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  Can eating a vegetarian diet lower blood pressure? Both this review and other reviews of studies say YES, that those following vegetarian diets have a lower prevalence of hypertension. Overall, the mean prevalence of hypertension was 21% in those consuming a vegetarian diet and 29% in those consuming a nonvegetarian diet (the differences varied between studies).Those following a vegetarian diet also tended to have a healthier lifestyle. As the researchers point out: blood pressure medicine lowers blood pressure for one day, while lifestyle changes (diet, exercise, not smoking, limiting or avoiding alcohol) can lower blood pressure for life. From Medscape:

Vegetarian Diet: A Prescription for High Blood Pressure?

Hypertension is one of the most costly and poorly treated medical conditions in the United States and around the world. Consequences of hypertension include morbidity and mortality related to its long-term effects, which include stroke, myocardial infarction, renal failure, limb loss, aortic aneurysm, and atrial fibrillation, among many others. Although there is an armamentarium of medications to treat hypertension, we do little for prevention. In this review we examine the relationship between vegetarian and nonvegetarian diets and the prevalence of hypertension. 

Current nonpharmacologic treatments include: physical activity (≥ 30 minutes of moderate-intensity activity on most days of the week); smoking cessation; dietary modification (lower sodium, increased potassium; mainly plant-based foods; low-fat foods; reduced-fat dairy products; moderate amounts of lean unprocessed meats, poultry, and fish; and moderate amounts of polyunsaturated and monounsaturated fats, such as olive oil); weight reduction; management of stress; and limited alcohol consumption.

It is well known that hypertension is modulated by dietary influences. In this review we examine vegetarian, vegan, and nonvegetarian (omnivore) diets and prevalence of hypertension among these dietary populations. A vegetarian diet (ie, lacto/ovo-vegetarian) includes plant foods, dairy products, and eggs (excludes all meat, such as turkey, beef, poultry, seafood, bacon, etc.). A vegan diet is similar to vegetarian, except it further excludes dairy products and eggs (no animal or animal products). On the other hand, an omnivore diet (referred to as nonvegetarians throughout this study) includes both plant and animal foods and products.....The majority of studies included in this review addressed vegetarians and vegans as a single group (vegetarians), whereas others differentiated them. Vegetarian diets are known to be low in saturated fat and cholesterol, high in fiber, low in sodium, and high in potassium. These key elements have been shown to correlate with lower incidence of cancer, heart disease, and other chronic diseases, such as diabetes type II, hypertension, and hyperlipidemia.

The exact percentage of those following a vegetarian or vegan diet in the US is unknown; however, a 2014 study found that 221 of 11,399 adult respondents, from a group generally representing the demographics of the US, identified as vegan (0.5%), vegetarians (1.5%), or meat-eaters (98%). The prevalence of hypertension in the US in 2011 was roughly 33.8%.

The mean prevalence of hypertension in those consuming a vegetarian diet was 21% and 29% in those consuming a nonvegetarian diet. The overall prevalence of hypertension among vegetarians was 33% lower than nonvegetarian diets. These data support the hypothesis of a decreased prevalence of hypertension in those maintaining a vegan or vegetarian diet versus a nonvegetarian diet, in cross-sectional, cohort, and case-control studies, and in those consuming a vegan or vegetarian diet according to an experimental dietary change. The blood pressure benefit is noted to disappear in those reverting back to a nonvegetarian diet. 

Overall, these findings support previous reviews and meta-analyses of vegetarian and nonvegetarian diets and blood pressure. A recent meta-analysis that identified 39 studies with 21,915 participants concluded vegetarian diets were associated with a drop in mean systolic (-5.9 mm Hg) and diastolic (-3.5 mm Hg) blood pressures when compared with nonvegetarians. Other reviews had similar conclusions, showing that vegetarians have a lower blood pressure compared with nonvegetarians. Of the studies that included a vegan diet separate from other vegetarians (eg, lacto/ovo), the data show a significantly lower prevalence of hypertension when compared with nonvegetarians and other vegetarians. However, limited research has been conducted on strict, consistent vegan diets.

There are possible rationalizations for the observed associations between diet and hypertension. First, vegetarians have a lower rate of smoking tobacco. Smoking can increase blood pressure acutely and chronically over time.....Second, vegetarians tend to drink less alcohol compared with nonvegetarians. Alcohol, specifically ≥ 2 drinks/day, increases blood pressure by causing vasodilation, followed by a compensatory increase in blood pressure.....Further, vegetarians have a lower mean BMI when compared with nonvegetarians, which means a lower overall weight....Fourth, vegetarians tend to exercise more than nonvegetarians. Vegetarians reported a greater incidence of physical activity of ≥ 30 minutes of moderate to vigorous activity per day.

A limitation of this study is that it remains unclear whether vegetarians are more health conscious and therefore live healthier lives, or whether a predominant diet of fruits and vegetables is a basis for lower blood pressure.

 People have asked me if eating sweet desserts or hamburgers is bad for the health if the rest of their diet is good - with lots of fruits, vegetables, whole grains, legumes (beans), and nuts (much like the Mediterranean diet). My sense over the past few years of looking at the research is that one should look at the overall diet, and that a "perfect diet" all the time is pretty darn hard to achieve, if not impossible, for most of us. So this new research looking at gut bacteria and "chemical fingerprints of cellular processes" (by looking at stool and urine samples) of people eating different diets (vegan, vegetarian, omnivore) was reassuring.  The findings suggest: make sure to feed your beneficial bacteria with a healthy diet like the Mediterranean diet (lots of plant-based foods), and then some deviation (cookies! steak!) is OK.

The researchers found that while the kind of gut bacteria dominating were different among the groups (vegan, vegetarian, omnivores), they also found that eating a lot of fiber-rich foods, such as fruit, vegetables, and legumes (typical of a Mediterranean diet) is linked to a rise in health promoting short chain fatty acids (SCFA). Yes, levels of trimethylamine oxide (TMAO) (which is linked to cardiovascular disease) were significantly lower in vegetarians and vegans than they were in those of the omnivores. But the more omnivores closely followed a Mediterranean diet, the lower were their TMAO levels.(Which is great!). As the researchers said: "Western omnivore diets are not necessarily detrimental when a certain consumption level of plant foods is included. From Science Daily:

High dietary fiber intake linked to health promoting short chain fatty acids

Eating a lot of fibre-rich foods, such as fruit, vegetables, and legumes--typical of a Mediterranean diet--is linked to a rise in health promoting short chain fatty acids, finds research published online in the journal Gut. And you don't have to be a vegetarian or a vegan to reap the benefits, the findings suggest.

Short chain fatty acids (SCFAs), which include acetate, propionate, and butyrate, are produced by bacteria in the gut during fermentation of insoluble fibre from dietary plant matter. SCFAs have been linked to health promoting effects, including a reduced risk of inflammatory diseases, diabetes, and cardiovascular disease.

The researchers gathered a week's information on the typical daily diet of 153 adults who either ate everything (omnivores, 51), or were vegetarians (51), or vegans (51), and living in four geographically distant cities in Italy....The Mediterranean diet is characterised by high intake of fruit, vegetables, legumes, nuts and cereals; moderately high intake of fish; regular but moderate alcohol consumption; and low intake of saturated fat, red meat, and dairy products. Most (88%) of the vegans, almost two thirds of the vegetarians (65%), and around a third (30%) of the omnivores consistently ate a predominantly Mediterranean diet.

The investigation showed distinct patterns of microbial colonisation according to usual dietary intake. Bacteroidetes were more abundant in the stool samples of those who ate a predominantly plant based diet, while Firmicutes were more abundant in those who ate a predominantly animal products diet. Both these categories of organisms (phyla) contain microbial species that can break down complex carbohydrates, resulting in the production of SCFAs.

Specifically, Prevotella and Lachnospira were more common among the vegetarians and vegans while Streptococcus was more common among the omnivores. And higher levels of SCFA were found in vegans, vegetarians, and those who consistently followed a Mediterranean dietLevels of SCFAs were also strongly associated with the quantity of fruit, vegetables, legumes, and fibre habitually consumed, irrespective of the type of diet normally eaten.

On the other hand, levels of trimethylamine oxide (TMAO)--a compound that has been linked to cardiovascular disease--were significantly lower in the urine samples of vegetarians and vegans than they were in those of the omnivores. But the more omnivores closely followed a Mediterranean diet, the lower were their TMAO levels, the analysis showed.

TMAO levels were linked to the prevalence of microbes associated with the intake of animal proteins and fat, including L-Ruminococcus (from the Lachnospiraceae family). Eggs, beef, pork and fish are the primary sources of carnitine and choline--compounds that are converted by gut microbes into trimethylamine, which is then processed by the liver and released into the circulation as TMAO.

The researchers point out that SCFA levels can naturally vary as a result of age and gender, and their study did not set out to establish any causal links. But they nevertheless suggest that the Mediterranean diet does seem to be associated with the production of health promoting SCFAs. They conclude: "We provide here tangible evidence of the impact of a healthy diet and a Mediterranean dietary pattern on gut microbiota and on the beneficial regulation of microbial metabolism towards health maintenance in the host." And they add: "Western omnivore diets are not necessarily detrimental when a certain consumption level of [plant] foods is included."