Inflammation – The Silent Killer (Part One)

Janet was 52 when she came to me worried and confused. Her doctor had diagnosed her with high cholesterol and coronary artery disease, a narrowing of the arteries in her heart. He wanted to put her on cholesterol-lowering statins — drugs that would address both of her symptoms, but not the underlying cause.

Janet wanted to reverse her condition and knew that medications were not the solution, but she wasn’t sure what to do next. After taking a lengthy health history, it was clear to me that her problem was due, in part, to chronic inflammation — something her doctor had overlooked.

Janet was overweight, didn’t exercise, and had a lot of allergies, tendonitis, and a gum infection. She thought these problems were minor and separate from one another. They weren’t. They were interrelated. After Janet went on a diet and supplement program designed to lower chronic inflammation, she began to feel better — and her cholesterol numbers proved it wasn’t just emotional.

Recent studies are pointing to chronic inflammation as being a major risk factor for heart disease. Because inflammation can be painless and frequently goes undetected, its relationship to disease has been overlooked. If you have several diseases caused by inflammation, you may have a low-level chronic inflammatory process that could eventually lead to heart disease. An inflammation is like a fire. If you don’t put it out, it spreads. It may lie smoldering so you don’t even know it’s there, but unless it’s squelched, it continues to burn slowly.

“Itis” means inflammation, so arthritis, gastritis, dermatitis, pancreatitis, bronchitis, colitis, dermatitis, gingivitis, hepatitis, and psoriasis have a common denominator: chronic inflammation. So do other conditions like some forms of cancer, asthma, diabetes, inflammatory bowel disease, and coronary heart disease. When you reduce chronic inflammation, all of these conditions can improve.

Inflammation and your heart
Not all inflammation is bad. It helps our bodies get rid of foreign matter like bacteria and toxins, keeping them from spreading into other tissues and organs. Its protective responses — redness, heat, pain, and swelling — help the body get rid of foreign substances and prepare injured tissues for repair. Occasional inflammation is part of the normal healing process.

But like just about everything, inflammation has its down side. When it’s chronic, it becomes destructive. Repeatedly inflamed tissues become damaged and break down, creating diseases. In the case of heart disease, blood vessel walls can become inflamed from either a low-level infection, high levels of homocysteine (an amino acid made from methionine), or oxysterols (rancid cholesterol).

Small quantities of red meat and dairy products, all high-methionine foods, usually pose no problems. But large amounts can create too much homocysteine, and this is the beginning of a vicious cycle, because excessive homocysteine produces free radicals that, in turn, make oxysterols.

Oxysterols are the harmful, oxidized form of cholesterol that can cause plaque to form on artery walls. Oxysterols are not only created from homocysteine, they are found in some processed foods like powdered eggs and milk, re-heated lard, and gelatin products. Some nutrients, like beta carotene, folic acid, and vitamins B6, B12, C, and E, can neutralize both homocysteine and oxysterols. Be sure you’re taking a good quality multivitamin/mineral especially if you eat a high animal-protein diet. You may need stronger anti-inflammatory nutrients as well.

Inflammation and C-reactive protein
How can you find an inflammation if you can’t see or feel it? With a blood test that measures the levels of a particular protein called C-reactive protein (CRP). Inflammation is a major cause of increased CRP, and two major studies, the Physician’s Health Study and the Women’s Health Study, found that people with the highest CRP levels were three times more at risk for having a heart attack and two times more likely to have a stroke than those with normal CRP levels.

If you suspect you have chronic inflammation anywhere in your body, talk with your doctor about being tested for CRP. This blood test costs between $20-$50 and is now widely available. If your CRP level is over 0.20 mg/dL it’s time to take action and reduce it.

The dietary connection
Some foods reduce inflammation while others promote it. The foods you choose are the foundation for a healthy heart program, and the type of fats in your diet will either increase or decrease inflammation. So will your choice of sugars.

To reduce inflammation, replace refined sugars with whole grains and fruit, and watch the balance of fats in your diet. The amount of individual dietary fats has a direct influence on chronic inflammation.

Prostaglandins are hormone-like substances made from fats that either promote or reduce inflammation. A high animal-protein diet contains arachadonic acid (AA) that, in turn, makes a pro-inflammatory prostaglandin, PGE2. A diet high in fish and green leafy vegetables makes an anti-inflammatory prostaglandin, PGE1. Popular high-protein diets can either promote inflammation or contain too much mercury from fish. Be sure the fish you eat is wild Alaskan salmon or small fish from cold waters.

Why drugs are not the answer
Statin drugs, the usual treatment for heart disease, don’t always work and may do more harm than good. Even when cholesterol levels declined they didn’t reduce cardiac events significantly in several clinical trials. More importantly, statins reduced the levels of protective Coenzyme Q10 in heart tissues. Always take 200-400 mg/day of supplemental Coenzyme Q10 if you’re taking any statin.

High doses of statins may be harmful. Two-thirds of the cholesterol-lowering effects from statins occur at their starting dose. So if your doctor suggests you take a higher amount, ask if this is necessary. High doses of statins combined with other medications can lead to life-threatening complications. If you are at a low to moderate risk for heart disease and are willing to make lifestyle changes, talk with your doctor about a more natural, safer approach than taking drugs.

Nutrients to reduce inflammation
Particular nutrients can stop inflammation, reverse it, and repair damaged tissues. I’ll discuss them in more detail in Part Two of this inflammation article. There are new anti-inflammatory products on the market you may not be aware of. So check in next month for the rest of the story. Until then, begin by taking a good multivitamin and cleaning up your diet. Remember, supplements are not “instead of” lifestyle changes!

American Federation for Aging Research. “The latest research on the role of inflammation in heart disease,” http://www.infoaging.org.

Challem, Jack. The Inflammation Syndrome, John Wiley & Sons, Inc., 2003.

Heart Protection Study Collaborative Group. “MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomized placebo-controlled trial,” The Lancet, July 6, 2002.

Ichihara, Kazuo and Kumi Satoh. “Disparity between angiographic regression and clinical event rates with hydrophobic statins,” The Lancet, June 22, 2002.

Shepherd, James. “Resource management in prevention of coronary heart disease: optimizing prescription of lipid-lowering drugs,” The Lancet, June 29, 2002.

Pro-inflammatory foods include:
* Omega-6 fats (vegetable oils like corn, safflower, peanut)
* Trans fats (partially-hydrogenated vegetable oils, margarine)
* Refined sugar, grains, and high-glycemic foods

Anti-inflammatory foods include:
* Omega-3 fats (fish oil, flaxseed, green leafy vegetables)
* Omega-9 fats (olive oil, avocados, macadamia nuts)

Challem, Jack. The Inflammation Syndrome, John Wiley & Sons, 2003.