In the last section, we looked at the impact of increased aldosterone from a high level in diabetes. There is so much more to the story with very practical application. The latest scientific evidence supports a much broader role for this hormone in the metabolic syndrome (obesity, high blood pressure, high cholesterol, diabetes etc.) and chronic illness. It is important to look at this topic more closely so that you understand the power of the new science to keep to healthier longer.
Processed and fast foods that combine fat, salt, sugar, and processed carbs drive increased intake that leads to weight gain and increased abdominal fat. Too much abdominal fat increases aldosterone and cortisone-like steroid production which drive the excess oxidant production and signaling we discussed in the last section. That leads directly to increased cell growth in the wall of the artery that makes it thicker. It causes the death of cells lining the artery that produce molecules that expand the artery to provide more blood flow with exercise, prevent clotting, and reduce inflammation. Those changes lead to high blood pressure.
So you can easily see that disease begins very early. Unhealthy diet and weight gain lead to increased aldosterone and cortisone type steroid effects. That is not normal and it leads to an artery that is thicker and does not dilate as well. That artery is not normal. It is diseased. It is more likely to form a clot that blocks the artery. That is not normal. It is not healthy. When the artery becomes sick enough, abnormal enough, the blood pressure increases. High blood pressure or hypertension is not a disease. It is a measurement that reflects the abnormal arterial function and structure in the person with high blood pressure.
Patients who have increased aldosterone activity are more likely to have resistant hypertension. That is high blood pressure that is not less than 140/90 on three different classes of blood pressure medication with one of them being a diuretic or fluid pill. Adding a medication that interferes with aldosterone effects at the MR receptor like spironolactone, eplerenone, or finerenone drops the pressure by 25 points on the top number, but that is not the most important effect. By blocking the effects of excess aldosterone and cortisone-like steroids, it makes the artery more normal. It becomes thinner. It expands more easily to provide more blood flow with exercise. Treating high blood pressure with eplerenone is not prevention of disease. It attacks the root causes of arterial disease. It is the most precise treatment.
Treating high blood pressure with diuretics is very often necessary, but treatment with a fluid pill increases aldosterone levels in the blood. Then there’s this fact. There is a kind of vicious cycle involved. Poor diet leads to increased abdominal fat. Increased abdominal fat leads to increased aldosterone and cortisone-like steroid production. Those hormones make it easier to form fat and produce inflammation in the fat tissue. If a patient is overweight and their pressure is poorly controlled, taking spironolactone or eplerenone is precision treatment that treats the root cause of their disease.
The is a fairly common type of patient who can help us understand more about chronic disease and aldosterone. They have a benign tumor that makes too much aldosterone (primary aldosteronism). These patients just have increased aldosterone activity—that’s it. They are more resistant to the effects of insulin and they have higher glucose levels. Adiponectin levels are lower. Adiponectin regulates glucose levels, cholesterol metabolism, and insulin sensitivity. It is anti-inflammatory, antioxidant effects, and reduces scar formation in the vessels and other vital organs. Patients with these tumors are more likely to be depressed. Surgical removal of the benign tumor returns these patients to normal sensitivity to insulin.
There is a lot more to the aldosterone story and the exact mechanisms that cause chronic illness and accelerate aging but we need not go there. You just need to understand that spironolactone and each of the green box medications are precision treatments that cut to the root cause of chronic illness and faster aging. The old medical science paradigm cannot explain how poor diet, lack of exercise, abdominal fat, and smoking all produce the same problems of faster aging, premature death, disability, vascular disease and cancer. Now there is a model that explains it. More importantly, we can very precisely attack it and we will get better and better at preserving your health.
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