Hypertension, Essential Hypertension, Assault discussed on The Peter Attia Drive
He's and an problems as well. So you don't WanNa be extreme on either end especially as you get older this whole thing's kind of such a it's a real clinical mystery in some ways still because in medical school we learn about this term called essential hypertension which is kind of a wastebasket term for hypertension or high blood pressure for which. We don't have an obvious cause the problem is in so having sort of that. wastebasket term would be okay if it accounted for the minority of cases. But then you get to the clinic and you realize everybody everybody walking around with high blood pressure basically getting labelled as having quote unquote essential hypertension. So it really is this epidemic without a clear description. And we're going to come to a lot of reasons that I mean I think you have arguably one of the most compelling cases for what is at the root of hypertension but for people listening to this for doctors is listening to this. Who treat hypertension? I feel it. We just haven't made much progress in the twenty years. Since I've been out of medical school there have been some real breakthroughs in the understanding of of primary hypertension. Just in the last five ten years. And there's two major aspects I can talk about the first one is that it does appear appeared. That salt really is important. And one of the key discoveries was that the kidneys are often normally handle assault fine but they develop our choir a change in the kidneys that lead them to hold onto sodium and the mechanism has been uh identify. Just in the last few years it's due to the fact that there's an inflammatory inflammation that occurs in the kidney and and that inflammation which is driven by t cells and macrophages causes a constriction of the blood vessels that leads to low. Oh Greatest Kimia in the kidney and that Escambia can translate into increased sodium absorption which then leads to high serum sodium and the effects is there a correlation between serum sodium and blood pressure across normal physiologic ranges of say one thirty five to one forty five mil equivalents for leader. Yeah I believe so I naturally I can quote the paper but yes. I think that's true. So what you're saying is in people with high blood pressure that's otherwise wise viewed as quote unquote essential. There's an inflammatory. Response mediated by both t cells and macrophages that injures the kidney schematically schematically meaning it for the listener that result in reduced blood flow and tissue damage due to reduced blood flow and reduced oxygen. And it's that injury that then leads to do a Barent retention of sodium so there's actually been really a lot of studies looking at the mechanism of inflammation and originally. It looked like it was people thought it might might be a reactive response of the kidney so we think that there may be external stimuli that initially cause a decrease in blood flow to the kidney like sympathetic nervous system response you can do it. Translated by giving medicines or drugs that can cause a constriction of blood vessels. When you do that you get gather? Transient reduction blood flow. To the kidney that induces an inflammatory response that then causes persistent reduction in blood flow. And what we've learned in the the last few years and I'm an author in one of these studies is that this inflammatory reaction can actually be an autoimmune reaction and we've even identified certain proteins that there's an auto immune response to in one is a heat shock protein. You can actually create high blood pressure in animals by inducing an immune response response to this and you can black the immune response and black the high blood pressure and and now there's even data showing that in humans that there's evidence for for an auto immune response to heat shock proteins and people with essential hypertension. which is not to say heat shock proteins necessarily bad because so many of the benefits we get out of Sauna or exercise may be transmitted through these? But you're saying a subset of people where the heat shock protein itself becomes the night for inflammation via an autoimmune mechanism. Yes yes oh heat shock proteins or great just as you say they do all these really good things but what happens is they're involved in the clearance of MIS folded proteins and they're right helping keep a clean system but what happens is when you trigger injury to the kidney for example these heat shock proteins get produced to help help fix problems but the immune system can sometimes get confused and make an immune response that actually is against the heat shock proteins. And when that that happens you can develop high blood pressure in the animal. And there's some evidence for it in humans so anyway. So that's one of the big breakthroughs has been the discovery that inflammation inflammation in the kidney can be a mechanism for triggering. Persistent elevations in blood pressure and probably has a big role in the cause of primary hypertension inch before you go on Rick. How prevalent do you think that particular mechanism is that you just elucidated? Let's very major. In fact we've even looked at genetic polymorphisms presumes that link with the development of primary hypertension and most of them are involved with the immune response. And it looks like this is a major pathway. This creates a bit of a quandary for someone WHO's trying to rid themselves of hypertension. Because wouldn't the implication of this be that exercise or things like exercise that induce heat shock proteins may paradoxically increase their hypertension. I don't think so so. Hypertension is kind of a complicated pathway. So there's several different aspects but exercises sizes extremely good for improving Mida conrail function improving the ability for your blood vessels to dilate. It improves kidney function function. The benefits of exercise are so much greater and releasing heat shock proteins that really occurs with. I don't know if it's just general. Exercise would have a big effect heat shock proteins as you're saying basically the net effect of exercises still going too far outweigh. Yes absolutely. But I'd like right to get back to this the link between salt and sugar if I could okay because there is this data as I say that salt. When it increases the Syrup Sodium is what drives the cute blood pressure response and when the kidneys have trouble getting rhys all? It's easier to get that effect with assault but even with a normal person you can with normal blood pressure you can raise their blood pressure. Transient Louis by giving giving them salt and you can block it by giving water. Interestingly in the process of developing high blood pressure there's the initiators and then there's the things that make it persistent and the inflammation in the kidney is involved in the persistence but what is involved in. The initiation turns turns out that sugar has a major role and what we discovered. Is that when you give a high salt diet to animals walls that the high salt increases the serum sodium and the serum sodium when it goes up it activates an enzyme that Converts Glucose which is in our blood and our tissues to fructose and that conversion to fructose is driven even by a high salt diet. And it's driven by an increase in serum is morality or increase in Serum Sodium. Once the fructose is made aide in the body so this is not fructose. Coming from the Diet this is made in the body. The fructose gets metabolize and raises blood pressure and when we gave high salt to animals they developed an increase in blood pressure and they also were making fructose and when we block black the metabolism of fructose. We actually black the rise in blood pressure as well as the hypertrophy of the heart. So let's pause for a moment I've had rob west on on the podcast before so anyone who's listened to that will be familiar with what fructose is. What glucose is what sugar is? All of these things became you spend one minute just defining defining these things for people who listened to that podcast sure so there's different types of sugar and the main one that we call blood. Sugar is glucose and this is the primary sugared that our body uses to make energy. It's the main sugar that's used to make energy and it can be stored in the tissues as glycogen and when that's too high. We call it diabetes. When the blood glucose is too low it's hypoglycemia? Yeah and so glucose is like the principal energy fuel carbohydrate fuel that we use as you said we store lots of it in our muscles once it gets the muscles. It can't get out and we store maybe a quarter to a third of it in our liver and that's mostly there to buffer the blood supply in particular the brain. What is Glucose macos taste? Like a pure drink of glucose people like it animals like it but it isn't as sweet as classics sugar but it is often very very much like by animals. Humans like it you can buy these dextrose pops and stuff like that. dextrose is another word for glucose and also the kidneys Store glycogen and Produce Glucose to the second type of sugar is fructose and the best way to think of fructose is is it is a fuel first off. It's present in fruit but it turns out to be the sugar that is involved in energy storage rather than energy production. And so when you eat glucose you use that to produce energy but when you eat fructose it will actually trigger changes in the body that will favor the storage of energy and this is the sugar that animals use to store energy so in the store in the way of fat in the way glycogen Leica Gin and all those kinds of anything that will facilitate starring. Energy is done by fructose. Fructose and glucose if you're looking at pictures of them in a Biochemistry Book Look Pretty Similar. They're both ringed carbon structures. They both have six carbons one of them has a firing versus six ring. But you know it's sort interesting to think that molecules that look almost identical. With the exception of a couple of bonds different can have quite different properties now for tos tastes a lot sweeter as well. Oh yes in so. Fructose is like in honey and fruits and then that's right so it tastes a lot sweeter and the other thing is if you mix the fructose and Glucose coast together you can get what's called high fructose Corn Syrup and at their bound together you get table sugar so table. Sugar are sucrose is is one molecule of glucose and fructose bond together and that occurs in nature in sugar cane and beets and things like that and Maple Syrup and things like that right so just to clarify for everybody we when we get a little comfortable with this terminology. Throw the word sugar around quite liberally but it's always important for people to think I think when we talk about sugar we could be talking about Blood Sugar Glucose. We could be talking about fructose by itself. oftentimes when we talk about sugar in diets. We're talking talking about added sugars such as the sucrose high fructose corn syrup. You just alluded to. I want to go back to what you just said about the ability of fructose to store something but but if you don't mind can we do it through the Lens of a beautiful story that you've written about in the past about a mutation that basically allowed that to happen this thing that it took place about twelve to fifteen million years ago share so fructose again is A. It's an fruit and many many animals. Use News fructose is a means is their primary nutrient or and also as a way to help store fat and for example Animals animals before they hibernate will often eat lot of ripe fruit and the ripe fruit gives them the sugar that allows them to store fat and Ranga. Tang's will eat huge amounts of fruit at one setting to try to increase their body fat and we don't get fat from eating fruit but that's because we eat tart fruit that that has less sugar content and we tend to only a few fruit whereas if reacts you drink fruit juice that large amounts of fruit juice can actually increase so anyway so fruit is a nutrient that is used by animals to help store fat so if you go back about twenty million years ago the very first fossil apes show up in the world and they show up in west Africa and the original one was called proconsul saw where they were living in about. Twenty two million years ago and they were these. Apes were big breakthrough in evolution because the prior the monkees were had already been around. But these these were bigger creatures. The apes were they had bigger brain size..