To Your Health: Inflammation, Doubled-edged Sword

20 Feb To Your Health: Inflammation, Doubled-edged Sword

Inflammation often gets a bad rap. Truth is without an adequate inflammatory response, we would die of infections. We need a good immune system to fights off those evil bacteria and viruses. Those of us who have certain primary immunodeficiency diseases are prone to problems.

Antibody deficiency characteristically leads to recurrent, often severe, upper and lower respiratory tract infections with encapsulated bacteria. Viral infections of the respiratory tract also occur with greater frequency and severity in these patients. We definitely need a good immune system – but with adequate controls.

Unfortunately autoimmune diseases in the industrialized world are increasing dramatically. We are seeing a marked increase in Crohn’s disease, ulcerative colitis, Type I diabetes, rheumatoid arthritis, lupus, and other autoimmune challenges. Crohn’s is up about 360 percent since 1965; multiple sclerosis has increased in incidence by about 300 percent since 1950.

Many other diseases can be linked to low levels of inflammation including Alzheimer’s disease, colon cancer, esophageal cancer, and even coronary artery disease.

A fascinating recent study had to do with an abnormal rhythm of the heart called atrial fibrillation. We doctors never imagined that vaccinating against influenza could possibly protect against this abnormal electrical rhythm of the heart, but we were wrong. Atrial fibrillation is a well-recognized risk factor for developing complications from influenza, and becoming sick with the flu just may be associated with an increased risk for developing Afib.

In a newly reported nationwide, case-control study from Taiwan, influenza infection was significantly associated with new onset atrial fibrillation (Afib), with study participants who had the flu during the previous year having an 18% increased risk for an Afib diagnosis. The study revealed a modest, but statistically significant association between influenza infection in the prior year and influenza vaccination and Afib.

Is it the post viral lingering inflammation that triggers this abnormal rhythm? We also know that after a significant upper respiratory infection,  for months you could be at a greater risk for a cardiac event.

So how and what do we screen for ongoing inflammation in our body?

Some blood tests including C-reactive protein (CRP), gives us important clues.

Elevations of the CRP occur in association with acute and chronic inflammation for many reasons, including infectious diseases and noninfectious inflammatory disorders. Very small changes in CRP levels, detected with highly-sensitive assays, may also occur in association with metabolic stresses in the absence of acute or chronic inflammatory states as they have traditionally been viewed. Minor CRP elevation (concentrations between 3 and 10 mg/L) is generally regarded as a marker of what has been called low-grade inflammation. I often use CRP to follow my patients with inflammatory bowel disease. There is a continually expanding literature on the predictive value of CRP in cardiovascular disease and on the possible role of serum CRP in screening for cardiovascular risk.

There are a lot of unanswered questions this discussion of inflammation brings to the forefront. For example,we have to ascertain the best diet to fight inflammation – which appears to be one rich in fruits and vegetables, as well as nuts and healthy oils.

We need to get more of our protein from the plant kingdom and avoid red meats as much as possible.

For many reasons, I still get the influenza vaccine, as well as recommending at appropriate ages the pneumococcal pneumonia vaccines and the herpes zoster vaccine. Post-infectious inflammation can last for many months and is real.

Lastly, there has been a lot written on chronic polyunsaturated fats and inflammation.

How do polyunsaturated fatty acids (PUFAs) influence our health?

This is a confusing topic and we are only at the infancy of our understanding. Do these agents actually improve our health and should we all take fish oil supplements? Unfortunately we are still studying this question. I will give some of the information we have to date, but at the end of the VITAL study next year, we may have a lot more information on Vitamin D and fish oil supplements.

Unlike n-6 PUFAs which promote inflammation and insulin resistance, n-3 PUFAs are believed to have anti-inflammatory properties. Indeed, n-3 PUFAs are being used in the prevention and treatment of coronary artery disease, hypertension, arthritis, cancer, and other inflammatory and autoimmune disorders in humans. Just because it is recommended, however, does not mean it is done with evidence-based medicine in mind.

Again, I get back to recommending a Mediterranean diet.

The Mediterranean model has already been linked to a number of beneficial health effects: both fat and non-fat components of this sort of diet have been shown to promote important anti-inflammatory activities by affecting the arachidonic acid cascade, the expression of some proinflammatory genes, and the activity of immune cells.

The traditional Mediterranean diet is characterized by an abundance of plant foods, such as vegetables, legumes, fruits, grain, cereals and nuts, plus fish. Olive oil is the main source of fat. Poultry, dairy products and eggs are eaten in moderation. Culinary herbs and spices are another important component of the Mediterranean diet that seems to increase health-promoting characteristics, as well as food palatability.

Our western diet may be high in pro-inflammatory fats such as saturated fat, cholesterol, and n-6 polyunsaturated fatty acids, whereas the Mediterranean diet is instead high in monounsaturated fatty acids (MUFAs) and, in particular, oleic acid.

Although some aspects concerning the mechanisms of action through which the Mediterranean diet pattern exerts its beneficial effects still needs explaining, arthritis patients and patients with a variety of inflammatory conditions including auto-immune diseases could potentially benefit.

It is worth a try.

Editor’s Note: 

Our relationship with Dr. Alan Safdi started several years ago when we attended a Wellness Conference at The Peaks Resort & Spa. Dr. Safdi, is a gastroenterologist with a talent for offering evidence-based medical findings for healthy living in easily digestible sound bytes. We next heard him speak at Telluride First Foundation’s inaugural Integrative Wellness Conference, where the audience got just a taste of his encyclopedic knowledge on mind-body wellness. To fill in the gaps, Telluride Inside… and Out plans to post nuggets from Dr. Safdi regularly.

More about Dr. Alan Safdi:

Dr. Alan Safdi is a speaker, contributor, and serves on the advisory board of the Telluride First Foundation.

He is board certified in Internal Medicine and in Gastroenterology and is a Fellow of the American College of Gastroenterology. A proven leader in the healthcare arena, he has been featured on the national program, “Medical Crossfire” and authored or co-authored numerous medical articles and abstracts. He has been an investigator in over 581 studies and is President of both the Consultants For Clinical Research and the Ohio Gastroenterology and Liver Institute.

Dr. Safdi has been involved in grant-based and clinical research for about 35 years and is passionate about disease prevention and wellness, not just fixing what has gone wrong. He is an international lecturer on the subjects of wellness, nutrition, and gastoenterology.