The Case for Fructose Induced Salt Sensitive Hypertension

September 21, 2019

(upbeat music) – Good morning I’m Rhian Touyz, a past chair of the
Council on Hypertension and I’m delighted to be
chatting with Jeff Garvin today who is the 2016 awardee
of the Seldin Award of the Kidney Council. Sir Jeff on behalf of all of us in both the Hypertension
and the Kidney Council we are so delighted to know
that you are the recipient of this very prestigious award in 2016. – Thanks Rhian, it’s a great
honor and a privilege to be given this award and
receive this recognition from one’s peers. – Jeff perhaps you could
tell us a little bit about your research, how you got into it, and how over the years it’s
progressed to what you’re going to be sharing with us in
your award lecture tomorrow. – So we were, initially
our research was dealing with salt sensitive
hypertension and we got into that research because
of the Seminole work done by Lewis Dahl and developed into the Dahl salt sensitive rat. We were one of the first
laboratories to show that nitric oxide inhibited
sodium re-absorption along the nephron and
that that was defective in the model of the Dahl rat causing salt sensitive hypertension. Since then over the years we’ve progressed and studied a number of factors
that cause salt sensitive hypertension including angiotensin,
reactive oxygen species, nitric oxide of course and more recently because of this we’ve
moved into diet induced salt sensitive hypertension. My lecture tomorrow is going
to be about fructose induced salt sensitive hypertension
because as you know over the past 40 years
or so the consumption of salt has gone up
dramatically in the U.S. diet as has the consumption of fructose. This correlates remarkably
well with the increase in hypertension overall
which has gone from about 18% in the early 70’s to nearly 30% now. In about half of that
increase in hypertension is salt sensitive hypertension. – So Jeff this is really
complicating the whole system much more than what it
was just a few years ago when we believed that it was just the salt sensitive component
that was contributing to this hypertension and
now adding to this the aspects of fructose or
sugars this really becomes quite a complicated para-dime in terms of teasing out the mechanisms and I guess at the human population level,
I guess it reflects really what we’re eating ultimately
in terms of our salts. – Well absolutely Rhian but
as you know hypertension is a very complicated disease
and there’s many factors as I will discuss tomorrow. Things that effect your
blood pressure include genetics and epi-genetics,
the environment, any sort of pathology such
as renal artery stenosis, how much you exercise or
whether you’re a couch potato and of course your diet and
many studies have now correlated increases in blood
pressure and renal injury with increases in fructose in the diet. There are some studies that
don’t show that correlation and we think that that’s
due to the variable of salt and our research which I’m
going to talk about tomorrow clearly shows that when
you add the two together, they are very detrimental
in terms of blood pressure. – So Jeff perhaps you
could tell us in terms of what we consume, what are the foods that actually contain fructose? – Well, the biggest increase
in fructose in our diets is caused by the
consumption of soft drinks, so about 40% of fructose intake comes from sugar sweetened beverages. I hate to age myself but in
the early 70s when I was a kid you could get a soft drink for a dime and it was either a six ounce version or a 10 ounce version and now you can go into a convenience store and get a drink that costs approximately
the same amount of money and it could be 64 ounces. So there’s been an order of
magnitude increase in the volume and with that volume comes an
order of magnitude increase in fructose consumption
because the beverages now are sweetened with high
fructose corn syrup which is 42% fructose. – So Jeff as we can all see
in our populations at large there’s more and more
consumption of both peanuts and salted snacks and of course
with that goes the desire to drink more and of
course one would associate drinking more sodas as
we eat more salty foods and certainly in the western world and probably in the
developing world as well, this increased consumption
of salty and sugary foods is increasing most likely contributes to the increasing
prevalence of hypertension, probably at a global level. – You’re absolutely correct Rhian. Hypertension is now the leading cause of quote, loss of health worldwide, and this is due to the fact
that there is increased salt consumption around the world and in developing countries
they look to the west and want to mimic many things that we do. Unfortunately they want
to mimic our diets as well and so with the increase
in salt consumption they also have increased consumption of sugar sweetened beverages. Most of those beverages are sweetened with high fructose corn syrup because it’s relatively
inexpensive and you perceive it as being sweeter
than actual table sugar and so that combination of increasing salt in your diet and increasing
fructose in your diet through primarily sugar sweetened
beverages causes the problem of elevated blood pressure. – So Jeff if you wanted
to give us one message in terms of population health
I guess I could imagine what it would be but perhaps
you could just reiterate what it is we should be doing
to have a healthy lifestyle in terms of fructose and salt intake. – So unfortunately too
many Americans are looking for the magic bullet and there
really is no magic bullet. It of course is eat a well balanced diet with lots of fruits and vegetables. Try to limit your salt
intake, get plenty of exercise and also I would say there’s
new studies now looking at sleep as a cause of
hypertension and I would say get your eight hours also. – So I guess perhaps our mothers and our grandmothers
were correct after all. A healthy lifestyle will certainly create a healthy population. – Absolutely. – So Jeff once again on
behalf of our Council and the Kidney Council
congratulations and we certainly look forward to learning
much more tomorrow in your award presentation. – Well thank you very
much Rhian and as I said this is a great honor. Dr. Seldin was a huge
factor in the development of our understanding of the
role in both renal disease and in hypertension and has
made many Seminole contribution. (upbeat music)

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