CHAPTER
1

Understanding Inflammation

In This Chapter

We now know inflammation is a leading player in many of the diseases that can make life miserable and even cut it short. But the good news is if you control your inflammation by following an anti-inflammatory diet, you may be able to control and even prevent heart disease, Alzheimer’s disease, arthritis, and many other health problems.

In this chapter, we give you basic information about inflammation—how it’s involved in numerous diseases, as well as the aging process, and how to tell if you have high levels of inflammation in your body. We also cover the benefits some medications have for reducing inflammation levels and how a healthy diet and lifestyle can reduce inflammation.

What Is Inflammation?

Under normal circumstances, inflammation is a protective, healing friend. It’s your body’s defense against attack. Simply put, if you’re burned, if you cut yourself, or if a virus invades your body, fighter molecules rush in to protect you from infection. The molecules “lock down” the area of the wound to prevent contamination and to focus on healing.

DEFINITION

Inflammation is the body’s reaction to injury or other irritations and stresses such as infections, allergies, chemical irritations, and sometimes functional loss. Common reactions are swelling, redness, and feeling pain and/or heat. Any area of the body may become inflamed.

When the attack is over and the threat of infection is gone, inflammation should depart and stand down, ready to defend any new attacks. However, sometimes this doesn’t happen; sometimes inflammation doesn’t leave, leading to a long-lasting inflamed condition.

Constant attacks on your body by too many saturated fats, too much body fat, smoking, and other assaults can also lead to long-lasting inflammation—a condition called silent, low-grade, or chronic inflammation.

Silent inflammation can invade with no known cause or trigger. It’s sneaky. It can fall below the pain threshold so victims don’t even notice it. This type of inflammation has been the subject of a great deal of research in recent years because of its connection to so many health problems. This is the type of inflammation we address in this book.

The Common Thread

Inflammation is the common thread that runs through many diseases—some incapacitating and others fatal. We take a closer look at these inflammation-related diseases in Chapter 2. For now, here’s a brief overview:

DEFINITION

Itis is a suffix used in medical terms to describe an inflammatory disease. When you see it used at the end of a word, it means “inflammation of” the first part of the word. For example, colitis means inflammation of the colon, and pancreatitis means inflammation of the pancreas.

Inflammation’s symptoms differ according to the part of the body under attack. For example, your blood vessels can develop atherosclerosis as a result of inflammation. In this case, the first symptom you’d notice might be a heart attack. As another example, you might fall and twist your ankle, which immediately hurts, turns red, and swells. Or you might develop macular degeneration, and your first symptom is, tragically, vision loss.

Inflammation and Aging

Recent research shows that what most of us think of as the inevitable forces of aging—the wasting away of muscle, wrinkling skin, and the high risk of acute and chronic disease, to name a few—is really due to inflammation. Not necessarily. In fact, if you can reduce inflammation, you can also reduce the risk of or delay many of these so-called effects of aging.

Noted Italian researcher Claudio Franceschi, of the Italian National Research Center on Aging, in Ancona, Italy, believes so strongly in the aging-is-inflammation connection, he calls the process “inflammaging.” According to Franceschi, “Inflammaging is the common and most important driving force of age-related disease.”

The inflammaging idea has been championed by Dr. Caleb Finch, director of the University of Southern California Alzheimer’s Disease Research Center. Finch says a major reason why people lived longer in the twentieth century than ever before is because we were exposed “to fewer infectious diseases and other sources of inflammation.”

Inflammaging has also gotten the public’s attention through the writings and appearances of doctor Andrew Weil. In fact, Weil’s prescription for reducing aging-related health problems is to follow an anti-inflammatory diet.

Inflammation and C-Reactive Protein

How do you know if you have high levels of inflammation in your body? An inexpensive blood test can help you and your doctor determine your levels of inflammation.

If any part of you is inflamed, the C-reactive protein (CRP) levels in your blood will be high. As inflammation increases, your CRP level also increases.

DEFINITION

C-reactive protein (CRP) is a protein in the blood. The CRP level rises dramatically during inflammatory processes occurring in the body. It’s also believed to play a role as an early defense system against infections.

CRP measurement is not new. Doctors have used it for decades to follow and monitor the care of patients with lupus, rheumatoid arthritis, and other inflammatory conditions. People with these diseases often have elevated CRP levels.

About one quarter of Americans have a high-sensitivity CRP (hs-CRP) level above 3 milligrams per liter (mg/l), placing them in a high-risk group for heart disease. Studies have found that the risk for heart attack in people in the upper third of CRP levels is twice that of those whose levels are in the lower third. Most infections are associated with CRP levels above 10 milligrams per deciliter (mg/dl). CRP levels are also higher in people who are obese.

Where Does CRP Come From?

CRP is produced by the liver, in the fat around the stomach area, and within the two arteries that supply blood to the heart (the coronary arteries or vessels).

The amount of CRP produced varies from person to person, depending on genetic history and lifestyle. If you smoke, have high blood pressure, are overweight, and don’t exercise, your levels are likely to be high. If you are lean and athletic, there’s a good chance your CRP levels are low.

CRP and Risk Factors for Heart Disease

Many studies have shown an association between high CRP levels and heart disease. This is the case even for people with normal cholesterol levels.

The American Heart Association warns that if your CRP levels are high, and you have a condition called unstable angina (an increasing or “crescendo” pattern of chest pain that occurs with little activity) or have previously had a heart attack, you are at high risk for a heart attack. Furthermore, if you do have a heart attack with these risk factors, your chance of surviving it is much lower.

If, according to blood tests, your cholesterol level is low or normal (below 200 mg/dl), don’t assume you have a low risk for heart disease. If your CRP levels are high, regardless of your cholesterol reading, you’re at high risk for cardiovascular problems such as heart attacks or strokes.

In fact, a recent study published in the New England Journal of Medicine concluded that C-reactive protein predicted heart attacks and strokes better than any other laboratory test.

What’s more, researchers recently have identified the following risk factors that, if coupled with high CRP levels, spell trouble:

These facts emphasize the importance of following an anti-inflammatory diet and lifestyle.

CRP Testing

Changes in CRP levels are often the first sign of inflammation or infection. In fact, your CRP level may rise even before you feel any pain.

To measure your C-reactive protein level, your doctor will draw your blood and order a hs-CRP test. CRP testing is relatively inexpensive and requires only a small amount of blood.

The Centers for Disease Control and Prevention and the American Heart Association have developed a widely used classification system of hs-CRP to determine risk for heart disease:

Low risk: less than 1 milligram per liter of blood

Moderate risk: 1 to 3 milligrams per liter

High risk: more than 3 milligrams per liter

A higher or increasing amount of C-reactive protein in your blood suggests raging inflammation. This system might change with more research, but at this writing it is the medical standard.

INFLAMMATION INFORMATION

CRP testing can fluctuate widely. If your hs-CRP level is above 10 mg/l, you should have the test repeated after 2 or 3 weeks. The high level could be from an infection and not due to an underlying disease with inflammation.

The best time to start getting your CRP levels tested is now—regardless of your age. If you’re in your teens or 20s, your current CRP level will provide a comparison for your levels later in life.

Medicine and Inflammation

Four categories of medications can help ease inflammation: statins, nonsteroidal anti-inflammatory drugs (NSAIDS), anti-diabetes drugs, and steroids.

Let’s take a closer look at each category.

Statins and CRP

Co-author Dr. Cannon has done extensive research on drugs used to treat people at risk for heart disease. These drugs, called statins, stop your body from making too much cholesterol and increase your liver’s ability to remove cholesterol from your blood. They also slightly raise high-density lipoprotein (HDL), which is good for your heart.

It’s recently been found that statins, usually prescribed to lower cholesterol, also reduce CRP. (Cholesterol is a fatlike substance in your body and in many foods. Everyone needs some cholesterol in their blood, but too much of it can cause heart disease.)

Ask your doctor if a statin drug is appropriate for you. Remember, however, that the best medicine is prevention, beginning with following an anti-inflammatory diet and lifestyle.

NSAIDs

NSAIDs, such as aspirin and Aleve, help control many inflammatory diseases, including heart disease, arthritis, and even Alzheimer’s disease. People who take NSAIDs, such as aspirin, appear to have less inflammation-related disease than people who do not take them.

However, side effects can occur, such as bleeding. Your doctor might consider NSAIDS to reduce inflammation in some situations.

Some people are allergic to aspirin and other NSAIDs, which can cause the serious breathing disease asthma. The first symptoms are a runny nose, sneezing, and facial flushing. You can develop an aspirin allergy even if you’ve taken the drug in the past and had no problems. If you take aspirin and have had any of these symptoms, talk to your doctor.

Diabetes Drugs and CRP

If you’re diabetic, here’s some good news: relatively recent studies have shown that the diabetes drugs Actos and Avandia, known as thiazolidinediones (TZDs), may help fight inflammation.

They’re particularly effective in reducing CRP levels when taken with statins.

Steroids and CRP

Another category of drugs that can ease inflammation is corticosteroids, man-made drugs that closely resemble a hormone called cortisol that your body produces naturally. Corticosteroids are often referred to by the shortened term steroids. (These aren’t the same as the hormone-related steroids some athletes use.)

Common steroid medicines include cortisone, prednisone, and methylprednisolone. Prednisone is commonly used to treat some types of arthritis.

Steroids can have unpleasant side effects and are used only when no other options exist. Some common problems are increased appetite, weight gain, sudden mood swings, muscle weakness, blurred vision, increased body hair growth, bruising easily, low resistance to infection, swollen or “puffy” face, osteoporosis (bone-weakening disease), worsening of diabetes, high blood pressure, stomach irritation, nervousness, restlessness, sleeping difficulties, cataracts or glaucoma, water retention, or swelling.

Reducing CRP

In the introduction to this book, Dr. Cannon wrote about the startling results of a study he and his colleagues at Harvard Medical School (and other prestigious medical centers) conducted. The study showed that even when people take high dosages of drugs that lower CRP levels, diet and other lifestyle factors determine how low they can actually go.

According to Dr. Cannon, “Because of the results of this study and others, there is a new standard of care emerging in medicine to check CRP levels to see how patients are doing health-wise.

I call this testing the global risk barometer. With this one measure—CRP—you can find out if you are high risk for getting a number of diseases. And, if you are, it is clear what you can do about it.”

DEFINITION

Global risk barometer is using CRP testing on a regular basis to measure health. If your CRP levels aren’t normal, you should work to reduce them by following the anti-inflammation diet and lifestyle.

Here is the bottom line: because of CRP testing and the knowledge base Dr. Cannon and his colleagues have built, the future is bright. You can control a major driver behind heart disease, stroke, Alzheimer’s disease, and other illnesses. Have your CRP levels tested regularly, and if they’re not normal, step up the anti-inflammatory practices we outline in this book.

The CRP/Diet Connection

Hippocrates, the father of Western medicine, said, “Let your food be your medicine, and your medicine be your food.” Clear evidence shows that a healthful diet is great medicine for inflammation. It involves eating nutrient-rich foods and eliminating empty calories.

The anti-inflammation diet has seven principles:

  1. Eat a well-balanced variety of wholesome foods.
  2. Eat only unsaturated fats.
  3. Eat one good source of omega-3 fatty acids every day.
  4. Eat a lot of whole grains.
  5. Eat lean sources of protein.
  6. Eat plenty of fruits and vegetables.
  7. Eliminate processed and refined foods as much as possible.

In addition, to reduce inflammation and enhance the positive impact of the anti-inflammation diet, it’s important to follow an anti-inflammatory lifestyle—get regular exercise, keep your weight in control, and reduce the stresses in your life.

The point of the anti-inflammation diet is to eat foods that taste great and are great for you. And you will, by eating a lot of fresh foods. Eat whole grains, not refined rice or food made with refined flour. Choose lean meats, and eat them only for special occasions. Eat lots of the good-for-you type of fish. Make olive oil, walnuts, and other nuts your fat sources, and cut out butter and margarine. Cut out processed foods as much as you possibly can. And have a little wine from time to time (unless drinking alcohol is a problem for you).

The anti-inflammation diet isn’t a diet specifically to lose weight. It’s not low carb, low fat, low calorie, or highly regimented. It’s a way to reduce the amount of inflammation in your body by making smart choices. It’s a way of life.

However, a word of caution: if you’re overweight, you’re putting your body under tremendous stress. Body fat is a direct cause of inflammation. People who are overweight store high levels of arachidonic acid (AA), the building blocks of pro-inflammatory cells called eicosanoids. And body fat makes C-reactive protein.

A word of encouragement: after you start eating a healthful diet, you’ll probably lose weight if you also exercise and don’t overeat. (We cover more about the effects of being overweight on inflammation in Chapter 3.)

The Mediterranean Connection

For nearly 50 years, the typical Mediterranean diet has been touted as a smart way of eating, and hundreds of books have been written about it. With a few refinements, the Mediterranean diet fits the description of a healthful, anti-inflammatory diet.

The traditional diet of people in the Mediterranean region consists of foods from a rich diversity of sun-drenched plants—lots of fruits, vegetables, whole grains, beans, nuts, and seeds. Olive oil is the area’s principle fat source. Fish and meats are served only on special occasions.

The benefits of the traditional Mediterranean diet first gained attention in the early 1960s, when physician Ancel Keys brought together a group of scientists to look at disease and the diet patterns of seven countries. Their conclusion was that the Mediterranean-style diet was responsible for the generally good health and lack of disease common in those people living in countries bordering the Mediterranean Sea, such as Greece, Crete, and southern Italy, in comparison to people living away from the Mediterranean. People from the Mediterranean area were particularly heart healthy.

DID YOU KNOW?

Keys began following the Mediterranean diet in the 1950s; he died in 2004—a month before his 101st birthday. Whether his long life was a result of his diet, good genes, or both, Keys is known for promoting healthful nutrition instead of, as he put it, “the North American habit for making the stomach the garbage disposal for a long list of harmful foods.” He and his wife, Margaret, popularized dried beans in their cookbook, The Benevolent Bean, a best-seller in the 1960s. The recipes at the end of this chapter are based on their famous book.

Much recent evidence has confirmed and expanded on Keys’s study. One of the researchers studying the Mediterranean diet is Dr. Demosthenes Panagiotakos of the University of Athens in Greece. “The Mediterranean diet,” he says, “independent of any other factor, reduces levels of inflammation.”

Dr. Panagiotakos’s comments are based on a research project called the Attica Study. He and his colleagues studied the dietary habits of 2,282 men and women, aged 18 to 89 years, who had no history or signs of heart disease. The more participants followed the Mediterranean diet, the better their CRP levels.

Another study found that the Mediterranean diet, along with exercise three times a week for 3 months, caused CRP levels in 65 heart disease patients to drop by 31 percent. In addition, their body fat fell an average of 5 percent, and their exercise capacity improved 36 percent.

Our philosophy toward eating to prevent inflammation is a refinement of the Mediterranean diet. The nutritional approach we believe works best was developed by Dr. Walter Willett and his colleagues. Dr. Willett, a professor of epidemiology and nutrition at Harvard Medical School, draws on the most up-to-date research in nutrition and also emphasizes exercise and taking a multivitamin every day. Dr. Willett’s diet, which he calls the Healthy Eating Pyramid, incorporates and expands on the Mediterranean diet. (To learn more about the diet, see Chapter 4.)

You’re never too young to start living healthfully. And right now is the best time to adopt the principles in this book and learn how to defeat inflammation.

The Least You Need to Know

Balkan Bean Soup

Beans provide a creamy texture and dose of protein to this flavor-rich, vegetable-filled soup.

21⁄2 cups dried white beans (1 lb.)

2 medium stalks celery, chopped

1⁄4 cup tomato purée

2 large onions, chopped

2 large carrots, peeled and chopped

2 TB. minced fresh parsley

1⁄4 cup olive oil

Salt

Black pepper

  1. Wash white beans, and soak overnight in 3 quarts water. Drain. Alternatively, place washed beans in a 5-quart glass container with 8 cups water. Cover with an all-glass lid or plastic wrap, and microwave on full power for 8 to 10 minutes or until boiling. Let stand for 1 hour or longer, stirring occasionally, and drain.
  2. In a large pot over medium-low heat, combine beans, celery, tomato purée, onions, carrots, parsley, olive oil, salt, and pepper. Cook for 2 hours or until beans are soft but still whole, and serve hot.

Bean and Squash Soup

This warming, filling soup makes a delicious dinner or lunch on a cool day.

21⁄2 cups dried white beans (1 lb.)

2 TB. olive oil

2 lb. hubbard, buttercup, or other hard yellow squash, peeled and cubed

1 pt. skim or low-fat milk

Salt

Black pepper

  1. Wash white beans, and soak overnight in 3 quarts water. Drain. Alternatively, place washed beans in a 5-quart glass container with 8 cups water. Cover with an all-glass lid or plastic wrap, and microwave on full power for 8 to 10 minutes or until boiling. Let stand for 1 hour or longer, stirring occasionally, and drain, reserving liquid.
  2. In a large saucepan over low heat, heat olive oil. Add hubbard squash, and cook, covered, for 15 to 20 minutes.
  3. In a blender or a food processor fitted with a chopping blade, purée beans and squash. Add to bean liquid.
  4. Add milk, season with salt and pepper, stir well, and serve hot.