Hypertension
Hypertension is chronically elevated blood pressure. Standard medical advice centers on salt restriction, a recommendation the evidence, per Ray Peat, doesn't actually support.
Salt restriction doesn't deliver the promised benefit
[edit]A large review of roughly 100 studies found that salt restriction lowers blood pressure only slightly, and the small drop doesn't translate into better health outcomes:[1]
Salt restriction, according to a review of about 100 studies (Alderman, 2004), lowers the blood pressure a few points. But that generally doesn't relate to better health.
The review put real numbers on that "few points": a substantial sodium cut of 75-100 mmol/day lowered diastolic pressure by only about 1 mmHg and systolic by about 3-5 mmHg on average. The one study directly linking baseline urinary sodium to cardiovascular outcomes in hypertensive patients found the opposite of what restriction advocates would predict: a 66 mmol/24h increase in sodium excretion was associated with a 36% reduction in cardiovascular events.[3]
He also pointed out that restricting salt has its own cost: it raises adrenaline, with real downstream harm:
The increase of adrenalin caused by salt restriction has many harmful effects, including insomnia.
Counterintuitively, he cited research showing blood (plasma) volume tends to run lower, not higher, in people with essential hypertension compared to normal subjects, the opposite of what "too much salt raises blood volume, which raises pressure" would predict:
Plasma volume is usually lower in patients with essential hypertension than in normal subjects.
Nattokinase
[edit]A meta-analysis of six randomized trials (546 participants) found nattokinase supplementation lowered systolic blood pressure by about 3-6 mmHg and diastolic by about 2-3 mmHg versus placebo, with no significant adverse events reported across the trials; effects on cholesterol were not significant at the doses studied.[6] Separately, a Chinese clinical study directly comparing nattokinase to statin therapy over 12 months found nattokinase reduced carotid plaque size by roughly a third as measured by ultrasound, alongside reduced intima-media thickness; a larger 1,062-participant dose-response study found the effect required a higher dose (10,800 FU/day), with a lower dose (3,600 FU/day) failing to slow atherosclerosis progression.[7][8]
Hypothyroidism as a hidden cause
[edit]Underactive thyroid function can itself produce diastolic hypertension, and correcting it resolves the pressure in roughly half of those cases. When researchers deliberately made 40 formerly thyrotoxic patients hypothyroid with radioiodine, 16 developed diastolic pressure above 90 mmHg; restoring normal thyroid hormone levels with thyroxine brought diastolic pressure back under 90 mmHg in 9 of those 16. In a separate screen of 688 people referred for hypertension treatment, 3.6% turned out to be hypothyroid, and correcting their thyroid status normalized diastolic pressure, off all blood-pressure medication, in about a third of the ones who could be followed up.[9]
Practice
[edit]This framework treats adequate salt intake, thyroid support, and general metabolic health as more relevant to blood pressure than blanket sodium restriction. This is not a substitute for medical management of diagnosed hypertension. See Salt, Blood pressure, Adrenaline.
See also
[edit]References
[edit]- ↑ Ray Peat, "Salt, energy, metabolic rate, and longevity," raypeat.com.
- ↑ Salt, energy, metabolic rate, and longevity, Ray Peat newsletter
- ↑ Alderman MH. "Dietary sodium and cardiovascular health in hypertensive patients: the case against universal sodium restriction," J Am Soc Nephrol. 2004;15 Suppl 1:S47-50.
- ↑ Salt, energy, metabolic rate, and longevity, Ray Peat newsletter
- ↑ Salt, energy, metabolic rate, and longevity, Ray Peat newsletter
- ↑ "Nattokinase Supplementation and Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials," Nutrients. 2024. PMID 39076715.
- ↑ Ren NN, Chen HJ, Li Y, Mcgowan GW, et al. "A clinical study on the effect of nattokinase on carotid artery atherosclerosis and hyperlipidaemia," Zhonghua Yi Xue Za Zhi. 2017. PMID 28763875.
- ↑ Chen H, Chen J, Zhang F, Li Y, et al. "Effective management of atherosclerosis progress and hyperlipidemia with nattokinase: A clinical study with 1,062 participants," Front Cardiovasc Med. 2022. doi:10.3389/fcvm.2022.964977. PMID 36072877.
- ↑ Streeten DH, Anderson GH Jr, Howland T, Chiang R, Smulyan H. "Effects of thyroid function on blood pressure. Recognition of hypothyroid hypertension," Hypertension. 1988;11(1):78-83. PMID 3338842.