# Hypertension

Category: Conditions

Also known as: high blood pressure

Hypertension is fundamentally an adaptive response to a perceived deficiency of oxygen or glucose delivery, driven by stress signals that become chronic under conditions of metabolic dysfunction. Ray Peat argued that when the body senses inadequate supply, it instructs the…

9 passages · 1 author · 1993–2025 · Most-cited: [Ray Peat](https://bioenergeticoracle.com/md/voices/ray-peat/index.md)

Canonical page: https://bioenergeticoracle.com/concepts/hypertension

## Synthesis

**Hypertension** is fundamentally an adaptive response to a perceived deficiency of oxygen or glucose delivery, driven by stress signals that become chronic under conditions of metabolic dysfunction. [Source 1] Ray Peat argued that when the body senses inadequate supply, it instructs the heart to pump more blood, a mechanism that becomes pathological when **polyunsaturated fatty acids (PUFA)** interfere with glucose and oxygen utilization while simultaneously sending false starvation signals to the pituitary and nervous system. [Source 1] A very large proportion of hypertension is simply a symptom of **chronic hypothyroidism**, where elevated *TSH* itself acts as a pro-inflammatory factor that increases stress hormones and tightens small blood vessels. [Source 3, 8] This compensatory drive is also seen in the increased cardiac output at the onset of both pregnancy toxemia and essential hypertension, where a smaller blood volume is being pumped more forcefully to maintain tissue perfusion. [Source 2, 9]

The physiological regulation of blood pressure is intimately tied to mineral balance and energy metabolism, not simply sodium excess. Peat cited the work of David McCarron extensively, emphasizing that **calcium deficiency**, rather than high sodium intake, is a primary dietary driver of hypertension. [Source 5, 6] A low calcium status increases the tone of small arteries, while adequate calcium, supported by sodium, helps cells expel calcium and relax. [Source 6] Sodium plays a critical structural role by associating with **albumin** to exert *oncotic pressure*, which attracts water into the bloodstream, maintains blood volume, and prevents the leakage of fluid and albumin through capillary walls. [Source 2, 9] When energy metabolism fails—as in diabetes, hypothyroidism, or hyperestrogenism—the physiological loss of sodium occurs, leading to hypo-osmotic fluid retention, cell swelling, and a compensatory adrenergic stress reaction that further raises blood pressure. [Source 9]

The hormonal environment dictates the vascular pathology. An increased level of **aldosterone** is common to both preeclampsia and essential hypertension, where it promotes sodium retention but also increases *vascular endothelial growth factor (VEGF)*, making capillaries leaky and causing edema. [Source 2] Restricting salt paradoxically increases aldosterone production, whereas increasing salt in the diet lowers both aldosterone and VEGF, reducing vascular leakiness. [Source 2] Peat noted that the drug industry's historical approach of treating hypertension and edema with diuretics and low-salt diets mirrored a fundamental misunderstanding of this physiology, analogous to the catastrophic early management of pregnancy toxemia. [Source 9] Newer anti-aldosterone drugs, which are similar in action to **progesterone**, are effective precisely because they oppose this leakiness and stress cascade. [Source 4]

Therapeutically, lowering blood pressure requires improving energy production rather than simply forcing numbers down pharmacologically. Peat recounted the case of a man on a six-month, fat-free diet of milk and sugar whose hypertension, migraines, and fatigue resolved as his cholesterol dropped, attributing the benefit to the high calcium-to-phosphorus ratio of the diet. [Source 5] Supporting thyroid function is central, as thyroid hormone antagonizes the sympathetic stress hormones like *adrenaline* and *serotonin* that drive pressure up acutely. [Source 8] Nutrients such as **niacinamide**, which is anti-lipolytic, and **vitamin E**, which opposes estrogen and promotes oxidation, can improve circulation by addressing the underlying metabolic interference from free fatty acids. [Source 1, 7] Peat maintained that lowering inflammation and improving glucose oxidation will lower blood pressure while supporting tissue renewal, whereas lowering pressure without restoring energy production merely intensifies existing problems. [Source 4]

## People also ask

### How does hypothyroidism cause high blood pressure?

Peat argued that chronic hypothyroidism is a major cause of hypertension because elevated TSH acts as a pro-inflammatory factor, increasing stress hormones and tightening small blood vessels.

### Why did Ray Peat believe calcium deficiency drives hypertension more than salt?

Peat cited evidence that low calcium status increases the tone of small arteries, while adequate calcium helps cells relax; he maintained this mineral imbalance is a primary dietary driver, not simply sodium excess.

### What is the role of aldosterone in making blood vessels leaky?

The corpus describes how elevated aldosterone, common in hypertension, increases vascular endothelial growth factor (VEGF), which makes capillaries leaky and causes edema, a process opposed by progesterone-like drugs.

## Related concepts

- [Caffeine](https://bioenergeticoracle.com/md/concepts/caffeine/index.md)
- [Salt](https://bioenergeticoracle.com/md/concepts/salt/index.md)
- [Adrenaline](https://bioenergeticoracle.com/md/concepts/adrenaline/index.md)
- [Albumin](https://bioenergeticoracle.com/md/concepts/albumin/index.md)
- [Anemia](https://bioenergeticoracle.com/md/concepts/anemia/index.md)
- [Atherosclerosis](https://bioenergeticoracle.com/md/concepts/atherosclerosis/index.md)

## Cited passages

Passage numbers match the `[Source N]` markers in the synthesis above.

### Source 1 — Ray Peat Interview on Iron Toxicity, Estrogen, PUFA, Thyroid, and Stress Hormones

Ray Peat · Interview · Sep 15, 2025 · https://www.youtube.com/watch?v=9UmFIaFm2Mc

> **Josh Rubin:** Good stuff. Good stuff. We've got a caller in the... buzz this caller in. Caller from the 386, you're on the air. Caller from the 386, you're on the air. And we're going to take them off because we can hear ourselves in the background. Guys, when you call in, make sure you're kind of in a quiet spot. If you want to ask your question and I can kind of hang up on you and let Ray answer it, that's fine as well. Question about blood pressure. Can high blood pressure be looked at similar to, like, high cholesterol, meaning more stress, so it's an adaptation mechanism?
>
> **Ray Peat:** Yeah. When your body senses that it's not getting enough oxygen or glucose or other essential factor, it tells the heart to pump more blood to deliver more oxygen and glucose. And that's the way it should work. But when you're loaded with PUFA, they're tending to give chronic signals to the brain that nothing is getting the glucose and oxygen that it needs because, in truth, the PUFA are interfering with the use of of glucose and oxygen, but the proof are also telling the pituitary and the nervous system to crank up the stress signals.

### Source 2 — When Energy Fails

Ray Peat · Newsletter · Jul 1, 2013

> Typically, the decrease of blood volume is accompanied by an increase in the extracellular fluid, edema, resulting from leakage of fluid through the walls of the capillaries, and albumin appears in the urine as it leaks through the capillaries in the kidneys. The amount of blood pumped by the heart, however, is increased in toxemia,[[22](#ref022)] showing that the increased blood pressure is at least partially compensating for the smaller volume of blood.
>
> A similar situation, reduced blood volume and edema, can be seen[[61](#ref061)] in “essential hypertension,” the “unexplained” high blood pressure that occurs more often with increasing age and obesity. At the beginning of “essential hypertension,” the amount of blood pumped is usually greater than normal.
>
> In both situations, preeclampsia and essential hypertension, there is an increased amount of aldosterone, an adrenal steroid which allows the kidneys to retain sodium, and to lose potassium and ammonium instead. A restriction of salt in the diet causes more aldosterone to be produced, and increased salt in the diet causes aldosterone to decrease. One effect of aldosterone is to increase the production of a substance called vascular endothelial growth factor, VEGF, or vascular permeability factor, which causes capillaries to become leaky, and causes new blood vessels to grow.
>
> While increased salt in the diet tends to lower both aldosterone and VEGF, reducing the leakiness of blood vessels, sodium also has a direct effect that tends to prevent the leakage of water and albumin out of the blood vessels, helping to maintain the blood volume which is needed to perfuse the kidneys, preventing them from producing signals to increase blood pressure and aldosterone. There is a large amount of albumin in the blood serum, and sodium ions associate with the negative electrical charges on the albumin molecule. This association causes the complex of albumin and sodium to attract a large amount of water, that is to exert osmotic or oncotic pressure. This oncotic pressure causes any excess extracellular water to be attracted into the blood vessels, preventing edema while maintaining the blood volume. When there is too little sodium, the albumin molecule itself easily leaves the blood stream along with the water.

### Source 3 — Current Trends in Nitric Oxide KMUD 2015

Ray Peat · Interview · 2015 · https://www.youtube.com/watch?v=6TquRcpR8RY

> **Herb Doctor:** Okay, I hold you there a moment, Dr. Peat. We have one person on hold and another coming in. Let's start with by next caller. Caller where are you from?
>
> **Caller:** Eureka.
>
> **Herb Doctor:** Eureka. Go ahead, and what's your question.
>
> **Caller:** I wondered what alternatives to blood pressure medicines?
>
> **Ray Peat:** If you look at the symptoms of chronic hypothyroidism, hypertension is one of the prominent things. A very large proportion of the people who think they have a high blood pressure problem are simply hypothyroid. The TSH itself, which rises when you are hypothyroid-even within the normal range-it's increasing your various stress hormones and increasing your blood pressure. So TSH is a pro-inflammatory factor and one of the factors causing hypertension. So you wanna keep that low just for general health.
>
> **Herb Doctor:** So caller you could ask your doctor for a test of TSH: and if it is above 0.4, then perhaps you can think about taking a thyroid supplement.
>
> **Herb Doctor:** OK, I think we have another caller on the line. Let's take this next caller. [... caller's question about contact details skipped]

### Source 4 — When Energy Fails

Ray Peat · Newsletter · Jul 1, 2013

> Lowering inflammation and the associated excess of free fatty acids in the blood, and improving the ability to oxidize glucose, will lower blood pressure while improving tissue renewal, but lowering blood pressure without improving energy production and use will create new problems or intensify existing problems. After 40 years the medical profession quietly retreated from their catastrophic approach to pregnancy toxemia, but in the more general problem of essential hypertension, the mistaken ideology is being preserved, even as less harmful treatments are introduced. That ideology prevents a comprehensive and rational approach to the problems of stress and aging.
>
> [references]

### Source 5 — This interview has a lot of good info and I highly suggest reading it.

Ray Peat · Interview · 2012

> **Sarah Johannesen:** So a calcium-deficient diet is really associated with the stimulation of a lot of inflammatory mediators ?
>
> **Ray Peat:** Yeah. In fact, the tone of the small arteries is very responsive to calcium. So, if you're low in calcium, your blood pressure goes up. And for about 30 years, David McCarron has been saying it's not sodium that causes high blood pressure, it's calcium deficiency. So, eating extra calcium can often cure hypertension. Or, avoiding excess phosphate in the diet. Or, a good ratio; for example one of the things that started getting me interested in phosphate was looking at the fat-free diet that George Burr and a group did in the 1930s; they believed that unsaturated fatty acids were nutritionally essential. So, one of their group, William Brown, went on a 6-month fat-free diet, where his diet consisted of nothing but a total of 2500 calories a day, made up basically of sugar, syrup, for several meals; and for supper, fat-free cottage cheese with a small potato starch biscuit and half an orange. So basically it was a sugar and milk diet, a gallon total of milk, some of it made into cottage cheese for his dinner, for 6 months. He had chronically life-long migraines headaches every week; and at work, he experienced a normal amount of fatigue at the end of the day. And he had hypertension, 150 over a 100 sometimes. His cholesterol was 250 and he was about 10 pounds overweight. But a few months into his diet, the sugar and milk diet, his cholesterol had come down about 50 points, his weight stabilized about 10 pounds lower, his blood pressure came down to normal; and he never again had migraine headaches. One of the things they kept talking about in the article was that, surprisingly, at the end of the work day, he wasn't tired.

### Source 6 — Water Retention 2011 KMUD the Herb Doctors

Ray Peat · Interview · 2011 · http://l-i-g-h-t.com/files/herb-doctors-water-retention-and-salt.mp4

> **Please describe your professional and academic background:** So even short term exposure to higher blood levels of calcium or tissues, endothelium picking up the calcium, can contribute to that lack of elasticity, is it more characteristic of high blood pressure?
>
> **Ray Peat:** Yes. Each of these things sets in motion the whole sequence of events. The low carbon dioxide which lets calcium get into cells and excite them, and tighten up the blood vessels for example, low carbon dioxide also lets the platelets release their serotonin, and the serotonin, besides adding to the tension of the blood vessels, makes them permeable and leaky, so that the water isn’t retained in the bloodstream but leaks through into the cells, and the cells that are taking up calcium, are also taking up water.
>
> **Please describe your professional and academic background:** So 2000mg of calcium is really important for someone with hypertension to start implementing into their regime?
>
> **Ray Peat:** Yes, and supporting it with the other minerals. The facts that David McKerron looked at showed that this inverse connection between salt and blood pressure, that high salt intakes actually had lower blood pressure, and one of the things that is involved there is that sodium helps the cell, stimulates the cell to expel calcium. The sodium activates the thyroid function, and the thyroid function pushes calcium out of the cell and lets the cell relax.

### Source 7 — Nutrition for Women

Ray Peat · Book · 1993

> Other vitamins that can improve circulation by opening the small blood vessels are folic acid and niacin. Vitamin C can help to eliminate toxins that could contribute to high blood pressure. Trace minerals (such as those found in kelp and bran) and magnesium should also be considered in circulatory problems. Magnesium acts against calcium (and estrogen) in the clotting system, can prevent spasms of blood vessels, and can spare oxygen. According to Barnes, nearly all hypertension can be helped with thyroid.
>
> ## IV. Some Diseases
>
> ### Nearsightedness (Myopia)
>
> Many years ago I noticed that my nearsightedness increased when I was under stress. Many people become slightly nearsighted at night, or in the dark. Since the blood sugar concentration decreases at night, and under certain stress conditions, I guessed that myopia might be caused by chronic deficiency of sugar supply to the eye. This idea was reinforced when I read that tears normally contain more glucose than do the other body fluids, and then found that my tears usually had less sugar than the eyes of people with normal vision or with farsightedness. I found that many people (not just diabetic, whose altered refraction is usually blamed on swelling of the eyeball) had experienced very rapid and large changes in their degree of nearsightedness. In young women, I found that it was very common for them to become myopic within weeks of the time they began taking birth control pills, and that their vision sometimes corrected itself when they stopped taking the pill after a year or two. In women who were on the pill, and then began taking thyroid hormone, the thyroxin tended to correct their vision. Since estrogen tends to lower the blood sugar level, and thyroxin tends to raise it, these observations are consistent with the idea that myopia is caused by a deficiency of glucose in the eye. In the walls of the eyes of chickens, cells which look like smooth muscle cells are present. If smooth muscles in the wall of the eyeball are responsible for maintaining the roundness of the eye, against the near-focus apparatus around the lens, then chronic starvation of those cells would lead to elongation of the eyeball (in proportion to the amount of close work), producing myopia.

### Source 8 — Ask the Herb Doctor: You Are What You Eat (2014)

Ray Peat · Interview · 2014 · https://www.youtube.com/watch?v=CxsSVCclRyI

> **Ray Peat:** Were the other things like albumin and blood sugar OK?
>
> **Caller:** They said all my labs were fine.
>
> **Ray Peat:** Do you get a fairly balanced diet, with milk and cheese and eggs?
>
> **Caller:** I stopped doing that silly little thing with the high-dense (salt) diet. Since then, I drink milk - 1.5 qt, organic fresh squeezed OJ (1 quart plus), cheese and eggs and great lakes gelatin.
>
> **Ray Peat:** Is there anything that might be irritating your digestive system? Sometimes that can cause stress and increased pressure.
>
> **Caller:** No, but maybe there's something wrong with my numbers (even though doc's say they are fine)?
>
> **Ray Peat:** It's good to have albumin well above 40 and blood glucose anywhere from 70 to 110, and Potassium and Sodium should be around the middle of the scale.
>
> **Caller:** Well, they put me on medicine - it was up to 200 over 100 and then it would kind of go down.
>
> **Andrew Murray:** It sounds a lot like some kind of a stress related alarm reaction of adrenaline producing that kind of blood pressure. What do you think about thyroid hormone, Dr. Peat, and blood pressure? It's actually a regulator of BP. When people get high BP generally, they are subject to adrenaline and the other sympathetic hormones that drive BP up. Thyroid hormone specifically antagonizes that and brings BP down into a...

### Source 9 — When Energy Fails

Ray Peat · Newsletter · Jul 1, 2013

> This oncotic pressure causes any excess extracellular water to be attracted into the blood vessels, preventing edema while maintaining the blood volume. When there is too little sodium, the albumin molecule itself easily leaves the blood stream along with the water.
>
> Instead of considering the significance of sodium's effects on albumin, aldosterone, and VEGF, textbooks have often talked about the factors that “pump” sodium, and factors that specifically regulate the movement of water. Experiments in which an excess of aldosterone is combined with a high salt intake produce increased blood pressure, and—by invoking various genes—salt is said to cause hypertension in certain people. This reasoning is hardly different from the reasoning of the drug companies in the 1950s who said that since women with toxemia have hypertension and edema, they should be treated with a diuretic and a low salt diet, to eliminate water and to reduce blood pressure.
>
> The physiological loss of sodium occurs when energy metabolism fails, as in diabetes, hypothyroidism, hyperestrogenism, and starvation. What these conditions have in common is an increased level of free fatty acids in the blood. Increased free fatty acids impair the use of glucose. The consumption of carbohydrate, like an increase of thyroid hormone, insulin, or progesterone, increases the retention of sodium; fructose is the most effective carbohydrate.[[51](#ref051)]
>
> The loss of sodium is often accompanied by the retention of water, reducing the osmotic pressure of the body fluids. The leakiness of blood vessels allows the extracellular fluid volume to increase, as understood in the standard definition of edema. However, when this fluid is hypo-osmotic, it will enter cells, causing them to swell. Cell swelling excites cells,[[2](#ref002), [3](#ref003)] and can kill them if they are unable to produce enough energy to restore their original volume, by measures including the excretion of amino acids and potassium. Both low sodium (hyponatremia) and low osmotic pressure stimulate the adrenergic nervous system.
>
> The increase of adrenalin, caused by a deficiency of sodium, is one of the factors that can increase blood pressure; if the tissues' glycogen stores are depleted, the adrenalin will mobilize free fatty acids from the tissues, which tends to inhibit energy production from glucose, and to increase leakiness.

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