Tens of millions of Americans have been reclassified into a chronic disease category over the past few decades without their actual blood pressure, cholesterol, or blood sugar changing at all. The reason: the diagnostic thresholds that define “normal” have been redrawn more than once. Here’s what actually changed, and why it matters. (Based on the insights of Dr. Eric Berg)
Key Takeaways
- The 2017 hypertension threshold change (140/90 to 130/80) added roughly 31 million Americans to the “hypertension” category overnight, with no change in their actual readings.
- Cholesterol and prediabetes thresholds have also been lowered over the decades, adding tens of millions more people to those diagnostic categories.
- Committees that set these thresholds have included members with financial ties to the industries producing the resulting medications.
- All three conditions trace back to chronically elevated insulin, largely driven by refined carbohydrates and sugar.
- Research-backed lifestyle approaches — including a documented diabetes remission trial — offer real alternatives worth discussing with your doctor.
Threshold #1: Blood Pressure (2017)
For years, 140/90 mm Hg was the standard threshold for a hypertension diagnosis. In 2017, a panel of cardiologists lowered that threshold to 130/80. Same readings, same people — but overnight, roughly 31 million more Americans became classified as hypertensive. Meanwhile, the UK, Europe, Canada, Japan, and Australia reviewed the same underlying evidence and chose to keep their threshold at 140.
Threshold #2: Cholesterol
In 1988, a normal LDL level was considered to be around 190. In 2001, a committee dropped that number to 130 — and statin prescriptions doubled over the following three years. The threshold was lowered again in 2013. Overnight, 12.9 million more people were newly diagnosed with high cholesterol. Today, roughly 86 million people carry a high cholesterol diagnosis, and most of them are on medication.
Threshold #3: Prediabetes
Perhaps the most striking example: an entirely new diagnostic category, “prediabetes,” was created based on a specific blood sugar cutoff. With a single definitional change, 72 million people became prediabetic. Add that to the diabetes numbers, and roughly 115 million American adults now sit somewhere in the diabetes or prediabetes category.
A Conflict of Interest Worth Knowing About
One detail that stands out: the committees that decided on these threshold changes included a number of members with financial ties to the industries that produce the medications prescribed once someone crosses the new line. This pattern — and the broader question of whether these diagnostic shifts actually extend people’s lives — is explored in depth in the book Overdiagnosed by physician H. Gilbert Welch, and has been the subject of an ongoing campaign by the British Medical Journal called “Too Much Medicine.” A similar pattern has played out with osteoporosis diagnostic criteria and the definition of BMI, which can classify very muscular individuals as obese despite having low body fat.
Does Lowering the Threshold Actually Help?
The key question raised here is simple: if you change the numbers so more people get diagnosed and put on medication, does that actually extend their lives or improve their health? According to this analysis, it hasn’t been shown to extend mortality. Instead, it can set off a cascade sometimes called polypharmacy — one medication causes a side effect, which leads to a second medication to manage that side effect, and so on.
The Common Thread: Insulin
Underlying all three of these conditions is chronically elevated insulin. Chronic insulin elevation contributes to stiffer arteries, higher cholesterol, and the progression toward insulin resistance, prediabetes, and eventually diabetes. The biggest driver of chronically elevated insulin is a high-carbohydrate diet, particularly refined sugars and refined starches.
What Actually Moves These Numbers
There’s solid research behind natural, lifestyle-based approaches to these three conditions. For type 2 diabetes, one well-known trial found full remission after 12 months in 46 out of 100 participants — a result worth knowing about before starting medication, since patients are entitled to be informed of alternatives as part of informed consent.
For LDL cholesterol, there’s research behind red yeast rice, niacin (which significantly lowers LDL and raises HDL), plant sterols, exercise, and a low-carb diet. For blood pressure, there’s research behind garlic, hibiscus tea, the DASH diet combined with sodium reduction, exercise, increasing potassium while lowering sodium, and magnesium.
Randomized controlled trials are typically designed to test one variable against a placebo, and aren’t well suited to studying multiple stacked lifestyle factors at once — which is part of why there isn’t a formal trial testing all of these combined. But common sense suggests that stacking several of these evidence-backed approaches together — diet changes, exercise, better sleep, reduced stress — could compound their individual benefits, even without a trial specifically proving the combination.
The Bottom Line
Much of the chronic disease epidemic, as measured by diagnosis rates, has been shaped by where these lines got drawn — not necessarily by people getting sicker. Since all three conditions circle back to insulin resistance, understanding and addressing that root cause is central to working with, rather than just being defined by, these numbers.
Frequently Asked Questions
Why were these diagnostic thresholds lowered in the first place?
Committees of medical experts periodically review and revise these thresholds. According to this analysis, some committee members involved in these decisions have had financial ties to the pharmaceutical industry, raising questions about the motivations behind the changes.
Does getting diagnosed under a lower threshold actually help me live longer?
According to this analysis, these threshold changes have not been shown to extend mortality, and can instead lead to a cascade of medications as side effects from one drug get treated with another.
What’s the root cause connecting hypertension, high cholesterol, and prediabetes?
Chronically elevated insulin, typically driven by a high intake of refined carbohydrates and sugar, contributes to all three: stiffer arteries, higher cholesterol, and progression toward insulin resistance and diabetes.
Can type 2 diabetes actually be reversed with lifestyle changes?
Yes — one well-known trial found full remission after 12 months in 46 out of 100 participants using a structured dietary intervention, a result worth discussing with your doctor as part of informed consent before starting medication.
Quick Start Checklist
- ☐ Ask your doctor which threshold and guideline they’re using for your diagnosis
- ☐ Ask about lifestyle-first alternatives before starting new medication
- ☐ Reduce refined carbohydrates and added sugars to help manage insulin levels
- ☐ Explore research-backed options: DASH diet, exercise, garlic, hibiscus tea, magnesium for blood pressure
- ☐ Discuss red yeast rice, niacin, or plant sterols with your doctor before starting
- ☐ Never stop or adjust a prescribed medication without medical guidance
Source: Dr. Eric Berg
Disclaimer: This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Never stop or adjust a prescribed medication without talking to your doctor first, and consult your doctor before combining any supplement (such as red yeast rice or niacin) with prescription medication, since interactions are possible.