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Holistic Approaches to Inflammation and Chronic Disease

An Introduction to Chronic Inflammation

In many chronic disease states, inflammation is a common underlying factor.  If you are suffering from something that ends with “itis” (arthritis, tendinitis, pancreatitis, diverticulitis, etc), this is a medical term for “that part of your body has inflammation”. So what is inflammation?  On the large scale, we look for heat, redness, pain, and swelling; these are all key factors that tell us inflammation is taking place. Microscopically, we see that blood vessels become more permeable and extra fluid and immune cells come to the area to protect and heal the body and remove waste from the area.

What is the purpose of inflammation?  It is your body’s natural defense system: this is how your body protects and heals itself in cases of infection, allergy, and injury. When a foreign organism such as a bacteria, virus or fungus enters the body, your immune system launches a highly sophisticated attack to kill the invader and then clean up the remains of the battle afterwards.

While inflammation is a very important and appropriate action for the body to take, when it pops up in inappropriate places or continues on beyond the normal course of infection or injury it causes chronic pain and damage to that part of the body.

Chronic inflammation is the underlying cause of many very common chronic diseases.  Cardiovascular disease, arthritis, asthma, autoimmune thyroid disease, IBS and other digestive disorders, and eczema are all cases of chronic inflammation. When inflammation becomes chronic the area will be in a state of simultaneous destruction and healing, which over time can lead to scarring and loss of function.

Conventional treatment for inappropriate inflammation primarily relies on four types of drugs, all of which act by suppressing a key component of the body’s inflammatory response: Steroids such as prednisone mimic your body’s stress hormones’ ability to suppress inflammation.  Nonsteroidal antiinflammatories such as ibuprofen and acetomenophen suppress an enzyme called cyclooxygenase that creates the mediators that cause inflammation in the body.  Biologic drugs such as embrel and humira block the action of another inflammation-causing protein called Tissue Necrosis Factor. For more allergic sypmtoms, antihistamines such as Allegra suppress the release of histamine from allergic cells.  Although the effects of all of these drugs have different effects and can be quite useful to control symptoms in the short term, what they all have in common is that they suppress our body’s natural reaction to an underlying issue and can have significant unwanted side effects.  

There are a few primary concerns regarding the use of conventional medications for reducing inflammation. In the case of steroids and biologic drugs, they can suppress your immunity, leading to unwanted infection that can be difficult to treat.  NSAIDs can damage the liver, gut and kidney.  Antihistamines impact the nervous system and can cause drowsiness, hyperactivity, a decrease in secretions to the eyes, nose and mouth, and difficulty in urination. Rather than suppressing natural function, the goal with natural treatments is to divert the body’s innate function towards anti-inflammatory pathways.

Natural options for minimizing inflammation

There are three key elements to minimize inflammation holistically:  Exercise, Diet, and Supplements.  If you feel good now and want to minimize inflammation in the long-term, diet and exercise are a great place to start.  If you are already in a position where inflammation is a concern for you, botanicals and supplements may be necessary to get things under control.

Exercise:  While in the short-term exercise can trigger an acute inflammatory reaction, research has shown a long-term moderate training regimen decreases the body’s production of inflammatory cytokines.  The inflammation that is caused by working out is important for remodeling and building muscle mass.  In fact, post-workout treatments such as ibuprofen and icing the area have been shown to decrease the body’s ability to build muscle mass.  As the initial inflammation post-workout decreases, though,  It is important to keep in mind, however, that repetitive exercise that pushes the muscles past their capacity, such as long-distance running and body building, cause short-term inflammation (aka, delayed soreness after working out) that over time causes scarring damage to the muscle fibers.

Diet:  There are three basic components to reducing inflammation in the diet:  Eat more antiinflammatory foods, eat fewer pro-inflammatory foods, and avoid allergens or sensitivities.

Antiinflammatory Foods are those that support healthy digestion and improved liver function help the body rid itself of wastes that can trigger inflammation.  These include high fiber foods such as leafy greens, broccoli, and carrots, foods high in soluble fiber such as apples, flax, pears, and chia, foods high in omega-3 fats such as fish and flax, liver support foods such as beets, cucumbers, and greens, and probiotic foods such as kefir, yogurt, natural sauerkraut and pickles, miso, and kombucha.

Pro-Inflammatory Foods encourage the formation of pro-inflammatory cytokines.  While meats can be beneficial for other reasons, they are good to consume in moderation because their fat content can create more inflammation.  Refined carbohydrates in white flours and sugar can cause inflammation in the digestion; they also spike the blood sugar, which in turn can cause the formation of excess triglycerides which then causes inflammation in the blood vessels and can lead to cardiovascular disease and diabetes.  Alcohol depresses the ability of the liver to move toxins from the body which can create more inflammation and also spikes the blood sugar.

Finally, food allergens or sensitivities can compromise the integrity of the lining of the digestive tract, which allows larger particles of foods to enter the bloodstream, which in turn can cause the body to have an immune reaction to those particles.  One particularly good example of this is the association between celiac disease and autoimmune thyroid disease.  The most common food sensitivites tend to be dairy, gluten, egg, and soy, but the body can react to any food; testing or elimination diets can be useful to help sort this out.

Omega-3 fatty acids:  These fats have gotten a lot of press in the past 15 years because of their remarkable ability to decrease inflammation and improve the texture and quality of the skin and mucus membranes.  Omega-3 fats divert the biochemical pathway that normally creates inflammatory cytokines to a pathway that creates anti-inflammatory mediators.  There are several good sources of Omega-3 fats on the market today: generally, our bodies are able to use animal derived sources (such as those found in fish)  more readily than vegetarian sources (such as flax or borage seed).  While krill oil has recently become quite popular as a supplement, I do not recommend it because I have been hearing reports that krill populations are becoming threatened due to overharvesting: I prefer to leave them for the whales.

Botanicals and Supplements:  There are a number of plant medicines available that are quite useful for decreasing inflammation.  These include curcumin, derived from the turmeric plant, quercetin, derived from onions, and boswellia, or frankincense.  Supplements such as deglycyrrhizinated licorice (DGL) and L-glutamine can help restore the integrity of the digestive tract.  There are also a number of proteolytic enzyme products on the market that can be useful for decreasing scar tissue that can form during times of chronic inflammation, which will decrease pain and increase the ability of the area to heal.

 

Women Need More Protein In Pregnancy

This article was originally printed in the Natural Medicine Journal–if you would like to see the references, Click here
Especially during a first pregnancy, many women have a pronounced concern about diet: how to eat, what to eat, and when to eat. As providers, we have the opportunity to help guide them towards optimal nutrition and provide reassurance that they are making sound choices. Within the context of so many “don’ts” regarding maternal nutrition–foods to avoid because of possible bacterial contamination, mercury, lead, pesticides, nitrates, blood sugar dysregulation, insufficient or too much weight gain etc–it is good to also have some advice that helps women relax and trust their intuition. This study finds that the protein needs of women throughout pregnancy is higher than previously recommended and possibly closer to what women may be craving.

IAAO is a relatively new method that has become popular for determining protein requirements in human subjects.1-4 In the past, protein requirements were assessed by the nitrogen balance method which can be difficult because it requires that all nitrogen intake and output is carefully recorded and that the subject stays in the testing facility for the duration of the testing to measure nitrogen loss from urine, feces, saliva, and wounds. This testing takes much longer to perform and requires that subjects are put in a deficiency state for longer, which makes it unsuitable for pregnant women. For this reason, the current recommendations for protein intake during pregnancy (Estimated Average Requirement (EAR) of .88 g/kg and RDA of 1.1 g/kg) have been based on nitrogen balance studies of nonpregnant adults that have been extrapolated with total body potassium studies of protein deposition during pregnancy. 5 With the development of IAAO, researchers have been able to more accurately determine protein needs during pregnancy because they can run this study on pregnant women. Additionally, this is one of the first studies to distinguish maternal needs during early and late gestation.

Understanding protein requirements during pregnancy is important because protein is the macronutrient with the most influence on birth weight. This study assumes caloric sufficiency; for well nourished non-diabetic women, increasing protein intake is the macronutrient most likely to increase birth weight.6,7 In addition to neonatal complications and increased mortality, low birth weight is also correlated with long-term health problems such as type 2 diabetes, kidney disease, cardiovascular disease, and respiratory problems. 8-11 Ensuring that pregnant women have a protein-sufficient diet is therefore crucial for the short- and long-term health of their children.

It is important to keep in mind, however, that while this study showed protein needs to be higher than current recommendations, it is still by no means extraordinarily high. The average weight of the subjects during early pregnancy was 64.4 kilos, indicating a need for 78.6 grams of protein per day, or 314 calories. Calculated resting energy expenditures (REE) averaged 1370 calories per day, so subjects were given an average of 2329 calories (1.7 REE), putting sufficient protein consumption at 13% of calories. In late pregnancy, average weight was 71.1 kg, with a need for 108.1 grams of protein or 432 calories per day. REE was 1480, so subjects were given an average of 2516 calories, with sufficient protein consumption at 15% of calories. 13-15% of calories from protein is far lower than the recommended amounts in virtually any contemporary dietary plan save for some raw, vegan and pritikin diets which are rarely recommended or undertaken during pregnancy.

Based on these new recommendations the example below provides sufficient protein sources on average for late pregnancy with far fewer calories than necessary for a day; a pregnant woman could be encouraged to include these foods within the context of whatever other foods she prefers to meet her additional caloric needs:

Breakfast: 2 eggs, 2 slices toast=21g

Snack: One ounce of cheese=7g

Lunch: 1 cup cooked lentils with steamed veggies=18g

Snack: 2 Tbsp peanut butter on 2 rye krisp crackers=12g

Dinner: 1 cup cooked chicken breast with 1 cup quinoa and steamed veggies=51g

Total: 109g protein, approximately 1300 calories

With this in mind, practitioners may find that their patients may intuitively be eating an appropriate amount of protein: a current Canadian study found pregnant women generally eating amounts of protein more consistent with the findings of this study, rather than the current DRI.12 This assumes, of course, that women have adequate caloric intake and the financial and practical means to choose what foods they eat.

One question that is relevant to how complete the information is from the study is the possible impact of the types of food consumed rather than just macronutrient content. On the day of the study, all of the calories for the day were consumed as a shake consisting of the protein supplement which was based on an egg-white composition, kool aid or tang, and a shake base powder consisting of palm, soy, coconut and sunflower oils, corn syrup, corn starch, sucrose, calcium phosphate, sodium citrate, vitamins and minerals, plus unspecified “protein-free cookies.” This does meet the requirements of the macronutrient breakdown desired for the purpose of the research study, but certainly doesn’t resemble a dietary plan that would be advocated by most providers who would be counseling a pregnant woman. While this study certainly gives us a good baseline from which to advise patients, it is certainly within the realm of possibility that a pregnant woman’s metabolic and protein needs will shift if fiber, complex carbohydrates, and phytonutrients are present in the diet.

While it can be confusing to create an optimal diet for each individual during pregnancy, the findings from this study indicate that advising for protein intake may be a little more intuitive. For women who are adequately nourished with the financial means to choose what foods they eat, as long as they feel well enough and remember to eat some protein-containing food every few hours, they will probably be able to approximately meet their protein needs each day. For women who struggle to meet this recommendation for increased protein intake, it is important to instruct them on which foods contain protein and remind them to eat these foods every few hours. This will help to optimize the health of their baby as a newborn and throughout life.

Minimizing Colds and Flu for Athletes

iStock_KidsSoccerCold and flu season is here! This morning when I dropped my kids off at school there were 16 kids missing out of 50 due to illness. Seeing all these spaces on the list made me curious to come home and do some research to see what the scientific literature has found to be the best ways to prevent colds and flu. In Traditional Chinese Medicine, the colder Autumn months are associated with the lungs which provide “defensive energy”; meaning our ability to maintain a good barrier between ourselves and the outside world. Here are some of the best ways that Western science has found to help keep our immune systems and lungs strong as we head into the holidays:

Crowded offices, schoolrooms and homes predispose us to sharing germs; higher humidity in these indoor spaces increases the risk of transmission because sneezed or coughed viral particles more readily enter into water droplets that can be inhaled. What to do? Beyond the obvious regular handwashing and sneezing into your elbow, minimize the use of the humidifier and open doors and windows whenever possible to let in fresh air.

Both the quantity and the quality of sleep play a role in immune function; make sure to get enough hours of sleep and try to minimize disturbances during the night.

Both too much and too little exercise tends to decrease immunity and increase incidence of infection. Consistent, daily, moderate exercise has been shown to prevent colds and flu.

While exercise will boost endorphins and immune function, chronic exposure to cold air during endurance exercise can damage bronchial and lung tissue. While you ski, snowboard, run, or skate in cold weather, wear a balaclava or neck gaiter to help warm the air you are breathing.

If you are doing some significant exercise, the most effective way to support the immune system is to ingest a carbohydrate-rich drink before, during, and after. This helps to moderate blood sugar and minimize the impact on immunity.

Generally keeping blood sugar consistent is also key for maintaining immune health. Minimize consumption of alcohol, white flours, and refined sugars, and eat a significant source of protein at least twice per day.

A couple of my favorite immune-boosting foods are jerusalem artichokes and coconut oil.

Stay Healthy!

How Things Work: Red Blood Cells

When we draw blood for a complete blood count, what are we actually counting? About 55% of our blood is made up of plasma, comprised of water, proteins, electrolytes, nutrients, and hormones. The other 45%, or the part that we count, is comprised of White Blood Cells—our immune cells, platelets—cells that make the blood clot, and red blood cells (RBCs), which are required to transport oxygen from the lungs to our tissues and carbon dioxide from the tissues back to the lungs.

Because they are responsible for bringing nutrition to and wastes from the entire body, when RBCs are low, a condition called anemia, it is easy to understand why one would experience the symptoms mentioned in Iron Ironies. Blood gases are carried in RBCs via hemoglobin which is contained in the RBCs. Hemoglobin is made of proteins that fold around a central heme molecule with an atom of Iron in the center, which gives the cell its red color. RBCs are formed primarily in the bone marrow of the sternum, ribs, vertebrae, skull, and pelvis, although the femur, tibia, liver, and spleen also have the ability to make RBCs. Causes of anemia include nutritional deficiencies, chronic disease, and chronic blood loss.

Good nutrition is integral for formation of RBCs. Deficiencies in Iron, which functions as noted above, or Copper, which is necessary for transporting iron to the blood marrow, will create cells that are too small. The B Vitamins B12 and Folic Acid are necessary for making DNA and influence cell division; deficiencies in these will cause large, immature cells to be released into the blood. Vitamin C enhances absorption and utilization of Iron, Copper, B12, and Folic Acid. In particular, it enhances intestinal absorption of Iron, particularly from vegetarian sources, and thus is of particular importance for those choosing not to eat meat.

Eating Seasonally In the Off Season

I have been dreaming of vegetables lately. I am a great proponent of eating seasonally, but what does that mean here in Colorado where we just don’t have much growing at this time of year? February is a challenging time to find fresh, healthy foods; this shoulder season is somewhere between using our storage produce such as winter squash and root vegetables and starting to savor the first asparagus and artichokes of spring. So what do we do to get the freshest, most nutrient-packed foods at this time of year? Here are a few suggestions:

Look for what’s local. Even if vegetables have been in storage, local means that they haven’t had to go far to get here. Colorado-grown produce (which is usually marked clearly at the grocery store) will have had less damage during shipping and fewer chemicals applied to it to preserve it during shipping. Also, less fossil fuels will have been used to get it here.
Flash-frozen produce. Although fresh is definitely the ideal, at this time of year some produce will be superior for taste and quality. For instance, domestically grown, organic, flash frozen berries would probably be a better choice than conventionally grown berries from Chile.
Cold-weather crops. Even though we’re not growing much in Colorado at this time of year, some of our neighbors on the West Coast are in climates that can support growing some crops right now. Some of what you may find right now would be the cool-weather crops such as leafy greens, cauliflower, broccoli, and possibly some of the root vegetables such as beets, radishes and early turnips.
Make friends with your local produce people! Those guys and gals quietly stacking onions are generally very friendly and chock full of knowledge about where things come from, when they were picked, how they were grown, and what’s most delicious right now–remember this great resource!
Happy Eating!