INFLAMMATION

I was told in 1987 by my Rheumatology & Immunology professor, Dr. Tommy Sims, that the key to heart & vascular disease would be the immune system. There a number of risk factors for heart & vascular disease, though I have continued to search for the etiology. Of course, aging is inevitable. Genetics also plays a role, but to simply give up trying and blame on age and genetics is unreasonable. I remember sitting on the front row at national meetings listening to Dr. Valentin Fuster discuss vulnerable and unstable coronary artery plaque and its role in coronary artery thrombosis. We learned that severity of stenosis did not always correlate with risk of heart attack and research into plaque morphology and rupture was a hot topic. We felt that ballooning and stenting plaque would somehow reduce heart attacks; however, the plaque with its immunological matrix was still present and only pushed out to the periphery of the artery lumen.

There are many factors at play in the mineralization of the heart arteries. I was able to listen to Dr. Bond discuss his years of work with atherosclerosis at one of Brad Bale's conferences. The immune system was clear at play and the lipoproteins were seemingly easy targets. Once oxidized, the LDL-cholesterol is attacked by immune cells and then atherosclerosis begins. It is an amazing process that silently narrows the heart arteries, but in some arteries the fibrous cap that keeps this inflamed plaque in the wall of the artery separate from the blood in the artery lumen can become thinned and break. This break exposed this pus-like plaque to the blood and then a scab or thrombosis is suddenly formed.

My interest has been focused on IL-6. It is one of many factors involved in atherosclerosis. IL-6 is not always bad. It has a purpose, just like LDL-cholesterol. Even HDL-cholesterol can go rogue. IL-6 is necessary for proper balance and control of the body's defense mechanisms and even cognitive function. IL-6 is typically higher when you are ill. If you exercise, your muscle will release IL-6 and some feel that too much exercise may result in a negative response as well. Before you go thinking that exercise is bad and jump for the sofa, let us finish looking at IL-6.

When asked what I feel is best for keeping inflammation low I usually recommend:

1. Quality sleep.

2. Adequate hydration (water!)

3. Exercise

4. Fiber at 40 grams a day as tolerated.

5. Diet focused more on veggies, beans and fruit.

6. Minimal processed food, sugar and related drinks.

7. Keep weight to goal for body and avoid too much belly fat.

8. High protein and beneficial fats.

9. Reduce unnecessary stress.

10. Avoid any tobacco products.

11. Omega 3 Fatty Acids - particularly EPA

12. Avoid over consumption - only diet I know for longevity was calorie restricted.

13. Aspirin per guidelines & your physician.

14. And the list can go on...Dark Chocolate...Chia...Tumeric...

Note that IL-6 is increased in most chronic disease states, asthma, diabetes, arthritis, irritable bowel syndrome, major depression and many more. IL-6 can negatively effect testosterone production and reduce conversion of the thyroid hormones. When we check C-reactive protein, we are looking at the degree of inflammation in the body. A study is underway looking Methotrexate to see if it has an impact not only on Rheumatoid Arthritis, but on heart & vascular disease. Another drug is being studied as well and looking into not only reduced heart disease, but cancer and arthritis. If you look at the literature, you will see studies looking at statins and breast cancer, angina and Allopurinol and Colchicine, and other agents to see their impact on atherosclerosis.

Though we do not have definitive evidence for treating inflammation yet, we have some evidence that Tumeric may reduce the oxidation of LDL-cholesterol and even studies looking at CBD oil and its ability to reduce IL-6 in asthmatics. Switching immune macrophages from more harmful to more beneficial to the heart arteries using similar agents is very promising. I was looking at the study where meditation reduced heart related events and my residents were surprised a non medicine treatment worked so well. If you look at studies of IL-6 and meditation you will find that IL-6 levels were significant reduced. It isn't just about pills!

This is key to understanding the etiology of heart & vascular disease. We are currently looking at new medications being developed to treat heart & vascular inflammation that will cost ten to twenty thousand dollars a year. They will no doubt work, but at what cost and side effects. Lifestyle changes and risk factor modification can work, but we must be willing to make the changes. Plans must be turned into habits and not idly wait for motivation to kick in. Motivation comes once motion begins and momentum carries us forward. One of our couple clients has been following Joel Fuhrman's The End of Diabetes diet for 3-4 months and she was amazed that her Rheumatoid symptoms were minimal to resolved, but simply eliminating sugar and simple starches. This can be a challenge for those with Gout since increasing greens may worsen the inflammation, but each person is different in how they respond.

The first problem is that we are putting 20 gallons of gas (calories) in our 5 gallon tanks daily. We are simply consuming too much and our bodies are suffering. We think that by taking anti-oxidants we can somehow overcome our bad habits and forget that the basics of water, sleep, exercise and a plant-based diet can meet most of our needs. Clients want me to check their telomeres. Telomeres are associated with aging and cancer. Recent studies have shown changes in telomeres in obese children with just diet, exercise and weight loss. Really? Now read about telomeres and IL-6 levels on the net and you will learn that your body has the potential to heal heart and vascular disease. Prevention is not perfect, but getting to the basics is key. I remember Dean Ornish comparing current healthcare to a group of doctors mopping up water on the floor, but no one had though to turn of the faucet. Prevention is key. If you don't control the cause, you can bypass and stent all day, but the problem is still present and getting worse.

Sorry for my rushed entry, but typed while riding in the car to see my kids at college.