January 31, 2003

Newsletter #36

By Frances E. FitzGerald

Think you know the risk factors for heart disease? You're correct if you list high blood pressure, high cholesterol, smoking, being overweight, family history, and diabetes. But you'd be wise to consider another potential risk: inflammation.

As many as 35 million middle-aged Americans have normal cholesterol--but above-normal inflammation. These individuals face twice the risk of heart attack as people with elevated cholesterol. And the risk is even worse for people with high cholesterol and high levels of inflammation: Their risk increases by a factor of nine.

What does inflammation have to do with heart disease? Plenty, as it turns out. Inflammation can make the plaque in your arteries spongy and fragile. If a small chunk of this plaque should erupt, you could develop a blood clot that could block off blood flow and trigger a heart attack. Inflammation also gives rise to the free radicals that oxidize LDL ("bad") cholesterol, making it "stickier and more toxic," says Farid Wassef, RPh, CCN, coauther of Breaking the Age Barrier (to be published this year), who serves on the editorial boards of the Journal of the American Nutraceutical Association and the International Journal of Integrative Medicine.

Insulin resistance is a critical, yet underrecognized, factor in inflammation and heart disease. Wassef points out that insulin resistance, also known as Syndrome X, is associated with inflammatory disease. Not so coincidentally , it also leads to diabetes, weight gain, high cholesterol levels, and heart disease. Inflammation also is produced as the result of body fat, which generates inflammatory proteins: smoking; stress; prolonged, low-grade infections (chronic gum disease, Chlamydia pneumoniae, Helicobacter pylor, and cytomegalovirus); and even a confused innume system. As arterial plaque develops, white blood cells rush to protect the body. The result is inflammation.

Wassef adds that chronic inflammation is "inherent in the aging process. When inflammation becomes chronic, severs, and progressive, it causes degeneration."

Interestingly, excess inflammation seems to affect women more than men. Some 3,173 individuals, 52 percent of them women (adult children of subjects of the original Framingham Heart Study), were evaluated initially for inflammation and checked for carotid artery thickness four years late. The carotid artery goes to the brain, and plaque buildup--the cause of thickness--in this artery can lead to a stroke.

Researchers found that women with the most inflammation had the highest level of carotid artery thickness, compared to women who had the least inflammation. This result did no hold true for men, however.

Wassef believes that estrogen may contribute to this difference between women and men. "On top of the estrogen women have in their bodies, they're exposed to xenoestrogens--foreign estrogens--through diet, environment, and hormone replacement therapy (HRT)," he says. A prospective, case-control study from the Women's Health Initiative found that HRT is linked with elevated levels of C-reactive protein (CRP) rises when blood vessels are inflamed, so CRP levels are considered a reliable marker for both inflammation and resulting atherosclerosis. Wassef encourages people to start asking for this test when they're between 45 and 50 years old.

There are many types of inflammation, of course, and for some of them physicians often recommend aspirin, Plavix (clopidogrel bisulfate), ACE inhibitors, or statin drugs such as Lipitor (atorvastatin calcium) and Zocor (simvastatin). "You have to respect the research behind aspirin, "Wassif notes. "A safe dose is 80 mg of baby aspirin daily." He points out that higher doses of aspirin may lead to gastrointestinal bleeding. Another nonsteroidal anti-inflammatory, ibuprofen, is not recommended for people with kidney disease.

Although statins can effectively reduce inflammation and cholesterol, Wassef believes they are overused. Statins, he says, can deplete the body's stores of fat-soluble nutrients, including coenzyme Q10, which helps the heart pump more efficiently. Warning: Always consult your healthcare provider before reducing or discontinuing any of your medications.

Since body fat generates inflammatory compounds, weight reduction can reduce inflammation. It also improves insulin sensitivity.

Alcohol, in moderation, appears to reduce inflammation as well as raise HDL ("good") cholesterol. Wassef points out that the form of alcohol most often cited is red wine. "It's not so much the alcohol," he says, "but the phytochemicals found on the skin of red grapes" that help control inflammation and fight damaging free radicals. Eating red grapes offers the same benefit, he adds.

Other useful strategies include these:

• Stop smoking. Each cigarette you smoke delivers more toxic and inflammatory chemicals into your

bloodstream.

• Manage stress. We know that chromic stress is hard on the heart. A less-recognized fact is that stress

generates inflammation. A study of 229 British civil servants assessed the

correlation between psychosocial factors and biological stress markers. Researchers

found that those with high blood levels of a stress protein (Hsp60) and negative social

factors, such as feelings of isolation, were more likely to have high levels of

proinflammatory compounds.

Vitamins A, C, and E are pwerful antioxidants that fight infection and mop up free radicals before they can damage cells and trigger inflammation. Mixed carotenoids disarm free radicals, boost immunity, and reduce the oxidation of LDL ("bad") cholesterol.

Fish and flaxseed oils supply a wealth of omega-3 fatty acids, which help the body produce its own anti-inflammatory agents, improve insulin metabolism, lower cholesterol, and increase vasodilation, or widening of the arteries. Proteolytic enzymes are not only good for digestion but also have anti-inflammatory properties. Probiotics fight infections--a key source of inflammation. Quercitin, a flavonoid, decreases inflammation, neutralizes free radicals, and works with vitamin C to fortify weak capillaries and connective tissues.

Garlic (Allium sativa) provides plenty of anti-inflammatory activity. Also, it moderately reduces blood pressure and strengthens the cardiovascular system. Ginger (Zingiber officinale) thins the blood andhelps the body combat inflammation. Responsible for the yellow color in curry, turmeric (Curcuma longa) also protects against the development of blood clots. Licorice (Glycyrrhiza glabra), a popular herb in Chinese medicine, fights inflammation. The glycyrrhetinic acid in licorice is associated with high blood pressure, however. So select products containing deglycyrrhizinated licorice (DGL).

In addition, a water-soluble extract of cat's claw (Uncaria spp.) has also been found to reduce inflammation caused by oxidative stress, which leads to cardiovascular disease and other problems. This extract should be taken separately, not at the same time as other anti-inflammatory herbs and supplements.

Every part of the body is connected, and when something happens in one system, everything else is affected. By reducing inflammation through diet, weight loss, and supplements, we can effectively balance blood pressure and glucose levels--and reduce our risk of oxidized LDL cholesterol.

• "Alcohol and Inflammation" by S.H. Stewart
• "Association of C-Reactive Protein with Carotid Atherosclerosis…the Framingham Heart Study" by T.J.Wang
• "Circulating Human Heat Shock Protein 60…Relationship to Physiological and Psychosocial Stress" by J. Lewthwaite
• The Green Pharmacy by James A. Duke, PhD
• "Inflammation, Heart Disease and Stroke: The Role of the C-Reactive Protein" American Heart Association 2002
• "Inflammatory Biomarkers, Hormone Replacement Therapy, and Incident Coronary Heart Disease…" by A.D. Pradhan
• Reverse Aging by Ronald Pero, PhD, and Marcia Zimmerman, CN

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