ZOE Science & Nutrition - 4 lifestyle changes that lower high blood pressure | Dr Sanjay Gupta

Episode Date: January 29, 2026

High blood pressure is the number one risk factor for deaths globally. But what if your blood pressure numbers were only part of that story? In this episode, we’re joined by leading cardiologist Dr Sanjay Gupta, who explains why blood pressure is not a disease, but often a scream for help. Together with ZOE’s Chief Scientist, Professor Sarah Berry, he explores when blood pressure is a harmless response to stress, food, or movement, and when it signals real, long-term damage. You’ll learn why blood pressure targets aren’t universal, why worrying can make things worse, and why quality of life matters as much as numbers. This episode also breaks down what you can do to lower your blood pressure. Not quick fixes. Not pills. But everyday lifestyle changes that address the root cause. If your blood pressure is your body sending a message, what might it be asking you to change? Unwrap the truth about your food 👉 ⁠Get the ZOE app  🌱 Try our new plant based wholefood supplement - Daily 30+ *Naturally high in copper which contributes to normal energy yielding metabolism and the normal function of the immune system Follow ZOE on Instagram. Timecodes 00:00 Intro 03:40 What blood pressure really is 09:10 The damage builds slowly (and you won’t feel it) 11:00 The two numbers explained in plain English 13:05 Why the ‘right’ number depends on you 15:04 Why doctors can’t agree on ‘high’ 16:35 The first rule: don’t panic 17:45 The clinic reading problem 20:20 The misdiagnosis issue 22:02 What high blood pressure can damage 23:40 Why problems show up years later 24:30 How common is high blood pressure? 27:00 The ‘silent killer’ warning signs 28:10 The bigger cause most people miss 29:10 Salt: why it helps some people more than others 33:30 The age effect most people ignore 35:11 How stress can push blood pressure up 36:35 The gut microbiome link (and the new research) 39:15 Why treatment can still fail 40:10 The uncomfortable numbers on medication benefit 41:15 The simple home-measurement routine 44:05 Sugar vs salt: what surprised the cardiologist 46:45 Where most salt really comes from 49:25 The exercise effect (and why it matters) 51:05 How fast lifestyle changes can show up 📚Books by our ZOE Scientists The Food For Life Cookbook Every Body Should Know This by Dr Federica Amati Food For Life by Prof. Tim Spector Ferment by Prof. Tim Spector Free resources from ZOE How to eat in 2026 - Discover ZOE’s 8 nutrition principles for long-term health Live Healthier: Top 10 Tips From ZOE Science & Nutrition Gut Guide - For a Healthier Microbiome in Weeks  Better Breakfast Guide Mentioned in today's episode Your gut microbiome and heart health Gut microbiome diversity and hypertension, Journal of Hypertension (2021) Ultra-processed food raises risk of heart disease, heart attack and stroke, BHF (2023) Potassium and blood pressure, British Journal of Nutrition (2010) Have feedback or a topic you'd like us to cover? Let us know here. Episode transcripts are available here.

Welcome to Zoe Science and Nutrition, where world-leading scientists explain how their research can improve your health. Can you name a health condition that has no symptoms, but it's the single greatest risk factor for death globally? No? Here's another clue. 30% of adults in the world have it, and it causes dementia, heart disease and stroke. Any guesses? The answer is high blood pressure, known to doctors as the same. silent killer. However, while high blood pressure is serious, today's guest explains there are steps you can take right now that can make a huge difference. Today, I'm joined by Dr. Sanjay Gupta, one of the UK's leading cardiologists based at York Teaching Hospital. He's a passionate believer that lifestyle changes are the most powerful way to improve your blood pressure.

In this episode, Sanjay shares evidence-based, sustainable lifestyle changes that can significantly reduce blood pressure and support overall health and well-being. By the end, you'll have all the tools you need to keep your blood pressure in check. Sanjay, thank you for joining me today. Thank you for having me. And Sarah, thank you for being here. Pleasure. So Sanjay, we have a tradition here at Zoe where we always start with a quick fire round of questions from our listeners. And we have these very strict rules. You can give us a yes or a no, or if you have to a one-sentence answer. You're willing to give it a go? Yeah. All right. Can long-term high blood pressure lead to dementia?

Yes, absolutely. Is low blood pressure always better than high? No. Can simple lifestyle changes lower your blood pressure significantly? Yes. Does alcohol help lower your blood pressure if you're stressed? It may do. Can your gut microbiome influence blood pressure?

Absolutely. And finally, what's the most common misunderstanding about blood pressure? The idea that blood pressure is a disease. For many people, blood pressure, I believe, is a scream. The body is screaming out and saying, I'm unhappy. And if we take the scream and make it a disease, then you end up treating the blood pressure, but not addressing the root cause of the scream. And in some ways, you do that patient into service. I've definitely heard of high blood pressure, and I know that it's one of those things that lots of us are talking about. by our doctors that we should worry about. But I can't be the only person who doesn't really understand what it means, why my blood pressure rises, and what it means for my health. So luckily, we have one of the UK's leading cardiologists to help us finally understand

what it's all about. And we're joined by Professor Sarah Berry, who I discovered actually spent many years running clinical trials in humans looking at the impact of food on blood pressure. So I think we're in for a treat. Can we just start at the beginning, Sanjay? What is blood pressure? Okay. to understand blood pressure, we have to understand pressure. And pressure is physiologically a formula,

which is force over area. You exert some force over an area, and that equates to pressure. If you increase the force, you increase the pressure, provided the area remains the same. Or if you reduce the area, and the force is the same, the pressure goes up. So blood pressure is the pressure exerted by blood on the area of our blood vessels. So the force is dictated by the heart rate and how much blood is coming out of the heart because the heart is pumping the blood into these blood vessels. And the area is dictated by the radius of our arterials, our blood vessels. So blood pressure will vary based on heart rate, how much blood is coming out of the heart, and also the surface area of our arterials.

So it is a constantly changing dynamic variable. It is not something which is static all the time, and this is a common misconception amongst the general public. And blood pressure will go up physiologically, depending on what you're doing. So if you're moving, your heart rate will go up, your blood pressure will go up. If you are stressed, your blood pressure will go up.

If you've had too much salt, your blood pressure will go up. If you're producing stress hormones, they cause our blood vessels to constrict. So your area has gotten less and the blood pressure will go up. That is not a disease. That is just a response to the body in response to the things that that person is doing. Why is blood pressure important? Well, I'd liken it to a little bit like when you're trying to water your plants.

You have to have a certain amount of pressure in your host pipe to get the water to that plant. if you don't have enough of a pressure, the plant doesn't get the water and dies. If you have too much pressure, you damage the plant. And this is exactly how blood pressure works. It has to be within a certain range. If it's too low, then the patient's organs don't get the blood, and those organs suffer. And if it's too high, you damage those organs by damaging the blood vessels. And that is why blood pressure is important.

So you don't want it to be too low and you don't want it to be too high because you risk damaging the blood vessels. And therefore, those blood vessels then heal by clotting off, which means less blood gets to those organs. And so, like, during my day, if my heart rate goes up because I'm running to catch the bus, are you saying that literally because my heart rate has gone up, then suddenly my blood pressure goes up almost in proportion to my heart rate? Absolutely. And you can see this very starkly when you're watching Olympians, for example, weightlifters. When they're lifting all this weight above their head, you can see their blood vessels sticking out and their eyes ready to pop out, you know. And we don't see anything bad happen to them. We say, well, this is because they are exerting this amount of effort.

It is in direct response to what they're doing. So the point is that our body and our body's blood vessels have the ability over a period of time to cope with certain pressures, on environmental factors, etc. The problem arises when over a period of time our blood vessels start losing their elasticity. And when our blood vessels start losing their elasticity, they can no longer stretch to accommodate some of that pressure, keeping that pressure down. And so if the blood vessels cannot stretch because of wear and tear, hardening, etc., that's when the blood pressure goes off. So one has to distinguish between, oh, is this just physiological? Is this because I'm just stressed?

Is this because I'm just eating the wrong food? Or is there a harmful process going on in my body, which is causing progressive hardening of my blood vessels, which then results in the sustained elevation in blood pressure? I think that in some people, the blood pressure is a symptom of something else, and it is probably the lifestyle, the obesity, the bad food, all that kind of thing that probably causes the blood pressure to be elevated and also contributes to type 2 diabetes, fatty liver, all that kind of thing.

And that probably harms more people than just looking at blood pressure as a single variable. You know, I think that's really important to say. For example, what happens is a patient goes because they carry too much weight, they're stressed, they're not sleeping, they're eating all the wrong food, they go to their doctor, their blood pressure is up. The doctor says your blood pressure is up. We need to give you some tablets. tablets, the blood pressure goes down. The patient is happy.

He's comforted by the fact that those tablets have done the job, and he thinks that is no longer a problem. But then you find that his HBA1C starts rising. And then he goes back to the doctor. And again, perhaps the HBA1C going up is another scream from that unhappy body. So I think it's very important that we start realizing that some of these things are symptoms,

not conditions of their own accord. I'm not understanding the harm. yet. So long term, like, I understand I don't want to die of a heart attack or I don't want to get dementia. Help me to understand if this blood pressure keeps up high long term, like, do I care about these little clots in my tiny blood vessels? Absolutely, because at the end of the day, if this is happening every day, the amount of blood getting to your vital organs is going to go down substantially. That's how all these things happen. So it's not a case of the blood pressure is not doing anything to your body and suddenly you have a heart attack 10 years down the line and someone

says, oh, it's the blood pressure that causes this. Something has to be happening on a microscopic level over a sustained period of time, and then it translates into macroscopic damage, stuff that you can see. So dementia isn't a case of you're fine, fine, fine, and then something happens and you develop dementia. It is a progressive, insidious, slow process that's going on in the brain that gets missed because the person looks fine. You know, on the outside, the person looks fine.

they feel fine, but what is going on in their bodies. So if you look at hypertensive patients, for example, patients with true high blood pressure, and if you look in their eyes, for example, you will see evidence of bleeding within the retina. And that is a very good marker. It tells you that that number is too high for that patient. The problem we have is we have this kind of value, and everyone says, oh, a blood pressure of 140 over 90 is high, treat it, treat it. But we're all different. So that number in a 90-year-old has very different connotations to a 20-year-old and someone who's an athlete compared to someone who is elderly and very frail. You can't treat them in the same way. The benefit-risk ratio of medications changes based on who that patient is.

And Sanjay, could you explain what those different numbers are that you've mentioned? So many listeners, I assume nearly all listeners all have had their blood pressure measured at some point and will have been told, you know, there's these two different numbers. Can you explain what they mean? Have you tried our dark cacao chia pudding yet? You should. It's filling, delicious and packed with anti-inflammatory ingredients. You can find it in our new free Better Breakfast Guide,

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To get more recipes like this, download your free better breakfast guide right now at zoey.com slash breakfast or click the link in the show notes. That's zoey.com slash breakfast or click the link in the show notes. So the two numbers that we commonly measure blood pressure with is a systolic number, a top number and a diastolic number, which is the bottom number. The systolic pressure is the highest pressure your blood vessels are exposed to and is the pressure which happens when the heart is actually pumping blood out into the vessels. So if I had a balloon, for example, the systolic would be me blowing into the balloon,

and that pressure is the systolic pressure. The diastolic pressure is if I then put my fingers at the end of that balloon, there's still a pressure which is being exerted by the recoil of that balloon onto the thing. So if I let my hand go, the balloon flies off, because of this pressure. That is the diastolic pressure. So the systolic pressure tells you about the heart rate, about how much blood is coming out of the heart, and it tells you about the capacity of the blood vessels to accommodate that pressure. The diastolic pressure is all about elastic recoil of the blood vessels, so it tells you about the health of your blood vessels. It has nothing to do with the heart,

etc., etc. The question then is, which is more important? And the systolic is more important in terms of treatment because it is the higher pressure. If your blood vessels can tolerate a pressure of 140, then we shouldn't really be too worried about a pressure of a hundred because it is the lower pressure and the way the pressure damages you is the higher the value, the more likely you're going to get damaged. However, the diastolic does tell you a little bit about the health of your blood vessels. So when it comes to treating lifestyle will help both. Medications tend to just lower the pressure. And that is the difference.

So the systolic blood pressure is more important in terms of the harm the number does to you. But both values tell you a little bit about what's going on in your body. And could you summarize what you think the target numbers that people should be aiming for? I know that that's a tricky question for a cardiologist. I don't believe that high blood pressure or low blood pressure is a bunch of numbers. It is what that number is doing to that patient. which is very much aligned with what you guys do, individualized medicine. High blood pressure is blood pressure that does that patient harm.

It's not a number. But if a 90-year-old comes to me with a blood pressure of 150 over 90, I wouldn't automatically rush in and say, oh, you know, you must take a tablet, et cetera. In fact, doing that, we'll just raise that person's blood pressure further. So I would say, hey, look, you know, you're here. You are 90 years old. the more important thing in your case is quality of life, not, oh, I'll give you a tablet and suddenly

guarantee that you'll live till 95. But this is what is happening these days, because we've become so protocolized, we're so guidelines-centered, we're not patient-centered anymore. In my practice, what I am interested in is taking that in the context of that patient and then working out how you bring those numbers down in as natural a way as possible, and if medications are needed, so be it, but not at the cost of that person's quality of life. That is, I think, really important. And you refer to those numbers as a scream for help. And people do like to put their numbers in the context of what the average is or when they should seek advice.

So whilst I know it is very individualised, is there a number that you could give to listeners to say, look, this is what it ideally should be before you see it as a scream for help? Well, if you go by the guidance, 140 over 90 is sort of the kind of value. If it's sustained and it's elevated beyond that on repeated measurements, then it's probably what is considered high. Of course, different places have different criteria. So if you go to the Americans, they have low values, you know. And what is very interesting and quite absurd about the whole thing is if you have a bunch

of American doctors there and you have a bunch of European doctors and you say, what is high blood pressure? The two groups give different values. The Americans will say it's 130 and the Europeans will say 140 and I say, well, okay, well, why don't you just give your hypertensive patients in America one-way ticket to Europe and you've cured their condition? That is ridiculous. That is how absurd the world has become. You know, this is our fixation on numbers. That is, to my mind, not the way to practice good, individualized medicine, you want to see that person and you want to address them holistically rather than just targeting one set of numbers. And interestingly, those sets of numbers and those guidelines change every so often anyway. So I just want to understand, Sanjay,

because it's a bit nuanced. Are you saying, if my blood pressure is high, don't worry about it. It's not relevant for my health. Everything about high blood pressure is non-reliven. or are you saying something else? No, I'm saying the first thing is don't worry about it because worrying is only going to increase your blood pressure. Worrying doesn't stop anyone dying or anything. Warring just erodes your quality of life, so don't worry about it. But I think it is important that you are empowered to understand that your blood pressure may be a manifestation of a whole host of different things. And just going and getting a pill to lower it is not the answer.

So I'm not saying ignore it. I'm saying it is important to take into account what that blood pressure is trying to tell you. I think it is really important for patients to educate themselves because actually we've become so protocolized, so guideline bound, that now even doctors, you know, who are doing this have only been taught, well, the blood pressure is this value. You've just got to hit it with tablets, hard, hard, hard, hard. And so I'm very much for patients understanding. that it is nuanced. I am very much for patients saying, okay, my blood pressure is high, how is it measured? Is it just a one-off? Is it a crude measurement? Is it sustained? Is it been done in a better way? Has it been measured? Because blood pressure, you know, when you go to your doctor's office and have your blood pressure check, that's a very artificial environment. The heart rate's going to be up, you're going to be stressed, et cetera, et cetera. If on the basis of that, you are told that you have this diagnosis, that you have to then carry around as a label for the rest of your life. Well, I think I have an issue with that. I think what we need is

patients to realize that that's a very crude reading. You want a better way before you are labeled with something like that to measure it. And then I think you have to have a detailed evaluation of whether that number is actually harming you. And if you have all that information, then you are in a better position to make lifestyle choices and even start treatment and then have your measurements repeated in the same way. Not, oh, I had a very sophisticated 24-hour blood pressure monitor first, and then I went to my doctor and he did a hand reading and he says it's not coming down.

Well, you have to compare apples with apple. So I think that we should never ignore something. I think worrying about it doesn't sort the problem out, but I do think that we are in an era, especially with the internet, where patients are keen for more information and they're keen to feel more empowered about it. taking charge of these things. This is a really important point we see in our own research, and this is

in a research setting which is slightly similar to the doctor setting, that there's a huge change upon repeat visits in blood pressure readings. So when they first come to us to get their blood pressure done compared to the second time, there's quite a significantly higher blood pressure reading the first time versus second time. I know the doctor's surgery. It's called white coat hypertension, and that's why I think what you've just said now is really important. that you don't just take a one off reading, that you do repeat readings. And why is that? Because if I do my blood pressure now, whilst facing all your complex questions, it's going to be higher than when I go home.

Because you're anxious, your heart rate is higher. Yeah, absolutely. So for me to be labeled with a condition that is going to flick the rest of my life, and it is not just about having a label, it will affect my insurance, it will affect my insurance, it'll affect everything. And it will cause my blood pressure to go up as well. To be told now, I have a medical condition which is associated with a very high risk of heart attacks and strokes. So I think it's very important that we are more responsible and we do the harder thing, which is a more detailed evaluation of the patient rather than this standard, oh, let's just do a blood pressure.

Now with automated machines as well. So there's a lot of scope there. And I think that one would say that almost a quarter of people, people who are told who have high blood pressure probably don't have sustained hypertension, and they end up carrying this label, taking medications, suffering the indignity of side effects, etc. So much more detailed readings are important. Another point to mention is that I think when we talk about blood pressure, the question is, how do we know blood pressure is a bad thing? okay well we know because someone has done some research and said okay high blood pressure is associated with bad things but you've got a variable that is constantly moving so how did those people do that research because we are following on from that research and so most people do a much more

sophisticated reading of the blood pressure these stained readings etc whereas what that is now degraded into is these oh come to clinic two or three times in a month and if your blood pressure is high we'll just put you on some tablets. Yeah, and I think the really good news is blood pressure monitors are very cheap. They're very easy to access. Most people can just get them from, you know, shops that are nearby. They're about £40 in the UK, similar dollars in the US. And these are ones that are typically accredited with hypertension societies.

So it is something you can measure at home. And then you can do these repeat measures and also at different times in the day. Before we move on, can you clarify what would happen if my... blood pressure is high, and I don't do anything to treat that. If it is high and your blood pressure is damaging you, then that damage will accrue over the number of years and will then translate into signs of visible damage. So those include dysfunction of the brains, so things like dementia, strokes, heart attacks.

Because the heart is a muscle and has to push against a higher blood pressure all the time, the heart becomes more and more muscular, and after eventually it becomes so muscular that it outstrips its own blood supply and can then lead to heart failure. And also, where our tiniest blood vessels are in our eyes and our kidneys, the eyes can get damaged,

and the kidneys can get damaged, and high blood pressure can lead to progressive renal failure as well. So eventually, because the blood vessels supply all the organs, blood pressure will have an impact, an adverse impact on virtually all our organs. But the most notable ones are the brain, the heart, the kidneys, and the eyes. Listening to that, firstly, it's pretty serious if you do nothing about it, is my takeaway. Absolutely. But the second thing I'm really surprised by is I had no idea I had anything to do with my brain or dementia.

I always think about blood pressure as something to do with my heart and heart attacks. Have we always known this and this is just like poor PR? No, I think the problem is that you can only measure that which you can see. Dementia is something you don't actually see until it becomes very advanced. So again, empowering people to realize that these are not processes that don't do anything to you and then one day something bad happens is perhaps a very simplistic view. There's stuff going on in your body, and that damage is happening, happening, happening, and then it starts showing up 10, 15, 20 years later. So I could have high blood pressure, and it could be causing this, like, very small damage into my brain, for example, over as long as 20 years before anyone sees the

results of dementia. Yeah, absolutely. I'm very convinced that that happens. Just to come back to the numbers for a minute, because I think you've both really emphasized the fact that one single measurement in the doctor's lab is the worst possible way to tell whether or not I have high blood pressure. But let's say, I've done this over an extended period of time. It's a measurement that you would believe was quite accurate. What would be a number that would make me feel good, that it's sort of low enough? And how many of us today in the Western world are sort of higher than that range? So one would argue that certainly in the UK, one in four people have hypertension. One in four? Yeah. Globally, it's about 30%. Wow. They have high.

pretension, meaning their numbers are higher than what the guidelines recommend. In terms of numbers, I think also it's important to understand that your number may be within normal range, but may still be high for you and may still be harming you. And therefore, that is why it's so useful to look for evidence of harm, because you understand that person. If we're just going on the superficial side and saying, oh, what number will keep me happy? I'd say if it's below 140 over 90, then that's what the guidelines say is acceptable, right? We're in the business of treating populations, and when you're trying to treat populations, resources tend to be a little bit more limited.

You want to do the easiest thing, et cetera, et cetera, and that's why things are happening. But I think there is a better way of doing it. So if I have a patient, I would say, well, look, first let me work out what your number is. Let's work with one number, not it's 120 of 80 now. it was 130 of 80, 10 minutes ago, yesterday was 125. What is your number? Let's get one number. Then let's see whether that number is high for you.

And I would do that by looking at the back of their eyes, making sure there's no bleeding. I'd look at their heart. Is the heart more muscular than normal? That tells me about that person. And then I would say, okay, we have evidence that your number is a little bit where people would say it's high, and there's some evidence of damage. So that makes it more urgent we do something about it. And that should always be with education, lifestyle management, and potentially medications.

And then I would then bring them back and I would say, let's look at all those things again. Let's repeat the blood pressure and see if your numbers come down. Let's see if your body mass index is a bit better. Let's see if you're eating better. Let's see what these medications are doing. Are they actually destroying your quality of life or are they suiting you? and how effective are those interventions by repeating that 24-hour blood pressure moment? And that is the way I think it should be done for patients.

And Sanjay, there'll be lots of people that won't have the privilege to come to see a cardiologist like yourself. And I know that hypertension is often called the silent killer. Are there any symptoms that people at home could look out for themselves? Yeah, I think, I mean, certainly things like fatigue, headaches, breathlessness when you're exercising because you're, your heart has to work against a higher pressure. Will everyone who has high blood pressure have symptoms and therefore know that something is going wrong? No, not at all.

Only a minority of people who have elevated blood pressure actually develops symptoms to the extent that they know something is wrong. That does not sound good. I think I now understand anything that's called the silent killer is something that clearly I don't want to have. I think we understand now that this can be really serious condition, that also that there's there's nuance beyond just like one single number and that it's really common,

I'd love to understand what causes the high blood pressure because I assume that, you know, my six-year-old daughter probably does not have high blood pressure and that most of the people who could come to see you also when they were six years old did not. So this is something that develops over time. The only thing I know about is somehow eating lots of salt is supposed to be bad.

I think that's what I grew up being told and being very stressed, Is that the answer? No, I think there's a lot more to it than that, and we're beginning to realize it, and I think that our nutrition plays a huge role. My belief is that the food industry is bothered about our taste, not about our health. And so a lot of compromises are made, and we're consuming all sorts of things that we have no idea of because they're packaged in a way which is sold to us as healthy.

I think alcohol plays a role. I think lack of sleep, I think, is huge. there are certain supplements which have been eroded in our diet, magnesium, for example, due to modern farming methods and processing, and all those things probably also have an impact on blood pressure. So I think there are a ton of things in our environment, in our lifestyle, which contribute to essentially premature aging of our blood vessels, which then become stiffer and the blood pressure keeps going up.

obesity being a big thing, lack of exercise being a big thing. Something that I'm really interested in is the variability in response to salt. Now I know at a population level, if you reduce your salt intake, about 75% of people will get some sort of reduction in blood pressure. What we see is about 25% of them actually get a really big reduction, so a really big benefit. They're salt sensitive. And yet we see that there are a proportion of people that actually have no benefit from reducing their salt intake. So as a kind of public health policy, many countries have focused on sold as a target, which is great because yes, at population level, it's important. But I think we should be thinking about it a little bit differently.

And I'd love to hear your view on potassium and how important that is, because I think we need to change the narrative a little bit around this. Absolutely. I completely get that. With regards to your question about potassium, absolutely. There are data to show that actually a higher potassium increases salt-exempt. It's better for endothelial function. It's a vasodilator. It suppresses the hormonal mechanisms in the body which regulate pressure. So potassium supplementation will also do these things. And those are all things. And I don't think it's necessarily also going to be for everyone, just like salt. Maybe these are things that we need to understand that patient and we need to see whether that works for that patient. And then we need to have ways by which we measure that pressure again. to get an accurate representation of what it's doing. So they have to be proper clinical studies, and they have to go on for a long period of time,

and ideally they need to be measuring hard outcomes. What are the key things that are most likely, in our modern world, to lead to high blood pressure? Certainly age contributes, and you can't do much about that. But I think all those things that come along with a Western lifestyle, putting on weight, more stress, a reliance on fast foods, reliance on processed foods, all those things that are designed to make our lives easier, in some ways, probably have an impact on all that and may contribute to our pressures going up. If you look at the data,

the prevalence of hypertension under the age of 40 is 10%. It goes up, you know, 40 to 60, it becomes almost 30, 40%, 40%. And then above 6,000, it's the amount. it's over 60%, so more than one in two people have high blood pressure once you get to 60. This is with all the research, with all the tools that we have at our disposal, clearly it isn't working. Why is this happening? And therefore, we have to have the courage to start thinking differently. And I think this is where holistic, individualized healthcare comes in,

where we should be integrating and we should be collaborating with nutritionists and all people, you know, for that person. And Sanjay, I've seen estimates that about 70% of the variability in blood pressure, i.e. the chance of you developing high blood pressure, is due to modifiable factors. So factors that are within our control. You've listed a few of these. Age obviously isn't one of them, but you've listed diet, stress and body weight. Are there any other factors that are also within our control that we can do something

about to prevent this rise in blood pressure? I think sleep is really important. Exercise is important. Diet, what you're putting in your body, things like smoking, alcohol excess and stress. And why is it that stress impacts our blood pressure? Because stress is in so many ways associated with all those kind of hormones that are produced, which actually constrict our blood vessels. So if you're in a state of chronic stress, our blood vessels are going to be much tight.

in general, and that will then contribute to the blood pressure going up. And of course, stress will affect your sleep. When you don't sleep, you develop a predilection for sweet foods. When you develop a predilection for sweet foods, you get these huge surges in insulin. So it's all interlinked. And it's also very important, I think, that people become a lot more aware of the food industry and what the food industry is all about and what kind of compromises are made with your food before it ends up on your table. It's important to understand that sometimes your blood pressure is a manifestation and outwardly manifestation of the compromises you're placing on your body. And therefore, it shouldn't be looked upon as, oh, blood pressure is the worst thing in the world. It should be what you're doing

to your body. That Western lifestyle is probably more harmful. Stress is probably more harmful. If you're smoking 100 cigarettes a day, that's more harmful than trying to control the blood pressure that has risen as a consequence of that. Yeah, I think it's a great way of looking at it as a symptom of our lifestyle, as a symptom of what's in our supermarket and our grocery stores. 100%. And if you look at diabetes, type 1 diabetes is a condition, but type 2 diabetes for most people is a symptom. That, I think, is really important.

What about our gut microbiome? Sir, I know you've done some research on this. What have you found? Yeah, so we've done quite a lot of, lot of work at Zoe and at King's College London looking at microbiome and links with blood pressure. So firstly, we've run a study in the Twins Department, which Tim Specter, one of the co-founders at Zoe overseas. And what we found was that there's a different microbiome composition between those people

who have hypertension, so have high blood pressure versus those that have normal blood pressure. We also see a different in the diversity, so how diverse that microbiome is, which we know is quite important in terms of health. We've also looked at this in our own Zoe studies. So in up to 35,000 people now, we've looked at this. And what we see is that there's actually a microbial signature. So there's this signature of specific species, so specific bugs in our gut that are linked with a high blood pressure and conversely a signature that's linked with low blood pressure. And we've actually replicated this and recently published it a couple of weeks ago in nature. We've, we've, looked at this in lots and lots of different cohorts. And consistently we see it's these same

bugs associated with the higher blood pressure, same bugs associated with lower blood pressure. We don't fully understand why. We think one of the reasons going back to low-grade inflammation, we know that these species release different chemicals like short-chain fatty acids. They're involved in how they process other food debris that's reaching our gut that may also impact how the lining of our blood vessels interact, how constricted they are and so forth. So the mechanistic stuff is, I think, where it gets interesting where we need to learn a bit more. But I think the results that we've seen are really exciting and could be a potential target for the future as well, because instead of just treating the symptom, we'll be treating one of the underlying causes.

And this is why diet's so important. We know diet impacts those microbes. And I think this is exactly where we need to be heading. And it would be really interesting to see whether what your findings are, not only benefits, fit people with high blood pressure, but also with type 2 diabetes, also with obesity, because I think they're all different screams from an unhappy body. And I see this all the time. I see this. So I will go up to my coronary care unit and I'll have a patient there who's had a heart attack. So let's say a 60-year-old man heart attack. And I'd say, well, what are his risk factors? And the doctor who's

presenting the patient will say, oh, he's had diabetes and high blood pressure. And I said, how long has he had diabetes and high blood pressure. Oh, well, he's had diabetes and high blood pressure for 20 years. And I say, okay, and has he been treated for those? And they say, yeah, he's been on tablets. And I say, so why has he had a heart attack? Because he's got diabetes and high blood pressure. So what were we treating him for? But no one looks at it like that. No one says, okay, perhaps that is a failure in the treatment that we've been giving that patient, that he has still ended up having the outcome. you know, we have to be a little bit more reflective. We can't just say, oh, he's been on treatment, but hey, ho, people on treatment still have heart attacks.

And Sanjay, is that why you were saying things aren't working in terms of treating high blood pressure? Is this what you're saying? Absolutely. I think more people are having heart attacks. I think younger people are having heart attacks. I think places like America where they have stricter guidelines still are having more heart attacks than other places. So the current treatment for blood pressure isn't. actually reducing the heart attacks and the dementia and these other sorts of things you can talk about.

And if you look at the data, the number needed to treat is the number needed to treat being an idea as to how many people you have to treat to achieve benefit in one person, be that some kind of reduction in a hard endpoint, death or a heart attack or something like that. And the number needed to treat is big. You may have to treat between 30 and 60 people for several years to achieve benefit in one person. So the question then is we have to look at that and say, is that good enough? If those were the returns in a bank, I wouldn't be putting my money in that bank. So I would love to switch here actually into there for what people can do because I think lots of listeners like me are probably coming away saying, well, this high blood pressure thing sounds quite serious. I'd like to know what I can do to not just lower my number, it sounds like,

of blood pressure, but actually lower my risk of having these heart attacks and strokes and so on. How would you advise me to get that sort of one good reading to see whether or not I should be worried about this? I don't think it'll be a case of one reading because I think the first reading tends to be a little bit higher and then the second reading's a little bit lower and the third reading's even better. But whatever you do, you're looking for changes. You want to do the same thing every time so that you're comparing apples with apples. So I would say perhaps you measure your blood pressure twice a day, do three recordings, record the third one on each occasion and do that for a few days. And you calculate a general average from that. And if that's okay and you're doing the best you

can in terms of your lifestyle, that's okay. And what's the number that you would say it's worth going and having a conversation with your physician? Well, I certainly think if it's like 160, you know, some people would say even over 140 persistently, then it's a good idea to go and see your physician. And you take those readings with you and show them to them because at the end of the day when the physician measures, it's just going to be higher. So I don't understand why one would put more credence on that.

And I think it's always really, really important that the minute you start thinking about your blood pressure, you must think of your lifestyle. That is the thing that I think, a poor lifestyle probably kills more people than anything else. We know that diet and lifestyle plays a huge role in this. I'd love to hear from you in order of what you think is the most important, the diet and lifestyle factors that people can think about changing.

Certainly, there's a lot of reliance on kind of fast foods, you know, unhealthy foods, some of which we know are unhealthy, but we still do it because it makes our lives easier. and some which we don't even know are unhealthy. And I think that would have an impact on everything else as well. Sleep, stress, weight gain. I think it'll have an impact on all that. So nutrition, I think, is perhaps the most important thing of all, because stress is huge, but it's very difficult to quantify stress.

Food is something that people can make a change to. And I think exercise, cardiovascular exercise is important, but people are becoming more conscious of exercise, et cetera, and they are doing more. But all those things, you cannot do lots of exercise and then be really proud that you can get away with four hours of sleep every night. You have to do it all. Yeah, I think the four pillars of health that you're talking about, sleep, stress, activity and diet are not just going to help blood pressure. They help every single disease, but they help how you feel in the here and now. And I think that's really important from a motivational point of view. From a dietary perspective, what are the kind of recommendations that you would make to someone coming to your clinic who has high blood pressure?

I personally think sugar is the enemy because sugar causes a bunch of insulin spikes, whereas a lot of blood pressure is about cut down salt. I think sugar is the more important thing. And I think that processed foods, refined oils, all those kind of things. additives. And Sarah, what's your experience in terms of thinking about blood pressure specifically and what dietary changes you might suggest to someone based upon, you know, your research and others? So I think that what constitutes a general healthy dietary pattern for everyone will also help with blood pressure. So that's a diet high in unprocessed foods, a diet high in whole fruits, vegetables, beans, whole grains, a diet low in processed meat, low in sugar, sweet and beverages,

a diet low in refined carbohydrates that cause these big peaks and dips that can lead to inflammation. There are a few additional recommendations. So one is to increase your potassium intake, but to increase your potassium intake actually through diet constitutes a healthy diet. It's mainly achieved through increasing your intake of fruits, vegetables, pulses, you know, beans, for example. They're really high in potassium. So plant foods are very high in potassium. than others. So if we think about fruits, for example, typically bananas, figs, apricots, they're very high in potassium. If we're thinking about vegetables, lots of green leafy vegetables,

like spinach are high in potassium. Interestingly, in the UK, most of our potassium actually comes from potatoes because we're a nation of potato lovers and crisps. They are quite high in potassium. Obviously, be careful how you're having your potatoes to contribute towards your potassium because they don't have much else unless you're keeping all the, skin on for the fibre. They don't have much else that's necessarily improving your diet. I love it. The first time you've ever managed to find an excuse for why we should be eating potatoes, Sarah, gone. Jonathan doesn't like potatoes, by the way. And so potassium is one single nutrient that, yes, we know from clinical trials that use potassium supplementation as well as supplementing

through the diet can reduce blood pressure. I did a randomised control trial on this many years ago. we also know salt is important but the really important point to make here is that reducing your salt intake isn't going to benefit everyone that you will have some people who are salt sensitive who will have a really large benefit from reducing their salt in order to reduce their blood pressure some people have no benefit generally at population level if we reduce our salt yes we benefit and where is most salt in our diet today so most salt in our diet is in food that's pre-prepared, that's prepackaged. Only about 20% of salt comes from food that we make or that we add at the table. And so we call this discretionary salt that

there's actually very little salt now added at the table. About 70 to 80% of the salt that we consume in the UK, in the US, in many countries come from heavily processed foods, pre-packaged foods, pre-made meals. And so really, if you're just following a basic healthy diet, cutting out all of these heavily processed, pre-packaged foods, if you're switching to a more whole-food plant-based diet, you're naturally going to increase your potassium, or naturally going to reduce your salt. You're adding in fibre,

which we also know can reduce our blood pressure through various mechanisms, one of which is through improving the composition of the gut microbiome. And you're also adding in by going to a very whole plant-based diet, you're also adding in lots of other nutrients that we know are important. And Sanjay mentioned earlier about magnesium. It might only play a small role. But again, you know, accumulatively, you're adding in lots of components of the diet

that are going to help your blood pressure, improve your microbiome, reduce inflammation and so forth. And you talked earlier about this new study showing like these particular microbes linked to, you know, high blood pressure or not. Is it possible to get more of the good ones and fewer of the bad ones? through my diet? So we've recently published research from our ZO.I. Studies, where we've seen that by changing your diet, you can change these specific microbes, that you can change the microbiome signature that you have. And so you can increase the microbes that are associated with lower blood pressure, and you can reduce the microbes that are associated with higher blood pressure from switching from a typical kind of UK diet to the kind of diet that we promote at Zeri.

Going back to the microbiome as well, I think we're starting to see studies emerging where people are giving probiotic supplements. And these are often single strains or they might have multiple different strains in them. And they see reductions in blood pressure specifically through adding in particular species. And so this is where I think, again, it's getting really interesting that you'll see an even greater effect by changing your microbiome through the diet to reduce your blood pressure. We've covered a lot of the different things you could do. I'd just like to talk about exercise a little bit more. Is there evidence that doing more exercise can reduce my blood pressure? Absolutely.

So some data indicate that if you do cardiovascular exercise, your blood pressure can come down by an average of 6mm of mercury. Sanjay, is that good? It's comparable to some medications that we get. Okay, so that's a lot. It's good, yeah. And then there is additional benefit because with the weight loss for every kilo you lose, your blood pressure comes down by one to two millimeters of mercury, your systolic

blood pressure. So not only is the weight loss helpful, but weight loss plus exercise, there are data to suggest that they benefit. So it's interesting why you just said. So you're saying all of these things, if they also help you to reduce your weight, then you're going to reduce your blood pressure because this extra weight is pushing up your blood pressure. Yeah, and you're going to reduce your blood pressure. And you're going to reduce your blood pressure. And you're going to reduce your reliance on medications, some of which also increase your blood pressure. What we are not doing is we're not making a healthier population at this point in time. We're making it a medicated population. And I think we have to start going back and focusing on the things that we can do

to make our population healthier, slimmer, more mobile, less stressed, less medicated. And that is the way we will achieve something different to what we are at this point in time. If our listeners started making these sorts of changes that you're talking about, how fast could they expect to see it have an impact on their blood pressure and how big an impact can that be versus taking the pill that otherwise you're offering to them? Well, the first thing is they'll feel better and that feeling better will become noticeable after only a few weeks, I suspect. It's very dramatic. And if for no other reason, rather than just saying, oh, I'll do these things because my number will come down,

you should do it because you will feel better. You will have a better quality of life. If you feel more rested, you're happier, you're putting good stuff in your body, you're feeling more confident, you go to the doctor, the blood pressure will be lower. And I think this is really motivational because we know from my own research, people changing their diet, changing their lifestyle, you start to feel better within days. And we know from published research on dietary studies looking at dietary modifications to improve blood pressure, you can see improvements in blood pressure in as little as two weeks. So it's not something that's going to take months and months.

Make that change now. Start with small changes, build them up and you will feel better, but you will see a difference in your numbers as well quite quickly. Amazing. Thank you so much. This was definitely a new topic for me, quite complicated to understand. I'm going to try and summarise it, and please correct me if I've got anything wrong, both of you.

I feel like I'm about to do an exam. So the thing that I'm actually most amazed by is this new discovery that there are specific bugs in our gut linked to high blood pressure and low blood pressure, which is extraordinary. We don't fully understand why, but we think it might be linked to this long-term inflammation. About a quarter of people are told by their doctor they have high blood pressure, but they don't because when you go in and see your doctor, you're really anxious and your heart rate goes up, and so you have this measurement that is higher than your average would be.

And I think you said about 30% of people globally have high. blood pressures, that short-term high blood pressure is fine. Like, I run for the bus. It's nothing to worry about, but this long-term high blood pressure over years and decades can be really harmful. And that affects things like my brain, so dementia could be starting 15 or 20 years earlier with these, like, tiny damage to blood vessels from the high blood pressure, strokes, heart attack, heart failure, but also, you know, your eyes could get damage your kidney. So this is really important. The numbers that we used to measure it, they have these two numbers, and the first one is the one that you're saying, I should really worry about, the big number, the systolic number,

because that's what happens when my heart is pressing really high. That interestingly, doctors do not agree around the world even about what that number is that you should worry about. So in America, it's 130. In Europe, doctors are more relaxed, and you can get up to 140. That it is good to measure your own blood pressure, but not to obsess about it. And you know, if you're going to measure it at home, then you said multiple times in the day, did it each time you do sort of three recordings, sort of write down the last one, do it for a couple of days. They give you sort of average, which is going to be much more accurate than this sort of one single measurement. And I think you said, well, you know, if that is above the guidelines in your country,

then it's worth going and talking to your physician and share this data. But for the reasons you talked about, it needs to then be looked at in the context of your overall health. And then we talk about what could you actually do? And I think interesting, there was this really big alignment, Sanjay, between you and Sarah, and of course, Sarah is going to focus on nutrition as a nutrition scientist. But actually, you said, like, diet is the number one thing that you think is affecting high blood pressure, which is extraordinary. That the overall healthy diet for blood pressure is the same as overall diet for everything else. But there are some interesting, specific things, Sarah. And what I caught was particularly increasing your potassium intake. And that means more fruits and vegetables. And you had some particular examples. I think I got bananas, figs, apricots, right, green leafy vegetables like spinach. These are particularly high in potassium. Reducing salt is good, but actually the salt isn't where, I guess, I would think it is, which is adding lots of salt to the table.

This is mainly and heavily processed food. So it's sort of hiding in a lot of these meals and sort of ready meals and things like that. So actually, if you can cut back on that, I can still add, you know, salt to the eggs that I make at home without feeling so bad about it. Absolutely. And I think what's really interesting is that your taste buds change. very quickly. We become so used to that salty taste. So actually, if you can cut down your salt intake from these heavily processed foods, quite quickly you'll realize you don't need to be

adding much salt at the table because you become more sensitive to it. And finally, more fiber supports the microbiome, hopefully helps to give you those good bugs that you want to have fighting the blood pressure. But then it's not only about diet. We talked about stress a lot, but also that it's hard to adjust for. So these other things like sleep and exercise that we know are so important from many other aspects of our health, like very strong data to support

the fact that it can reduce our blood pressure and not only will we reduce our blood pressure at the end of this, Sanjay, but we're all going to feel better, which sounds a great way to wrap up. I'll end this episode with something I think you'll like, a free Zoe gut health guide. If you're a regular listener,

you know, just how important it is to take care of your gut. Your gut microbiome is the gateway to better health, better sleep, energy and mood. The list just goes on. But many of us aren't sure how to best support our gut. I wasn't sure before doing Zoe, which is why we've developed an easy-to-follow gut health guide. It's completely free and offers five simple steps to improve your gut health. You'll get tips from Professor Tim Specter, Zoe's scientific co-founder and one of the world's most cited scientists,

plus recipes and shopping lists straight to your inbox. We'll also send you ongoing gut health and nutrition insights, including how Zoe can help. To get your free Zoe gut health guide, head on over to zoey.com slash gut guide. Thanks for tuning in and see you next time.