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Multiple lifestyle intervention reverses hypertension

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DOI: 10.1080/2331205X.2019.1636534

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CARDIOVASCULAR DISORDERS | RESEARCH ARTICLE

Multiple lifestyle interventions reverses

hypertension
Albert Sanchez, S. Christine Chung, Alfredo Mejia, Francisco E. Ramirez, Gerald W. Shavlik,
Randall L. Bivens, Sherine Brown-Fraser and Roger D. Gallant

Cogent Medicine (2019), 6: 1636534

Sanchez et al., Cogent Medicine (2019), 6: 1636534
https://doi.org/10.1080/2331205X.2019.1636534

CARDIOVASCULAR DISORDERS | RESEARCH ARTICLE

Multiple lifestyle interventions reverses
hypertension
Albert Sanchez1,2*, S. Christine Chung2, Alfredo Mejia2, Francisco E. Ramirez1,3,
Gerald W. Shavlik1, Randall L. Bivens1, Sherine Brown-Fraser2 and Roger D. Gallant1
Received: 20 March 2019
Accepted: 21 June 2019 Abstract: Hypertension is worldwide and the most common problem in clinical
First Published: 28 June 2019
practice in the United States. It is typically treated with medications, but it also
*Corresponding author: Albert responds to various lifestyle principles. This study assessed the effectiveness of
Sanchez, Coordinator of NEWSTART
Research 20601 Paoli Ln., Weimar, reversing hypertension using a multi-lifestyle medical residential intervention. We
CA 95736, USA.
E-mail: research@newstart.com
evaluated retrospective data from the pretest-posttest intervention of the 114
subjects that were hypertensive from among all 173 enrolled in NEWSTART during
Reviewing editor:
Yang Gao, Department of Physical 2014. Of the 114 individuals with hypertension, there were 37% males and 63%
Education, Hong Kong Baptist
University, Hong Kong, Hong Kong
females. Baseline values (Mean±SD) were: 66.5 ± 10.6 years, 31.9 ± 6.6 kg/m2, and
139 ± 20 mmHg. Systolic blood pressure decreased significantly (p < 0.001) within
Additional information is available at
the end of the article 14 days in all population sub-groups from −8% (diabetic) to −31% (normal weight).
Forty percent of subjects achieved <120 mmHg. Medications were discontinued or
decreased by 93% of the subjects. This lifestyle intervention is appropriate for first-
line treatment of hypertension.

Subjects: Exercise Therapy; Hypertension; Clinical Nutrition

Keywords: systolic blood pressure; hypertension; lifestyle; vegan diet; exercise

ABOUT THE AUTHOR PUBLIC INTEREST STATEMENT

The authors of this paper are a group of indivi- High blood pressure affects people worldwide
duals with an active interest in the complete and is the main cause of doctor’s visits in the U.S.
health of as many individuals as possible. We It can be treated with drugs but also with life-
have seen the benefits of short-term adoption of style. We tested NEWSTART, an 18-day compo-
the NEWSTART health principals but these results site lifestyle of Nutrition, Exercise, Water,
are not widely know because they have not been Sunlight, Temperance, fresh Air, Rest, Trust in
tested and published. Hence, we are dedicated to divine power, for reversing high blood pressure in
scientifically test the health benefits of those who had come to the program throughout
NEWSTART and have begun with high blood 2014. Systolic blood pressure dropped an aver-
pressure, the most common medical problem in age of 19 points in two weeks. It dropped in men
the U.S. We are amazed at how effective and and women, and in those with diabetes, high
rapid the NEWSTAR lifestyle intervention is for cholesterol or triglycerides, or overweight.
reversing high blood pressure. We look forward to Moreover, the use of high blood pressure drugs
Albert Sanchez testing other important clinical parameters that was decreased or discontinued in 93% of indivi-
affect individual and public health such as dia- duals. Continued use of NEWSTART lifestyle
betes, cardiovascular disease, and overweight to should continue its benefits since these are
see how lifestyle can improve public health at low health principles in the Adventist Lifestyle that
cost and without side effects from drugs. prevents high blood pressure. This is compelling
evidence for use of the NEWSTART lifestyle for
reversing high blood pressure.

© 2019 The Author(s). This open access article is distributed under a Creative Commons
Attribution (CC-BY) 4.0 license.

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1. Introduction
Hypertension is recognized as a worldwide problem. It is the most common clinical condition in
primary care in the United States and it is associated with increased mortality from cardiovascular
disease (James et al., 2014). The common form of hypertension among the older population 50
years and older are isolated elevated systolic blood pressure (SBP), an important predictor of
coronary heart disease (Basile, 2002; Franklin, Khan, Wong, Larson, & Levy, 1999). Hypertension
is typically treated with medications. The SPRINT report shows that elevated SBP was decreased
among non-diabetic patients to 120 mmHg by intensive treatment with medications (Wright et al.,
2015). It was also shown that a lower blood pressure decreases mortality from cardiovascular
disease and this multicenter study set a new lower standard for normal blood pressure. The
decreases in SBP, however, were accompanied by serious side effects (Schiffrin, Calhoun, & Flack,
2015; Wright et al., 2015). These side effects can be avoided if the patient is responsive to
a lifestyle intervention for the treatment of hypertension following lifestyle modification as
recommended by the American College of Cardiology/American Heart Association Task Force on
Clinical Practice Guidelines for patients with hypertension between ≥130 mmHg to <160 mmHg
(James et al., 2014; Whelton, Carey, Aronow, Casey, & Jones, 2018).

Lifestyle interventions are effective because they address unhealthy habits or behaviors that are
responsible for hypertension (James et al., 2014; Mozaffarian et al., 2016). Research on lifestyle
interventions have focused on salt restriction, limited alcohol intake, use of fish oil supplements,
weight loss, and increased exercise (Appel et al., 2003; Saneei, Salehi-Abargouei, Esmaillzadeh, &
Azadbakht, 2014; Dickinson et al., 2006; Gay, Rao, Vaccarino, & Ali, 2016; He, Li & Macgregor, 2013;
Jenkins et al., 2015). Vegetarian diets are also known to protect against hypertension (Yokoyama
et al., 2014), and vegan diets seem to offer additional protection over vegetarian diets and other
diet patterns (Le &Sabate, 2014). Vegan or near vegan diets are consistently associated with
decreases in SBP with or without exercise (Goldhamer, Lisle, Parpia, Anderson, & Campbell, 2001;
Goldhamer et al., 2002; McDougall, Litzau, Haver, Saunders, & Spiller, 1995; McDougall et al., 2014;
Razavi et al., 2014; Silberman et al., 2010).

Interventions targeting multiple lifestyle modifications appear to be more effective in lowering SBP
than those targeting a single or limited number of lifestyle changes (Appel et al., 2003; Frisoli, Schmieder,
Grodzicki, & Messerli, 2011). There is work in progress to assess the effectiveness of interventions
addressing multiple lifestyle modification for decreasing hypertension (Li et al., 2014). The purpose of
this study was to test the effectiveness of NEWSTART, an intense short-term application of eight
simultaneous lifestyle principles that are components of the Adventist Lifestyle, a lifestyle that is
associated with low risk of hypertension (Pettersen, Anousheh, Fan, Jaceldo-Siegl, & Fraser, 2012).

2. Methods

2.1. Study design and population

This is a retrospective pretest-posttest study that by design has no controls. We examined the
consecutive 114 subjects who had hypertension (66%) out of the total 173 individuals who
attended the NEWSTART lifestyle health program during 2014 at Weimar Institute, Weimar, CA.
Each subject was his or her own control for measurements at baseline and at 14 days after
beginning lifestyle intervention. Hypertension was defined in this study by one or more of the
following criteria: (1) medically diagnosed as hypertensive, or (2) a SBP of ≥130 mmHg (Whelton
et al., 2018), which is the same as the SPRINT study (Wright et al., 2015), or (3) regular use of
antihypertensive medications. Many subjects had one or more of the following comorbidities:
diabetes (fasting blood glucose ≥6.99 mmol/L [≥125 mg/dL] and/or hemoglobin A1c ≥6.5% or
taking medication for diabetes); overweight (BMI ≥25); dyslipidemia (total cholesterol ≥6.22 mmol/
L [≥240 mg/dL] and/or HDL-cholesterol <1.04 mmol/L [<40 mg/dL] and/or triglycerides ≥1.69
mmol/L [≥150 mg/dL]). Individuals who were not hypertensive according to the criteria of this
study or who had missing data were not included as subjects in this study.

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2.2. The NEWSTART program

NEWSTART is an acronym for an 18-day intensive residential multiple lifestyle intervention and
education program composed of eight lifestyle health principles that are components of the
Adventist Lifestyle that is associated with lower blood pressure (Pettersen et al., 2012). These lifestyle
principles are individually associated with lower blood pressure—Nutrition (Appel et al., 2006), Exercise
(Skutnik, Smith, Johnson, Kurti, & Harms, 2016), Water (Thorton, 2010), Sunlight (Feelisch et al., 2010;
Mead, 2008), Temperance such as abstinence from tobacco and alcohol (Hillbom, Saloheimo, & Juvela,
2011; Kannel & Higgins., 1990), fresh Air (Mao et al., 2012), Rest (Calhoun & Harding, 2010; Gangwisch
et al., 2006), and Trust in God—spirituality (Charlemagne-Badal & Lee, 2016; Holt-Lunstad, Steffen,
Sandberg, and Jensen (2011); Koenig (2015); Nedley and Ramirez (2014); Tartaro, Luecken, & Gunn,
2005). Application of the NEWSTART principles may vary somewhat from place to place and from
person to person, particularly with diet—vegan or lacto-ovo-vegetarian diet that includes milk and
eggs (Crane & Sample, 1994; Slavíček et al., 2008). The NEWSTART program at Weimar Institute
includes a vegan diet; daily walking in the fresh air and sunlight; drinking substantial quantities of
water; regular and adequate daily sleep; avoiding intemperate habits such as smoking or drinking; and
fostering trust in God. All the subjects daily follow all the same health principles. The vegan diet
consists of legumes, whole grains, vegetables, fruits, nuts, seeds, olives, avocados, soymilk, almond
milk, and whole-grain breads. The diet contains 26% of total energy as fat. Salt is used in preparing
dishes; it provides 1193 mg sodium/1000 calories and 1380 mg potassium/1000 calories. A voluntary
medically directed water-fast of three days precedes the whole-foods vegan diet.

2.3. Measurements
NEWSTART clients receive two major health assessments—at Day 1 (baseline) and at Day 14. Blood
pressure was taken at 7:00 to 8:00 AM before breakfast from the forearm while sitting. Blood
pressure was measured by a Welch Allyn: 420 Series Serial: 200,413,369 blood pressure meter. (A
minimal unknown number of subjects had their blood pressure taken by an Omron model: BP786N
Serial: 20,170,300,321 blood pressure meter). The mean systolic blood pressure difference between
the 2 m was 1.8%. A chief desire among the incoming subjects was to discontinue their anti-
hypertensive medications. Subjects of NEWSTART are under medical supervision during their stay
at this residential medical lifestyle clinic and are given the option at the beginning of the program
to decrease the use of antihypertensive medication. Client blood pressure was monitored one or
more times daily to encourage compliance as blood pressure decreased. All clinical tests, however,
were performed on all subjects at baseline and at 14 days and the blood pressure taken at these
two times is what we report here. There are other measurements that are important for assessing
cardiovascular health but this study is limited to the clinical measurements that are included in
this lifestyle intervention program.

2.4. Statistical analyses

We assessed the pre and post-treatment differences in SBP with paired t-test and the mean
differences between groups using ANOVA tests with SPSS statistical package version 23 (IBM
Corporation, 2015). The Waterfall Plots were done with SPSS and Microsoft Excel, V.12. This
research protocol was reviewed and approved by the Andrews University IRB.

3. Results
There were 42 men (37%) and 72 women (63%) with elevated SBP (Table 1). The baseline
characteristics of subjects with hypertension were (mean±SD): age, 66.5 ± 10.6; BMI, 31.9 ±
6.6 kg/m2; and SBP of 139 ± 20 mmHg. SBP decreased highly significantly (−14%, p < 0.001) within
14 days (Table 2) and the decrease in diastolic blood pressure was also 14%. SBP decreased in two
weeks to <120 mmHg in 40% of the subjects. SBP significantly decreased (p < 0.001) in both men
and women; among users or non-users of antihypertensive medications; and among those with or
without various comorbidities including diabetes, overweight, or dyslipidemias. The use of medica-
tions was discontinued in 69% of subjects and decreased in 24% of them. Figure 1 shows
a waterfall plot distribution of the blood pressure changes after the 14-day study period and
Figure 2 shows the waterfall plot distribution for diastolic blood pressure.

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Table 1. Baseline description of subjects with hypertension who attended NEWSTART Lifestyle
Center
Variable All Men Women
Subjects (N and %) 114 (100) 42 (37) 72 (63)
Age, years 66.5 ± 10.6* 63.0 ± 10.3 68.6 ± 10.2
Height, cm 166.1 ± 9.9 174.5 ± 8.1 161.3 ± 7.4
Weight, Kg 87.77 ± 19.69 96.30 ± 18.33 82.69 ± 18.78
Body mass index 31.9 ± 6.6 31.7 ± 5.6 32.0 ± 7.1
Systolic blood pressure, 139 ± 20 137 ± 19 140 ± 22
mmHg
* Mean±SD

4. Discussion
NEWSTART was effective in significantly reversing SBP within 14 days among all clinical groups in
this study. In addition, the use of antihypertensive medications was reduced or discontinued in
93% of the subjects.

4.1. The effectiveness of NEWSTART

The NEWSTART lifestyle intervention decreased SBP significantly in all subjects (−19 mmHg, −14%)
within 14 days (Table 2). The decrease of SBP for all the groups in this study varied from −8% for the
group with diabetes to −31% for the group with normal weight. Forty percent of the subjects attained
a SBP of <120 mmHg by the end of 14 days. The decrease in diastolic blood pressure was the same as
the decrease in SBP (−14%). Likewise, the Waterfall plot distribution of SBP and diastolic blood
pressure following the 14 days intervention of NEWSTART are similar (Figures 1 and 2). Thus, the
responses of SBP and diastolic blood pressure to NEWSTART intervention were similar in percent
decrease and in their distribution of decrease. The data show that a multiple lifestyle interventions
with Adventist Lifestyle health principles is an effective means for decreasing systolic and diastolic
hypertension in a senior population of men and women whether or not they take medications, and
whether or not they have comorbidities including diabetes, overweight or dyslipidemia.

The SPRINT study that is responsible for the new standard for SBP showed a decrease of (−19
mmHg) in three months by intense medication therapy among non-diabetic patients and there were
significant decreases in risk and mortality from cardiovascular disease (Wright et al., 2015). It is
interesting to note, in comparison, that SBP in our study decreased by −18 mmHg in 14 days among
non-diabetic subjects, showing the value of this multiple lifestyle interventions for treating hyper-
tension. Decreases in SBP were also recorded in other studies using the NEWSTART lifestyle inter-
vention. SBP decreased by 23 mmHg (−15%) within 3 weeks of intervention among diabetic patients
with neuropathy (Crane & Sample, 1994). SBP decreased 6 mmHg in individuals from the general
population attending a one-week wellness program using NEWSTART principles (Slavíček et al.,
2008). Thus, this multiple lifestyle interventions lowers SBP to levels comparable to those observed
with intensive therapy of antihypertensive medications (Wright et al., 2015), but without the side
effects that followed the use of antihypertensive medications (Schiffrin et al., 2015; Wright et al.,
2015).

A 93% drop in the need for antihypertensive medications accompanied the NEWSTART interven-
tion. This decreased need for medication is similar to the reported decrease or discontinuation of
antihypertensive medications (87%) within 7 days following a low-sodium, low-fat vegan diet
together with exercise (McDougall et al., 2014). There was a similar 81% decrease in the use of
medications after using a low-sodium, low-fat plant-based diet (Barnard, Zifferblatt, Rosenberg, &
Pritikin, 1983), or a100% decrease after a medically supervised water-only fast followed by a vegan
diet in a 20-day program for patients that had a SBP baseline of >140 mmHg (Goldhamer et al., 2001).

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 Table 2. Changes in systolic blood pressure from Baseline values after two weeks of NEWSTART lifestyle intervention
N Baseline 2 Weeks Mean Difference Change p*
https://doi.org/10.1080/2331205X.2019.1636534
Sanchez et al., Cogent Medicine (2019), 6: 1636534

mmHg mmHg mmHg

All hypertensive subjects 114 139±20† 120±26 -19 14% <0.001
Gender
Men 42 137±19 122±19 -15 11% 0.001
Women 72 140±22 119±30 -21 15% <0.001
Use of medications for
hypertension
Not using 56 142±17 121±25 -21 15% <0.001
Using 58 136±23 120±28 -16 12% <0.001
Clinical condition
Non-diabetic 57 138±21 120±28 -18 13% <0.001
Diabetic 57 140±20 129±25 -11 8% <0.001
Normocholesterolemic, 71 137±20 120±26 -17 12% <0.001
<6.22 mmol/L, TC‡
Hypertcholesterolemic, 43 143±22 121±27 -22 15% <0.001
≥6.22 mmol/L, TC
Normal HDL cholesterol, 83 141±21 122±27 -19 13% <0.001
≥1.04 mmol/L
Low HDL cholestesrol, 31 134±20 116±23 -18 13% 0.003
<1.04 mmo/L
Normotriglyceridemic, 59 138±20 120±25 -18 13% <0.001
<1.69 mmol/L
Hypertriglyceridemic, 55 140±21 120±28 -20 14% <0.001
≥1.69 mmol/L
Normal weight: BMI <25 16 143±18 112±32 -31 22% 0.007
Overweight: BMI ≥25 98 138±21 122±25 -16% 12% <0.001
* Statistical significance
between means.
† Mean±SD

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‡ TC= total cholesterol
Sanchez et al., Cogent Medicine (2019), 6: 1636534
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Figure 1. Systolic blood pres-

sure change in mm Hg
From day 1 to 14.

Figure 2. Diastolic blood pres-

sure change in mm Hg
From day 1 to 14.

4.2. NEWSTART compared to other vegetarian interventions

An early study with a low-sodium, low-fat, plant-based diet together with exercise showed that SBP
decreased −4 mmHg within 26 days among those with hypertension and using antihypertensive
medications. The decrease in SBP was −14 mmHg among those who were not taking medication
(Barnard et al., 1983). The comparable decreases in SBP by NEWSTART were −16 mmHg among those
using antihypertensive medications and −21 mmHg among those not using them, but our results are
for only 14 days rather than 26 days. SBP was decreased by −17 mmHg in 12 days with a whole-foods,
sodium restricted, low-fat vegan diet together with exercise (McDougall et al., 2014). SBP decreased
−37 mmHg (−23%) at 20 days after ingesting a low-sodium, low-fat, whole foods vegan diet which
was preceded by an individualized medically supervised water-only fast in individuals with baseline
SBP >140 mmHg (Goldhamer et al., 2001). The decrease in SBP was −60 mmHg in persons with
baseline SBP ≥180 mmHg and −20 mmHg among individuals with a baseline SBP of 129 mmHg with
the same fasting design (Goldhamer et al., 2002).

4.3. NEWSTART compared to conventional lifestyle interventions

A review on lifestyle interventions and hypertension shows that the average SBP is decreased by
conventional therapeutic diets (−4.6 mmHg), exercise (−3.8 mmHg), salt and alcohol restriction
(−3.6 mmHg), and fish oil supplements (−2.3 mmHg). The DASH diet is associated with a decrease
in SBP from −6.7 mmHg (Saneei et al., 2014) to −7.6 mmHg (Dickinson, et al., 2006) and with
a lower overall risk of cardiovascular disease. The DASH diet focuses on a reduction of sodium,
saturated fat, red meats, and snack foods while it encourages the consumption of whole-grain
cereals, low-fat dairy products, fruit and vegetables (Wong et al., 2016). The Portfolio Diet
decreased SBP by −2.1 mmHg more than the DASH diet (Jenkins et al., 2015). The Portfolio Diet
is a plant-based diet with increased content of viscous fiber, soy protein, plant sterols, and nuts.
The PREMIER study (Appel et al., 2003) with an arm of behavioral modification plus the DASH diet

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achieved a drop in SBP of −8 mmHg (−6%) at 3 months, and −11 mmHg (−8%) at six months. None
of these interventions were as effective as an intervention with NEWSTART.

4.4. NEWSTART potential mechanism of action

The effectiveness of NEWSTART in reversing SBP is undoubtedly due to its multiple health compo-
nents—Nutrition, (Appel et al., 2006) Exercise (Skutnik et al., 2016), Water (Thornton, 2010),
Sunlight (Feelisch et al., 2010; Mead, 2008), Temperance (abstinence of tobacco and alcohol)
(Hillbom et al., 2011; Kannel & Higgins, 1990), fresh Air (Mao et al., 2012), Rest (Calhoun &
Harding, 1010; Gangwisch et al., 2006), and Trust in God—spirituality (Charlemagne-Badal and
Lee, 2016; Holt-Lunstad et al., 2011; Nedley and Ramirez, 2014; Tartaro et al., 2005). These factors
may act alone and they may also interact synergistically one with another. While research has
focused on the relation of the physical components to lowering SBP, there is evidence that the
spiritual component is also important for controlling hypertension (Charlemagne-Badal & Lee,
2016; Holt-Lunstad et al., 2011; Nedley & Ramirez, 2014; Tartaro et al., 2005). Dietary factors are
perhaps the best-known contributors to controlling hypertension using conventional therapeutic
diets (Appel et al., 2003; Dickinson et al., 2006; Saneei et al., 2014; Wong et al., 2015, 2016) and
plant-based diets (Goldhamer et al., 2001, 2002; McDougall et al., 1995, 2014; Razavi et al., 2014;
Silberman et al., 2010). The current plant-based diets that are used for controlling hypertension are
restricted in fat and/or salt (Barnard et al., 1983; McDougall et al., 2014).

The multiple lifestyle interventions of NEWSTART is with a vegan diet that is not restricted in
neither fat nor salt. The diet contains 26% of energy as fat, but only 5% of energy is from saturated
fat. Vegans following the Adventist Lifestyle consume 35% to 38% of energy as fat (Hardinge &
Stare, 1954; Sanchez, Mejia, Sanchez, & Runte, 2019), with saturated fat being <5% of total energy
(Sanchez et al., 2019). Such vegans have the lowest risk of hypertension as compared to other
dietary groups (Pettersen et al., 2012). These data show that blood pressure is decreased in the
presence of ordinary levels of dietary fat, suggesting that the restriction of vegetable dietary fats
may not be an important contributor to lowering blood pressure.

Sodium restriction has been used to control hypertension (Adrogue & Madias, 2014; Wong et al.,
2015, 2016). It is hypothesized, however, that the pathogenesis of hypertension is related to not
only dietary sodium excess, since the intake of sodium, potassium, and the sodium-to-potassium
ratio are all independently associated with hypertension (Du et al., 2014; Huggins et al., 2011).
Potassium intake and decreased sodium intake estimated by excretion were inversely associated
with systolic blood pressure (Mente et al., 2014; O’Donnell et al., 2014) and both were necessary to
explain the decreases observed in hypertension (Binia, Jaeger, Hu, Singh, & Zimmermann, 2015).
The lowest risk of cardiovascular events and deaths occur among populations with sodium intakes
between 3 and 5 g sodium/day while the risk is increased at the higher or lower sodium intakes
(Graudal, Jürgens, Baslund, & Alderman, 2014; Mente et al., 2014; O’Donnell, Mente, & Yusuf,
2015). The NEWSTART diet contains 1193 mg sodium and 1380 mg potassium per 1000 calories,
with a sodium-to-potassium ratio of 0.86. The sodium and potassium content and the sodium-to-
potassium ratio of this diet were compatible with reversing elevated SBP.

Plant-based diets are characterized by having no cholesterol, low-saturated fat, high fiber, high
phytochemical content, and plant proteins (Altorf-van Berkow & Barnard, 2005; der Kuil et al.,
2010). The NEWSTART vegan diet has all these characteristics, but we find it significant that
epidemiological data seem to suggest a dose-related protection of plant proteins against elevated
blood pressure. Vegans who consume only plant proteins have the lowest blood pressures,
followed by lacto-ovo-vegetarians, while omnivores who consume the least vegetable proteins
experience the highest blood pressures (Pettersen et al., 2012).

Plant proteins are associated with increased levels of plasma arginine. Arginine is the precursor
of nitric oxide, which is a vasodilator as well as an antiatherogenic molecule. Elevated plasma
arginine levels are linked to a reduction in hypertension (Boger, 2014; Pernow & Jung, 2016;

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Pretnar-Oblak, 2014; Sudar-Milovanovic et al., 2016). The prolonged administration of arginine

increases nitric oxide production and decreases the risk to CVD (Boger, 2014). Thus, the higher
postprandial and steady-state levels of plasma arginine might be involved in facilitating greater
production of nitric oxide and this may be a mechanism for decreasing SBP. There is evidence for
plant proteins to increase plasma arginine.

Postprandial fasting plasma arginine levels increases within 30 min and the increase is
greater after a drink of soy protein (69% increase) as compared to casein (33% increase) in
the same subjects (Sanchez, Filler, Hubbard, & Shavlik, 1988). The mean fasting plasma arginine
level is also increased by plant protein diets. The mean fasting steady-state plasma arginine
level was significantly increased by 18% in human subjects that switched from their typical
U.S. diet to a plant–based diet for four weeks—from 61 ± 2 µm/L, mean±SE, to 72 ± 3 µm/L
(Sanchez, Horning, Shavlik, Wingeleth, & Hubbard, 1985). The fasting steady-state plasma
arginine level among long-term vegetarians was (90 ± 4 µm/L), 66% higher (Sanchez A, Mejia
MA, and Hubbard RW, unpublished data) when compared to subjects on the typical U.S. diet
(Sanchez et al., 1985). The role of arginine and NO in relation to hypertension in the NEWSTART
vegan diet is unknown.

Arginine, important as it seems, is only one of several dietary contributors to the effective and
rapid reversal of systolic blood pressure by the NEWSTART lifestyle intervention. Low fat and low
salt are associated with mechanisms for controlling hypertension (McDougall, et al., 214; Wong
et al., 2016), yet the NEWSTART vegan diet does not fit a paradigm of restricting fat or salt. This
diet contains moderate amounts of fat and salt and it is an effective means for reversing SBP. It
may be that factors other than diet intervened in lowering SBP, or that a drastic reduction in fat
and salt are not as critical in controlling for hypertension as has been thought.

While the level of dietary salt or fat for the control of SBP has not been resolved, we are aware
that moderate levels of fat and salt in the NEWSTART vegan diet improve its palatability and this
favors adherence to the diet. The taste appeal of a diet is an important issue in life that favorably
favors the patient adherence to the treatment and thus impacts public health by the number of
persons that will adhere to the lifestyle and are thereby benefited by it.

4.5. A note on fasting

Fasting seems to enhance the decrease of high SBP when it precedes a vegan diet (Goldhamer
et al., 2001, 2002). It has been hypothesized that the mechanism for the benefit of the water-only
fast prior to a vegan diet is that it reverts the metabolism from pathological to healthful pathways
and thus enhances the reversal of systolic blood pressure (McCarty, 2003). No specific metabolic
pathway, however, has been suggested for these changes. The NEWSTART dietary intervention
begins with a three-day medically supervised water-only fasting followed by a whole-food vegan
diet, but the contribution of fasting to the effectiveness of NEWSTART for lowering SBP is unknown.

4.6. NEWSTART clinical implications

This is a limited short-term retrospective study, yet it presents compelling implications. The
clinical implications of decreasing SBP by −19 mmHg in all subjects in this short-term study of
two weeks could have significant clinical implications as suggested by a meta-analysis of 147
randomized clinical trials with SBP ≥ 130 mmHg (Law, Morris, & Wald, 2009). A reduction in SBP
of −20 mmHg is achieved using three standard half-dose medications. Such a reduction in SBP
is calculated to reduce the risk of coronary heart disease by 40–50% and the risk of stroke by
50–62%. Thus, the reduction in SBP achieved by NEWSTART (−19 mmHg) could have the
potential to reduce the risk of coronary heart disease by nearly 50% and the risk of strokes
by over 50%, if the levels in blood pressure achieved can be sustained on a long-term basis.
This seems feasible based on epidemiological data of vegan subjects who practice the
Adventist Lifestyle and have the lowest risk of hypertension (Pettersen et al., 2012). The health
principles of the Adventist Lifestyle are intensified in the NEWSTART program and this

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intervention seems to provide an effective new start in life for those who seek to control
systolic blood pressure by this lifestyle.

4.7. Conclusion
We conclude that the NEWSTART Lifestyle intervention is an effective and rapid means to decrease
SBP in a variety of clinical groups, while eliminating or decreasing the need for antihypertensive
medications in nearly all subjects. The long-term effects of this lifestyle with multiple health
principles need to be investigated. This lifestyle program should also be studied for its effective-
ness in decreasing other comorbidities of cardiovascular disease.

Acknowledgements blood pressure control: Main results of the premier

We are grateful to Amy Camille Krueger and Hepisipa clinical trial. Journal of the American Medial
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Author details Basile, J. N. (2002). Systolic blood pressure It is time to
Albert Sanchez1,2 focus on systolic hypertension—Especially in older
E-mail: research@newstart.com people. British Medical Journal, 325, 917–918.
ORCID ID: http://orcid.org/0000-0001-7918-8138 doi:10.1136/bmj.325.7370.917
S. Christine Chung2 Berkow, S. E., & Barnard, N. D. (2005). Blood pressure
E-mail: sungsim@andrews.edu regulation and vegetarian diets. Nutrition Reviews.,
Alfredo Mejia2 63, 1–8. doi:10.1111/j.1753-4887.2005.tb00104.x
E-mail: mmejia@andrews.edu Binia, A., Jaeger, J., Hu, Y., Singh, A., & Zimmermann, D.
Francisco E. Ramirez1,3 (2015). Daily potassium intake and sodium-to-
E-mail: eramirez@weimar.edu potassium ratio in the reduction of blood pressure: A
ORCID ID: http://orcid.org/0000-0001-7918-8138 meta-analysis of randomized controlled trials.
Gerald W. Shavlik1 Journal of Hypertension, 33, 1509–1520. doi:10.1097/
E-mail: gshavlik@hughes.net HJH.0000000000000611
Randall L. Bivens1 Boger, R. H. (2014). The pharmacodynamics of l-arginine.
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E-mail: brownfraser@andrews.edu Calhoun, D. A., & Harding, S. M. (2010). Sleep and
Roger D. Gallant1 hypertension. Chest Journal, 138, 434–443.
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1
NEWSTART Program, Weimar Institute, Weimar, CA, USA. Charlemagne-Badal, S. J., & Lee, J. W. (2016). Intrinsic
2
Department of Public Health Nutrition and Wellness, religiosity and hypertension among older North
Andrews University, Berrien Springs, MI, USA. American Seventh-day Adventists. Journal of Religion
3
Research, Nedley Clinic, Weimar, CA, USA. and Health, 55, 695–708. doi:10.1007/s10943-015-
0102-x.
Citation information Crane, M. G., & Sample, C. (1994). Regression of diabetic
Cite this article as: Multiple lifestyle interventions reverses neuropathy with total vegetarian (vegan) diet.
hypertension, Albert Sanchez, S. Christine Chung, Alfredo Journal of Nutritional Medicine, 4, 431–439.
Mejia, Francisco E. Ramirez, Gerald W. Shavlik, Randall L. doi:10.3109/13590849409003592
Bivens, Sherine Brown-Fraser & Roger D. Gallant, Cogent der Kuil, A.-V., Engberink, W., Brink, M. F., van Baak, E. J.,
Medicine (2019), 6: 1636534. Bakker, M. A., Navis, S. J., … Geleijnse, J. M. (2010).
Dietary protein and blood pressure: A systematic
Source of Funding review. PloS One, 5, e12102. doi:10.1371/journal.
Funded internally pone.0012102
Dickinson, H. O., Mason, J. M., Nicolson, D. J., Campbell, F.,
Cover image Beyer, F. R., Cook, … Ford, G. A. (2006). Lifestyle
Source: Author. interventions to reduce raised blood pressure:
A systematic review of randomized controlled trials.
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