 years of statin use.

The conditions that were found to be associated with statin use were:

  • Moderate to serious liver dysfunction
  • Acute renal failure
  • Moderate to serious myopathy (impaired muscle function)
  • Cataracts1

Statins have also been linked to increased diabetes risk in another recent study.

Statins, which block a key enzyme in the body’s production of cholesterol, are the most widely prescribed class of drugs in the U.S. Statin use is growing, and will expand even to those who do not have elevated LDL levels, based on the drug-company funded JUPITER study.2 More widespread statin use will continue to give Americans a false sense of security, that they are protected from cardiovascular disease when they are only treating a single symptom. Only excellent nutrition, not drugs, can provide complete protection against heart disease. With widespread use of statins, the nutritional causes of heart disease are not addressed, and a significant number of liver dysfunction, renal failure, myopathy, and cataract cases will be produced. The authors of the statin adverse effect study stressed that physicians should weigh the possible risks and benefits before placing someone on a statin. But since it is rare that a person (on a nutritarian diet) would actually require a statin, realistically the benefits do not weigh heavily. These adverse effects are simply unacceptable when the alternative to these drugs is a nutrient-dense diet and exercise, treatments with only positive side effects.



1. Hippisley-Cox J, Coupland C. Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. BMJ 2010 May 20;340:c2197.

2. Spatz ES et al. From here to JUPITER: identifying new patients for statin therapy using data from the 1999-2004 National Health and Nutrition Examination Survey. Circ Cardiovasc Qual Outcomes. 2009 Jan;2(1):41-8.

Stroke in the news: Beau Biden, Bret Michaels

Stroke is the leading cause of disability in the U.S., and the third leading cause of death. Almost 800,000 people in the U.S. have a stroke each year. Although stroke is usually perceived as a condition that afflicts older Americans, it occurs in people of all ages. About 25% of strokes occur in people under the age of 65, and 10-15% occur in those under age 45.1

At the age of 41, Beau Biden, Delaware Attorney General and son of U.S. Vice President Joe Biden, suffered what was called a mild stroke. Joe Biden himself suffered from a hemorrhagic stroke due to a ruptured brain aneurysm in 1985 at the age of 45.2

Bret Michaels, of the band Poison and a contestant on The Celebrity Apprentice, suffered a subarachnoid hemorrhage (a type of hemorrhagic stroke) at age 47.3

What is a hemorrhagic stroke?

Most strokes, about 85%, are ischemic strokes, in which blood flow to the brain is blocked either by a clot or atherosclerotic plaque. The remaining 15% of strokes are hemorrhagic strokes, caused by bleeding in the brain due to the rupture of a blood vessel. This may be the rupture of a small, damaged artery or an aneurysm. Hemorrhagic stroke is even more devastating than ischemic stroke – the rapid bleeding into the brain compresses the neural tissue, most often resulting in permanent damage or death.1

What makes the small blood vessels of the brain susceptible to rupture?

Hemorrhagic stroke, on average, affects younger people than ischemic stroke does, and the most common cause of hemorrhagic stroke is high blood pressure.4  Elevated blood pressure places stress on the walls of the small delicate vessels in the brain, and is the foremost risk factor for both ischemic and hemorrhagic strokes. Small vessels contain a much thinner layer of muscle, or no muscle layer at all, making them more susceptible to the effects of elevated pressure.

How to protect yourself from hemorrhagic stroke: Avoid salt!

High blood pressure is the most important risk factor for hemorrhagic stroke, and Americans have a 90% lifetime probability of having high blood pressure. The most effective way to keep blood pressure in a favorable range is to avoid the huge amounts of excess salt that most Americans consume. Stroke mortality is significantly higher in Japan and exceptionally high in certain areas of China where salt intake is high, in spite of low-fat diets.5 It is also well established that Third World countries that do no salt their food are virtually immune to hypertension and strokes.

High-salt consumption may be potentially more dangerous for vegans, vegetarians, and others who have earned low cholesterol levels by eating otherwise healthful diets. Many vegans believe that their low cholesterol levels and decreased atherosclerosis risk make them exempt from all types of cardiovascular disease, but this is not the case. Unlike heart disease, cholesterol is not an important risk factor for hemorrhagic stroke. In fact, low cholesterol levels are associated with increased risk of hemorrhagic stroke. A number of studies both in Japan and in the West have illustrated that fewer animal products and a low serum cholesterol were associated with increased risk of hemorrhagic stroke.6 The plaque-building process that results in atherosclerosis and premature death may in some way actually protect the fragile blood vessels in the brain from rupture due to high blood pressure. A high-salt diet may dramatically increase the risk of hemorrhagic stroke in vegans because they can live longer than the general population and not die from a heart attack first. Of course, excess sodium increases both heart attack and stroke death in all diet styles, but in vegans, a high-salt diet may be even more dangerous. To protect against heart attacks, ischemic strokes, and hemorrhagic strokes, you must dramatically curtail salt consumption. 

Excess salt is more dangerous than most people realize. In addition to high blood pressure and stroke, salt contributes to kidney disease, heart diseaseosteoporosis, ulcers, and stomach cancer.7 Avoiding salt is an essential component of a health-promoting, disease-preventing diet.

To learn more, read my articles and newsletters about salt, hypertension, and reducing blood pressure.


1. Centers for Disease Control: Stroke.

American Heart Association: Stroke.

5. Kono S, Ikeda M, Ogata M. Salt and geographical mortality of gastric cancer and stroke in Japan. J Epidemiol Community Health. 1983 Mar;37(1):43-6.

6. Iso HM, Stampfer MJ, Manson JE, et al. Prospective study of fat and protein intake and risk of intraparenchymal hemorrhage in women. Circulation 2001;103:856.

Yano K, Reed D, MacLean C. “Serum Cholesterol and Hemorrhagic Stroke in the Honolulu Heart Program.” Stroke 1989;20(11): 1460-1465.

7. Tsugane S, Sasazuki S. Diet and the risk of gastric cancer. Gastric Cancer 2007;10(2):75-83