Inflammation and disease

The Anti-Inflammation DietExperts now believe there's a common culprit behind our most deadly diseases, including cancer, heart disease, and diabetes. The best defense is right on your dinner plate--and may be the only diet you'll ever need.
By Catherine Guthrie Alternative Medicine Magazine
As the CEO of a supplement company in Los Angeles, Andy Pham eats, breathes, and dreams nutritional supplements. In fact, he downs roughly 80 pills a day. Pham knows he's far from the norm. Heck, most people pat themselves on the back if they remember to swallow a single dietary booster, much less six dozen. So when asked to think like the average time-pressed American and choose just one nutrient to take every day, he doesn't hesitate. "Fish oil," he declares. "I take it for the omega-3 fatty acids. They're a great all-around inflammation reducer."
Whether he realizes it or not, Pham's advice is in lockstep with the latest medical buzz. Researchers are uncovering an insidious new medical reality: Inflammation, the body's most primitive weapon against infection and injury, may be at the root of some of the deadliest diseases of the 21st century, including heart disease, diabetes, cancer, and Alzheimer's.
The typical 65-year-old with arthritis, an ulcer, and heart disease goes to see three different doctors: a rheumatologist, a gastroenterologist, and a cardiologist, says Jack Challem, author of The Inflammation Syndrome. And he may walk out with three different treatment plans. "No one stops long enough to connect the dots and see the underlying inflammatory current," Challem says. As a result, what's missing is a unified voice offering patients nuts-and-bolts advice about how to stamp out inflammation before it burns out of control.
That's where the alternative approach comes in. Many practitioners say they've been connecting the dots between inflammation and disease for years, only to have their warnings go unheeded. They've been particularly ahead of the curve in suggesting what they claim is the best defense against inflammation-related diseases: eating the right foods. Leo Galland, an internist and founder of the Foundation for Integrated Medicine in New York City, says he's been writing and lecturing about the benefits of anti-inflammatory foods since the early 1980s. "Things I talked about 20 years ago that were considered out in left field are now so mainstream they're almost boring," he says. "I feel vindicated on a daily basis."
Here's how the inflammatory cycle can go awry. Under normal circumstances, inflammation is part of the immune reaction that helps the body heal when injured. When you slice your finger cutting onions, for example, blood vessels near the accident scene expand. That clears the way for the entrance of white blood cells, good guys who annihilate any bacteria that sneak in on the knife blade. They also mend ragged tissue by ordering in new cells to seal the cut. By the time the signs of inflammation kick in--heat, soreness, and swelling--the wound is well on its way to healing.
Still, like an inconsiderate houseguest, inflammation can overstay its welcome. Medical researchers discovered long ago that certain diseases, such as lupus, Graves' disease, and fibromyalgia, emerge when the immune system flips on and refuses to turn off. And a new theory paints an even broader picture of how other killers gain a foothold when inflammation runs amok.
It all started with the heart. Until the early 1990s, experts believed that heart disease, specifically atherosclerosis (hardening of the arteries), resulted when sticky plaque glommed on to smooth artery walls, causing the arterial passageway to narrow. A heart attack was thought to be the end-case scenario, a blood clot finally plugging the last remaining opening in the dam. But as it turns out, the process is more complex than that.
Experts now know that arteries aren't smooth pipes lined with white globs of gluey fat. Instead they are dynamic, multilayered tissue structures. Arteries do absorb LDL (bad) cholesterol from the bloodstream. But instead of sticking to the artery wall, LDL seeps between the tissue layers and festers, like an angry plaque-filled blister. The body triggers an inflammatory response to contain the damage and the artery swells, constricting blood flow to the heart. Disaster finally strikes when the plaque bursts and debris barricades the artery.
With Alzheimer's, a backward glance uncovered the inflammation connection. Numerous studies show that people who use ibuprofen, a popular anti-inflammatory, lower their risk of acquiring the disease. Although the mechanism isn't fully understood, neurologists believe the brain's immune cells rally to attack a form of plaque that signals Alzheimer's. The ensuing skirmish creates inflammation that may spur progression of the disease.
As for diabetes, it's often related to how much fat a person carries around on his or her frame. Fat cells ooze inflammation-boosting proteins called cytokines, so more fat equals more inflammation. Over time, too many circulating cytokines dampen the body's ability to monitor insulin production. Eventually the body's efforts falter, and the gate swings open for Type 2 diabetes. (It's no coincidence that rates of the disease are nudging upward in unison with America's belt size.) Chronic inflammation in the body also causes cells to oxidize, which may trigger a cascade of cancerous mutations. In fact, Bruce Ames, a biochemist at the University of California at Berkeley and former board member of the National Cancer Institute, thinks inflammation is responsible for up to 30 percent of all cancers.
Scary stuff for sure, but fortunately, experts are also learning more about some simple, even pleasurable, ways to reduce inflammation. Exercise and stress relief are important, but the best defense, most researchers agree, is through diet. Most foods either fuel the fires of inflammation or tamp them down, Galland explains. And fat is the crux of the issue. The goal is to eat a good balance of inflammatory fats (mainly omega-6s, as found in safflower, sunflower, and corn oil) and anti-inflammatory fats (like omega-3s, found in fish, and omega-9s, which olive oil has). But most people chow down on up to 30 times more inflammatory fats than anti. "The typical American diet is priming people for inflammation," says Challem. "It's like sitting in a parked car with your foot on the gas. Eventually you'll overheat."
The good news is that dozens of foods, herbs, and spices are proven to rev up the body's ability to stomp out inflammatory hot spots. For evidence, one need look no further than studies of rheumatoid arthritis. In one published last January in Rheumatology International, patients who followed an anti-inflammatory diet had a 14 percent decrease in joint tenderness and swelling compared to those who ate a typical Western diet. Fish oil supplements goosed the results even further, bringing the final tally of those feeling an improvement up to 31 percent.
Small studies suggest that an anti-inflammatory diet may also hold Alzheimer's disease at bay. In a French study of cognitive decline, scientists followed the diets of 1,600 seniors for seven years. In the end, those who ate fish at least once a week were less likely to develop the disease.
Because the concept of eating to curb inflammation is still relatively new, most of the existing evidence is anecdotal. Jacob Farin, a naturopath in Portland, Oregon, has seen patients with everything from chronic back pain to pancreatitis improve after adopting an anti-inflammatory diet.
The bottom line? This new eating plan, laid out in these pages, may be the most efficient diet you've ever seen. In one fell swoop, you'll hedge your bets against some of the biggest health threats facing Americans today.
1. Get Friendly With Fish
Eat fish at least twice a week. Why? Because it overflows with two key omega-3 fatty acids--eicosapentaenoic and docosahexaenoic (EPA and DHA for short)--that are potent anti-inflammatories. Good sources are fatty fish such as mackerel, salmon, trout, sardines, and tuna. Canned tuna is fine, but make sure it's packed in water. Otherwise, the omega-3s leach into the surrounding oil.
You do need to watch out for toxins in fish, though, especially if you're in a high-risk category. Women who are either pregnant or hoping to be should avoid shark, swordfish, king mackerel (a different species from regular mackerel), and tilefish, all of which harbor potentially dangerous levels of mercury, which can be damaging to their developing fetus. (Nursing mothers and young children should avoid these fish, too.)
If you don't want to mess with mercury, you're not so fond of fish, or you just want to hedge your bets, try fish oil supplements. Look for a supplement with EPA and DHA and take 2,000 milligrams every day.
Whatever fish-oil delivery system you choose--fresh, canned, or supplement--don't let this one get away. "There is an absolute need for fish oil if you're going to quell inflammation," says Jim LaValle, an integrative physician and clinical nutritionist at the Longer Living Institute in Cincinnati, Ohio.
There are options for vegetarians, too, though they're not perfect. The body can make its own EPA and DHA from the omega-3 fat found in plant sources such as flaxseed, wheat germ, and walnuts. But the body's mechanism for converting plant-based omega-3s isn't particularly effective.
Although flaxseed is often touted as a substitute for fish oil, it just can't compete, says LaValle. "That's one of the biggest misconceptions in the natural products industry."
One solution is to take flaxseed supplements, but you'll need to down four times as many of these as you would of fish oil pills.
2. Choose Fats Wisely
Replace trans fats with those high in omega-3s. Good fats include fatty fish, extra-virgin olive oil, canola oil (expeller-pressed), walnuts and their oil, hemp oil, and flaxseed or flaxseed oil.
Trans fats are the worst offenders because they're high in omega-6s, fatty acids that gum up the body's ability to regulate inflammation. "If your diet is rich in trans fats, you're going to drive your body to make more inflammatory chemicals," says LaValle. The worst culprits are vegetable shortenings and hard margarines, but most processed foods house a trans fatty acid or two, usually in the form of partially hydrogenated oil. (Soon, trans fats will be easier to spot thanks to new legislation requiring food makers to list them on ingredient labels by 2006.) Other fats to avoid (also because of their omega-6s) include safflower oil, sunflower oil, and corn oil.
3. Embrace Your Inner Herbivore
Load your plate with fruits and vegetables--the more colorful the better. Brightly pigmented produce such as blueberries, peppers, and spinach have the most anti-inflammatory compounds.
For a simple way to make sure you're eating enough plant-based foods, Melanie Polk, a registered dietitian at the American Institute for Cancer Research in Washington, D.C., suggests using your dinner plate as a measuring tool. Ideally, two-thirds of the plate or more should be covered with fruit, vegetables, whole grains, and/or beans, she explains. The remaining one-third can be filled with lean animal protein, like a chicken breast or fish fillet, or tofu.
How to Find Out If You're InflamedTake the test. Inflammation is measured by a marker called C-reactive protein or CRP. As inflammation creeps up, so do CRP levels in the blood. A blood test to measure levels of CRP is inexpensive ($25 to $30) and extremely reliable. Patients with autoimmune disease and cancer often have high CRP levels, but the test is making headlines for its ability to suss out heart disease in otherwise healthy-looking people. Those who have the most to gain from being tested are people at moderate risk (poor diet plus a lack of exercise) with otherwise healthy-looking cholesterol levels. (If you already know you're at high risk for heart disease, the test probably won't tell you anything new.)
In the future, some experts predict that the CRP test will be added to other routine medical tests, such as cholesterol and blood sugar exams. But if you're interested now, any doctor can perform it. --C.G. 4. Cut Back on White Foods
Give dairy, sugar, and refined grains a smaller spot on your plate. Too much dairy and white flour can kick the immune system into high gear, particularly if you're lactose intolerant or have celiac disease. In people who suffer from these conditions, the gut treats dairy and wheat products as hostile invaders: Often it only takes a bite of bread or a spoonful of ice cream to get the inflammatory cycle going. One exception to the dairy rule is eggs, especially those enriched with omega-3s.
Sugary foods can also be a problem, especially when eaten between meals, since they cause a surge in blood sugar. To reestablish balance, the pancreas lets out a gush of insulin, which in turn switches on the genes involved in inflammation. This biochemical roller coaster is thought to contribute to the onset of Type 2 diabetes.
"When I'm trying to reduce people's inflammation, I make sure they knock out refined grains, dairy, and sugar," says LaValle. "You've got to get rid of the inflammatory chemistry."
5. Take Supplements
If you want to take just one supplement every day, make it fish oil. But a host of vitamins and herbs can also help. The most rigorously tested herbal anti-inflammatories are ginger and turmeric. Both are widely used in India to treat inflammatory disorders, such as arthritis and carpal tunnel syndrome. Physician Andrew Weil suggests taking 400 to 600 milligrams of turmeric extract (either in tablets or capsules) three times a day.
Ginger is less well studied but still highly regarded. Weil recommends one to two tablets (500 to 1,000 milligrams) of powdered dry ginger twice a day with food until pain subsides. Both ginger and turmeric need to be taken consistently for two months before showing results.
When it comes to vitamins, E is a good bet. The fat-soluble vitamin keeps inflammation from even getting started by disarming integral inflammatory genes. Vitamin E is also a powerful antioxidant. Galland suggests taking 200 to 400 IU (134 to 268 mg) of mixed-tocopherol vitamin E daily.

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