Welcome, my name's Dr. Warrick Bishop. I'm a cardiologist, I'm an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, cholesterol for better health. If you enjoy this podcast, I would be honored for a five-star review. You can share it with your family and friends. It may well save someone you love. Hi, my name is Dr. Eric Bishop. Welcome to my podcast and videocast station and thank you for tuning in. I really hope I can give you something that you find interesting and informative. Today I'd like to share a little bit more from Cardiac Society Australia New Zealand that was held in Adelaide in August and what I'd like to do specifically is talk a bit about the... session that I went to on inflammation and what I can tell you is that if you find someone who believes they understand inflammation I think they're pulling your leg. I'm going to talk about first of all this observation that white blood cells and that's lymphocytes and polymorphs tend to be found in the walls of arteries in people who have high blood pressure. Now this has led to all sorts of speculation asking is it a genetic predisposition that these cells end up in the walls of the arteries and therefore lead to high blood pressure or is it the high blood pressure that drives changes within the arteries that then mean that those white cells are attracted there interesting concept chicken and egg I'm not sure we're 100% sure, but we do know that inflammation is linked to high blood pressure. And there was a fabulous trial called the Cantos trial a number of years ago that was all about inflammation. In the Cantos trial, they used high sensitivity C-reactive protein, a marker that we can draw from the blood to give us an idea of inflammation within the body. of HSCRP levels into quartiles. And in the highest quartile, it was clearly shown that those individuals had the highest blood pressure, the lowest quartile, the lowest blood pressure. So certainly galvanizing our results that there seems to be some clear relationship between inflammation and blood pressure. Well, in this particular study, what was super interesting, or sorry, in this particular presentation, the presenter went on to then talk about where the most obvious sites of inflammation are in you or I, or in the general population. Where can we see it easily? Well, the answer is in your mouth. Periodontitis is probably the exemplar of inflammation that we can easily assess and can be there pretty regularly within the population. Well, taking periodontitis, the question was asked is, could we randomize people with this condition and evaluate the impact on hypertension? Well, fascinating study. In this particular study, they took a bunch of people with elevated blood pressure and periodontitis and randomized them to two groups. One group was conventional therapy of periodontitis, and the other was intensive therapy for periodontitis. Don't ask me what the difference is. I don't actually know, but let's imagine that one was just far more thorough in trying to get rid of that associated disease. Well, the long and the short of it was after two months, there was a clear and significant statistical, I'll say that again, statistical reduction in blood pressure in the group in the intensive periodontal therapy group. Wow. So think about that. We are talking about five millimeters to 10 millimeters of mercury reduction. Just by reducing inflammation, there's no therapy over and above that. So just by improving that oral hygiene, these people were getting a 5 to 10 millimeter reduction in their blood pressure. That's as good as most of our blood pressure therapies. So what's the take home? Look after your teeth. Please keep them nice and clean. I'm now going to talk quickly about a presentation that was absolutely fascinating and speaks to this observation that if someone has a stroke, it's pretty common to see that they can run into problems with pneumonia a couple of days later. And we've always thought that was because of immobility. But beyond that couple of days and out to a week or two weeks or even beyond, People with strokes don't seem to run a high risk of stroke at all. So someone quite reasonably asked the question, could that acute insult on the brain, the stroke, lead to changes that could put those people at increased risk of infection? Well, lo and behold, they've done some rat studies. They've simulated a stroke in these rat studies and observed what... And they've demonstrated this, which is absolutely amazing. In the early stages of a stroke, there is a change in the autonomic nervous system, which impacts the gut, altering gut function, therefore altering the gut microbiome, leading to dysbiosis. That dysbiosis or change in the gut microbiome then changes the leakiness of the gut. gut and as that leakiness of the gut changes guess what bacteria from inside the gut can leak through the cells into the bloodstream and lo and behold that's how we get bacteria into the lungs or into the urinary system in these poor individuals who've just had a stroke giving rise to significant sepsis and increased risk obviously of death from that event. Is there much that can be done about it? No, but it is worth recognizing and understanding and knowing that in that first 24 to 48 hours, these individuals will run a very high risk of significant systemic infection as a result of that leaky gut syndrome. I'm going to crack on with one of the other presentations, which was just absolutely fascinating, and that was on salt. and hypertension. Now, we all know that salt's important for high blood pressure. We're told not to eat too much. But a presenter from Baker IDI, I think his name's Andrew Murphy, don't quote me, but I think his name's Andrew Murphy, presented a fantastic session on high salt diet and blood pressure. And he proposed that high salt diet of its own causes changes in the blood vessels. which we see in high blood pressure even before high blood pressure has occurred. Well, what's going on? Well, it turns out that this high salt diet leads to damage to the gut microbiome in the ileum or the small bowel. And that damage to the gut microbiome allows leakage of inflammatory proteins, lipopolysaccharides through the cells or the lining of the small intestine. Those inflammatory cells are then transported through the bloodstream to the bone marrow where they trigger responses and generate inflammatory cells. As we spoke about in that first situation, those inflammatory cells pass through different modulation and end up in the blood vessel wall. Well, all this happens before the blood pressure has even gone up, which is just fascinating. So what's the take-home here? Well, the take-home for me really came in one of the last slides of this presentation. The first take-home is keep your salt levels down because salt is directly toxic to your microbiome. It's directly toxic to your microbiome. And by doing that, by altering... your microbiome leading to dysbiosis you will lead to leakiness of your gut so don't do it keep that salt down if you do happen to have too much accidentally there is two things you can do one is use fiber it seems that fiber breaks that cycle protects the endothelium protects the integrity of the gut lining and keeps away some of the adverse effects of salt so if you are going to have salt on your chips maybe before you do have a glass of psyllium and follow it up with a glass of psyllium the other thing is keep your hydration up absolutely fascinating stuff so salt and blood pressure is it actually a problem way before the blood pressure actually goes up Well, that's what this presenter would have us believe. Keep your mind open there. It is a fascinating space. Don't take too much salt. Do put a bit of fiber in your diet and do keep hydrated. For now, I'm going to say goodbye. I hope you've enjoyed this inflammation. and immune journey. If you have any queries or questions, as always, drop us a note at info at drWarrickbishop.online. Again, I really appreciate you listening. It does mean a lot to me to know that people are tuning in and I hope you are finding the information interesting. For now, I'm going to wish you the very best. I hope you live as well as possible for as long as possible. Take care and bye for now. Hi. Ever wondered what your risk of heart attack is? You should. It's the single biggest killer in the Western world. We're talking one death less than every 30 minutes in Australia. One death less than every 60 seconds in the United States. Nine million deaths globally per annum. Well, how do you check your risk? Well, you can go to... www.virtualheartcheck.com.au You'll find out about your risk and what can be done beyond that to be even more precise.
