Your Body & Inflammation: What You Can Do Nutritionally to Put Out the Fire Judy A. Fulop, ND, FABNO Northwestern Integrative Medicine Northwestern Memorial Hospital

Inflammation • We need inflammation for survival • Injury • Wound repair

• We don’t need chronic inflammation • Cell and tissue destruction • Chronic pain • Accelerated aging

Inflammation and Disease • Cardiovascular Disease: inflammatory disease of • • • • •

blood vessels Autoimmune: inflammation in the joints, muscles GI: inflammation in the bowel Asthma, eczema, psoriasis Obesity: increases body’s production of inflammation producing substances (C-reactive protein, IL6) And more….

Measuring Inflammation • Sedementation rate : non specific indicator of

inflammation • High-sensitivity C-reaction protein (hsCRP) • Elevations associated with 4.5 X risk of MI • Also elevated in Alzheimer’s disease, cancer, arthritis,

acute infection, physical trauma

Cardiovascular Disease and 
 Inflammation • Inflammation in blood vessel caused by: • Homocyeteine • Low grade infection • Oxidized cholesterol

Immune, Infections and 
 Inflammation • Osteoarthritis • Rheumatoid arthritis • Lupus, Sjogrens disease, myositis, • • • •

dermatomyosistis, scleroderma Colds, flu, otitis media Celiac disease Food allergies Inhalant allergies

Gastro-Intestinal Tract and 
 Inflammation • • • • • • •

Irritable bowel syndrome GERD, eosinophilic esophagitis Gastritis, ulcers Crohn’s disease Ulcerative colitis Diverticulitis Chronic sinusitis

Anti-Inflammatory Drugs • Aspirin, ibuprofen, naproxen, Cox-2 inhibitors • 30 billion tablets of NSAIDs sold every year • 70 million prescriptions for even stronger NSAIDs • Examples: • Aspirin and reducing risk of MI • Ibuprofin and Alzheimers

Pro-Inflammatory Fats • Arachidonic Acid • Animal products • Limited amounts from omega – 6 oils • Makes PGE2 (↑↑platelet aggregation, inflammatory response, smooth muscle contraction, temperature, pain, stimulates kidney to increase retention of salt, thus increase in BP)

• Trans fatty acids (partially hydrogenated vegetable

oils) shortening, stick margarines, nondairy creamers • Interferes with Omega 6 handling in the body

Anti-Inflammatory Fats
 Omega 3 • Encourages body’s production of inflammation• • • • •

suppressing compounds Omega – 3 (alpha-linolenic acid)provides building blocks of powerful anti-inflammatory substances Eicosapentaenoic acid (EPA) most potent Docosahexaenoic acid (DHA) Fatty fish, fish oil, algae Flax, pumpkin, walnut, soy

Omega 6:Omega 3 ….by favoring the production of EPA in the body, or by increasing the dietary intake of EPA and DHA… reductions may be achieved in the incidence of many chronic diseases that involve inflammatory processes; most notably, these include cardiovascular diseases, inflammatory bowel disease (IBD), cancer and rheumatoid arthritis, but psychiatric and neurodegenerative illnesses are other examples. Nutrition Reviews 2010; 68 (5):280-9

Other Anti-Inflammatory Fats • GLA (gamma-linoleic acid) technically an Omega 6

fatty acid, but behaves as anti-inflammatory O-3, enhances inflammation suppression • Borage, black current evening primrose oil,

human milk

• Omega 9 works with Omega 3 as anti-inflammatory • Olive oil, avocados, macadamia nuts and oil

Inflammation Begins in the Gut

Deep Within the Body – THE INTESTINES Intestinal lining: • Protective barrier – goblet cells that secrete mucous • Healthy gut flora crowd out unhealthy organisms • Enterocytes- intestinal cells that absorb nutrients • Mucosal Associated Lymphatic Tissue (MALT)

Digestion of Foods: Checklist • • • • • • • • • • •

Do you have gas, bloating? Pain after eating foods? Fall asleep after foods? Feel worse after eating foods? Lack of appetite? Never feel full? One fruit/veggie fills you up? Food sits in your stomach? Ready for more food after you have finished eating? Find food particles in your bowel movement other than corn? Wake up in the middle of the night for no reason at all?

Foods and Inflammation • Some foods increase inflammation • Our diet contains 30X more pro-inflammatory

nutrients than a century ago • Primes body for powerful, out of control inflammatory reactions • Injury, infection, age related wear and tear can start the spark to set body up for inflammation • Many foods decrease inflammation Links Between Behavioral Factors and Inflammation. Clinical Pharmacology & Therapeutics . 2010;87(4)479-82


 Standard

American Diet (SAD)



Flavoring in Utero

• Taste and olfactory systems are capable of

detecting flavor information prior to birth

• Experiences with flavors, good and bad, create an

individual’s unique pattern of food preferences. The more familiar a food is the more it is liked

Impact of flavour exposure in utero and during milk feeding on food acceptance at weaning and beyond. Cooke, Fildes (2011)

90/10 % Rule

Foods That Decrease Inflammation

Tumeric – found in the herb Reveratrol – found in red grapes, wine (organic) curcuma longa

Curcumin • Phytochemical component of tumeric used for centuries • Dietary spice • Topical ointment • Anti-inflammatory agent • Mediated by up-regulation of peroxisome proliferatoractivated receptor-y (PPAR-y) activation • Down regulates NFK-B • Efficacious in clinical trials (3.6 grams) with colorectal

cancer Mechanism of the Anti-inflammatory Effect of Curcumin: PPAR-y Activation. PPAR Research 2007;(1)1-5

Overall Top 10 Foods • • • • • •

Green tea Fish Organic red grapes (resveratrol) Garlic/onions Curcumin (tumeric) Cruciferous veggies • Broccoli • Cauliflower • Brussels sprouts • Cabbage • Bok choy

Most Contaminated* Veggies & Fruits Peaches Apples Strawberries Nectarines Pears Cherries Red Raspberries Imported Grapes

Spinach Bell Peppers Celery Potatoes Hot Peppers

*Go for Organic ewg.org

Least Contaminated Veggies & Fruits • • • • • • • • • •

Pineapples Plantains Mangoes Bananas Watermelon Plums Kiwi Blueberries Papaya Grapefruit

• Avocado • Cauliflower • Brussels Sprouts • Asparagus • Radishes • Broccoli • Onions • Okra • Cabbage • Eggplant

Genetics and Epigenetics • Environmental factors: i.e. foods we eat,

pollutants, cigarettes that are smoked can turn genes off and on

Duke University mouse study • Agouti mice: obesity and pale coats • Control group vs. experimental group • Thin brown baby mice with parent’s genes for obesity and pale coats

Bisphenol A • Estrogenic • Decreases adiponectin • Canadapronounced it toxic in 2011 • Unlikely in 1, 2, 4, 5, 6 possibly in 3/7 triangles • Alternates normal differentiation of breast tissue • Abnormal weight gain • Insulin resistance

Oxidative Stress Stress

Environmental Pollutants

Smoking/Second Hand Smoke Hereditary Factors

Metabolizing food

…Even Exercise

Metabolic Stress Encompasses

Toxins Cholesterol Oxidative Stress (Free Radicals)

Excess Glucose and Insulin

Bacteria

Viruses Disease Causing Enzymes

Free Radicals and Inflammation • Free radicals damage cells and accelerate

aging process • Air pollutants, cigarette smoke, radiation • Metabolism, liver breakdown of chemicals, infection • Increase activity of genes involved in making IL6 • Create adhesion molecules, stick to infectious microbes. This causes chronic inflammation by adherence to normal cells in arteries and joints

Antioxidants and Inflammation • Natural antidotes for free radicals • Counteract pro-inflammatory effects of free

radicals • Reduces free radical mediated endothelial damage and lipoprotein oxidation • Vitamins such as E, C, selenium, zinc and more • Flavonoids in veggies fruits, herbs

Antioxidants • Vitamin C: red peppers, avocado, cabbage, tomatoes, turnip greens, kale, oranges, banana, parsley, collards • Vitamin E: brown rice, wheat germ whole grain breads, egg yolk, peas, nuts, rye • Selenium: brazil nuts, snapper, halibut, salmon, swiss

chard, oats, molasses, sunflower seeds, brown rice, garlic • Zinc: mushrooms, seafood, sunflower seeds, • Beta-carotene: apricots, apples, carrots, prunes, papaya, avocados, spinach, pumpkin

Flavonoids • Vitamin like nutrients- 5,000 identified in plants • Natural insecticide the plant makes against insects • Anti-inflammatory, anti-oxidant • Quercetin (apples, onions, tea, berries, brassica veggies) • Also found in botanicals (Ginkgo, Hypericum, Elderberry) • One apple: • 5.7 mg of Vitamin C • 500mg of antioxidant polyphenols and flavonoids (equivalent to 1500mg of Vitamin C)

Camellia Sinensis

10 Steps to Put Out the Fire #1 Use olive, almond, hazelnut, grapeseed oil and avoid conventional cooking oils

#2 Eat high amounts of colorful veggies

#3 Use spices and herbs to flavor your foods Cinnamon, curcumin, sage, other spices

#4 Eat more fish, non-flesh proteins

#5 Eat organic as much as possible, less chemicals, artificial additives

10 Steps to Put Out the Fire #6 Identify and avoid food allergens and intolerances

#7 Avoid or limit refined sugars and grains

#8 Avoid dairy products

#9 Use nuts and seeds as snacks

#10 Drink plenty of water that tastes good to you

Smell Your Food First.... If You’ve Eaten Enough … ….and still want more drink water or plain herbal tea

Let food be your medicine; let medicine be your food Hippocrates

What You Eat Either… Feeds the fire Or puts out the fire....

Your choice!

Your Body & Inflammation: What You Can Do Nutritionally to Put Out the Fire Judy A. Fulop, ND, FABNO Northwestern Integrative Medicine Northwestern Memorial Hospital