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The number one killer in the United States and on the planet Earth is a bad diet. (That is why I’ve dedicated my life to the study of nutrition.) Killer #2 is high blood pressure. The reason it’s so deadly is that it increases your risk of dying from so many different diseases: heart disease and stroke, to heart and kidney failure.

We’re talking an exponential increase in risk of dying from a stroke as our pressures go up, starting from around 110 over 70, an exponential increase in the risk of dying from heart disease, again starting at a blood pressure of about 110/70. We used to consider a blood pressure as high as 175 to be normal––normal if you wanted to die from the normal diseases, like heart attack and stroke. A “normal” of 175 over 110 could put you at over a thousand percent higher risk of having you croak from a stroke compared to the ideal—not the normal, but the ideal, which is down around 110/70.

The definition of high blood pressure, hypertension, dropped from as high as 190/110 down to 160/95, with treatment thresholds for high-risk groups starting at 150/90 down to 140/90, and then, most recently, 130/80. Now…instead of one in three Americans having hypertension, with the new definition, it’s closer to one in two, or more like two-thirds among those over the age of 45. Every time the threshold drops, labeling tens of millions more people as diseased, there’s this backlash. Same thing every time the cholesterol guidelines get more and more stringent; but don’t blame the guidelines. Americans are diseased. That’s the real problem. The American way of life is the problem, not the guidelines.

Maybe we should focus on that instead.

After all, the number one killer of American men and women is heart disease, a disease that can be prevented, arrested, and reversed with a healthy-enough diet.

So, even though a cholesterol of 200 may be normal, maybe we should tell people to strive for under 150. Even though a BMI of 24.9 is technically not overweight, an average height woman, for example, would be better off down around 120 pounds than 145. And, similarly, though a blood pressure of 120/80 may be normal, 110 would be a better top number, and 70 a better lower number, as even down in that range between 70 to 75, or 75 to 80, each 5-point increment is associated with a third more stroke, and at least a fifth more heart disease.

So, why are the new guidelines up at 130 over 80? With an average of three different blood-pressure drugs, you can force people’s blood pressures from 140 down to 120, compared to just giving them two blood-pressure drugs, and high-risk people live longer because of it. Significantly less death in the intensive treatment group, but, because of the higher doses and drugs, had more side effects. So, you have to weigh the risks versus benefits…

One to 2% of people on the drugs for five years will benefit, not having a cardiovascular event when they otherwise might have, and that has to be balanced against the higher risk of adverse side effects. So, you’ll hear commentators saying things like, yeah, the drugs decreased your risk of “events” by 25%, but increased your risk of a serious side effect by 88%. Okay, but those events can include things like death, whereas the side effects are more on the order of fainting.

“These adverse events [do] need to be weighed against the benefits with respect to cardiovascular events and death that are associated with intensive control of systolic blood pressure.” Like, if we use drugs to push high-risk people down to a top number of 120, we might prevent over 100,000 deaths and 46,000 cases of heart failure every year, but could cause “43,000 cases of electrolyte abnormalities and 88,000 cases of acute kidney injury.” Not great, but better than dying.

So, you can see the conundrum guidelines committees are in. On one hand, lowering blood pressure is good for your heart, kidneys, and brain, but at a certain point the side effects from the drugs could outweigh the benefits. Ideally, we want to get patients’ blood pressures as low as possible, but only want to use drugs to do it “when the effects of treatment are likely to be less destructive than the elevated blood pressure.”

The problem is that most people who die from heart disease, heart failure, and stroke may be in that borderline range not sufficiently elevated to warrant drug treatment.

If only there were some way to lower blood pressures without drugs to get the best of both worlds. Thankfully, there are. Regular aerobic exercise, weight loss, smoking cessation, increased dietary fiber intake, decreased alcoholic beverage intake, consumption of a more plant-based diet, and cutting down on salt. The advantage is, first of all, no bad side effects. Some lifestyle interventions can actually work better than drugs, because you’re treating the cause, and actually have instead good side effects. So, not 1 or 2% benefit over five years—everybody benefits.

We’ll explore one drug-free approach—water-only fasting, next.

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