EVOLVE WELLNESS SEPTEMBER 2013 FEATURE

inflammation- the silent killer

what is inflammation?

The ancient Greeks called it an “internal fire” and the Romans linked it to “pain, swelling, heat and redness”. Put simply, inflammation is your body's automatic response and natural defence to foreign invaders and infection. We have all experienced some form of classical inflammation – it’s the type that hurts, for instance, when we have bruising, swelling or inflamed tendons and joints. It’s often acute and intense. When the healing is successful, the symptoms will subside, the repairs complete, and the inflammatory process stops.

The second type, silent inflammation – the type that has no pain – is the secret killer, and it doesn’t stop without the underlying causes being addressed. Since there is no pain associated with this type of inflammation, nothing is done to stop it and thus it can linger for years, if not decades, causing continuing organ damage.

With silent inflammation, it’s a case of “Out of sight, not in mind” and unfortunately, for most of us, we may not recognise their real effects until things are at a chronic stage, affecting our health and performance. We can attribute some of today’s chronic diseases to silent inflammation.

what causes silent inflammation?

Empty calorie foods and junk, unhealthy fake foods. What to avoid? Foods high in trans fat, sugar, highly-refined carbohydrates, gluten, alcohol, vegetable oils high in omega-6s, dairy milk, MSG.
Pollution and synthetic chemicals in our environment, cosmetics, and food supply
Various bacterial, viral, and parasitic infections
Sedentary lifestyles and low levels of physical activity/exercise
Chronic ongoing stress (relationships, career, health, etc.)
Poor digestion that results in non-digestible residues lingering in our intestines
How do you know if you are suffering from silent inflammation? 

Symptoms of chronic inflammation can manifest as arthritis, colitis, fatigue, sinusitis, cataracts, chronic pain or hair loss. Consider these easy markers…you might have silent inflammation if you:

Are overweight
Crave carbohydrates
Are constantly hungry
Are tired especially after exercise
Have brittle finger nails and limp hair
Need a lot of sleep
Are constipated
Are groggy when first you wake up
Lack mental concentration
Have headaches
Have dry skin

Diseases associated with inflammation

Heart disease:
According to Dr. Dwight Lundell, “Inflammation in the artery wall is the real cause of heart disease. ” Not cholesterol. He goes on to confess that after years as a physician, prescribing anti-cholesterol drugs and advising clients to severely restrict their fat intake are simply not working. “Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped, “ he wrote.

Type II Diabetes: Diabetes is a health problem of epic proportions worldwide. The World Health Organisation estimates that 2.9 million deaths per year are attributable to diabetes, and this number is likely to increase by more than 50% in the next decade. Currently, in the US, 20 million have diabetes and 57 million have pre-diabetes. Closer to home, 11.3% of Singaporeans are estimated to be suffering from it. In most people with Type II diabetes, the body cannot use the insulin properly - when the usual targets of insulin (liver cells), cells of both skeletal and smooth muscles, and adipocytes (in fat/adipose tissues) - do not respond at all, or adequately, to insulin. This is known as Insulin Resistance. Studies have demonstrated that even a mild state of inflammation precedes and predicts Type II diabetes.

Obesity: No matter which reports you have read and it almost doesn’t matter what stats I throw at you, you can just look around and know that this is a HUGE problem (excuse the pun). Obesity is strongly linked with increased inflammation. As the inflammation in adipose tissue (fat) increases, this becomes a strong driving force for the development of increased systemic inflammation that results in metabolic syndrome, eventually leading to the development of overt Type II diabetes. The good news is, the reversal of both conditions can be achieved by reducing the levels of inflammation through the use of an anti-inflammatory diet.

Alzheimer’s: Studies have found that Inflammation clearly occurs in the pathologically vulnerable regions of brains with Alzheimer's disease (AD), and also accelerates it.

Cancer: Sad that the letter ‘C’ today is linked to one of today’s most dreaded diseases. And inflammation has long been associated with the development of various forms of cancers. Chronic inflammatory states within bodies associated with infection and irritation is known to lead to environments that foster tumour initiation.

testing for silent inflammation

To be sure, you may want to see your doctor and test for markers of Silent Inflammation, such as:

1) Silent Inflammation Profile (AA: EPA Ratio)
If you ask your doctor about it, he or she may not know this yet. SIP measures the ratio of the pro-inflammatory eicosanoids versus the anti-inflammatory eicosanoids. SIP is the Arachidonic Acid (AA): EPA (EicosaPentaenoic Acid) ratio. This is done via a blood test, and done indirectly as eicosanoids (EPA) are fleeting hormones that last a few seconds making them challenging to measure. But, AA is the source of pro-inflammatory eicosanoids and can be measured. EPA is an anti-inflammatory omega-3 fatty acid and can be easily measured in the blood. The stats I found are for Americans, who typically have a ratio of 20:1 (very bad!). Ideal is 1.5:1 (< 3:1 is good).

2) Indirect Biomarkers 
Fasting insulin levels – an easy one to carry out by your doctor. I have had this don before. Ideally, you’ll want your fasting insulin levels to be below 5 uIU/ml. This is far lower than the 12 uIU/ml that is considered normal.

Triglyceride (TG) to HDL ratio – your standard cholesterol test. Levels above 2:1 indicate you have some silent inflammation. The TG/HDL ratio coincides with insulin levels.

Percent body fat and waist size – A weaker indicator of silent inflammation but easy to do. For BMI (Body Mass Index) for men, < 15% is good. For women, < 22% is good. Personally I always take BMI with a pinch of salt especially for those who are very muscular, as muscles add weight and weigh more than fat. Waist size measured at the level of your belly button or the half way point between your lower rib and the tip of your hip bone. For men a waist size < 40 inches is good (< 35 inches is optimal). For women, < 35 inches is good (and < 30 inches is optimal).

Foods to reduce silent inflammation

For a heart healthy diet, add more garlic to stir-fries, or even bake it till soft to add to pastas

Indians take turmeric with milk for a myriad of inflammation related ailments. Very good for digestive, circulatory and immune system.

Ginger is very popular across Asia as an aid to digestion and circulation.

Don’t despair! If you have symptoms or biomarkers to suggest silent inflammation it doesn’t mean you’re doomed to have it for life. Reducing silent inflammation is most likely the single best act you can do to improve your health. Silent inflammation is very much under your control! :)

So, what can we do to help ourselves?

The real answer to controlling inflammation and preventing disease lies in nutrition. Certain foods, nutrients and herbs have powerful anti-inflammatory effects.

Omega-3’s: Our body’s own anti-inflammatory system depends primarily upon the balanced consumption of omega-6 and omega-3 essential fats and saturated fats. These help deter and control silent inflammation. Omega-3 fatty acids can be found in fish oil, nuts, seeds, fish and supplements.  And remember you need to balance your Omega 3 and 6 intake with the rest of your diet, so you may want to see a nutritionist or health coach to be certain you are providing your body with the appropriate ratio. For example, if you eat unhealthy foods, you are likely to need more Omega 3’s and 6’s when compared to a person that eats all healthy foods. Omegas have also been known to slow down cancer cells development and forestall the progression of Alzheimer’s Disease, while enhancing brain function.

Probiotics: Probiotics support and balance good bacterial health in our gut. They can be found in food or supplements. Yogurt, fermented milk and some soy beverages contain probiotics that are generally safe for consumption. There have been conflicting reports about Probiotic supplements. Thus, it is advised to consult your doctor first. If your bacteria level goes haywire and you experience a fungal or bacterial infection, anti-fungal and anti-bacterial medications may be important and needs to be prescribed by your doctor.

Turmeric: This is one of nature’s most powerful antiseptic and antibacterial agents with strong anti-inflammatory properties. You can find Turmeric in most nutrition stores after you check with your physician to make sure it’s right for you.

Resveratrol: Found in red wine, peanuts and blueberries, Resveratrol tackles silent inflammation. In fact, there is even a Resveratrol pill that is said to be the equivalent of 1000 bottles of red wine. The benefits of Resveratrol have been documented in many studies and clinical trials, including: cancer prevention, diabetes and weight control, as well as, enhanced cardiovascular health, memory, strength and endurance.

Garlic and Ginger: Both are known to be anti-inflammatory and help stimulate the immune system.

Vitamin D-3: If your doctor identifies that you have a Vitamin D deficiency, Vitamin D supplements may help.  Vitamin D helps kill viruses, fungus and bacteria that may silently stir in your body. Vitamin D deficiency has been linked to a cancer risk, bone diseases, birth defects, and Crohn’s disease (inflammatory bowel disease). Vitamin D is produced by our bodies after sun exposure, and found in foods like raw milk butter, salmon and tuna, beef, fish oil, and egg yolk.

Anti-inflammatory Drugs: Personally I like the herbal and more natural approaches better. A 2004 study published in the journal, Oncogene found that curcumin (as well as resveratrol) were effective alternatives to the drugs such as aspirin, ibuprofen, sulindac, phenylbutazone, tamoxifen, etc. But if your condition is chronic, you may need a medical intervention for the short term, in which case, please consult a medical professional.

Remember: Silence is definitely not Golden when it comes to inflammation!

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Article Contributed by:
Sally May Tan
Nutrition Warrior, Health Coach, Entrepreneur

Layout and design:
Sonia Ong

Sources:
Barry Sears, PhD., Get into the wellness zone, The Role of Anti-Inflammatory Diets, IIN Lecture series.
Journal of The American College of Nutrition
Yale Journal of Biology and Medicine
Dr. D. Lundell.