How Fat Lowers Your Blood Pressure

Hypertension (elevated blood pressure) is one of the triad symptoms of metabolic syndrome.  Most of the hypertension that I see clinically is driven by insulin resistance as Blood Pressure Surprisethe underlying cause.  I see this problem in a very large majority of the people in my office and I am seeing people younger and younger show up with continually increasing blood pressure.
In medical school, we were taught to treat “borderline” or “slightly elevated blood pressure,” through “lifestyle changes” which was another way of saying exercise, caloric restriction  & hold the salt.  But most physicians today will tell you that exercise, salt & caloric restriction doesn’t work.  When asked why the 34 year old male in my office suddenly has elevated blood pressure, the only explanation we had was it is a “genetic problem,” or “blood pressure naturally goes up as we get older,” or “you’ve been eating too much salt,” and they are started on blood pressure medication and sent on their way. But, as time went on, I found that I had to keep adding more and more blood pressure medication to control the continually rising blood pressure of the patients in my practice.

Most of these people will have a progressive elevation in blood pressure over time, and these blood pressure (anti-hypertensive) medications are/were continually raised until the person is on four or five different blood pressure pills at maximal doses.  Again, when questioned why, their genetics are blamed and that is the end of it.  Or is it?!Time Changes Everything

What shocked me was that when I took patients off of salt & caloric restriction, and placed them on low carbohydrate high fat diets (and yes, I gave them back their salt), their blood pressure normalized. I noticed that as their fasting insulin levels began to fall, their blood pressure began to return to normal.

What?!  Blood pressure rise is caused by insulin?!

Ummm . . . Yes!

I am a prime example.  During the first few years of my medical practice and reserve military service, we had routine vitals checkups. I was working out 3-5 days a week with weights and running 3-5 miles 2-3 times a week and restricting my calories to 1500 per day.  So, I thought I was in pretty good shape.  However, it was not uncommon for for the nurse to raise her eyebrows at my blood pressure readings in the 140-160 systolic and 85-98 range diastolic.  “Oh, it’s the lack of sleep last night,” or “it’s the caffeine I had this morning,” would be my excuse.  But I was making a lot of excuses, and in light of those excuses, my caloric restriction, exercise and salt restriction, I was also still gaining weight.

Nally 1998 Expanding Waist


By the 5th year of my medical practice, I weighed 60 lbs heavier than I do today and I struggled to keep my blood pressure under 150/95.  I was violating my own counsel . . . don’t trust a fat doctor for nutritional advise. (Or, was that advise from Dr.House?)

Nally 2016

A much slimmer, healthier and happier Dr. Nally (center) in 2016

After cutting out the carbohydrates (I’ve kept my carbohydrate intake < 20 grams per day), moderating my protein intake and eating all the fat I am hungry for each day, my recent physical examination at the beginning of June 2016 revealed my blood pressure at 112/64.  I don’t remember ever having blood pressure that low. And to be honest, I didn’t sleep well the night before my exam due to a number of middle of the night patient calls.

Loegolas Blood Pressure

When I first started treating the insulin resistance problem in the human, rather than the blood pressure problem, I began to see immediate reductions in blood pressure within one to two weeks.  So much of a reduction that if I didn’t warn the patient that they should Himalayan Saltbegin to back down their blood pressure medications, they would experience symptoms of dizziness, light-headedness, headache and a few patient’s nearly passing out.   On a low-carbohydrate, high-fat (ketogenic) diet you need salt (sodium, potassium, & magnesium).
The process of burning fat as fuel causes you to lose increased amounts of sodium & potassium, and you have to replace these electrolytes.  A number of my patients begin a low-carbohydrate, high-fat diet and are afraid of increasing their salt intake.  Not replacing these electrolytes while on a ketogenic diet can also lead to low blood pressure, dehydrate and dizziness.


I often wondered why applying a ketogenic diet had such a profound effect on blood pressure so quickly.  Dr. Robert Lustig helped answer that question for me.

In order to understand how the Standard American Diet (we call it the SAD diet in my office) raises your blood pressure, it is important to understand how the body processes the basic sugar molecule.  Sugar is one glucose molecule bound to a fructose molecule.  This is broken down in the body and 20% of the glucose is metabolized in the liver, the other 80% is sent on to be used as fuel throughout the body. Fructose, however, is where the problems arise.  100% of the fructose is metabolized in the liver, and the by product of fructose metabolism is increasing the liver’s production of MORE glucose and the byproduct of uric acid. Uric acid is produced and this inhibits the production of nitric oxide. The diminished nitric oxide in the presence of an increased level of glucose (stimulating increased insulin production due to eating starches) constricts the blood vessels and raises blood pressure.   Yes, that donut you just ate raised your blood pressure for the next 12 hours. GetAdaptBars

The mechanism that fructose containing carbohydrates, sugars and starches raise blood pressure, cholesterol and cause weight gain can be seen in the really complex diagram found in Dr. Lustig’s 2010 article:

Metabolism of Fructose


So, how do you lower your blood pressure through diet?

First, cut out all the simple sugars. These include anything with table sugar, high fructose corn syrup and corn syrup.  (This is why people with any change in diet see some improvement in weight and blood pressure as they remove the simple sugars like candy, sugared drinks and pastries from their diet.)

Second, limit your overall intake of other sources of carbohydrates including any type of bread, rice, pasta, tortilla, potato, corn and carrots.  Realize that carbohydrate in fruit is fructose, and when taken with other forms of glucose can have the same effect as table sugar – it can and will raise your blood pressure, as well as halt or cause weight gain.

Third, if you are taking blood pressure medications, see your doctor about close monitoring of your blood pressure as it can and will drop within 2-4 weeks of making these dietary changes.

Maintaining ketosis is really important for weight loss and blood pressure control. I am very much an advocate of using real food for this process, but I have also found that the use of exogenous ketone salts aid significantly in maintaining ketosis.  I have found that exogenous ketones are the next step in bridging the difficulty of day to day maintenance of ketosis.

It isn’t making the mistakes that’s critical; it’s correcting them and getting on with the task that’s important.  If you’ve been calorie restricting and exercising to lower you blood pressure, don’t fret.  A simple change in your diet focused on restricting starches and carbohydrates has been demonstrated in my office to be more powerful than many of the blood pressure medications we’ve used for years.

You can find out how to get started on a low carbohydrate, high fat (ketogenic) diet in my recent articles  The Principle Based Ketogenic Lifestyle – Part I and Ketogenic Principles – Part II.

12 Comments on “How Fat Lowers Your Blood Pressure

  1. Doc, how do I print a copy of this post? I really like it. Also, I miss your downloads where we could download copies of the “Low Carb Diet” and “The Truth About Sweeteners”.

  2. The mechanism of salt loss may be via SLGT2. This sodium-glucose transporter is insulin-dependent and resorbs glucose and/or sodium. In ketosis, insulin falls low enough that sodium is no longer completely resorbed. In type 1 diabetes, both sodium and glucose are no longer resorbed, and the loss of sodium specifically leads to the loss of fluid volume.
    This mechanism can be explained in evolutionary terms, as we evolved with widely differing access to carbohydrate and the body’s sodium content needs to match fluid volume which needs to match glycogen storage. Insulin-dependent sodium resorption means that sodium is lost as glycogen is used up, so the isotonality of the blood remains more or less constant. But in a pathology like hyperinsulinaemia or beta-cell failure, all bets are off, and the natristat becomes defective.
    Hence essential hypertension or severe loss of fluid volume.

  3. Hello,

    just stumbled upon your blog when I searched for keto relation with blood pressure, I am hypertensive and trying to lower it down until I can stop my medication. I am amaze at how you managed to drop 30+points following keto. I hope you can guide me in terms of the proper keto diet as how you did it.

    thank you doctor,


  4. I am a 55-year old woman with hypertension, weighing 120 kg . I have tried a lot of medications to bring down my weight and blood pressure but to no avail. My weight won’t come down , if it does because of dieting , after sometimes I will regain weight again even more and my blood pressure is always on d high side 140/210+ . After reading your article today which was very useful , I decided to write, so you can assist me in the process of bringing down my weight and blood pressure. My increased weight and high blood pressure isn’t healthy for my age and I am unhappy about it. what should i do to get rid of these problems ?

  5. Pingback: Ketosis: Everything you need to know to reach your peak performance - @BUTTERCOFFEEOZ

  6. Dr Nally, I listen to your podcast every week. I have been eating a ketogenic diet for 9 months. I’ve lost 45 lbs and went from a size 12 to a 4. However, my blood pressure wasn’t in a good range to begin with but now it has gone up substantially! This morning it was 164/107! I can’t understand what’s going on. When I measure my blood ketones, I’m definitely in ketosis and I’m still losing weight. Not sure what to do at this point. I had a lot of lab work recently done and my free T3 was a little low as well as iodine so my Dr put me on those. I also had a low CO2 and have been having shortness of breath for a few weeks. Any ideas what to do next for the BP? I have also decided to cut out dairy hoping it would help with the SOB but I don’t see how this will affect the BP. Any suggestions would be so much appreciated!

    • Individual issues like this need to be addressed directly with your physician. Because of a number of moving parts in the assessment of blood pressure, this needs to be done face to face visit with your doctor.

  7. I have experienced the exact same thing you describe which is how I found your post. I have had high blood pressure for the past 10 years and no amount of exercising, dieting, or salt restriction has helped in the slightest to bring it down. I’ve been on the ketogenic diet for about 8 weeks now and I noticed I can’t feel my pulse in my stomach as strongly…and I just feel so much better. I went to check my blood pressure and it has dropped well over 30 points (to a normal range 117/72). Because I thought the blood pressure machine might be fault I tried 3 different ones – all with the same outcome. My mind is blown….every doctor needs to be educated on this – it feels like a miracle cure for high BP.

  8. I have been on keto for a little over 2 months and I do not cheat. I keep my carbs under 20 which come mostly from vegetables. My bp has risen and doesn’t seem to want to come down. I drink bpc twice daily using decaf coffee. What could be the cause of the elevated bp?

    • Bobbie, there are a number of reasons for this. Without actually seeing you as a patient, I am unable to comment further. To maintain the highest standards of medical compliance, clarity and accuracy for answers regarding these issues, you will need to schedule an appointment with me face-to-face in the office or take these questions directly to your personal physician. Thank you for your understanding.

  9. Great article. I am devouring your entire website. Haha!!! Saw/met you at KetoKademy this weekend and nowI just want to learn MORE and MORE! Have lived with fibromyalgia, neuropathy, migraines, arthritis, anemia, IBS, since 2010, even had to stop working and stop singing (I sing opera) and was recently diagnosed with high bp, high cholesterol, low T3 and T4. I was a hot mess. Thank goodness, my friend introduced me to ketogenic eating and exogenous ketones. I’m only 2 months out, but already feel so much better. I’ve come out of the black cloud and I’m feeling better every day. Just trying to learn more now so I can get past this stall in my weight loss. I also had GPS in 2002. Lost 107lb and gained back about 80. Lost 16 now, but stopped losing. Have absorption issues and have suffered from chronic anemia and all kinds of vitamin/mineral deficiencies, mostly due to lack of compliance, I admit. From what I’ve been learning from you, I really think I just need to go down to 20 or so carbs and make sure I’m not overdoing my protein. Now I just need to figure out how to do that. Wish me luck, doc. 🙂

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