Hidden And Dangerous!

Cancer, heart disease, dementia, diabetes: In the lexicon of ageing and disease, these are some worrisome words. But researchers have suspected for years that all of these health issues, and more, have at their heart one common trigger: chronic low-grade inflammation. And now they may finally have proof.

In 2017, researchers in Boston reported on a clinical trial with more than 10,000 patients (mean age: 61) in 39 countries that tested whether an anti-inflammatory drug, canakinumab, could lower rates of heart disease. They discovered that it could, but they also found that it reduced lung cancer mortality more than 67 per cent, and reports of gout and arthritis (conditions linked to inflammation) also fell.

“Inflammation plays a role in everyone’s health,” says Dr Dana DiRenzo, a rheumatologist and instructor of medicine at Johns Hopkins University School of Medicine in Baltimore, USA. When inflammation levels increase, so does the risk of disease. But understanding inflammation can be tricky because, when you get a disease, inflammation levels naturally increase as your body fights the condition. Inflammation, in other words, is both good and bad.

When is inflammation a problem?

When you catch the flu and your body temperature rises to fight the virus, that’s a form of acute inflammation. So is the redness and swelling that occur when you sprain your ankle. The process is a temporary, helpful response to an injury or illness. It provides the healing chemicals and nutrients your body needs to repair the damage. Once the danger goes away, so does the inflammation.

Chronic low-grade inflammation, on the other hand, is a slow, creeping condition sustained by a misfiring of the immune system that keeps your body in a constant, long-term state of alert, says Dr Robert H. Shmerling, teaching clinician in the department of rheumatology at Beth Israel Deaconess Medical Center in Boston, USA.

Over time, inflammation damages healthy cells. Here’s why: When cells are in distress, they release chemicals that alert the immune system. White blood cells then flood the scene, where they work to eat up bacteria, viruses, damaged cells and debris from an infection or injury. If the damage is too great, they call in backup cells known as neutrophils, which are the hand grenades of the immune system—they blow up everything in sight, healthy or not. Each neutrophil has a short lifespan, but in chronic inflammation, they continue to be sent in long after the real threat is gone, causing damage to the healthy tissue that remains. The inflammation can start attacking the linings of your arteries or intestines, the cells in your liver and brain or the tissues of your muscles and joints.

This inflammation-caused cellular damage can trigger diseases like diabetes, cancer, dementia, heart disease, arthritis and depression. And because it’s low grade, “its slow and secret nature makes it hard to diagnose in day-to-day life,” says Roma Pahwa, a researcher for the National Institutes of Health who specializes in the inflammatory response. “You have no idea it’s even happening until those conditions show symptoms.”

Causes of chronic inflammation

When you contract a chronic infection like hepatitis C or Lyme disease, your body responds with inflammation that also lingers for a long time. In fact, it’s often the chronic inflammation, not the viruses themselves, that causes much of the long-term damage related to these diseases.

Genetics can be a factor. In some cases, the genes related to these health issues can be turned on by inflammation: Diabetes and cancer are two genetically related diseases that can be triggered by it. In other cases, the gene itself leads to a misfiring of the immune system that causes the inflammation in rheumatoid arthritis, multiple sclerosis, lupus and other diseases.

Diabetes and cancer are diseases inflammation can trigger.

The environment plays a role, too; pollution, air and water quality, environmental allergies and a host of other environmental factors can trigger and sustain inflammation. And then there’s lifestyle: Obesity, unregulated stress, tobacco use, drinking too much, lack of physical activity, lousy sleep and, of course, poor diet are all linked to chronic inflammation.

Plus, the older we are, the more exposure we’ve had to environmental toxins, stress, alcohol, bad foods and chronic diseases. Ageing also makes it more difficult for our bodies to properly manage our immune systems, to extract nutrients from food and to shed extra kilos.

Some of the key aggravating factors

Belly fat: Having a big belly means you have an excess of visceral fat, which builds up near your intestines and other internal organs. Every day, your belly fat is creating and releasing inflammatory compounds with Bond-villain names such as interleukin 6 and tumour necrosis factor-alpha. Remember, inflammation is a response to cell damage. Fat cells are bloated with triglycerides (the substance that can be turned into diesel fuel) and as a result, they are very fragile and can easily rupture. When they do, they trigger an inflammatory response as the immune system sends white blood cells to clean up the spilled fuel.

Chronic stress: If you handle stress poorly, or feel helpless or put-upon, your body goes into fight-or-flight mode, causing an increase in hormones like cortisol and adrenaline—which directly trigger a rise in inflammation. If you have an autoimmunity-based skin condition like psoriasis, you’ve probably witnessed flare-ups at times of stress. Mindfulness techniques such as prayer and meditation have been shown to reduce some markers of inflammation and can help people suffering from chronic inflammatory conditions.

Not enough exercise: Research has shown that you don’t have to be a marathoner to lower inflammation. In fact, a University of California, San Diego, study found that just 20 minutes of moderate exercise suppresses the inflammatory response. One reason, says Thomas Buford, an associate professor with the University of Alabama at Birmingham School of Medicine’s division of gerontology, is that exercise can positively affect your gut health.

“The difference between someone feeling okay and feeling great is exercise,” says DiRenzo. Even if you have physical limitations—bad knees, for example—exercise will most likely improve them. To get started, DiRenzo suggests picking an activity you can do for five minutes a day. Next week, do it for seven minutes. It could be as simple as a brisk walk. “Yeah, you’re gonna be sore,” she says, “but this is a good sore. Build and build and you will start to feel better.”

Poor sleep: If you have to pick one lifestyle area to improve, focus on sleep, both the quantity and quality. It not only lowers your inflammation levels, it also helps you do everything else better. “I find when people give their body time to rest and lower stress, they have an easier time making smart food choices and getting exercise the next day,” says Dr Elizabeth Boham, medical director at the UltraWellness Center in Lenox, Massachusetts, USA.

Foods play a major role: Foods high in sugar or unhealthy fats, and low in fibre top the list of ‘pro-inflammatory’ foods. They feed the ‘unhealthy’ bacteria in our digestive tract. We naturally have a balance of good and bad bacteria in our gut, but when the bad bacteria become too numerous, they can damage the lining of the digestive tract.

“The intestinal barrier that separates the microorganisms from the rest of your body can become permeable, allowing particles to escape into the body’s circulation,” says Buford. This is a condition known as leaky gut. The immune system recognizes these particles as foreign invaders and attacks. But since the gut keeps leaking, the immune system keeps attacking, and—boom—you have chronic inflammation.

High-fibre foods like whole grains, fruits and vegetables help to restore gut balance. They feed the good microbes in your gut during digestion, helping to correct dysbiosis. “There’s a lot of evidence that a high-fibre diet provides a positive balance of microbes and can potentially down-regulate inflammation,” Buford says. Also important: Avoid unhealthy fats because, he says, “even one high-fat meal can change the microenvironment.”

Red and processed meats can cause inflammation, but you don’t have to banish meats from your diet, Boham says. This is particularly important for older adults because protein consumption may help prevent age-related muscle loss. “I recommend a balance between plant protein—nuts, seeds, beans, grains—and animal protein,” she says.

She recommends organic, grass-fed meats and wild-caught fish, which have a lower inflammation factor because they feed on plants and animals that are high in phytonutrients. Try to eat one food from every colour of the rainbow every day.

***

Good foods, bad foods

What causes inflammation, and what soothes it?

Causes it: White bread

A diet low in fibre can allow unhealthy bacteria to gain the upper hand in your digestive system, contributing to a leaky gut, in which toxins are allowed to pass through into your body rather than being swept away by the digestive system.

Soothes it: Wholegrain bread

As the body digests fibre, like that found in whole grains, it creates butyrate, a beneficial fatty acid with anti-inflammatory powers. Butyrate seems to cross the blood-brain barrier and may help prevent neurological decline.

Causes it: Processed sweets

Most processed foods, especially desserts, are low in fibre, high in sugar, and packed with chemicals, all of which are bad for the gut. The less frequently you eat processed foods, the better.

Soothes it: Fruit and yoghurt

Certain fruits, vegetables and beans contain polyphenols, plant compounds with antioxidants that help mitigate the cellular damage created by inflammation. Examples include resveratrol (wine, grapes) and catechins (tea, apples, berries). Probiotics contain healthy bacteria, which help keep the bad gut bacteria in check.

Causes it: Deep-fried foods

Advanced glycation end products (AGEs) are inflammation-causing compounds produced when meats and grains are cooked at high heat—think doughnuts, french fries and fried chicken.

Soothes it: Healthy fats

Monounsaturated fats (olive oil, avocado, nuts) have been shown to lower the risk of heart disease, while polyunsaturated fats (fish, flax) include an inflammation-busting mix of omega-6 and omega-3.

Causes it: Bottled salad dressings

Look at the label of your favourite dressing. It’s probably high in fat, salt and sugar. Make your own salad dressings with inflammation-fighting olive oil, lemon or vinegar and spices.

Soothes it: Big, colourful salads

Vitamins and minerals found in fruits and vegetables prevent oxidative stress—meaning they fight inflammation. They have hundreds of antioxidants, such as vitamins A, C and E, lycopene and selenium.

***

Is there a test and a cure for chronic inflammation?

The problem with testing is that we all have a certain amount of inflammation in our bodies, and levels fluctuate constantly, so a reading at 8 a.m. will be different from one at 8 p.m. Also, something harmless like the common cold will spike levels of disease-fighting chemicals in our blood, DiRenzo says, so doctors don’t routinely test for inflammation. “Testing should come as a result of certain symptoms like swollen joints.”

For example, if you have heart disease, your doctor may test for C-reactive protein (C-RP), an inflammation marker that’s been linked to cardiac issues. But just chasing inflammation itself, without specific indicators, can open a Pandora’s box of unnecessary testing for patients, DiRenzo says. “Instead of trying to pin down this nebulous term ‘chronic inflammation’, work closely with your doctor to identify specific-enough symptoms that may lead to a diagnosis of an inflammatory issue.”

While researchers continue to experiment with anti-inflammatory drugs (beyond ibuprofen, which has side effects such as stomach bleeding and increased blood pressure), none has been approved for use in fighting chronic low-grade inflammation.

***

By a certain age, we all have some degree of inflammation in our bodies. The key is to keep it at a flickering ember and not let it erupt into a forest fire.

If you smoke, drink a lot, carry a lot of extra weight, never exercise, eat poorly or are constantly stressed, your chances of having some level of chronic elevated inflammation are high. If you are lean, healthy, lead a balanced lifestyle, stay up to date on your vaccinations and wash your hands regularly (since infections trigger inflammation, Shmerling says), you should have less of it.

Lifestyle is the thing you can change fastest and the one thing you can control. Maybe you dread that changes like adding exercise and improving your diet will be unpleasant. But heart surgery is probably much more unpleasant. And isn’t attacking one enemy—inflammation—a lot easier than worrying about dozens of them?

From AARP (1 November 2019), Copyright © 2019 by AARP, AARP.ORG