Inflammation

Physicians have long recognized inflammation as the culprit in asthma, arthritis, and many other painful "-itis" diseases. Almost overnight, medicine has redefined inflammation as the root of most chronic diseases.

The latest findings point to chronic low-grade inflammation as the underlying cause of coronary heart disease, Alzheimer's disease, and some cancers. Obesity and diabetes have powerful undercurrents of inflammation.

This changing view of inflammation has grown largely out of a new respect for C-reactive protein (CRP), a blood protein that both promotes and reflects inflammation levels in the body. Using a new and particularly sensitive blood test, known as high-sensitivity CRP, Paul Ridker, MD, of the Harvard Medical School, found elevated levels of inflammation increase the risk of a heart attack by four and one-half times. This strong association makes CRP a far more accurate predictor of heart-attack risk than total cholesterol, low-density lipoprotein cholesterol, or homocysteine.

A Normal Process Gone Awry

Inflammation is a normal part of the body's immune response to infection or injury. Activated white blood cells secrete a variety of inflammation-promoting compounds interleukin-6 (IL-6), CRP, free radicals, and prostaglandins to fight germs and to dispose of damaged cells. After the body recovers, the immune system and its white blood cells should settle down. If they don't, low-grade inflammation may simmer for years, eventually turning serious or repeated injuries to knee cartilage into osteoarthritis. Inflammation may also quietly damage the heart or brain cells.

CRP and IL-6 are highly specialized molecules called cytokines, which function as chemical messengers between cells. Somewhat like a cellular Paul Revere, they help activate armies of white blood cells that, in chronic inflammation, can turn against normal tissues. The big question is: what stimulates this pro-inflammatory activity in the first place? Part of the answer lies in the foods people eat.

Setting the Stage for Inflammation

Your body makes two families of hormone-like compounds, called prosta-glandins, which either promote or reduce inflammation. The "parent" molecules of these prostaglandins occur in fatty acids.

The largely pro-inflammatory omega-6 fatty acids are found in most cooking oils, such as corn, safflower, peanut, and soybean oils. In contrast, the anti-inflammatory omega-3 fatty acids are found in fish (particularly coldwater species, such as salmon), flaxseed, and leafy green vegetables. The body converts the fatty acids in these foods into more potent pro- and anti-inflammatory prostaglandins.

Saturated fats have little influence on inflammation, but trans-fatty acids (identified on labels as partially hydrogenated oils) interfere with the enzymes needed to process fatty acids, particularly the omega-3 fatty acids. A particular type of omega-6 fatty acid, gamma-linolenic acid behaves more like an anti-inflammatory omega-3 fat. Oleic acid, an omega-9 fatty acid in olive oil, also has anti-inflammatory properties.

Your body's levels of all of these fatty acids reflect dietary intake. Historically, diets contain relatively equal amounts of omega-6 and omega-3 fatty acids, providing a balance between the body's pro- and anti-inflammatory activities. But in highly processed foods - think fast foods and packaged convenience foods - the ratio of omega-6 to omega-3 fatty acids has increased from roughly 15:1 to 30:1. The result primes people for chronic inflammation, while greatly reducing the body's ability to turn off inflammation.

Carbohydrates can be just as problematic as some fats in promoting inflammation. According to research by Simin Liu, MD, PhD, of the Harvard Medical School, a diet high in refined carbohydrates and high-glycemic foods (which rapidly raise blood sugar levels) also seem to increase inflammation. In a recent study, Liu found that women eating large amounts of potatoes, breakfast cereals, white bread, muffins, and white rice had elevated CRP levels, indicating high levels of inflammation and an increased risk of heart disease. Overweight women who ate these foods had the highest and most dangerous CRP levels.

Anti-Inflammatory Nutrients

Many studies have shown that dietary supplements can bolster the body's own ability to control and reduce inflammation. Unlike aspirin, ibuprofen, or Cox-2 inhibiting drugs, these supplements are exceptionally safe. These include fish oils, gamma-linolenic acid, vitamin E, vitamin C, glucosamine, flavonoids, and botanicals.

Fish oils: Fish oil supplements rich in eicosapentaenoic acid (EPA) and docosahexanetoic acid (DHA), leapfrog the body's need to convert alpha-linolenic acid to EPA and DHA. That's important because trans-fatty acids, found in many processed foods, interfere with the enzymes involved in making these acids.

Fish oil also reduce levels of many inflammation-promoting compounds, including prostaglandin E2 and CRP. In one study, Scottish researchers found that daily fish oil capsules led to less pain and less need for anti-inflammatory drugs.

Dosage = three grams of fish oils daily. Flaxseed oil capsules may be used by vegetarians.

Gamma-linolenic acid: Although gamma-linolenic acid (GLA), is technically an omega-6 fatty acid, it is part of the body's normal system of checks and balances to control excessive inflammation. GLA boosts levels of prostaglandin E1, which reduces inflammation caused by prostaglandin E2.

Robert Zurier, MD, of the University of Massachusetts, Worcester, conducted two studies using GLA to treat patients with rheumatoid arthritis. Both 1.4 and 2.8 grams of GLA daily, lead to significant reductions in symptoms.

Dosage = At lease 1.4 grams daily. The amount of GLA is more important than the source, so read the fine print on the label.

Vitamin E: Several clinical studies found that natural vitamin E can lower CRP levels by 30 to 50 percent and IL-6 levels by 50 percent. This effect may account for the vitamin's well-known heart benefits. The anti-inflammatory benefits of vitamin E were also noted in two clinical trials that found the vitamin of benefit in patients with rheumatoid arthritis.

Dosage = 400 IU daily, but a clearer anti-inflammatory effect may be achieved at 800 or 1,200 IU daily.

Vitamin C, glucosamine, and chondroitin: These three supplements are commonly used to reduce the pain of osteoarthritis and to rebuild articular (joint) cartilage. But they - along with methylsulfonylmethane (MSM) - may have far broader tissue-rebuilding benefits. Vitamin C is required for the formation of collagen, one of the most basic proteins in the body. Meanwhile, glucosamine, chondroitin, and MSM provide rich sources of sulfur, a mineral that helps hold tissues together.

Dosage = 500 to 1,000 mg of vitamin C and 1,000 mg each of glucosamine, chondroitin, and MSM daily.

Flavonoids: Thousands of antioxidant flavonoids have been identified in plants, and probably all have some anti-inflammatory properties. They are likely a big part of the reason why vegetables are good for health. Several specific flavonoids may be helpful in reducing inflammation, specifically quercetin, Pycnogenol®, and grape-seed extract.

Dosage = 300 to 500 mg of quercetin daily or 150 to 300 mg of Pycnogenol or grape-seed extract daily.

Botanicals: All herbs are rich in flavonoids, which likely account for their anti-inflammatory properties. Boswellia, cat's claw, devil's claw, and green tea extracts are particularly potent anti-inflammatory herbs. Because of its mild taste, green tea has the advantage of being consumed as a beverage.

Dosage = Herbal potencies can vary depending on their form, such as capsule/tablet or tincture. Follow either label directions or advice from a naturopathic physician or herbalist.

To boost the body's levels of anti-inflammatory compounds, eat more fish and vegetables, consume healthier oils, and cut back on refined carbohydrates.