Interest in the anatomy of the Cardiovascular system is quite ancient, pre Roman and Greek times.The dissection of the human body could be a public affair at times and the gross anatomy of all organs witnessed. There was no shortage of specimens.How these organs functioned in life and why they existed in species homosapiens and other species was a mystery. Gross macroscopic changes like organ tumours or malformations were documented.Understanding organ function and their relation to all other organs lagged until biological, chemical and physical sciences progressed and contributed to the scene we described as physiological and medical science; the organ or tissue function.
So a condition referred to as ‘hard arteries’ is ancient and could be detected clinically. Clinicians today by finger palpation can estimate systolic pressure well. Its likely those with hard arteries died prematurely, like those with angina like symptoms of 2,500 BC in ancient Egypt, the worlds major grain producer. Hard arteries would have been the consequence of hypertension of some duration.But like CHD as angina, heart attack, heart failure, hypertension slowly became more prevalent in the early 20th century, manifesting as stroke, heart failure and CVD.
Hypertension can arise from different pathological origins but ‘essential’ hypertension is the predominant common variety,(95%)throughout the world. Hypertension and CHD prevalence grew steadily until WWII and were accompanied by tobacco consumption and OWOB! The lesions of CHD, atheroma were attributed to some poor science as due to consuming animal saturated fat and cholesterol. The origin of essential hypertension evaded research, but both CV pathologies stimulated extensive pharmacological treatments in the 1950’s,60’s,70’s.In this 20 year period drugs for angina, hypertension, heart failure, myocardial infarction cardiac arrythmias poured out of the drug companies and Coronary Care units sprung up in every hospital, irrespective of size. Mortality in CCU’s plummeted from over 20% to 3-4%!! Surgical intervention, while useful did not have the numbers. It was a medical war on the clinical manifestations of these CVD’s at primary, secondary and tertiary level. It has continued and we have noticed the change in the thrombotic behaviour in coronary arteries during acute myocardial infarction(AMI). You will have noticed, we have failed to prevent the basic pathology of atheroma and essential hypertension. Actually in the last 50 years, their prevalence has steadily increased in the affluent world and accelerated in the non-affluent world where they cannot afford the treatment.
It was in this period that mortality from CHD reached its peak in the US and started to decline.The war on tobacco commenced with good living practices like exercise, nutrition, avoiding saturated fat and cholesterol, reducing weight.Everyone was getting warm fuzzies, the patients, the doctors, the administrators and hierachy.Well there is nothing like a naughty fact, piece of evidence, to destroy the party, a fantasy. Here are a few! I think the war on CHD and hypertension pharmacologically most probably had impact on mortality, which I will expand on in another blog.Tobacco reduction improves mortality from CHD and AVD we have evidence of from many studies.I suspect this has been our most useful contribution to the decrease in CHD mortality.
So we have fixed the problem, the Tobacco companies buy into the Drug companies! We are all happy now and are happy to complete those surveys on happiness that the Psychology Depts., at Universities are for ever trying to find the reason for or origin of!You have probably forgotten my HSLC, where our change, progress, effects an opposite change of unknown nature, extent and duration. Well that poorly researched theory that we had to avoid saturated fat and cholesterol, had no impact on the prevalence of CHD at all and helped or was responsible for converting nation populations into ‘hefalumps’. That diet could not have had any impact on mortality, because saturated fat and cholesterol consumption remained low and unchanged in the USA for a century! Never in the history of the world has species homosapiens been so fat and it had nothing to do with consuming fat! Consuming excess animal fat does not make you fat!On the side-line was the processed food industry applauding. They will find any and every natural food we have consumed since we arrived on the planet and convert it into a ‘yummy’we must have because it is ‘good for us’. If we tell them it isn’t, they will get some synthetic ‘naturals’ to make it ‘healthy’, with plenty of sugar, processed CHO and expensive packaging.
Meantime the prevalence of CHD and Hypertension has not changed and OWOB is increasing.The processed food industry introduces high fructose corn syrup (HFCS) that is a more potent producer of fat tissue, as well as the vegetable oils, that effect a form of chronic inflammation. We once ate these vegetables as such, but now they have been promoted as oil to replace animal fat. Fat tissue in OWOBs acts as an endocrine organ and produces cytokines and other factors that effect chronic inflammation. So 65-75% of US adults as OWOBs, are likely to have chronic inflammation. As well they will be insulin resistant with hyperinsulinemia and consuming inflammatory vegetable oils.
Could this metabolic state play a part in Hypertension? Insulin can act like a mineralocorticoid hormone and retain sodium from the tubules of the kidney and as an OWOB there is excess insulin available. As total body sodium increases it drags water with it, which in turn increases total body mass.So this increase in total body mass of the OWOB is due to the hormone insulin parking CHO as fat in fat tissue and the same insulin parking sodium and water in vascular and extravascular tissue. To reduce mass, reduce insulin which is effected by removing the pancreatic and insulin stimulant, CHO.When you reduce your CHO load in your diet you should find you will pass more urine for several weeks as the insulin levels fall and you lose sodium and water. You will lose weight and help avoid degenerative diseases.
As clinicians we know that if the patient effects the above sequence they will reduce insulin production and levels, fat tissue mass, total body water and sodium as well as systolic and diastolic blood pressure. Theoretically you should be able to remove the need for medication, but do so under your doctors supervision. Many with essential hypertension will not consider they are OWOB and they may not be, but interfering with the above sequence can still help.
Insulin is not really a culprit here, its processed CHO overdose. It commenced at the Neolithic period and has become progressively intrusive in our energy nutrition and I believe the foundation metabolically of atheroma, CHD, CVD, DM, Hypertension, and OWOBs. Alzheimers Disease and endothelial cancers appear to be a consequence too.
The hunter-gatherers of the New World, observed, studied, written about, were lean, active and well and those studied did not experience our list of European, degenerative diseases. The cost of these diseases to diagnose, investigate, treat and manage is now such that affluent nations, Europe and the USA realise they cannot continue this cripling expensive program. China, India and much of Asia have set off on the same journey and cannot afford it.
Climate change, Pollution, Chronic degenerative diseases and Population Explosion are ‘man made’, homosapiens made entities, that are accelerating the species, with millions of other species to extinction. Each one of these ‘planet pathologies’ is reversible by us. We initiated them, maintained them, we know how to reverse them, but is the anachy of consumption, greed and faulty philosophies too much for a fallible species with a defective fore-sight?
Dr.Lindsay A Green. FRACP. FCSANZ.