Inflammation, Health and Disease

(This column was orginally published in September 2005)

Do you ever wonder why some people get certain diseases as they age and other people don’t? Heart disease, stroke, Alzheimer’s disease, arthritis, and even cancer aren’t the result of just a random pick of genetic numbers, but can be related to a process called inflammation, which is present in all of our bodies to some extent.

Unlike inflammation that occurs with sunburn, silent inflammation can go undetected for many years, affecting your immune system and body organs.  Excess body fat is one of the first outward signs of silent inflammation, usually apparent before symptoms of chronic disease appear. Inflammation is related to food intake, exercise, bacterial toxins, and even sunlight.

To understand inflammation, we have to go back to 1982 when the Nobel Prize in physiology was awarded for a study of  aspirin that led to elucidation of certain human bodily hormones labeled “eicosanoids.” The basic work that was done leading to the award of the Nobel had to do with the study of this simple drug, which had been around for a hundred years and which functioned very well as an anti-inflammatory.

However, in the hundred years that it had been used in medicine for treatment, no one really understood how it could act as an anti-inflammatory. We know that aspirin can make a headache better, and we also know that it can make an inflamed arthritic joint less painful.

Out of this study came a greater understanding of an extensive body production network that constantly creates chemicals known as “prostaglandins.” Just like everything else in life, there are the “good guys” and the “bad guys.”

Prostaglandin I and III are mostly good, while Prostaglandin II creates more inflammation and can wreak havoc with the body’s organ systems. Prostaglandin II causes inflammation, blood to clot, and tissue reactions which are characteristic of inflammation. However, they are essential for the body because if one gets an injury, such as a cut or fracture, the Prostaglandin II is essential in setting up the process of healing that begins with inflammation.

As you can quickly see, this is a complex process that depends on many chemical signals that are constantly ongoing in the body to tell the inflammatory processes “which way to go.” The pathways that certain foods undergo to create all types of prostaglandins seem complex and overwhelming to even a person like myself who has studied biochemistry and physiology.

However, there is an interesting bottom line in all of this. One of the chemicals, arachidonic acid, is a compound that leads directly to Prostaglandin II, which in excess contributes to development of the diseases that were mentioned earlier. If the ratio of omega-6 fatty acids to omega-3s is too high, it encourages the development of arachidonic acid. Lack of alpha-linolenic and linoleic acid in your diet can retard the production of other compounds that lead to the production of “good” prostaglandins. Given all this information, how do we translate it into something usable so that we can enhance our health status? It has been known for a long time in history that eating certain fish (wild salmon) or taking fish oil supplements (omega-3s) can be beneficial to health.

It has also been shown over the years that hydrogenated and trans-fat are very unhealthy, while polyunsaturated fats should be eaten in moderation in a fresh state rather than in the hydrogenated form. We also know that taking fish oil capsules and flax seed oil or ground up flax seed contributes to our health and well being. A low-glycemic diet, which is low or absent in sugar, flour, and starches, decreases inflammation and enhances the development of Prostaglandins I and III. Any food that raises your blood sugar quickly also raises your insulin level, and insulin has been shown to be an integral part of the inflammatory process, enhancing the role of arachidonic acid. We also note that exercise and lack of stress help to contribute to suppression of bad prostaglandins and increase of good ones. Obesity is a predictor of increased inflammation levels, and the higher the percent of body fat, the higher the inflammation level.

So when you really analyze what’s happening in this whole process of living every day, we are simply a series of chemical reactions which depend on the integrity of the body and the cells and also on what compounds are put into the body to be processed.            

The average American consumes 180 pounds of sugar a year in soft drinks, foods, ketchup, etc. All of this sugar, in addition to the processed, refined flour that is eaten, contributes greatly to a high insulin level. High insulin levels are associated with heart disease, Alzheimer’s disease, and the development of cancer. Although this process does not occur overnight, it does influence the development of these diseases over a long period of time.

So how can we prevent these bad diseases that occur? Again, this is not random or an “act of God” as much as it is an act of what we do every day for our bodies. I’ve often talked about the “Zone” diet, which has a balanced ratio of carbohydrates, proteins, and fats—again noting that about 30 percent of your daily intake should be fat made up of saturated, monosaturated, and polyunsaturated fat, and essential fatty acids, such as those found in fish oil and flax seed. If you are missing any of these components on a meal-to-meal or day-to-day basis, you are a prime candidate for inflammation. This process changes the cells in your body just a few at a time until the “bad” cells are capable of overtaking the good.

In short, whatever we can do on a daily basis over an extended period of time to decrease inflammation will also markedly decrease our incidence of heart disease, stroke, Alzheimer’s, and cancer. Who could ask for more? However, just like everything else in life, it is not always that simple. You have to follow the rules.

Here are some things you should do:

• Eat a balanced diet with 30 percent protein, 30 percent fat, and 40 percent carbs at every meal and every snack. See Dr. Barry Sears’ Zone Diet books for more information.

• Eat low-glycemic carbs. Avoid bread, bagels, pasta, polished rice, white potatoes, cookies, cakes, pies, candy, and sugar.

• Engage in twenty to thirty minutes of aerobic exercise at least three times a week.

• Manage your stress to prevent increased production of cortisol, the stress hormone.

• Take multivitamins and fish oil capsules every day.

• Get some sun exposure (15-20 minutes) several times a week, but don’t ever burn.

Follow these basic guidelines and this will help you add a few years of life and health, which we all know does not happen by accident.

Dr. Carraway is a plastic surgeon with EVMS, practicing in the Plastic Surgery Center in Va. Beach. He has a strong interest in anti-aging and wellness to augment his practice of plastic surgery. For information, call 557-0300.

James H. Carraway, M.D.

Dr. James Carraway is a full-time academic and practicing clinical plastic surgeon.  He is Director of the Cosmetic & Plastic Surgery Center of EVMS, is board certified in surgery and plastic surgery, and is a fellow of the American College of Surgeons.  Dr. Carraway has been teaching and practicing for 30+ years and has been director and chairman of residency training programs and fellowship programs in plastic surgery.
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