Systemic, chronic inflammation is at the core of so many health issues today. In this interview with Tieraona Low Dog M.D., she offers pragmatic advice on how to address systemic inflammation. Dr. Low Dog unpacks her medical kit of foods, supplements and pragmatic advice on how to quell this instigator of chronic illness. Interviewed by Kimberly Lord Stewart
KLS: The foundation for any anti-inflammatory therapy is diet. What is known now about the role of diet and inflammation?
TLD: We are learning a great deal about how fats and carbohydrates interact within the body to affect inflammation. I think one of the big mistakes that we made in nutrition science was to demonize fat, which resulted in people dramatically increasing their consumption of sugar-laden and high glycemic load carbohydrates. A diet that habitually causes a rapid and steep climb in insulin and insulin growth factors is going to drive inflammation. Anything that drives obesity also drives inflammation. They are intertwined.
The problem is that people consume far too many highly processed and refined carbs. Pop-tarts or white bagels for breakfast, spaghetti for dinner, mac-n-cheese, French fries, soda pop, candy, cookies and the like. The dramatic increase in added sugars in the diet over the past seventy years is nothing short of mind-blowing. The human body was not designed to process this much readily available sugar, especially when combined with a population that is increasingly sedentary.
While I don’t believe that whole grains can’t be part of a very healthy diet, I do think we need to ditch the food pyramids that put grain at the bottom. The DASH (Dietary Approaches to Stop Hypertension) diet, which has been shown to lower inflammatory mediators, improve blood glucose levels in diabetics and reduce blood pressure has the vegetables and fruits at the base of the pyramid. Much better!
KLS: Clinical science is leading to a better understanding of theories behind glycemic index and inflammation. What is your take on glycemic loads, inflammation and insulin growth factors?
TLD: There was an interesting study that came out recently on breast cancer. Women with breast cancer were put on a low glycemic diet or a control diet. The women on the low glycemic load diet that had insulin growth factor receptors (IGF-1R) on their tumors had a dramatically reduced risk of recurrence and longer survival times. IGF was contributing to the cancer growth. We know without question that elevated insulin and IGF-1 can increase tumor aggressiveness and growth (see the reference list at the bottom of the article.).
This study was one of the few to actually look for IGF receptors on the tumors themselves. Half the women had it. This may explain why some cancer studies that compare low fat and low-carb diets show mixed results –because we are not looking at specific tumor typing. And no one is routinely checking IGF-1R on breast cancer tumors. I don’t think it will be that far in the future when this level of personalized medicine becomes more commonplace. Then we will know what kind of diet is right for each person. But for now, given what we know our goal should be to drive down insulin and insulin related-growth factors.
It’s not just cancer. Insulin resistance and chronic lingering inflammation are responsible for much of the chronic disease we see today whether we are talking about diabetes, cardiovascular disease, metabolic syndrome, periodontal disease, osteoporosis or depression. It would not hurt us to weave a bit of evolutionary biology into our current understanding of health. The diets of our ancestors were comprised of meat, animal fat, and plants – not processed grains and added fructose.
KLS: What about Omega 3 fatty acids and inflammation reduction?
TLD: I am fascinated by the field of resolution biology, which is based upon the premise that nature seldom makes an “on switch” without an “off switch. We used to think that inflammation just sort of fizzled out when it ran out of fuel. We weren’t looking for the “off” switch. Well, it just so turns out that the long chain omega 3 fatty acids EPA and DHA are responsible for putting out the fire. This is why you want a lifetime of including grass fed beef, omega 3 enriched eggs, and cold-water fish in your diet.
If you are otherwise healthy, regularly eat fatty fish and/or other omega 3 rich foods, and consume a low-glycemic load diet you may not need to supplement. However, for most of us – taking a marine omega 3 supplement is probably a good idea.
KLS: What about other ways to reduce inflammation?
TLD: I am a huge fan of magnesium. It serves many functions but one that is vitally important is its role in maintaining the sensitivity of insulin receptors.* Low magnesium levels raise blood glucose and insulin levels. Unfortunately, when blood sugar is elevated it subsequently increases magnesium excretion, further aggravating insulin resistance. Multiple studies show that high intakes of magnesium can improve insulin-mediated glucose uptake, while also helping maintain cardiovascular health.* Of course, vitamin D is also another player when it comes to maintaining a healthy inflammatory response.*
The plant world provides an abundance of ingredients that are commonly used in cooking and in integrative health for their profound antioxidant activity.* Turmeric is way up on the list. Curcumin and other curcuminoids (the yellow pigments) in turmeric inhibits multiple inflammatory pathways including NF-kappa B, tumor necrosis factor alpha (TNF-alpha), IL-1, IL-6, IL-8, and COX2 to name a few.* I also love ginger, a cousin of turmeric, which inhibits NF-kappa B, and both COX and LOX pathways.*
I also like the berberine-rich plants like Oregon grape root and barberry root bark. These are critically important for reducing small intestinal bacterial overgrowth and decreasing intestinal permeability.* Intestinal permeability drives inflammation. One would consider the use of a berberine rich plant for 6-8 weeks, while turmeric and ginger can be used for extended periods of time.
Probiotics are incredibly important for insulin signaling, insulin sensitivity and reducing hemoglobin A1C. And then there is holy basil, as well as other adaptogens and nervines that help the body better adapt to stress, a state of being that itself drives inflammation by altering gut microflora and decreasing intestinal integrity.*
Then, there are spices like cinnamon. I recommend patients sprinkle ½ teaspoon cinnamon on yogurt in the morning, along with some walnuts and fruit. Cinnamon can help lower post-prandial glucose.* Essentially all spices and culinary herbs can play a role in calming inflammation: turmeric, cinnamon, cumin, cayenne, black pepper, cardamom, fennel, parsley, garlic, cilantro, chamomile and basil.*
KLS: In summary, what is your nutshell message to practitioners?
TLD: Figure out where you patient is willing and able to make changes. Shifting over to a low glycemic load diet for 8 weeks can often “jump-start” someone’s journey as they often find that they simply feel better. If dietary changes seem difficult, use wearable technology or a pedometer to help them step up their activity. One of the very best ways for the body to use sugar and drop insulin levels is through movement. Have your patient work up to 10,000 steps a day.
While getting rid of the processed carbs and increasing physical activity are foundational, when considering treatment – consider ordering your treatment in the following way: healing the gut, restoring gut integrity, improving the gut microflora and reducing systemic inflammation. I believe that you must address the gut if you really want to deal with persistent inflammation. Consider which supplements would be most beneficial: turmeric, omega 3 fatty acids, magnesium, berberine, pre and probiotics, etc. Remember, if the tree’s roots are sick, trimming the branches will not heal it. You’ll keep trimming forever. You’ve got to get to the bottom of it.
References cited in the interview:
1. Shin SJ, Gong G, Lee HJ, Kang J, Bae YK, Lee A, Cho EY, Lee JS, Suh KS, Lee DW, Jung WH. Positive expression of insulin-like growth factor-1 receptor is associated with a positive hormone receptor status and a favorable prognosis in breast cancer. J Breast Cancer. 2014 Jun;17(2):113-20.
2. Takada K, Ishikawa S, Yokoyama N, Hosogoe N, Isshiki T. Effects of eicosapentaenoic acid on platelet function in patients taking long-term aspirin following coronary stent implantation. Int Heart J. 2014;55(3):228-33. Epub 2014 May 7. PubMed PMID: 24806387.
3. Abdolahi A, Georas SN, Brenna JT, Cai X, Thevenet-Morrison K, Phipps RP, Lawrence P, Mousa SA, Block RC. The effects of aspirin and fish oil consumption on lysophosphatidylcholines and lysophosphatidic acids and their correlates with platelet aggregation in adults with diabetes mellitus. Prostaglandins Leukot Essent Fatty Acids. 2014 Feb-Mar;90(2-3):61-8.
4. Pettit LK, Varsanyi C, Tadros J, Vassiliou E. Modulating the inflammatory properties of activated microglia with Docosahexaenoic acid and Aspirin. Lipids Health Dis. 2013 Feb 11;12:16.
*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.