What’s Aldosterone? What’s the Connection With Alcohol Use Disorder

You’re sitting at your annual physical, listening to your doctor lecture you about staying mindful of your blood pressure. While you’ve heard all the common suggestions — stay active, eat healthy, and limit drinking — you’re left wondering what actually helps control your blood pressure within your body. Meet the helpful hormone: aldosterone. Aldosterone is often overshadowed by its better known cousins such as adrenaline and cortisol, but it works hard behind the scenes. It ensures everything runs smoothly by keeping our blood pressure and hydration in perfect balance. 

This hidden hormone, however, is more than just a key player in our body’s regulation. It has a surprising link to alcohol use disorder (AUD), which sheds light on the risk factors of AUD and potential directions for treatment and intervention. Understanding aldosterone helps us learn how our body’s inner workings can guide us toward healthier habits. Let’s delve deeper into their connection to uncover how this unsung hormone plays a crucial role in the body’s response to alcohol.

Aldosterone: The Stealthy Steward of Balance

Aldosterone is released by the adrenal glands. It’s a hormone classified as a mineralocorticoid, which is a type of hormone that helps regulate potassium and sodium balance. It’s a key player in the network of proteins, hormones, and enzymes that work together to regulate our blood pressure, fluid balance, and overall cardiovascular function known as the renin-angiotensin-aldosterone system (RAAS). 

When we experience disruptions to our blood pressure, it sets off a series of reactions in the RAAS that help our body get back to a balanced state. Think of a baseball player needing to get through three bases before returning to home base. When our blood pressure falls, our kidneys react by releasing the enzyme renin into the bloodstream, getting to first base. Renin then splits a protein called angiotensinogen (which circulates in our bloodstream), into two hormones: angiotensin I and angiotensin II. Angiotensin II, the more active hormone of the two, causes our arteries to constrict and triggers the release of aldosterone in the adrenal gland. The release of aldosterone signals our kidneys to retain sodium and excrete potassium. This increases our blood pressure and gets us back to equilibrium (home base). Think of aldosterone as a scale that balances sodium on one end and potassium on the other. Without this balance, critical functions of our adrenal system are affected.

Through its role in the RAAS, we can see that aldosterone is a critical hormone that regulates potassium and sodium, but how does it affect functions in our body?

What Does Aldosterone Do?

By managing sodium and potassium levels, aldosterone helps regulate blood volume and blood pressure. Sodium increases water retention, which increases blood volume and blood pressure. Have you ever woken up with a puffy face after downing a bag of chips as a midnight snack? Increased water retention from the salt may be to blame. 

This balancing act of potassium and sodium helps regulate not only our blood pressure but also our electrolyte balance. Electrolyte balance is essential for balancing the amount of water in our body — keeping us hydrated. It also helps regulate nerve and muscle function for our body’s systems to work properly.

Aldosterone imbalances can lead to excess aldosterone

(hyperaldosteronism) or not enough aldosterone (hypoaldosteronism). Hyperaldosteronism can cause high blood pressure. This increases the risk of heart disease, stroke, and diabetes. Hypoaldosteronism can cause low blood pressure and hyperkalemia (excess potassium) — causing the effects of hypotension and abnormal heart rhythms. Aldosterone functions as a potassium and sodium regulator, but its impact is much more widespread than its base mechanism. We can get a clearer picture of its effects when alcohol (a hormone disruptor) is added to the equation.

Uncovering the Link: Aldosterone and Alcohol

Alcohol increases aldosterone secretion by binding to aldosterone receptors throughout the body. Think of alcohol as the plug and receptors as a socket. When attached, it sends signals to our brain to release aldosterone. Aldosterone receptors are also known as mineralocorticoid receptors (MRs). In our brain, MRs are mainly located in two areas — the amygdala and the prefrontal cortex.

Amygdala: The Vigilance Vanguard

The amygdala is a part of the brain that regulates stress and emotions. Alcohol, which hijacks our hormones, binds to the MRs in the amygdala, promoting aldosterone release. This not only increases blood pressure, but can stimulate a fight-or-flight reaction. 

Our body naturally produces aldosterone to help us regulate our blood pressure, but when alcohol artificially stimulates abnormal levels of the hormone, it can lead to dysfunction. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), amygdala dysfunction activates our brain’s stress systems, resulting in mood fluctuations and anxiety.

Prefrontal Cortex: The Pragmatic Processor

Alcohol also binds to MRs in the prefrontal cortex. The prefrontal cortex is the area of the brain that controls intellectual and executive functions. Essentially, it’s involved in our thoughts, actions, and emotions. This encompasses higher functions from things like speech formation and working memory to our risk-processing and decision-making skills. The prefrontal cortex is one of the last areas of the brain to develop, as the rational part of our brain continues to develop and grow as we mature.

Alcohol increases aldosterone secretion, and when alcohol binds to MRs in the prefrontal cortex and causes elevated aldosterone, it interrupts our brain’s executive functions. This can impair our ability to make decisions and regulate our actions, emotions, and impulses.

We can see that alcohol is undoubtedly linked to aldosterone, but let’s probe further to see how aldosterone’s effects on the amygdala and prefrontal cortex increase the risk of alcohol use disorder.

Aldosterone and Alcohol Use Disorder (AUD)

Scientists at NIAAA who analyzed three separate studies conducted with humans, rats, and nonhuman primates — all investigating the connection between the aldosterone/MR pathway to AUD — confirmed a relationship between alcohol use disorder and the pathway.

The first study on nonhuman primates found that those that self-administered alcohol every day for 6 to 12 months had significantly higher blood-aldosterone concentrations. It also found that lower MR gene expression (decreased natural aldosterone production) was associated with increased alcohol consumption. This suggests that drinking, which decreases natural aldosterone production, stimulates a greater desire to drink. 

The second study looked at a rat model of AUD. It found that lower levels of MR gene expression in the amygdala increased anxiety-like and compulsive drinking behavior compared to rats that weren’t exposed to alcohol. This confirms that alcohol, which impacts MR gene expression, can lead to risk factors for AUD, including anxiety-related compulsive drinking.

In the human study, researchers looked at 40 individuals undergoing treatment for AUD. They found that higher alcohol consumption was associated with higher aldosterone concentrations. They also concluded that higher blood-aldosterone concentrations correlated with increased levels of anxiety and alcohol cravings.

Using the findings from the three different studies, researchers report a conclusive relationship between alcohol misuse, AUD, and changes in the aldosterone/MR pathway. Specifically, elevated aldosterone in the amygdala and prefrontal cortex increased anxiety-related alcohol consumption and alcohol cravings — increasing the risk of developing AUD. There may be a definitive link between aldosterone and alcohol misuse, but what can we do to drive a wedge between the  two?

Untethering Aldosterone and Alcohol Misuse

“The trick to overcoming addiction is thus the realignment of desire, so that it switches from the goal of immediate relief to the goal of long-term fulfillment.” — Marc Lewis, The Biology of Desire: Why Addiction Is Not a Disease 

While we can’t sever the connection between aldosterone and alcohol misuse, we can adjust our habits to reduce the risks of alcohol misuse and AUD:

• Reducing alcohol consumption. Since alcohol increases aldosterone production, which then causes an increased tendency to drink, quitting or cutting back on alcohol helps reduce hormone disruptions and their consequences.
• Managing stress. Stress can be a major trigger for drinking, especially when tied to elevated aldosterone. Managing our stress through alternative coping mechanisms (more on this later) can reduce the desire to self-medicate with alcohol.
• Identifying triggers. Tracking our alcohol consumption and the events and emotions that happen before and after helps us better identify triggers for our alcohol consumption. We can then develop strategies to avoid or work through them to reduce our consumption. 
• Managing cravings. Alcohol hijacks our brain’s reward system — making alcohol cravings a common experience for those with AUD or alcohol dependence. We can better manage them through healthy distractions and positive behavioral techniques.
• Limiting hormone disruptors. As we can see with aldosterone, the impact of hormones on our overall well-being goes far beyond their base function. Keeping our hormones balanced and limiting substances that disrupt our hormones, such as alcohol and nicotine, can help us maintain better overall health.

Quitting or cutting back on alcohol through these mindful drinking strategies helps us avoid disrupting aldosterone and its negative effects on our drinking habits. At the same time, we can develop alternative coping mechanisms to further reduce the risk of unhealthy drinking tendencies.

Avoiding Alcohol: Exploring Healthy Coping Mechanisms

Aldosterone is linked with anxiety-related compulsive drinking and alcohol cravings. While we may not be able to completely avoid them, we can develop alternative coping mechanisms. To further distance ourselves from alcohol’s harmful effects, let’s consider these healthier alternatives:

• Stay active. Exercise does wonders for our physical and mental health. Find movement you enjoy to help develop a consistent habit. For example, you can join a dance group or gather friends to explore new hiking trails.
• Meditate. This mindfulness practice relaxes the mind and helps us feel grounded in times of distress. 
• Breathe deeply. Deep breathing is another mindfulness practice that relaxes our nervous system and takes us out of the fight or flight state. 
• Spend time in nature. With the hustle and bustle of the world we live in today, it can be easy to forget that it’s ok to slow down. Getting out in nature helps us remember life’s simpler pleasures. Take a short walk outside during your lunch break or enjoy your morning coffee out in the natural sunlight.
• Connect with others. When we feel more heard and supported, we’re less likely to turn to destructive habits in times of high stress. Chat with close friends and family members, or join support groups to develop a positive social circle of support. 
• Explore hobbies. What starts out as an activity to pass the time can turn into our motivation in recovery to reach a happier, more fulfilling life. Try your hand at creative pursuits such as arts and crafts, or bring out your inner athlete by joining a run or pickleball club. 

The next time we experience alcohol cravings, we have a toolkit of other coping strategies to lean on — addressing the impacts of the aldosterone-AUD link.

Hormonal Harmony

Aldosterone functions as an important regulator that keeps our blood pressure and electrolyte balance in check. However, research shows that its effects on the body are even more widespread when exposed to alcohol — ultimately resulting in an increased risk of AUD. Delving into the connections between aldosterone and AUD reveals a nuanced narrative of how our physiology can steer our cravings and habits. By bringing these hidden dynamics into the spotlight, we empower ourselves with the knowledge to break free from unhealthy patterns. We can prioritize our hormonal health to improve our overall well-being. Cheers to happy hormones and a healthier relationship with alcohol!