Aldosterone is a hormone most people rarely think about, although it is vital for health. Aldosterone keeps the body hydrated and in proper mineral balance. But left unchecked, too much aldosterone leads to high blood pressure, heart disease, and mineral depletion.Too little of it and critical electrolyte imbalances can ensue. Read on to understand the roles of aldosterone.
Disclaimer: This post focuses on the science of blood pressure regulation and electrolyte balance in relation to aldosterone. It is solely informational. Talk to your healthcare provider if your blood pressure and/or labs are abnormal.
What is Aldosterone?
Definition & Function
Aldosterone is a hormone produced in the cortex of adrenal glands. It is known as a “mineralocorticoid.” [1]
Aldosterone helps the body retain sodium and water and excrete potassium, which results in higher blood pressure [1].
According to one experimental hypothesis, aldosterone has a daily rhythm to it. It seems to increase toward the end of the sleep phase, prior to the early morning (before cortisol rises) [2].
High blood levels of potassium typically signal the body to raise aldosterone production [1].
Aldosterone works in opposition to the atrial natriuretic peptide (ANP) produced in the heart, which excretes sodium and lowers blood pressure [3].
Both high and low aldosterone has been implicated in disease. The body is good at keeping this hormone in balance in health.
Blood Pressure Control
Aldosterone’s role in fluid balance is within the context of the renin-angiotensin-aldosterone system (RAAS), which keeps our body fluids and blood pressure in strict control [1].
When cells in the kidneys recognize a reduction in blood flow (lower blood pressure), through a cascade of events, angiotensin I is produced. The angiotensin-converting enzyme (ACE) then converts it to angiotensin II, which stimulates the adrenal glands to produce aldosterone [1, 4].
Prorenin->Renin->Angiotensinogen->Angiotensin I (+ACE)->Angiotensin II->Aldosterone.
ACE inhibiting drugs (also known as ACEI) are used to block the angiotensin-converting enzyme, resulting in lower angiotensin II, lower aldosterone, and lower blood pressure [1].
ACEI are available only with a doctor’s prescription. They include drugs like lisinopril (Zestril) and captopril (Capoten).
Limitations
Note that aldosterone is not the only hormone that affects blood pressure regulation and electrolyte balance. The health of blood vessels, the sympathetic nervous system (SNS), and other pathways also impact blood pressure and heart health.
As an example, beta 2-adrenoreceptor blockers like propranolol block beta receptors in the heart that belong to the SNS [9].
Sympathetic, fight-or-flight activity can also be counteracted by parasympathetic, rest-and-digest activity. This is part of the cholinergic pathway in the body.
Lastly, blood pressure regulation can involve many other possible factors – including blood chemistry, environment, health status, and genetics – that may vary from one person to another.
Aldosterone Health Effects & Research
Immunity
We know little about the effects of aldosterone on the immune system.
Scientists are investigating whether aldosterone:
- Increases CD8+ cells [5], which might hypothetically help fight viral infections
- Can be beneficial for some types of inflammation like Uveitis (in animal models) [6] via blocking Nf-kB-induced TNF-alpha in blood cells [7].
- Creates cysteine dioxygenase, which is important for the Sulfation pathway of Phase 2 detoxification. Sulfation is the addition of sulfate to a drug/toxin and most often it makes it less toxic.
Inflammation
High aldosterone is implicated in many chronic diseases.
Researchers are studying if it:
- Increases IL-6, IL-1b [8], TNF [9] and induces Nf-kB, sometimes described as the master control switch of inflammation [10].
- Promotes Th17 immunity [11], which has been linked with autoimmune diseases and chronic inflammation in limited studies.
More research is needed.
Heart Health & Blood Pressure
Too much aldosterone is particularly bad for the heart. High aldosterone directly raises blood pressure [12].
It is hypothesized to increase inflammation (ICAM-1, VCAM-1, TNF, IL-6, and CRP), fibrosis, oxidative stress, vessel dysfunction, and prevent regeneration of new cells in our blood vessels [13].
Other Research
Aside from the effects listed below, there are several experimental areas of aldosterone research. Animal and cell-based studies are exploring whether:
- Prolonged exposure to high aldosterone and cortisol induced by chronic stress reduces hippocampal CB1 receptor binding site density, potentially leading to lower cannabinoid function [14].
- High aldosterone can deplete the body of Magnesium [15] and Potassium [16].
- Aldosterone in excess can deplete the body of Calcium, possibly contributing to osteoporosis [17, 18].
Human data on these pathways are lacking.
High Aldosterone
Associated Conditions
Conditions shown here are commonly associated with high aldosterone. The majority of studies covered in this section deal with associations only, which means that a cause-and-effect relationship hasn’t been established.
- High Blood Pressure [19]
- Cardiovascular Disease [20, 21] – Including Congestive Heart Failure, Coronary Artery Disease, and stroke.
- Chronic kidney disease [21]
- Osteoporosis [17, 18]
- Autoimmune Disease [22]
- Conn’s Syndrome – High blood pressure with an adrenal mass [19]. Other symptoms include low potassium in the blood, increased blood volume, and abnormally alkaline blood (aldosterone increases acid secretion).
Potential Causes
Causes shown here are commonly associated with high aldosterone. Work with your doctor or other health care professional for an accurate diagnosis.
High aldosterone is typically caused by benign aldosterone-producing tumors on the adrenal glands [23].
The other causes listed below haven’t been proven in large enough studies and remain experimental.
- Stress and Anxiety [24]. When the fight or flight nervous system is activated, aldosterone is increased. ACTH part of the mechanism by which the nervous system increases aldosterone [25].
- Elevated CCK – CCK (a gut hormone) increases aldosterone secretion in humans and rats, which may increase blood pressure and cause salt retention [26].
- People with IBS may be more likely to release too much CCK in response to a fat-rich meal, but it’s unknown how this affects aldosterone [27].
- Lectin Consumption may elevate CCK in rats [28]. In men, beans also increased CCK release, and the study attributed that to the beneficial impact of fiber [29]. All in all, we don’t know if lectins can raise aldosterone in humans.
- Magnesium inadequacy [30, 31]
- Zinc inadequacy [32]
- Low blood pressure [33] – if you have low blood pressure, the body tries to compensate and temporarily brings up aldosterone. Once the blood pressure is back to normal, aldosterone normalizes.
- Potassium supplementation [33]
- High histamine levels stimulate the secretion of aldosterone in dogs, but the effects of excess histamine in humans are unknown [34].
Conventional Treatment
Treatment for hyperaldosteronism depends on the underlying cause. The main goal is to normalize or reduce the negative effects of high aldosterone levels, which include high blood pressure and low potassium levels.
If the cause is an adrenal gland tumor, treatment options include [35]:
- Surgically removing the gland containing the tumor (adrenalectomy)
- Aldosterone-blocking drugs (e.g. mineralocorticoid receptor antagonists)
- Lifestyle changes (e.g. limiting sodium intake, losing weight, regular exercise)
If the cause is overactivity of both adrenal glands (bilateral adrenal hyperplasia), treatment options include [35]:
- Aldosterone-blocking drugs (e.g. mineralocorticoid receptor antagonists)
- Lifestyle changes (e.g. limiting sodium intake, losing weight, regular exercise)
Complementary Approaches
You may try the complementary approaches listed below if you and your doctor determine that they could be appropriate for lowering your aldosterone levels.
Most of these approaches have only been researched in animals. Proper clinical research is lacking to support them.
Remember that none of them should ever be done in place of what your doctor recommends or prescribes.
Minerals & Diet
- Getting enough Magnesium and Zinc [30, 32]
- Reducing salt. Excess salt can raise Aldosterone [10, 36, 37, 38]
- Tea/EGCG [39]
Supplements
These supplements are proposed to Inhibit ACE, but their effects and safety in humans with high aldosterone hasn’t been investigated:
- Rooibos [40]
- Probiotic VSL#3 [41]
- Chitosan [42]
- Whey Protein/casein [39]
- Hibiscus (Hibiscus sabdariffa) [39]
- Rose (Rosa damascene) [39]
- Bilberry (Vaccinium myrtillus) [39]
- Kaempferol [39]
- Ginkgo [39]
- Quercetin [39]
- Black Currant [39]
- Genistein [39]
- Apigenin [39]
- Luteolin [39]
- Blueberry leaf [39]
Supplements have not been approved by the FDA for medical use and generally lack solid clinical research. Regulations set manufacturing standards for them but don’t guarantee that they’re safe or effective.
Additionally, supplement-drug interactions can be dangerous and, in rare cases, even life-threatening. That’s why it’s so important to consult your healthcare provider before supplementing and let them know about all drugs and supplements you are using or considering.
Low Aldosterone
Potential Causes
Causes shown here are commonly associated with low aldosterone.
The main potential causes include [43, 44, 45, 46]
- Primary adrenal insufficiency (Addison’s Disease) – a disease of inefficient steroid hormone production
- Genetic mutations
- Diabetes
- Kidney disease
- Lead poisoning
- Severe illness
- Certain medications (including NSAIDs)
Other possible causes that are being researched but are considered experimental and less relevant include:
- Chronic Inflammation (potentially via TNF-alpha, IL-6 and Interleukin 1) [47, 48].
- Age-related hearing loss – Also associated with age-related Potassium depletion [49].
- Hyponatremia and Headaches from intense, prolonged exercise
- Aging (aldosterone levels may naturally decline with age) [50].
- High Atrial Natriuretic Peptide (ANP) – Inhibits aldosterone release [51]. ANP has the opposite function of aldosterone on sodium in the kidney – aldosterone stimulates sodium retention and ANP generates sodium loss.
Treatment of low aldosterone levels (hypoaldosteronism) depends on the underlying condition.
Factors that May Increase Aldosterone (Experimental)
Scientists are researching whether the following factors and pathways increase aldosterone:
- Potassium [52]
- Licorice Root [53]
- Lactate (from strenuous exercise) [54]
- Progesterone [55]
- MSH [56]
- ACTH [57]
- Pathways: Renin [58], Angiotensin II [57]
However, their impact remains unknown. Human data are lacking.
