REVERSING CHRONIC INFLAMMATION: Reduce Your Risk of Arthritis, Cancer, Diabetes, and MoreDr. Zoltan P. Rona, MD, M.Sc. November 1, 2012
Inflammation is a normal, natural, and complex series of chemical and cellular activities performed by the body in response to injury or abnormal stimulation caused by a physical, chemical, or biological agent. The inflammatory response is a desirable defence mechanism but the side effects are usually undesirable.
The normal inflammatory response has an on/off switch. When the acute injury or abnormal stimulation is controlled, the switch is turned off. But in chronic inflammation (arthritis, dermatitis, and numerous other chronic health conditions), something has gone wrong with the switch.
Acute inflammation prevents the spread of damaging agents, disposes of cell debris, and sets the stage for tissue repair that returns the body to its original state. Acute inflammation is localized, intense, and of short duration lasting minutes to days. If the acute phase of inflammation is ineffective, chronic inflammation is triggered and this is something that can last from days to a lifetime. Chronic inflammation often leads to tissue destruction (e.g. rheumatoid arthritis, chronic bronchitis). Chronic inflammation is now thought to be the most important factor in causing heart disease, Type 2 diabetes, obesity, chronic fatigue syndrome, neurodegenerative diseases, dementia, and Alzheimer’s disease, as well as all autoimmune diseases.
The cells involved with inflammation are the white cells (neutrophils, lymphocytes) and macrophages. The chemical mediators participating in the inflammatory response are the complement system, histamine, serotonin, bradykinin, leukotrienes, and prostaglandins (PGE2 and PGI2). These cells and chemical mediators are ultimately responsible for the five signs of inflammation: redness, heat, swelling, pain, and loss of function. The redness and heat are caused by the dilatation of the local blood vessels. The swelling is caused by the influx of plasma proteins and phagocytic cells into the tissue spaces, while the pain is due to the local release of enzymes and increased tissue pressure. Loss of function usually follows tissue damage caused by chronic inflammation.
Inflammation can be caused by many aspects of daily living including diet or food choices, stress and worry, artificial chemicals in air, food, water, cosmetics, and drugs, pathogens like bacteria, viruses, and fungi.
Conventional medicine seems to acknowledge many of these causative agents but does not exactly promote strategies to deal with any of them in attempting to control the deleterious effects of inflammation. Rather, the overwhelming treatment and solutions offered for the problem is prescription drugs.
While short-term use of steroidal and non-steroidal anti-inflammatory drugs can be very effective, long-term use of any of these drugs (beyond a few weeks) can lead to life-threatening side effects (hemorrhage, osteoporosis, heart disease).
Do I Have Inflammation?
How do you know if there is any inflammation in your body? It’s very obvious if you have rheumatoid arthritis, psoriasis, scleroderma, a chronic pain syndrome or other disease that has signs you can see that you are suffering from inflammation. What if there are no signs and all you feel is some fatigue or brain fog? Yes, there are lab tests in that case.
Elevated levels of erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein (hs-CRP), and the white blood cell count can be seen when inflammation is present. Another lab test indicative of inflammation is the fibrinogen level, although this is most likely correlated to a greater risk for heart disease. On live cell microscope blood tests a high level of fibrin and rouleau formation (red cells stacking on top of each other) correlates well with the blood level of fibrinogen and can be reversed using proteolytic enzymes like serrapeptase (see below).
Diet and Inflammation
On a molecular level, the damage to tissues caused by inflammation is the result of free radical activity. Free radicals are highly unstable atoms or molecules possessing an unpaired electron that look to steal electrons from more stable molecules. This chemical reaction, especially when it occurs to the phospholipids present in cell membranes, can create premature cell death.
Free radicals come from pesticides in our environment and microwave damage to our food, along with burnt foods, fried foods, rancid foods, irradiated foods, microbe-contaminated food, trans-fats, hydrogenated oils, thousands of inhaled or transdermal chemicals as well as nitrates, nitrites, and preservatives in food. All of these in one way or another can trigger or perpetuate inflammation.
One defence against free radicals is antioxidants, a class of substances that can neutralize free radicals before they can cause any tissue damage. They prevent damage to cells but in particular, the DNA in our genes. Antioxidants can be found in many foods, especially colourful fruits and vegetables. They go by the names lycopene, beta-carotene, and vitamins A, C, E, bioflavonoids, and numerous others. In general, the foods containing these antioxidants are alkaline-forming, while other foods (meats, most grains, sugar, most nuts) are acid-forming and free radical-generating.
One can make a list of free radical, acid forming, or pro-inflammatory foods that ought best to be avoided. One can also attempt to eat more foods that are less likely to generate free radicals, provide more antioxidants, and are, in a sense, more anti-inflammatory. Julie Daniluk’s book, Meals That Heal Inflammation, is one of the best available that not only tells you what the best foods are for healing inflammation, but also gives you many practical suggestions for meals.
The natural food supplement company, Metagenics, has an anti-inflammatory program called UltraInflamX, which recommends a special diet more or less along these same nutritional guidelines. The following recommendations for an anti-inflammatory diet are generally quite effective for most chronic inflammation conditions and are adapted from dietary recommendations published by Metagenics (http://bit.ly/QQZOj1)
Anti-inflammatory Food Rules
Fruits: all fresh fruits and unsweetened fruit juices except oranges are allowed; especially beneficial are apples, pineapples, cherries, papayas, pomegranates, raspberries, strawberries, and blueberries.
Vegetables: all fresh vegetables except corn and creamed vegetables are allowed; kelp and other sea vegetables are allowed and encouraged; spinach, celery, kale, and sweet potatoes are also excellent choices.
Grains: gluten-free grains are allowed; these include brown rice, oats, millet, quinoa, amaranth, teff, tapioca, buckwheat, and arrowroot. On the other hand, wheat, corn, barley, spelt, kamut, and rye must be avoided.
Legumes: all beans except soy are permissible; lentils and peas are okay, but tofu, tempeh, soymilk, and anything made from soy is prohibited.
Nuts and seeds: all are allowed except for peanuts and peanut butter; almonds and almond butter are good substitutes; walnuts and pine nuts are highly recommended.
Meats, fish, and eggs: all fish, chicken, turkey, wild game, and lamb are allowed; but beef, pork, cold cuts, hot dogs, sausages, eggs, and shellfish are prohibited.
Dairy products and milk substitutes: all cow’s milk products are prohibited including cream, yogurt, butter, and ice cream. On the other hand, rice milk, almond milk, oat milk, coconut milk, and other nut milks are allowed substitutes. Avoid soymilk.
Oils: cold-pressed olive, flaxseed, hemp, coconut, safflower, sunflower, sesame, walnut, pumpkin, and almond oils are permitted. Avoid shortening, margarine, hydrogenated oils, mayonnaise, and commercial spreads.
Beverages: water, herbal teas, soda or mineral waters are allowed; but pop, diet soft drinks, alcoholic beverages, coffee, black tea, and caffeinated beverages are not allowed. N.B. Do not underestimate the value of drinking adequate amounts of water not only to help drive chemical reactions in the body but also to flush out toxins.
Spices and condiments: all spices are allowed but avoid chocolate, ketchup, mustard, relish, chutney, soy sauce, and barbecue sauce; best anti-inflammatory spices are turmeric, ginger, rosemary, and curry.
Sweeteners: brown rice syrup, xylitol, blackstrap molasses, stevia, and agave are permitted, but avoid sugar, honey, corn syrup, candy, and other sweets.
The antioxidants in plants have also been referred to as phyto-nutrients. They are the pigments that give plants their vibrant colour. They not only neutralize free radicals and thus inflammation but they help prevent cancer, as well as repair damaged genes. The yellow, orange, and bright red fruits and vegetables (carrots, pumpkin, peppers, tomatoes, mangos, papaya) contain carotenoids like beta-carotene and lycopene while the green vegetables (asparagus, broccoli, onions, mustard greens) are high in sulphur phyto-nutrients like sulphorane, isothiocyanates, indoles, and alpha lipoic acid. Purple-, blue-, black-, and magenta-coloured fruits and vegetables (acai berries, blackberries, cherries, beets) contain phyto-nutrients called phenolics and flavonoids.
Commonly occurring culinary herbs and spices have been shown to neutralize free radicals, as well as heal inflammation. These include garlic, onions, green tea, cinnamon, turmeric, rosemary, curry, ginger, parsley, and cayenne.
All antioxidant supplements are anti-inflammatory and all anti-inflammatory supplements are antioxidants. While there is clearly good evidence that following an anti-inflammatory diet will do wonders to control inflammation, there are also supplements that have been proven to control the adverse effects of inflammation.
Most antioxidant supplements are molecules isolated from foods and provided at dosages much higher than what we could possibly obtain from food. These are in no way a replacement for poor eating habits, but are best used as an adjunct to following a good anti-inflammatory diet. Even when we follow a very healthy diet, it’s virtually impossible to prevent exposure to environmental toxins and chemicals in our daily lives. Supplementation would therefore provide us with added protection from the free radical onslaught.
A good anti-inflammatory protocol is listed below. The severity of the inflammation involved dictates the number and dosages for all these supplements. Many companies have combined a large number of these antioxidants into a single pill or powdered beverage, so please don’t feel overwhelmed by the large number of products listed below. Choose non-pharmaceutical company brands to avoid damaging fillers and heavy metals. (One popular pharmaceutical brand recommended only by conventional doctors contains aluminum, carcinogenic dyes, and nickel.)
Multivitamin and mineral – this would be the bare minimum to provide antioxidants; avoid multiples containing iron since too much iron can be pro-inflammatory.
B complex vitamins – essential for numerous beneficial effects on inflammation, especially in heart disease.
Vitamins A, C, D, K, and E Complex – all demonstrated to have anti-inflammatory activity in all inflammatory conditions. Deficiencies make inflammation worse.
Bioflavonoids – bilberry, quercetin, rutin, pycnogenol, and grape seed extract are the best known ones and especially effective for inflammation seen in those with chronic allergies and vascular disease.
Coenzyme Q10 (ubiquinone) – this is a powerful antioxidant that is particularly useful for all cardiovascular problems including high blood pressure. CoQ10 is a must for anyone taking cardiac medications and statin drugs to lower high cholesterol because most cardiac drugs destroy the body’s own production of CoQ10. CoQ10 has anti-cancer effects and is effective in Parkinson’s disease.
Boswellia – a herbal remedy especially effective for arthritis and tendonitis.
Bromelain – an enzyme derived from pineapple especially useful for tendonitis and to heal from most physical injuries.
Ginger – long known and acknowledged as a high effective anti-inflammatory remedy, ginger can be especially effective in gastrointestinal ills, especially chronic nausea, even in early pregnancy.
Serrapeptase – this enzyme derived from the silkworm appears to be one of the most potent and effective of all the anti-inflammatory enzymes. In high enough doses, serrapeptase is capable of dissolving atherosclerotic plaque. It can also dissolve a cancer cell’s protective coat, thereby making virtually any chemotherapeutic remedy more effective.
Pancreatin – pig-derived enzymes from the pancreas can get into the human bloodstream, very much like serrapeptase, and help destroy free radicals and pro-inflammatory compounds. The net effect is a reduction of inflammation, cancer spread, and numerous other conditions dependent on inflammation to spread. Brand names you might be familiar with include Wobenzyme and Intenzyme Forte.
Tumeric – this spice is high in curcumin, a potent natural anti-inflammatory agent compared in efficacy as an anti-inflammatory agent to prescription corticosteroids. Research also indicates curcumin could be an effective natural anticancer agent.
Glutathione – this very powerful antioxidant reserved for very severe forms of inflammation is best injected intravenously because there are no oral forms that absorb intact into the circulation. Good evidence exists for its anti-aging benefits. N-acetyl-cysteine is an amino acid that can be supplemented and it helps boost the body’s production of glutathione.
Alpha Lipoic Acid – a very potent antioxidant that recycles vitamins C, E, and CoQ10 to full free radical capacity. It improves carbohydrate metabolism, controlling abnormal blood sugar levels, and protects our DNA.
Probiotics – since the immune system largely governs what happens during the inflammatory process and since 70% of our immune system resides in our gastrointestinal tract, it is important to help normalize our immunity with friendly microbes (lactobacilli, bifidobacteria, etc.).
Omega-3 fatty acids (DHA and EPA fractions) from fish oil are effective at suppressing pro-inflammatory cytokines without side effects. Ideally omega-3 fatty acids work best with high doses of vitamin D. EPA acts as a substrate for enzymes called cyclooxygenases and lipoxygenases. It competes with arachadonic acid (pro-inflammatory) for these enzymes. Supplementing with omega-3 fatty acids thus reduces inflammation because arachadonic acid derivatives (prostaglandins, thromboxanes, and leukotrienes) are less active. Studies with rheumatoid arthritis patients, in fact, have shown decreased morning stiffness and joint pain in patients who supplement with omega-3. The potency of these fish oils approximates those of non-steroidal anti-inflammatory drugs (NSAIDS), with negligible side effects.
(N.B. Avoid omega-6 fatty acids – it breaks my heart (and possibly yours) to see people supplementing with omega-6 in the belief it has some sort of magic benefit against disease. Omega-6 is pro-inflammatory and ubiquitous in the standard North American diet. It certainly doesn’t need to be supplemented because it offsets the anti-inflammatory benefits of omega-3. I know there are numerous companies marketing omega-3-6-9 products. If any of you are reading this: stop it! (See: http://bit.ly/PTFEky).)
Other Herbal and Plant Anti-inflammatory Supplements – alfalfa, aloe vera, cat’s claw, echinacea, goldenseal, silymarin from milk thistle, pau d’arco, red clover, and yucca have all been reported as effective in the control of inflammation.
If you wish to start an anti-inflammatory program of diet change and supplements, it’s highly recommended you see a natural health care provider to work with you on a personalized plan.
• Alan R. Gaby, M.D. Nutritional Medicine. Fritz Perlberg Publishing; Concord, NH 2011. http://www.doctorgaby.com
• Julie Daniluk. Meals That Heal Inflammation. Hay House Inc. Publishers: USA, 2011.
• UltraInflamX Quick Start Guide: http://bit.ly/QQZOj1
• Balancing Omega-3 and omega-6? http://bit.ly/PTFEky
• Dr. Robert A. Kornfeld. Five Ways to Reduce Inflammation Naturally. http://huff.to/QR1xVr
• Web MD. Vitamins that fight Inflammation. http://bit.ly/SK2H5C
Dr. Zoltan P. Rona practises Complementary Medicine in Toronto and is the medical editor of The Encyclopedia of Natural Healing. He has also published several Canadian best-selling books, including Vitamin D: The Sunshine Vitamin. Visit his website at: http://www.highlevelwellness.ca For appointments, call (905) 764-8700; Office: 390 Steeles Ave. W. Unit 19, Thornhill, ON