The good, the bad, and the deadly: Breaking down the new “official” blood pressure guidelines for diabetics

One day, the American Diabetes Association will get their facts straight and actually start doing something to help stop this country’s escalating diabetes epidemic. But unfortunately, today is not that day.

In case you haven’t heard, the ADA recently released their first blood pressure guidelines in about 15 years.1 And let’s just say they took one step forward and two steps back… way back. (But really, what did we expect?)

Don’t get me wrong—it’s not that I don’t think hypertension is an important issue. On the contrary. It affects so many people, most patients believe it’s practically inevitable. (It’s not—but I’ll circle back to that in a bit.)

And it’s an especially urgent concern for anyone with diabetes. Why? Because diabetes is, among other things, a disease of the blood vessels. Left unchecked, this condition destroys your circulatory system—and when that happens, controlling blood pressure just gets that much harder.

And I mean that literally.

As arteries and blood vessels stiffen and narrow in response to high blood sugar, blood pressure shoots up in response. This is just one of the ways diabetes increases your risk of heart disease and stroke. And it means that diabetics need to pay especially close attention to their blood pressure levels.

So let’s talk about these new guidelines, shall we?

One bad reading does not translate to a diagnosis

Considering this is such an important topic for diabetics, you might assume the ADA has had their finger on the pulse (so to speak) of blood pressure research over the last 15 years. Unfortunately, that assumption is dead wrong. Today, I’m feeling generous, though, so I’ll start with what they did get right.

For one thing, they’re calling for doctors to be more thorough and careful with their blood pressure measurements.

Yes, your doctor should be measuring your pressure at every routine visit. But elevated readings—anything greater than 140/90 mmHG—require confirmation before handing down a hypertension diagnosis.

This means checking pressure in both arms, to make sure the first reading wasn’t a fluke. And it means multiple readings, including at least one reading on a separate visit within a month of the first reading.

Patients with high blood pressure should also monitor their numbers at home to rule out “white coat hypertension”—which is when pressure only spikes in the doctor’s office. And of course, the size of the cuff needs to be double-checked, as well. Larger arms need a larger cuff, or the readings from it won’t be accurate.

These “new” standards are all well and good—no one should even consider treating high blood pressure based on anything less. But what I would like to know is who doesn’t do this already? It’s essentially been the standard of care since I was first training as a physician.

The fact that the ADA spent their time and money devising such mindless recommendations would be shocking to me, if I wasn’t so used to it by now… It’s a shame that any of this should even need to be said—but such is the state of primary care today.

So let’s move on to the next guidelines—which, while no less obvious, at least mark a departure from business as usual.

Treatment burden by the numbers

There’s clear scientific support for keeping blood pressure below 140/90. After reviewing 137 different studies, the ADA is toeing this line—and you won’t hear any complaints from me. (At least, not with the goal itself.)

But the issue gets a little stickier once you start talking about lower numbers. Especially considering the effort that often goes into reaching them—and among older patients in particular, for whom higher numbers can be perfectly healthy.

In patients with hearts at high risk, lower targets—below 130/80 or even below 120/80—may deliver better outcomes. But (wisely, for a change) the ADA only recommends shooting for these numbers if they can be reached “without undue treatment burden.”

And what exactly is “undue treatment burden?” Well that, as usual, depends on who you’re talking to.

In my opinion, just about any drug treatment for hypertension presents an “undue treatment burden.” Beta blockers can cause breathing problems and weight gain. Calcium channel blockers have been linked to breast cancer. And diuretics can deplete all the healthy minerals in your body. (Of the lot, I have found angiotensin receptor blockers to be the best tolerated, and will prescribe them myself as a last resort.)

Unfortunately, however, not everyone shares this conservative stance. And blood pressure targets have gotten more aggressive than ever, thanks to trials like the Systolic Blood Pressure Intervention Trail (SPRINT).

The high cost of hitting low targets

SPRINT is a study determining if lower systolic blood pressure can decrease stroke, heart disease, kidney disease, and age-related losses of memory and thinking. And it was one of the studies the ADA used to devise their guidelines.

One of the things proposed by SPRINT is that all patients aim for systolic blood pressure below 120—no matter how many drugs it takes to get there.2

For most hypertension patients, that could mean three or more prescriptions—which is absurd on its own. But what’s even more galling is their claim that this is a perfectly safe method to address high blood pressure.

It isn’t, obviously—and it didn’t take long for a new study to come along and demonstrate as much. In fact, just this past October, a team of Irish researchers found that falls and blackouts were five times higher in patients with systolic pressure so low. Of course, these results aren’t so surprising when you consider that sudden blood pressure drops upon standing nearly doubled in the participants with systolic levels this low.3

These are nowhere near “acceptable” risks. Especially considering that studies larger than SPRINT show no significant differences in cardiovascular events and mortality rates with systolic pressures below 120.

In fact, treatment this aggressive raises rates of low blood pressure, electrolyte imbalance, and elevated creatinine… all of which pave the way to kidney damage. So it’s a good thing the ADA took the only reasonable position on SPRINT’s recommendations—which is to ignore them.

Instead, they advise that treatment be individualized based on the risk/benefit profile of each patient. And, in a real shocker, they even suggest that this “be part of a shared decision-making process between the clinician and the individual patient.” (Who knew the patient should be consulted for anything?! Please excuse my sarcasm.)

So yes, the ADA got this one right too. But I hate to give more credit than what’s due—after all, it doesn’t take a genius to see why overmedication might not be the best strategy, especially for someone with diabetes. Unfortunately, this is the level of incompetence—and love of pharmaceuticals—we’re dealing with in mainstream circles.

So, if doctors need the ADA to spell it out for them, then so be it. Especially since these new guidelines go one step further, urging that patients meet blood pressure goals through lifestyle changes instead.

Go ahead and read that again if you have to. I know I did—because let me tell you, I could hardly believe my eyes.

Of course, you know what they say about things that look too good to be true… It’s way past time that the powers-that-be stopped worshipping at Big Pharma’s altar. But unfortunately, it doesn’t count for much if you’re pushing an alternative that doesn’t actually work.

And surprise! That’s exactly what the ADA is doing.

Ditch DASH—and do this instead

I appreciate that these “new” guidelines advocate weight loss, regular exercise, and dietary changes above all else. (Though I’m dismayed that this is being presented as some groundbreaking strategy. Explain to me again why doctors aren’t already using lifestyle as a first line of treatment?)

But then they had to go and blow it by bringing up DASH. That’s Dietary Approaches to Stop Hypertension (DASH), in case you’ve forgotten. And don’t let the name fool you.

Head-to-head studies have proven over and over again that DASH is the worst diet for weight loss, blood pressure control—or any health concern, for that matter. And yet government agencies still stubbornly cling to this low-fat, calorie-counting dinosaur like it’s the best thing since sliced bread (and you know how I feel about bread).

Not only that, but they also dredge up the same old myths about salt restriction. Never mind that sodium is a factor in a mere 5 percent of hypertension cases—or the fact that lowering your salt intake too much can lead to kidney disease, not save you from it. (And once again, diabetics are already at greater risk of this deadly complication.)

Meanwhile, they also push for low-fat dairy—a recommendation that comes completely out of left field for me. Because take out the fat—which, as everyone should know by now, you need for effective weight loss—and what you’re left with is sugar.

And I doubt I need to say much more about that. Low-fat dairy doesn’t have a place in anyone’s diet, much less a diabetic’s.

Look, I’m not saying that good nutrition isn’t your best defense against hypertension. There’s no doubt about it—the ADA and I can agree on that. But they need to get out of their own way with this ridiculous dietary advice if they actually want to help people.

And they can start by taking a page—or better yet, all of them—from The A-List Diet.

For diabetics, detox makes all the difference 

Before the A-List, there was my Hamptons Diet. Both are very sensible Mediterranean-style diets that work on blood sugar—and my patients have had great success against hypertension using both, as well.

But there’s one component to the A-List which makes it especially effective for diabetics struggling with high blood pressure—and it’s one the ADA, unsurprisingly, has completely ignored.

I’m talking about detox. With this simple addition, I am seeing improvements that I’ve never seen before in patients, even more quickly than I did with the Hamptons Diet.

And it’s not surprising. High blood sugar and hypertension deliver a double whammy to your kidneys. The tiny blood vessels that feed this organ take a beating. And they lose their ability to keep up with your body’s daily toxin load.

Detox slams the breaks on this damaging cycle—which is an urgent priority for hypertensive diabetics, whose kidneys are in particular danger from chronic high blood pressure.

But detox also primes metabolism for weight loss. And delivers results across the board that you’re certainly not going to get by following the ADA’s pathetic excuse for nutrition advice.

In fact, I just witnessed one of these success stories today. I’ve been working with this patient for two years now. She came to me having lost some weight, but unable to budge from the plateau she was on.

I started her on the A-List Diet, which begins with a thorough detox. Two months later, she walked into my office 28 pounds lighter. And most importantly, her HgbA1c was down to under 5.7—which puts her in the non-diabetic range for the first time in her adult life. Needless to say, this patient’s blood pressure is now also perfect.

These are the kind of results I expect from a lifestyle intervention—and you should too. But I doubt I would have seen the same dramatic improvements had she followed DASH.

So my recommendation to you? Don’t follow DASH. Start with my A-List Diet instead. (If you don’t already have a copy, you can pick one up at your local bookstore or by visiting And while you’re at it, be sure to revisit my supplement recommendations (see sidebar) for addressing hypertension.

Because ultimately, these are the only blood pressure pills I can wholeheartedly recommend to any patient, diabetic or otherwise.


My top seven supplements for battling high blood pressure

1) Pycnogenol®.Pycnogenol helps keep collagen and elastin in the blood vessel walls healthy. I recommend 100 mg per day.

2) Magnesium orotate. Regulating blood pressure is one of magnesium’s many roles in the body. And orotate is the most absorbable form. I recommend 60 mg per day.

3) Taurine. This is an amino acid and acts as a natural diuretic. But it doesn’t eliminate healthy minerals. Take 1,000 mg twice per day.

4) Garlic.Probably the oldest blood pressure “medication” there is. It’s been used for centuries—and is just as effective today as it was hundreds of years ago. I recommend 300 mg three times per day.

5) Theanine.This amino acid has significant calming properties. And since stress is a major factor in hypertension, theanine is one of the most helpful supplements. I recommend 200 mg three to four times per day.

6) SAM-e. Another amino acid I’ve found to be exceptionally helpful for regulating mood and stress. And, in turn, blood pressure. I generally recommend 400 mg each morning.

7) Vitamin D3. Low vitamin D is another common contributor to high blood pressure. So especially during the dark winter months, supplementation is key. I recommend at least 2,000 to 5,000 IU per day. But you can safely take up to 10,000 IU per day (which is the dose I take).




  1. de Boer IH, et al. Diabetes 2017 Sep;40(9):1273-1284.
  2. SPRINT Research Group, et al. N Engl J Med. 2015 Nov 26;373(22):2103-16.
  3. Sexton DJ, et al. JAMA Intern Med. 2017 Sep 1;177(9):1385-1387.